
Stop Pain Spreading
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Put Your Back Into It (Or Don’t)!
We’ve written before about Managing Chronic Pain (Realistically!), and today we’re going to tackle a particular aspect of chronic pain management.
- It’s a thing where the advice is going to be “don’t do this”
- And if you have chronic pain, you will probably respond “yep, I do that”
However, it’s definitely a case of “when knowing isn’t the problem”, or at the very least, it’s not the whole problem.
Stop overcompensating and address the thing directly
We all do it, whether in chronic pain, or just a transient injury. But we all need to do less of it, because it causes a lot of harm.
Example: you have pain in your right knee, so you sit, stand, walk slightly differently to try to ease that pain. It works, albeit marginally, at least for a while, but now you also have pain in your left hip and your lumbar vertebrae, because of how you leaned a certain way. You adjust how you sit, stand, walk, to try to ease both sets of pain, and before you know it, now your neck also hurts, you have a headache, and you’re sure your digestion isn’t doing what it should and you feel dizzy when you stand. The process continues, and before long, what started off as a pain in one knee has now turned your whole body into a twisted aching wreck.
What has happened: the overcompensation due to the original pain has unduly stressed a connected part of the body, which we then overcompensate for somewhere else, bringing down the whole body like a set of dominoes.
For more on this: Understanding How Pain Can Spread
“Ok, but how? I can’t walk normally on that knee!”
We’re keeping the knee as an example here, but please bear in mind it could be any chronic pain and resultant disability.
Note: if you found the word “disability” offputting, please remember: if it adversely affects your abilities, it is a disability. Disabilities are not something that only happen to other people! They will happen to most of us at some point!
Ask yourself: what can you do, and what can’t you do?
For example:
- maybe you can walk, but not normally
- maybe you can walk normally, but not without great pain
- maybe you can walk normally, but not at your usual walking pace
First challenge: accept your limitations. If you can’t walk at your usual walking pace without great pain and/or throwing your posture to the dogs, then walk more slowly. To Hell with societal expectations that it shouldn’t take so long to walk from A to B. Take the time you need.
Second challenge: accept help. It doesn’t have to be help from another person (although it could be). It might be accepting the help of a cane, or maybe even a wheelchair for “flare-up” days. Society, especially American society which is built on ideas of self-sufficiency, has framed a lot of such options as “giving up”, but if they help you get about your day while minimizing doing further harm to your body, then they can be good and even health-preserving things. Same goes for painkillers if they help you from doing more harm to your body by balling up tension in a part of your body in a way that ends up spreading out and laying ruin to your whole body.
Speaking of which:
How Much Does It Hurt? Get The Right Help For Your Pain
After which, you might want to check out:
The 7 Approaches To Pain Management
and
Science-Based Alternative Pain Relief
Third challenge: deserves its own section, so…
Do what you can
If you have chronic pain (or any chronic illness, really), you are probably fed up of hearing how this latest diet will fix you, or yoga will fix you, and so on. But, while these things may not be miracle cures…
- A generally better diet really will lessen symptoms and avoid flare-ups (a low-inflammation diet is a great start for lessening the symptoms of a lot of chronic illnesses)
- Doing what exercise you can, being mindful of your limitations yes but still keeping moving as much as possible, will also prevent (or at least slow) deterioration. Consider consulting a physiotherapist for guidance (a doctor will more likely just say “rest, take it easy”, whereas a physiotherapist will be able to give more practical advice).
- Getting good sleep may be a nightmare in the case of chronic pain (or other chronic illnesses! Here’s to those late night hyperglycemia incidents for Type 1 Diabetics that then need monitoring for the next few hours while taking insulin and hoping it goes back down) but whatever you can do to prioritize it, do it.
Want to read more?
We reviewed a little while ago a great book about this; the title sounds like a lot of woo, but we promise the content is extremely well-referenced science:
…and if your issue is back pain specifically, we highly recommend:
Healing Back Pain: The Mind-Body Connection – by Dr. John Sarno
Take care!
