Painful periods

What are painful periods?

The pain that accompanies periods is caused by contractions of the uterus or womb, similar to those of another 'normal' pain women suffer - during labour.

Painful periods - causes and risk factors

The pain that accompanies periods is caused by contractions of the uterus or womb, similar to those of another 'normal' pain women suffer - during labour.
Mild contractions constantly pass through the muscular wall of the womb, although most women are unaware of them. These are stronger than normal during menstruation and stronger still during labour.
Each contraction causes the blood supply to the womb to be cut down temporarily as the blood vessels in the muscle wall are compressed. As the tissues are starved of oxygen, chemicals that trigger pain are released.
At the same time the body is releasing chemicals called prostaglandins, which induce stronger contractions and which may directly cause pain in the womb. As the contractions get stronger, so the pain increases.
The aim of these contractions is to help the womb shed its delicate lining (as a period or bleed), so a new lining can be grown ready for a fertilised egg to implant itself. This is an essential part of female fertility, but pain is a side effect.
As a rough guide, if you've had severe period pain (known as dysmenorrhoea) since around the time your periods first started, it's less likely a particular cause will be found. However, even if this is the case, other factors - especially stress - can make the pain more difficult to cope with. Treating these factors can therefore help reduce the pain.
There are exceptions to this. Conditions such as endometriosis can sometimes cause severe pain from an early age (although the pain typically gets worse as the disease does more damage with each monthly cycle). Other causes include fibroids, pelvic inflammatory disease and sometimes a narrowing of the cervix.
Bear in mind, though, that period pains are rarely a sign of disease, especially in younger women.
If the pain begins to interfere with your life, preventing you from working or coping with daily tasks, you should seek help. Also if you have any sort of unpleasant vaginal discharge or pain with or after sex, speak to your doctor.

Painful periods - treatment and recovery

The first step is to find a simple treatment that works for you. If this doesn't control the pain, talk to your doctor.

• Exercise - you may not feel like it, but getting active is a good way to ease pain. Try gentle swimming, walking or cycling.
• Painkillers - ibuprofen and aspirin can be particularly effective as they have anti-prostaglandin effects. Take them regularly throughout the day (following the packet instructions), not just when pain becomes difficult to cope with.
• TENS - transcutaneous electronic nerve stimulation, or TENS, is widely used for period pains. Small electrodes are placed on the abdomen to stimulate the nerve in the pelvic area in a way that may reduce pain.

If these measures fail to control the pain or your doctor suspects endometriosis or another condition, a more detailed investigation may be recommended.
This will probably involve using an ultrasound scan to check the organs in the pelvis or minor laparoscopy, using a telescopic instrument to look inside the abdomen and pelvis.
In the US, more invasive surgery is quite common. However, in the UK such operations are controversial, except for proven endometriosis.
The final option, hysterectomy (removal of the womb), may seem drastic, especially if there's no underlying disease. However, the agony of period pains can be so great that a few women - who've perhaps completed their families and have tried other treatments without success - feel it's a rational option.
READMORE:http://www.bbc.co.uk/health

Deafness and hearing problems

What is deafness?

Deafness means difficulty hearing noise. It can be mild, moderate, severe or profound. for example, people with mild deafness have some difficulty following speech, mainly in noisy situations. Those with moderate deafness have difficulty following speech without a hearing aid.
People who are severely deaf rely a lot on lip-reading, even with a hearing aid. British Sign Language (BSL) may be their first or preferred language. Profoundly deaf people need to lip-read to understand speech. BSL may be their first or preferred language.
Deafness can cause difficulty communicating and people who are deaf may be at risk of physical and social isolation. They are also at greater risk of accidents because they may not hear warning alarms and sirens.
In the UK, there are an estimated 9 million deaf and partially hearing people. About 688,000 of these are severely or profoundly deaf.
Test your hearing

• Action on Hearing Loss has an information line.
• Call 0808 808 0123 (local rates apply)
• Action on Hearing Loss Online Hearing Check

Babies' hearing is tested as part of routine screening. About 840 babies are born with significant deafness each year in the UK. About one in 1,000 children is deaf at three years old and about 20,000 children aged up to 15 are moderately to profoundly deaf.
But the commonest cause of hearing loss is ageing, and three-quarters of people who are deaf are aged over 60.
From 40 years old, more men than women become hard of hearing. Among people over the age of 80, more women than men are deaf or hard of hearing, not because women are more likely to become deaf but because they live longer and there are more of them.

How does the ear work?

