Blog About Health & Medicine

With all of these physical changes going on in her body, a woman probably has every reason to feel distraught. When our bodies change at puberty there is usually an adjustment psychologically to the things which are happening to us. We need to learn to cope mentally with the changes in our bodies which signal the beginning of our reproductive lives. Menopause is another signal, and a marker for a different stage of life, and it is not unreasonable that it should have a significant effect.

These physical changes often occur at a time in a woman’s life when other changes are happening. Menopause often coincides with children growing up, leaving home, and perhaps a woman’s role as a mother and carer may be changing. Women who work outside the home are often looking at their careers and jobs, and contemplating retirement. Husbands may be retiring, or getting sick, or the woman herself may be suffering from diseases which are more common with age. A woman may be caring for an invalid parent, or coping with the death of a parent. Having one of these life stresses may be a handful,- coping with several could fee) overwhelming.

Hormonal variations can often cause fluctuations in mood. Premenstrual syndrome is evidence of this, and so are the ‘baby blues’ (relatively short-term lowering of a woman’s mood following the birth of a baby— very common) and postnatal depression (a more significant lowering of mood, longer lasting than the baby blues). The hormonal changes which occur during the climacteric may also give rise to emotional mood swings. Women have sometimes told me that they feel they are not in control of their emotions; as though their bodies can cry, independent of their thoughts. A woman recently was trying to explain this to me. Just the act of telling me about her hot flushes brought on a fit of sobbing. ‘I don’t normally do this. I don’t know what’s happening to me.’ Some women are aware that they are more ‘brittle’, with less emotional reserve. Things which normally would wash over them, like misbehaving teenage children, suddenly provoke a torrent of rage or tears. This kind of emotional fragility is not necessarily ‘depression’, in the medical sense.

Psychiatrists have classifications for disorders of mood. Depression is a very common condition in our community, with estimates of one in ten people having significant depression, warranting treatment, it is not just a state of feeling sad, but a condition where there are physical and emotional changes, like disorders of sleep, eating and thoughts. It is believed to be related to a change in the levels of some of the chemical messengers in the brain, and this is the basis on which specific anti-depressant medication works. The changes in mood many women experience around menopause may have some features of depression, and may be mild and short-lived. Some peri-menopausal women will have more significant symptoms, and may benefit from specific treatment for depression.

So there are several different factors which may be affecting a woman’s mood around the climacteric. There are adjustments to her physical state, changes in her lifestyle and roles, and hormonal variations. These may give rise to a variety of psychological symptoms. Some of the most commonly described include tearfulness, lowered mood and self-esteem, irritability, and lack of concentration and memory.

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How effective is abortion? Though there is no guarantee that abortion is 100 percent effective, it is almost 100 percent, especially if it is done after six weeks from your last period. If you have it before then, it may not be successful because the embryo is so small it could be missed.

After a later stage abortion, you might need to have a curette, where a different instrument is used to clear the walls of the uterus so that no tissue from the pregnancy is unknowingly left inside. Tissue from the pregnancy could cause bleeding and infection if it is not completely removed.

Why would I want to choose abortion? There could be many reasons why you would want to have an abortion. It might not be the right time in your life to have a baby. It may be that your physical or emotional state, or your living situation or Financial circumstances would affect the wellbeing of a child or yourself if you continued with the pregnancy.

You might want to choose abortion if you have a medical condition that would make it dangerous for you to continue with a pregnancy. You may also want to have an abortion if you know that the foetus has a severe abnormality, or if the pregnancy is a result of rape or incest

Are there any reasons why I could not have an abortion? Abortion is not available on request in Australia. Each state has its own laws about abortion, and you may have to meet certain requirements if you want to have one. Even in states where there are fairly broad requirements there is usually a stage of pregnancy where the line is drawn and you cannot have an abortion after that time. In some states that time is 12 weeks and abortions are not permitted after that Other states permit abortion up to 23 weeks as long as the other conditions are met, or even later if there is a big risk to the mother, or where the baby has a severe abnormality. If you want to find out what the law requires in your state, contact a Family Planning Centre or Community Health Centre. The availability of a doctor willing to perform abortions may also mean that even where the state permits abortion it can be difficult for a woman to actually have one.

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Are there any reasons why I could not use breastfeeding as a method of contraception?

If you do not produce enough milk to fully breastfeed, you would not be able to rely on breastfeeding to protect you against pregnancy. If you have HIV, you would not be advised to breastfeed because the virus can pass on to the baby through your milk. If you are working, you may not be able to breastfeed frequently enough to keep up the level of hormones your body needs to prevent ovulation.

How do you use breastfeeding for contraception? Well, the three things we discussed earlier: no periods, fully breastfeeding, and your baby being under six months old are very important. The main thing for you to do then is to make sure that your baby sucks frequently.

Sucking on the nipple causes your uterus to contract and also causes your body to release a hormone called prolactin, which helps in the production of breast milk. Prolactin can also prevent ovulation.

Some other questions people ask about breastfeeding to prevent pregnancy

Q. If you’re not having any periods how can you get pregnant?

A. The first period comes about two weeks after the first ovulation, so it is possible to ovulate and to get pregnant even before you have started to have periods again. As well, if you’re not used to having regular periods it might be several months before you even realise that you could be pregnant.