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Osteoarthritis Of The Knee
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝Very informative thank you. And made me think. I am a 72 yr old whitewoman, have never used ( or even been offered) HRT since menopause ~15 yrs ago. Now I’m wondering if it would have delayed the onset of osteoarthritis ( knee) and give me more energy in general. And is it wise to start taking hrt after being without those hormones for so long?❞
(this was in response to our article about menopausal HRT)
Thanks for writing! To answer your first question, obviously we can never know for sure now, but it certainly is possible, per for example a large-ish (n=1003) study of women aged 45–64, in which:
- Those with HRT were significantly less likely to have knee arthritis than those without
- However, to enjoy this benefit depended on continued use (those who used it for a bit and then stopped did not enjoy the same results)
- While it made a big difference to knee arthritis, it made only a small (but still beneficial) difference to wrist/hand arthritis.
We could hypothesize that this is because the mechanism of action is more about strengthening the bones (proofing against osteoporosis is one of the main reasons many people take HRT) and cartilage than it is against inflammation directly.
Since the knee is load-bearing and the hand/wrist joints usually are not, this would mean the HRT strengthening the bones makes a big difference to the “wear and tear” aspect of potential osteoarthritis of the knee, but not the same level of benefit for the hand/wrist, which is less about wear and tear and more about inflammatory factors. But that latter, about it being load-bearing, is just this writer’s hypothesis as to why the big difference.
The researchers do mention:
❝In OA the mechanisms by which HRT might act are highly speculative, but could entail changes in cartilage repair or bone turnover, perhaps with cytokines such as interleukin 6, for example.❞
What is clear though, is that it does indeed appear to have a protective effect against osteoarthritis of the knee.
With regard to the timing, the researchers do note:
❝Why as little as three years of HRT should have a demonstrable effect is unclear. Given the difficulty in ascertaining when the disease starts, it is hard to be sure of the importance of the timing of HRT, and whether early or subclinical disease was present.
These results taken together suggest that HRT has a metabolic action that is only effective if given continuously, perhaps by preventing disease initiation; once HRT is stopped there might be a ‘rebound’ effect, explaining the rapid return to normal risk❞
~ Ibid.
You can read the study here:
On whether it is worth it now…
Again, do speak with an endocrinologist because your situation may vary, but:
- hormones are simply messengers, and your body categorically will respond to those messages regardless of age, or time elapsed without having received such a message. Whether it will repair all damage done is another matter entirely, but it would take a biological miracle for it to have no effect at all.
- anecdotally, many women do enjoy life-changing benefits upon starting HRT at your age and older!
(We don’t like to rely on “anecdotally”, but we couldn’t find studies isolating according to “length of time since menopause”—we’ll keep an eye out and if we find something in the future, we’ll mention it!)
Meanwhile, take care!
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The Whys and Hows of Cutting Meats Out Of Your Diet
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When it’s time to tell the meat to beat it…
Meat in general, and red meat and processed meat in particular, have been associated with so many health risks, that it’s very reasonable to want to reduce, if not outright eliminate, our meat consumption.
First, in case anyone’s wondering “what health risks?”
The aforementioned culprits tend to turn out to be a villain in the story of every second health-related thing we write about here. To name just a few:
- Processed Meat Consumption and the Risk of Cancer: A Critical Evaluation of the Constraints of Current Evidence from Epidemiological Studies
- Red Meat Consumption (Heme Iron Intake) and Risk for Diabetes and Comorbidities?
- Health Risks Associated with Meat Consumption: A Review of Epidemiological Studies
- Associations of Processed Meat, Unprocessed Red Meat, Poultry, or Fish Intake With Incident Cardiovascular Disease and All-Cause Mortality
- Meat consumption: Which are the current global risks? A review of recent (2010-2020) evidences
Seasoned subscribers will know that we rarely go more than a few days without recommending the very science-based Mediterranean Diet which studies find beneficial for almost everything we write about. The Mediterranean Diet isn’t vegetarian per se—by default it consists of mostly plants but does include some fish and a very small amount of meat from land animals. But even that can be improved upon:
- A Pesco-Mediterranean Diet With Intermittent Fasting
- Mediterranean, vegetarian and vegan diets as practical outtakes of EAS and ACC/AHA recommendations for lowering lipid profile
- A Mediterranean Low-Fat Vegan Diet to Improve Body Weight and Cardiometabolic Risk Factors: A Randomized, Cross-over Trial
So that’s the “why”; now for the “how”…
It’s said that with a big enough “why” you can always find a “how”, but let’s make things easy!