The external parts of our ear act like trumpets to collect sound and funnel it into the external ear canal. The pressure waves that form sound hit the ear-drum at the end of the ear canal and are then transmitted across a chamber known as the middle ear, to the sensory organs of the inner ear. An organ known as the cochlea, deep within the inner ear in the skull, is responsible for converting the mechanical vibration of sound into electrical signals. These can then be detected by the brain.

What causes hearing loss?

It can result from damage or disruption to any part of the hearing system. Causes can range from wax blocking the ear canal and age-related changes to the sensory cells of the cochlea to brain damage.
Common causes of deafness in adults include presbyacusis (age-related hearing loss due to deterioration of the inner ear), side-effects of medication, acoustic neuroma (a tumour of the nerve which carries hearing signals) and Meniere's disease.
Common causes of deafness in children include inherited conditions, infection during pregnancy, meningitis, head injury and glue ear (more correctly known as otitis media, where fluid builds up in the middle ear chamber and interferes with the passage of sound vibrations, generally as a result of viral or bacterial infection).
Common temporary causes include earwax, infection, glue ear and foreign body obstruction.

Noise and hearing loss

Excessive exposure to noise is an important cause of a particular pattern of hearing loss, contributing to problems for up to 50 per cent of deaf people. Often people fail to realise the damage they're doing to their ears until it's too late.
Although loud music is often blamed (and MP3 players are said to be storing up an epidemic of deafness in years to come) research has also blamed tractors (for deafness in children of farmers), aircraft noise, sports shooting and even cordless telephones.

Treatment

Many different tactics can help to reduce the risk of hearing loss, and to help those who do develop problems.
Vaccination against infections and avoiding excessive noise exposure reduces the risk of deafness. Removing wax and foreign bodies, and treating infections and glue ear promptly helps improve hearing or prevent further damage. Hearing aids, and for some people cochlear implants (an operation to replace a damaged cochlear with an artificial device) can enable hearing.
READMORE:http://www.bbc.co.uk/health

Breast awareness

Your breasts

In each armpit there are about 20 to 30 lymph nodes (glands), which drain fluid from the breast. These form part of the lymphatic system that helps the body to fight infection.
It's common and perfectly normal for one breast to be larger than the other. The nipples usually point forward, although they may look different on each breast. It's not unusual for one or both nipples to be turned inwards (inverted). This can be present from birth or can happen when the breasts are developing. The nipples themselves are hairless, but some women have a few hairs around the areola.
Between 0.4 and 6 per cent of women have an extra breast or pair of breasts, although the tissue may not look like a breast and be misdiagnosed as lymphatic or cystic. These are usually in the lower armpit and are known as accessory breasts. Some women have an extra nipple or nipples. These are usually below the breast or above the belly button on an imaginary line between the normal nipples and the groins. Accessory breasts and extra nipples aren't usually a problem and don't need to be removed.

Breast development

The breasts are constantly changing from puberty, through adolescence and the childbearing years and into the menopause, affected by changing levels in the female hormone oestrogen.
For most girls, breasts start to develop around the age of nine to 11, but it can be earlier or later. It's not unusual for the breasts to grow at different rates. Breast lumps can occur while the breasts are developing. These are always benign and don't usually need any treatment once they've been diagnosed.
Once the breasts have developed, changes linked to the monthly menstrual cycle (cyclical breast changes) are common. Just before a period, your breasts may become larger, tender or feel a bit lumpy. After a period, this lumpiness becomes less obvious or may disappear altogether (although some women may have tender, lumpy breasts all the time). Many women also experience breast pain linked to their menstrual cycle (cyclical breast pain).
During pregnancy, the breasts get much larger as the number of milk-producing cells increases. The nipples become darker and may remain that way after you've given birth, the areaolae may darken and develop small bumps too.
Around the menopause lumps are common. These often turn out to be breast cysts (benign fluid-filled sacs).
Breast tissue also changes with age. It begins to lose its firmness and the milk-producing tissue is replaced by fat, making the breasts sag. This is more noticeable after the menopause, when oestrogen levels fall. As you grow older, your breasts may change size too. If you take HRT (hormone replacement therapy) your breasts may feel firmer and sometimes quite tender.

Being breast aware

Every woman should be breast aware throughout her adult life. It's an important part of caring for your body. It means knowing how your breasts look and feel normally, so you notice any changes that might be unusual for you.
Get into the habit of looking at and feeling your breasts from time to time. There is no set way to do this. You can decide what you're comfortable with and when it's convenient for you. You don't have to look and feel at the same time.

