Archive for March 23rd, 2009


Monday, March 23rd, 2009

The bones. Osteoporosis is thinning of the bones, and happens in men and women with ageing, but it is women who have the most significant and clinically important bone loss. Women’s bones never build up the same maximal bone density as men, who have thicker and stronger bones. (This peak bone density is usually reached during your twenties.) So women start off with relatively less bone density than men, and after menopause women have an accelerated rate of bone thinning, due to the drop in the level of circulating oestrogen.

These factors result in post-menopausal women having five times the rate of bone fracture of men of the same age. By the age of 70, 10 to 15 per cent of women will have suffered a break in a limb or a crush-type break in a vertebral (spinal) bone. (By the age of 80, about one-third of women will have had a fracture.) Many of these women will require hospitalisation. That means a great deal of suffering and expense is incurred when the bones get brittle.

Measuring bone density by a specialized testing method (bone densitometry), is becoming more widely practiced, and is being used in research. It would seem that not all women have the same risk of developing osteoporosis. Important factors include a family history, weight and smoking. At higher risk would be a fairly inactive, thin, smoking woman, whose diet is low in calcium, who doesn’t see much sunlight, and whose mother had several broken bones in her later years.

Osteoporosis is a relatively slow, silent process. It is not as though with your final period you develop a hunched back. It can take years for the changes to show as broken bones, or lost height, or a marked stoop, but the process begins around menopause in most women who are susceptible to it.

One factor which determines how thin your bones get is how thick they were to begin with (that is, the peak bone density). Maximising your peak bone density in your teens and twenties, by having adequate calcium in your diet, and getting plenty of weight-bearing exercise (like walking), can decrease your chances of problems later in life. It is like making deposits in your ‘bone bank’ for later on.

If you have bone thinning during these earlier years, when you are meant to be building up your peak bone density, you may be increasing your risks of osteoporotic fractures later in life. Bone thinning may occur if there is a prolonged time of decreased oestrogen production, for example in conditions like anorexia nervosa. Over time, weight-related and exercise-related amenorrhoea (no menstrual periods) can sap away your bone density, similar to post-menopausal bone thinning. So doctors would recommend giving oestrogen, usually in the form of the oral contraceptive pill, to women who have lengthy spells (over six to eight months) of amenorrhoea.



Monday, March 23rd, 2009

What is an abortion? Abortion is not a method of contraception. Contraception prevents pregnancy. An induced abortion is a medical procedure that terminates, or ends, a pregnancy. Sometimes, abortion is called a ‘termination of pregnancy’.

If your contraception rails, or you have unprotected sex, you could become pregnant. If you are two weeks overdue for a period and there is a chance that you could be pregnant, you will need to have a pregnancy test. You can buy a urine pregnancy test kit from the chemist and do it yourself at home, or you can have it done at a local doctor’s surgery, a Family Planning Centre, a Women’s Health Centre, a chemist, or in some hospital outpatient departments. If you take a urine sample for testing make sure that the sample is from the first time you go to the toilet in the morning and it’s in a very clean jar. If you see a doctor you may also have a blood test or a pelvic exam to check for pregnancy.

If it turns out that you are pregnant and you didn’t plan to be, you may feel very confused. Many people say ‘I never thought this would happen to me!’ Sometimes things seem to happen so quickly once you find out, that it’s hard to know what to do. It is really important to talk to someone about the choices you have. Your local doctor or someone at a Family Planning Centre will be able to help you.

Generally your choices are to have the baby and keep it or have the baby and offer it for adoption or foster care. Depending on where you live in Australia, and what is happening in your life, you may also choose to have an abortion.



Monday, March 23rd, 2009

Why is breastfeeding called a method of contraception? Most women do not have periods while they are fully breastfeeding their babies. Fully breastfeeding means you are not giving the baby any other foods, or bottles of milk. Traditionally, many women thought they could not become pregnant because they were not having periods, so they used breastfeeding as their method of contraception. We now know that it is possible for breastfeeding women to become pregnant even if they have not had a period since their baby was born, but we will talk about that a bit later.

How does breastfeeding stop you becoming pregnant? When a baby sucks on the breast, the mother’s body has a hormonal response. This hormonal response affects the mothers ovaries and stops them from releasing any eggs. If there is no egg available to be fertilised, there will be no pregnancy.

Why would I want to choose breastfeeding as a method of contraception? If you want to fully breastfeed your baby and you are prepared to accept a slight risk of another pregnancy during the first six months, then it may suit you just to rely on breastfeeding. It may especially suit you if you intend to have another child eventually, and would be able to accept an unexpected pregnancy were it to happen. Other reasons for choosing to rely on breastfeeding for a while include that it is free, and it gives you the opportunity to have a rest from using other methods of contraception.