Meatless Mondays
One of the biggest barriers to many people skipping the meat is “what will we even eat?”
The idea of “Meatless Mondays” means that this question need only be answered once a week, and in doing that a few Mondays in a row, you’ll soon find you’re gradually building your repertoire of meatless meals, and finding it’s not so difficult after all.
Then you might want to expand to “meat only on the weekends”, for example.
Flexitarian
This can be met with derision, “Yes and I’m teetotal, apart from wine”, but there is a practical aspect here:
The idea is “I will choose vegetarian options, unless it’s really inconvenient for me to do so”, which wipes out any difficulty involved.
After doing this for a while, you might find that as you get more used to vegetarian stuff, it’s almost never inconvenient to eat vegetarian.
Then you might want to expand it to “I will choose vegan options, unless it’s really inconvenient for me to do so”
Like-for-like substitutions
Pretty much anything that can come from an animal, one can get a plant-based version of it nowadays. The healthiness (and cost!) of these substitutions can vary, but let’s face it, meat is neither the healthiest nor the cheapest thing out there these days either.
If you have the money and don’t fancy leaping to lentils and beans, this can be a very quick and easy zero-effort change-over. Then once you’re up and running, maybe you can—at your leisure—see what all the fuss is about when it comes to tasty recipes with lentils and beans!
That’s all we have time for today, but…
We’re thinking of doing a piece making your favorite recipes plant-based (how to pick the right substitutions so the meal still tastes and “feels” the same), so let us know if you’d like that? Feel free to mention your favorite foods/meals too, as that’ll help us know what there’s a market for!
You can do that by hitting reply to any of our emails, or using the handy feedback widget at the bottom!
Curious to know more while you wait?
Check out: The Vegan Diet: A Complete Guide for Beginners ← this is a well-sourced article from Healthline, who—just like us—like to tackle important health stuff in an easy-to-read, well-sourced format
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How Science News Outlets Can Lie To You (Yes, Even If They Cite Studies!)
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Each Monday, we’re going to be bringing you cutting-edge research reviews to not only make your health and productivity crazy simple, but also, constantly up-to-date.
But today, in this special edition, we want to lay out plain and simple how to see through a lot of the tricks used not just by popular news outlets, but even sometimes the research publications themselves.
That way, when we give you health-related science news, you won’t have to take our word for it, because you’ll be able to see whether the studies we cite really support the claims we make.
Of course, we’ll always give you the best, most honest information we have… But the point is that you shouldn’t have to trust us! So, buckle in for today’s special edition, and never have to blindly believe sci-hub (or Snopes!) again.
The above now-famous Tumblr post that became a meme is a popular and obvious example of how statistics can be misleading, either by error or by deliberate spin.
But what sort of mistakes and misrepresentations are we most likely to find in real research?
Spin Bias
Perhaps most common in popular media reporting of science, the Spin Bias hinges on the fact that most people perceive numbers in a very “fuzzy logic” sort of way. Do you?
Try this:
- A million seconds is 11.5 days
- A billion seconds is not weeks, but 13.2 months!
…just kidding, it’s actually nearly thirty-two years.
Did the months figure seem reasonable to you, though? If so, this is the same kind of “human brains don’t do large numbers” problem that occurs when looking at statistics.
Let’s have a look at reporting on statistically unlikely side effects for vaccines, as an example:
- “966 people in the US died after receiving this vaccine!” (So many! So risky!)
- “Fewer than 3 people per million died after receiving this vaccine!” (Hmm, I wonder if it is worth it?)
- “Half of unvaccinated people with this disease die of it” (Oh)
How to check for this: ask yourself “is what’s being described as very common really very common?”. To keep with the spiders theme, there are many (usually outright made-up) stats thrown around on social media about how near the nearest spider is at any given time. Apply this kind of thinking to medical conditions.. If something affects only 1% of the population (So few! What a tiny number!), how far would you have to go to find someone with that condition? The end of your street, perhaps?