Q. I got some light bleeding for a couple of months after I had my last baby. Does this count as a period if I wanted to use breastfeeding for contraception?

A. This light bleeding is called lochia and is it is quite normal to get this, on and off usually, for up to six weeks after having a baby. As long as it is light and it is less than two months since you had the baby it doesn’t count as a period. Heavy periodlike bleeding (even early on), or light bleeding later than two months, probably does count and you should see your doctor or Family Planning Centre for advice.

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DMPA is a liquid that contains the hormone progestogen, similar to the progestogen in the progestogen-only pill.

Things to think about if you are considering using DMPA

• Once you have the injection, you will have the effect of DMPA in your system for three months. You cannot do anything to stop it or take it away. So while you are covered for contraception for three months, you will also have any side effects for those three months.

• After you stop having injections of DMPA, it may take up to twelve months before your periods get back to normal.

• If you stop having injections of DMPA and you want to be pregnant, it may take a while, though most women will become pregnant within two years.

• If you stop having injections of DMPA and you don’t want to be pregnant, you should use another method of contraception right away. Some women become pregnant very quickly after stopping DMPA.

• DMPA does not protect a woman from sexually transmitted infections (STIs). You may want to think about using condoms as well as DMPA because condoms help to protect you from STIs.

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Speak to most doctors about anal incontinence and they’ll tell you it is predominantly a women’s problem, is often traced back to problematic childbirth and is hardly heard of in healthy men.

This traditional view was recently turned on its head when a small group of Sydney specialists began analyzing the responses they received from a random survey of 1000 men and women.

To their surprise they discovered that almost double the number of men compared to women live with some form of anal incontinence. Based on overseas studies, they expected that up to 10 per cent of women and about 1 per cent of men would have the problem. Instead they found that 20 per cent of Australian men and only 11 per cent of women have it.

Anal incontinence can be severe or mild. The severe form, which requires surgery, is more common in women, but milder forms, which can be treated with dietary changes and medication, now seem to occur more frequently in men.

Men suffering mild anal incontinence experience seepage or uncontrollable flatus or both. A degree of flatus is, of course, normal, but incontinence arises when the passing of wind is beyond control and is socially embarrassing.

Mild incontinence is largely a hidden problem. Men don’t regard it as normal but believe there is little that can be done for it. They find it debilitating and a nuisance because it often means they have to remember to clean themselves up three or four times a day. Some can feel when it’s happening and know when it’s time to mop up. Others are not aware and, because the seepage is insidious, only realize after a certain threshold is reached.

A number of these men can’t feel what is happening because of nerve damage. They have a history of straining at stool, and the straining has caused such damage to their pelvic-floor nerves that tests show they can’t even feel a pin prick.

Mild anal incontinence can occur at any age. The survey showed that 19.6 per cent of men under the age of sixty-five lived with it, compared to 20.8 per cent over the age of sixty-five. One-third experienced incontinence more than once a week and two-thirds less than once a week.

This type of incontinence is particularly problematic for men who wear whites for work or sport. One such man complained it was affecting his game of bowls. He feared each time he bent over that stains would be visible.

Overseas, men are generally quite happy to contain the problem by wearing small cotton wool balls. Back in Australia men find this idea too fussy and delicate, but the survey showed a large number do use anal pads.

While no one really knows what causes mild incontinence in men, it is known that men (and not women) suffer from a bowel peculiarity that causes them to lose sensation in the rectum. They suffer an isolated degeneration of nerves around the area, and if a balloon is placed in the rectum and inflated, they can’t feel it. It is not known why this happens or why it is exclusive to men.

One footballer complained that he only experienced anal incontinence while he was running. He was a serious player and would unknowingly soil himself while on the field. Tests showed that the man had lost some rectal sensation and couldn’t tell with accuracy when his rectum was full and needed to be emptied. Because he was not aware he could not take steps to withhold until a socially acceptable time. The running and exertion caused a build-up of pressure in his abdomen and incontinence resulted. The player was treated by instructing him to use a suppository before each match so he could be sure his rectum was empty.

Treatment for mild anal incontinence usually involves dietary change and drugs and is successful only in about 50 per cent of people. Medication may be an antidiarrhoeal drug to slow the stool or a drug to help tighten up the anal muscle. Special diets are used to eliminate food causing loose stools. Alcohol, for example, is a potent cause of loose stools, and it’s not unusual for people who drink half a dozen schooners a day to develop mild anal incontinence.

There is a high prevalence of anal incontinence among people suffering irritable bowel syndrome. About 15 per cent of the population suffer from this syndrome and about 5 per cent of them have the incontinence. But it’s a little discussed problem as patients usually don’t volunteer the information and doctors don’t always think to ask.

One gastroenterologist describes continence as basically a struggle between the anal sphincter and the combined forces of colonic propulsion, rectal contractions and gravity. The consistency of the stool is an important factor in deciding if the battle is lost or won. Even the sphincter of an Arnold Schwarzenegger may be overcome by the violent propulsive force of vigorous colonic contractions and a flood of liquid diarrhoea when acute dysentery strikes.

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