Monday, March 23rd, 2009

How do you use DMPA?

The best time to have the first injection of DMPA is during the first seven days of your menstrual cycle. You count a menstrual cycle from the first day of a period until the first day of the next period. Count the first day of your period as day one. Any day between then and day seven, the seventh day, is a good time to start This is because you can be fairly sure you are not pregnant But really, you can start on DMPA at any time if you are absolutely sure you are not pregnant and you are happy to use another method of contraception as backup for the first seven days after you have the first injection.

Where do you get DMPA?

You need to go to a doctor to get an injection of DMPA. You can go to your local doctor or to a doctor at a Family Planning Centre. The doctor will talk to you and examine you, and then they will either give you a prescription for you take to the chemist or if they have DMPA at the surgery, they will give you the injection straight away. If you have to buy it from a chemist you will need to go back to the doctor to have the injection.

What does DMPA cost?

DMPA costs about $17 every 12 weeks on the Australian Pharmaceutical Benefits Scheme (PBS). It costs even less if you have a Pharmaceutical Concession Card.



Monday, March 23rd, 2009

A few years ago a man went to hospital with an unusual complaint. His kids were embarrassed by the way he looked and he wanted treatment to save them being teased at school.

The man, in his mid-thirties, was slightly built and perfectly ordinary except for a huge bloated abdomen which made him look pregnant. The director of the hospital’s anorectal physiology unit said the man had been like that all his adult life, was quite comfortable and regarded himself as normal until the children began ragging him about having a baby. He also regarded as normal the fact that he only had one bowel motion a month.

The level of acceptance and tolerance people have about their bowel function is amazing. Because bowel habits are not openly discussed, people believe what they do is normal. Current medical opinion is that a normal range for bowel motions is three a day to three a week.

On investigation, this man was found to have a disorder known as ‘megacolon’. The colon is usually three or four centimetres in diameter but his was the diameter of a football. Such a distended colon is beyond repair and the only option is to remove it. The enlarged sections were duly cut out and today the man has a flat abdomen and a regular bowel habit.

Fortunately, megacolon is not too common and the majority of men with constipation have a bowel that looks healthy. Most suffer from simple constipation. There is nothing wrong with the way their bowel works, they have no medical disorder, and their constipation responds to a change in diet.

Those with complex or severe constipation have a problem with bowel function and need more than a dietary change. They may have a slow transit difficulty, an imbalance in fluids or an abnormality in defecation. Such men may need laxatives and it is very important that they take the correct ones.

There are two types of laxative: those that stimulate the colon to make it contract and push the stool along, and those that alter the nature of the stool by, for example, drawing in water to make it bulkier, softer and easier to pass. Non-stimulant (bulking) laxatives can be used safely in the long term and won’t damage the colon. Stimulating laxatives can, however, cause considerable damage if used long term. They work by stimulating the nerves and eventually damage these nerves and affect muscle function.

The level of laxative abuse in Australia is alarming. As many as one in five men use them. Amazingly, 80 per cent of users don’t consider themselves constipated and believe taking laxatives is standard behaviour. Some men casually pop twenty or thirty pills a day. Just because a laxative is described as ‘natural’ doesn’t mean it’s not harmful.

Constipation means different things to different people, and in 1992 a symposium of international experts was convened to try to reach some consensus on definition, cause and treatment. Constipation is now defined in terms of frequency, hardness of stool and straining. Straining more than 25 per cent of the time is abnormal. With these three factors taken into account, between 15 and 18 per cent of Australian men would be considered constipated.

Men should train themselves to respond promptly to an urge to defecate. The urge is there because the bowel is stretched. If the urge is not obeyed, the bowel accommodates and dilates further, and a larger volume is needed before an urge is again felt. Further, as the stool waits, the bowel absorbs more of its water and it becomes harder.

Constipation can also be a consequence of other disease or a side effect of drugs and is known to be associated with depression, because with depression the metabolic rate can become sluggish and the bowels can, too. It can also occur, although rarely, in people suffering from an underactive thyroid or increased levels of calcium in the blood. Several drugs, particularly analgesics and codeine-based pain-killers, can cause constipation, too.

Any change in normal daily routine, such as a holiday, can cause constipation. It is not known if this is a local effect in the bowel or a psychological response. It can occur in the first few days of the holiday, before any dietary change could have had an effect.

The relationship between the psyche and constipation is not clearly understood, although the international symposium was told it was common after trauma such as an accident, bereavement or major surgery. There is also some evidence that a positive history of sexual abuse is associated with constipation in women. The same research has not been done in men.