Selection/Sampling Bias
Diabetes disproportionately affects black people, but diabetes research disproportionately focuses on white people with diabetes. There are many possible reasons for this, the most obvious being systemic/institutional racism. For example, advertisements for clinical trial volunteer opportunities might appear more frequently amongst a convenient, nearby, mostly-white student body. The selection bias, therefore, made the study much less reliable.
Alternatively: a researcher is conducting a study on depression, and advertises for research subjects. He struggles to get a large enough sample size, because depressed people are less likely to respond, but eventually gets enough. Little does he know, even the most depressed of his subjects are relatively happy and healthy compared with the silent majority of depressed people who didn’t respond.
See This And Many More Educational Cartoons At Sketchplanations.com!
How to check for this: Does the “method” section of the scientific article describe how they took pains to make sure their sample was representative of the relevant population, and how did they decide what the relevant population was?
Publication Bias
Scientific publications will tend to prioritise statistical significance. Which seems great, right? We want statistically significant studies… don’t we?
We do, but: usually, in science, we consider something “statistically significant” when it hits the magical marker of p=0.05 (in other words, the probability of getting that result is 1/20, and the results are reliably coming back on the right side of that marker).
However, this can result in the clinic stopping testing once p=0.05 is reached, because they want to have their paper published. (“Yay, we’ve reached out magical marker and now our paper will be published”)
So, you can think of publication bias as the tendency for researchers to publish ‘positive’ results.
If it weren’t for publication bias, we would have a lot more studies that say “we tested this, and here are our results, which didn’t help answer our question at all”—which would be bad for the publication, but good for science, because data is data.
To put it in non-numerical terms: this is the same misrepresentation as the technically true phrase “when I misplace something, it’s always in the last place I look for it”—obviously it is, because that’s when you stop looking.
There’s not a good way to check for this, but be sure to check out sample sizes and see that they’re reassuringly large.
Reporting/Detection/Survivorship Bias
There’s a famous example of the rise in “popularity” of left-handedness. Whilst Americans born in ~1910 had a bit under a 3.5% chance of being left handed, those born in ~1950 had a bit under a 12% change.
Why did left-handedness become so much more prevalent all of a sudden, and then plateau at 12%?
Simple, that’s when schools stopped forcing left-handed children to use their right hands instead.
In a similar fashion, countries have generally found that homosexuality became a lot more common once decriminalized. Of course the real incidence almost certainly did not change—it just became more visible to research.
So, these biases are caused when the method of data collection and/or measurement leads to a systematic error in results.
How to check for this: you’ll need to think this through logically, on a case by case basis. Is there a reason that we might not be seeing or hearing from a certain demographic?
And perhaps most common of all…
Confounding Bias
This is the bias that relates to the well-known idea “correlation ≠ causation”.
Everyone has heard the funny examples, such as “ice cream sales cause shark attacks” (in reality, both are more likely to happen in similar places and times; when many people are at the beach, for instance).
How can any research paper possibly screw this one up?
Often they don’t and it’s a case of Spin Bias (see above), but examples that are not so obviously wrong “by common sense” often fly under the radar:
“Horse-riding found to be the sport that most extends longevity”
Should we all take up horse-riding to increase our lifespans? Probably not; the reality is that people who can afford horses can probably afford better than average healthcare, and lead easier, less stressful lives overall. The fact that people with horses typically have wealthier lifestyles than those without, is the confounding variable here.
See This And Many More Educational Cartoons on XKCD.com!
In short, when you look at the scientific research papers cited in the articles you read (you do look at the studies, yes?), watch out for these biases that found their way into the research, and you’ll be able to draw your own conclusions, with well-informed confidence, about what the study actually tells us.
Science shouldn’t be gatekept, and definitely shouldn’t be abused, so the more people who know about these things, the better!
So…would one of your friends benefit from this knowledge? Forward it to them!
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The Toe-Tapping Tip For Better Balance
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Balance is critical for health especially in older age, since it’s amazing how much else can go dramatically and suddenly wrong after a fall. So, here’s an exercise to give great balance and stability:
How to do it
You will need:
- Something to hold onto, such as a countertop
- A target on the floor, such as a mark or a coin
The steps:
- Lift one leg up, bring your foot forward, and tap the object in front of you.