What to look for

You need to be aware of any changes that are new or different, such as:

• A change in size - one breast may become noticeably larger or lower
• A nipple that has become inverted (pulled in) or changed its position or shape
• A rash on or around the nipple
• Discharge from one or both nipples
• Puckering or dimpling of the skin
• A swelling under your armpit or around your collarbone (where the lymph nodes are)
• A lump or thickening in your breast that feels different from the rest of the breast tissue.
• Constant pain in one part of your breast or armpit

What to do if you find a change

See your GP as soon as possible. Don't worry that you may be making an unnecessary fuss and remember most breast changes aren't cancer, even if they do need treatment or a follow-up.
When your GP examines your breasts he or she may be able to reassure you that there's nothing to worry about. If the change may be connected with your hormones, your GP may ask you to come back at a different time in your menstrual cycle. Alternatively, he or she may decide to send you to a breast clinic for a more detailed examination.
Breast Cancer Care has more information about what happens at a breast clinic and the tests used to make a diagnosis.

Breast screening

As 80 per cent of breast cancers occur in women over the age of 50, if you're between 50 and 70 you'll be invited for breast screening every three years as part of the National Breast Screening Programme.
You'll be sent an invitation to come for a mammogram (breast x-ray). This may not happen the year you turn 50, but will happen by the time you're 53. It's important to remember that you still need to be breast aware even when taking part in the screening programme. Report any changes to your GP without delay, even if you've had a recent mammogram.
A small number of women will be asked to come back for further investigations after attending a routine mammogram. This doesn't necessarily mean you have breast cancer. It's more likely to be because the mammogram is unclear, or because it shows up something that needs further tests. If you're sent a recall letter, it's important to attend the appointment.
If you're over 70, you won't be invited for screening but you are entitled to free breast screening every three years on request. Contact the breast-screening unit or ask your GP or practice nurse to arrange an appointment for you.
At present, women under 50 aren't invited for screening. This is because screening hasn't yet been shown to benefit this age group.

Breast awareness five-point code

The Department of Health recommends that instead of examining your breasts every month for abnormalities, you follow this five-point code, which is much more effective at detecting changes and abnormalities.

1. Know what's normal for you

Woman of all ages should be aware of the normal appearance and texture of their breasts. The following can be normal:

• One breast bigger than the other
• Nipple inversion
• Accessory breast/nipple (two to five per cent)
• Lumpiness
• Tenderness or pain

During the menstrual cycle, some women experience enlarged, tender, lumpy breasts and these symptoms settle after the period. But some women experience lumpy, tender breasts all the time.
During pregnancy, breasts become larger as the milk-producing cells multiply. It's normal for the nipples to get darker and the blood vessels to become more prominent.
As you age, breast tissue loses its elasticity and it's normal for breasts to sag. During the menopause, your breasts may shrink (as a result of the reduction in oestrogen), although sometimes they do get larger. The nipples may alter, as the major ducts behind them get shorter and wider.
Get to know what is normal for you by:

• Feeling your breasts every day until you're familiar with their texture and how it can change through the menstrual cycle
• Look and feel your breasts regularly, whenever it's convenient for you

2. Know what changes to look and feel for

Once you're aware of what's normal for you, it's important to look out for changes in your breasts. You should look out for any of the following:

• A change in the shape of the breast (pulling of the skin, visible swelling)
• Changes in the nipple (pulling in)
• Swelling in the armpit
• Lumps or thickening that feels different from the rest of the breast

3. Look and feel

Whenever is convenient for you:

• Look at your breasts in the mirror and notice how they fall and move as you raise your arms
• Look at the position of your nipples
• Feel your breasts from time to time

4. Report any changes to your GP without delay

The majority of changes will be normal. Your GP may:

• Ask you to return at another time in your menstrual cycle
• Refer you to a breast clinic
• Invite you to attend routine screening if you're between the age of 50 and 70

5. Attend routine screening if you're 50 or over

Between breast-screening appointments, it's important that you continue to be breast aware and follow the five-point code.
Information in these breast awareness pages is reproduced with the kind permission of Breast Cancer Care.
READMORE: http://www.bbc.co.uk/health

Blood clots

What is a blood clot?

Each year more than one in every thousand people in the UK develops a blood clot in a vein, known as a venous thrombosis. For as many as 25,000, the clot will prove fatal; more deaths than from breast cancer, HIV and road traffic accidents combined.
Thousands more people will have long-term health problems as a result of a blood clot. Many of these people would have been completely unaware they were at increased risk of venous thrombosis, missing out on treatment which could be life saving.
Clots can form in any vein deep within the body, but most often can be found in the deep veins of the leg. These deep vein thromboses (DVT) form in the calf or lower leg, behind the knee, in the thigh or in the veins passing through the pelvis.