- Then, bring that foot back to where it started.
- Next, switch to the other leg and tap.
- Alternate between your right and left legs, shifting back and forth.
- Your goal is to do this for 10 repetitions on each leg without holding on.
How it works:
Whenever you tap, you have to lift one leg up and reach it out in front of you. Doing this requires you to stand on one leg while moving a weight (namely: your other leg), which is something many people, especially upon getting older, are hesitant to do. If you’re unable to stand on one leg, let alone move your center of gravity (per the counterbalance of the other leg) while doing so, you may end up shuffling and walking with your feet sliding across the ground—something you really want to avoid.
For more on all of this plus a visual demonstration, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Fall Special ← this is about not falling, or, failing that, minimizing injury if you do
Take care!
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4 Tips To Stand Without Using Hands
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The “sit-stand” test, getting up off the floor without using one’s hands, is well-recognized as a good indicator of healthy aging, and predictor of longevity. But what if you can’t do it? Rather than struggling, there are exercises to strengthen the body to be able to do this vital movement.
Step by step
Teresa Shupe has been teaching Pilates professionally full-time for over 25 years, and here’s what she has to offer in the category of safe and effective ways of improving balance and posture while doing the sitting-to-standing movement:
- Squat! Doing squats (especially deep ones) regularly strengthens all the parts necessary to effectively complete this movement. If your knees aren’t up to it at first, do the squats with your back against a wall to start with.
- Roll! On your back, cross your feet as though preparing to stand, and rock-and-roll your body forwards. To start with you can “cheat” and use your fingertips to give a slight extra lift. This exercise builds mobility in the various necessary parts of the body, and also strengthens the core—as well as getting you accustomed to using your bodyweight to move your body forwards.
- Lift! This one’s focusing on that last part, and taking it further. Because it may be difficult to get enough momentum initially, you can practice by holding small weights in your hands, to shift your centre of gravity forwards a bit. Unlike many weights exercises, in this case you’re going to transition to holding less weight rather than more, though.
- Complete! Continue from the above, without weights now; use the blades of your feet to stand. If you need to, use your fingertips to give you a touch more lift and stability, and reduce the fingers that you use until you are using none.
For more on each of these as well as a visual demonstration, enjoy this short video:
Click Here If The Embedded Video Doesn’t Load Automatically!
Further reading
For more exercises with a similar approach, check out:
Mobility As A Sporting Pursuit
Take care!
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What are the most common symptoms of menopause? And which can hormone therapy treat?
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Despite decades of research, navigating menopause seems to have become harder – with conflicting information on the internet, in the media, and from health care providers and researchers.
Adding to the uncertainty, a recent series in the Lancet medical journal challenged some beliefs about the symptoms of menopause and which ones menopausal hormone therapy (also known as hormone replacement therapy) can realistically alleviate.
So what symptoms reliably indicate the start of perimenopause or menopause? And which symptoms can menopause hormone therapy help with? Here’s what the evidence says.
Remind me, what exactly is menopause?
Menopause, simply put, is complete loss of female fertility.
Menopause is traditionally defined as the final menstrual period of a woman (or person female at birth) who previously menstruated. Menopause is diagnosed after 12 months of no further bleeding (unless you’ve had your ovaries removed, which is surgically induced menopause).
Perimenopause starts when menstrual cycles first vary in length by seven or more days, and ends when there has been no bleeding for 12 months.
Both perimenopause and menopause are hard to identify if a person has had a hysterectomy but their ovaries remain, or if natural menstruation is suppressed by a treatment (such as hormonal contraception) or a health condition (such as an eating disorder).
What are the most common symptoms of menopause?
Our study of the highest quality menopause-care guidelines found the internationally recognised symptoms of the perimenopause and menopause are:
- hot flushes and night sweats (known as vasomotor symptoms)
- disturbed sleep
- musculoskeletal pain
- decreased sexual function or desire
- vaginal dryness and irritation
- mood disturbance (low mood, mood changes or depressive symptoms) but not clinical depression.