Blood clot causes

There are several factors that significantly increase someone’s risk of developing a venous thrombosis:

• Slowing of blood flow through the veins - for example, when someone is confined to bed by illness or to a chair on a long journey
• Damage to the walls of the blood vessels - for example, during surgery on the legs, hips or pelvis, or as a result of age-related changes
• Increased tendency of the blood to clot - because of inherited problems with the blood’s clotting system, cancer or the hormone changes of pregnancy or the contraceptive pill

Those particularly at risk include:

• The elderly - one in 100 over the age of 80 are at risk
• Those who are immobile, because of illness, surgery or travel
• People undergoing surgery on the hips and knees - more than half of those people having a total hip replacement will develop a DVT if not given preventative medicine
• Heart attack or stroke patients
• People with cancer, especially after surgery or if they’re having chemotherapy.
• Women during pregnancy, or if they're using the contraceptive pill or HRT
• Those with previous blood clotting problems - including inherited abnormalities of clotting, which are much more common than most people realise
• Smokers

Blood clot symptoms

When a clot forms, it blocks the vein, preventing blood from draining from the limb as it should. The result is that the leg becomes swollen and painful, may change colour (turning pale, blue or reddish-purple) or the skin appears tight or shiny.
More worrying is the risk that part of the clot will break away, forming what is known as an embolus which travels around the circulation, through the heart and into the lungs where it blocks a blood vessel. This is known as a pulmonary embolus (PE) and estimates suggest that as many as 50 per cent of those with a DVT will go on to develop a PE.
The symptoms of PE include chest pain and shortness of breath, which may be sudden and severe. Although some people develop a PE without noticing any symptoms, it can be extremely dangerous and cause damage to the lung tissues proving fatal in as many as one in ten unless treated.
Long term complications include chronic pulmonary hypertension, where the pressure in the blood vessels of the lung remains persistently high.
If the DVT damages the delicate valves that help to keep blood flowing upwards towards the heart, a condition called post-phlebitic syndrome may develop (occurring in one in five after a DVT). As a result, blood pools in the lower leg, increasing pressure in the vessels, causing swelling of the leg and ankle and a heavy sensation, especially after walking or standing. Skin ulcers may also develop.

Diagnosing blood clots

Symptoms of a DVT or PE may be minimal and can often go undiagnosed. When suspected, it can be difficult to reach a definite diagnosis because tests aren’t straightforward and don’t always give a clear result.
Tests include:

• D-dimer blood test - although a negative result means a clot is unlikely, a positive can occur in a number of other illnesses so it isn't specific for a DVT or PE
• Ultrasound - good for showing a clot behind the knee or in the thigh, but not so accurate for a DVT in the calf
• Doppler ultrasound - increasingly used method to show how fast the blood is flowing through the veins
• Venogram - an x-ray dye test that's more invasive than ultrasound
• MRI or CT scans
• Ventilation/perfusion scan - parts of the lung being filled with air are compared with those with blood flowing through them

Blood clot treatments

Once a DVT or PE has been diagnosed, treatment is started to thin the blood. This is known as anticoagulant therapy and is designed to reduce the risk that the clot will grow or spread.
Immediate treatment is given in the form heparin injections and warfarin tablets, which take several days to build effect. When the cause of the clot formation is clear, such as after surgery, treatment is continued for three months. When there’s no obvious cause, it may be continued for six months or even indefinitely.
The effects of warfarin can vary. Other illnesses and treatments, or even a change in diet, can interfere and it’s quite easy to become over - or under - coagulated, leading to a risk of either a haemorrhage or further clots. Those taking warfarin must have regular blood tests to monitor their clotting levels, and the dose of warfarin adjusted accordingly.
Newer drugs are being developed which are more consistent in their effect and which one day may replace warfarin.

Preventing blood clots

When someone is known to be at risk of venous thrombosis, clots can be prevented by taking a few simple steps and giving small doses of anticoagulant drugs.
During long distance travel, or other periods of immobility, you should:

• Keep well hydrated
• Wear elastic compression stockings to support blood flow through the veins (it’s important that these are put on correctly)
• Take a little exercise at frequent intervals (if stuck in a seat, carry out simple leg exercises in the chair such as flexing your ankles).

Heparin treatment will reduce the risk of DVT following cancer treatment or hip or knee surgery by 70 per cent. People having major surgery have a 30 per cent risk of DVT, which is reduced by about 60 per cent with anticoagulants.
If you’re going into hospital for an operation or other treatment, you should be assessed for your risk of developing a blood clot and in most cases will be offered preventative treatment with anticoagulant injections. Compression stockings may also be used.
READMORE:http://www.bbc.co.uk/health