However, none of these symptoms are menopause-specific, meaning they could have other causes.
In our study of Australian women, 38% of pre-menopausal women, 67% of perimenopausal women and 74% of post-menopausal women aged under 55 experienced hot flushes and/or night sweats.
But the severity of these symptoms varies greatly. Only 2.8% of pre-menopausal women reported moderate to severely bothersome hot flushes and night sweats symptoms, compared with 17.1% of perimenopausal women and 28.5% of post-menopausal women aged under 55.
So bothersome hot flushes and night sweats appear a reliable indicator of perimenopause and menopause – but they’re not the only symptoms. Nor are hot flushes and night sweats a western society phenomenon, as has been suggested. Women in Asian countries are similarly affected.
You don’t need to have night sweats or hot flushes to be menopausal.
Maridav/ShutterstockDepressive symptoms and anxiety are also often linked to menopause but they’re less menopause-specific than hot flushes and night sweats, as they’re common across the entire adult life span.
The most robust guidelines do not stipulate women must have hot flushes or night sweats to be considered as having perimenopausal or post-menopausal symptoms. They acknowledge that new mood disturbances may be a primary manifestation of menopausal hormonal changes.
The extent to which menopausal hormone changes impact memory, concentration and problem solving (frequently talked about as “brain fog”) is uncertain. Some studies suggest perimenopause may impair verbal memory and resolve as women transition through menopause. But strategic thinking and planning (executive brain function) have not been shown to change.
Who might benefit from hormone therapy?
The Lancet papers suggest menopause hormone therapy alleviates hot flushes and night sweats, but the likelihood of it improving sleep, mood or “brain fog” is limited to those bothered by vasomotor symptoms (hot flushes and night sweats).
In contrast, the highest quality clinical guidelines consistently identify both vasomotor symptoms and mood disturbances associated with menopause as reasons for menopause hormone therapy. In other words, you don’t need to have hot flushes or night sweats to be prescribed menopause hormone therapy.
Often, menopause hormone therapy is prescribed alongside a topical vaginal oestrogen to treat vaginal symptoms (dryness, irritation or urinary frequency).
You don’t need to experience hot flushes and night sweats to take hormone therapy.
Monkey Business Images/ShutterstockHowever, none of these guidelines recommend menopause hormone therapy for cognitive symptoms often talked about as “brain fog”.
Despite musculoskeletal pain being the most common menopausal symptom in some populations, the effectiveness of menopause hormone therapy for this specific symptoms still needs to be studied.
Some guidelines, such as an Australian endorsed guideline, support menopause hormone therapy for the prevention of osteoporosis and fracture, but not for the prevention of any other disease.
What are the risks?
The greatest concerns about menopause hormone therapy have been about breast cancer and an increased risk of a deep vein clot which might cause a lung clot.
Oestrogen-only menopause hormone therapy is consistently considered to cause little or no change in breast cancer risk.
Oestrogen taken with a progestogen, which is required for women who have not had a hysterectomy, has been associated with a small increase in the risk of breast cancer, although any risk appears to vary according to the type of therapy used, the dose and duration of use.
Oestrogen taken orally has also been associated with an increased risk of a deep vein clot, although the risk varies according to the formulation used. This risk is avoided by using estrogen patches or gels prescribed at standard doses
What if I don’t want hormone therapy?
If you can’t or don’t want to take menopause hormone therapy, there are also effective non-hormonal prescription therapies available for troublesome hot flushes and night sweats.
In Australia, most of these options are “off-label”, although the new medication fezolinetant has just been approved in Australia for postmenopausal hot flushes and night sweats, and is expected to be available by mid-year. Fezolinetant, taken as a tablet, acts in the brain to stop the chemical neurokinin 3 triggering an inappropriate body heat response (flush and/or sweat).
Unfortunately, most over-the-counter treatments promoted for menopause are either ineffective or unproven. However, cognitive behaviour therapy and hypnosis may provide symptom relief.
The Australasian Menopause Society has useful menopause fact sheets and a find-a-doctor page. The Practitioner Toolkit for Managing Menopause is also freely available.
Susan Davis, Chair of Women’s Health, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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