Category Archives: Hormone Replacement Therapy

October is recognized as Breast Cancer Awareness Month. During this time, health care systems and organizations aim to provide education, resources, support and prevention information regarding the disease.

The American Cancer Society (ACS), offers these statistics about breast cancer:

Early detection is important because there are more treatment options available and a better chance of survival when breast cancer is caught early, said Charissa Williams, APN, a ThedaCare Hematology & Oncology Specialist. Studies show theres a more than 90% survival rate, if the tumor is caught early.

Regular self-breast exams are one way to detect a cancerous tumor. A breast cancer screening is another way. Mammograms can spot tiny tumors, making it more likely to catch the disease at an earlier stage.

For most women, screening mammography is a safe and effective way to detect breast cancer early, Williams added.

Medical organizations vary on the best age to start screening mammograms (some say as early as age 40) and how often to repeat them. The Centers for Disease Control and Prevention (CDC) has a comparative chart, Breast Cancer Screening Guidelines for Women, to better sort out the timing and frequency of mammogram screening based on your particular situation.

It is important to discuss your individual screening guidelines with your primary care provider, said Williams. For example, those who have a strong family history or certain genetic mutations (BRCA1 or BRCA2) often have earlier screening guidelines than the general population.

Women might also help minimize their chances of developing the disease by modifying their lifestyle. However, Williams notes there are some risks factors that cannot be changed: your age, family history, genetics, race, and being a woman.

There are several modifiable factors that can increase your breast cancer risk, including obesity, poor diet, lack of physical activity, alcohol and tobacco use, and certain types of hormone replacement therapy, she said.

To reduce your risk of breast cancer, Williams suggests you form these habits:

There are more than 3.8 million breast cancer survivors in the United States.

For more information on breast cancer prevention tips, screenings and treatments, visit thedacare.org/breast-cancer.

About ThedaCare

For more than 110 years, ThedaCare has been committed to improving the health and well-being of the communities it serves in Northeast and Central Wisconsin. The organization delivers care to more than 600,000 residents in 17 counties and employs approximately 7,000 health care professionals. ThedaCare has 180 points of care, including eight hospitals. As an organization committed to being a leader in Population Health, team members are dedicated to empowering people to live their unique, best lives. ThedaCare also partners with communities to understand needs, finding solutions together, and encouraging health awareness and action. ThedaCare is the first in Wisconsin to be a Mayo Clinic Care Network Member, giving specialists the ability to consult with Mayo Clinic experts on a patients care. ThedaCare is a not-for-profit health system with a level II trauma center, comprehensive cancer treatment, stroke and cardiac programs, as well as primary care.

For more information, visit thedacare.org or follow ThedaCare on social media. Members of the media should call Cassandra Wallace, Public and Media Relations Consultant at 920.442.0328 or the ThedaCare Regional Medical Center-Neenah switchboard at 920.729.3100and ask for the marketing person on call.

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Helping Reduce Your Risk of Breast Cancer ThedaCare - ThedaCare

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This Simple Blood Test Gives Incredible Insights Into Building Muscle Mass - Yardbarker

The Breast Cancer Awareness Walk at Fox Army Health Center is back this month for the first time since 2019, due to COVID-19, to raise awareness of the disease and early detection and to honor survivors.

The event will be Oct. 27 from 12-1 p.m. at the flagpole at Fox Army Health Center at 4100 Goss Road, and the Redstone Arsenal community is invited to participate.

How can we be aware of something unless we pay attention to it? said Mary Bouldin, a nurse educator at the Center for Comprehensive Wellness at Fox. Thats what Breast Cancer Awareness Month means to me that its time to sit up and pay attention to something thats very important to most women.

Overall, the average risk of a woman in the United States developing breast cancer sometime in her life is about 13%, according to the American Cancer Society. That means there is a 1 in 8 chance she will develop breast cancer.

That means, as a woman, if you dont get it yourself, you will likely know a friend, family member, mother, sister, even a brother, husband or father who may be diagnosed with it, Bouldin said. Men are not excluded, but their rates of development are only one out of 833 per lifetime risk.

Bouldin said participants at the walk will receive information on breast cancer self-examination and the screening options that are available.

The incidence of invasive breast cancer in women has increased 0.5% per year since the mid-2000s, Bouldin said. Meanwhile, breast cancer death rates dropped by 43% from 1989 to 2020, show the findings outlined in the latest edition of American Cancer Societys Breast Cancer Statistics.

She said the possible reasons are earlier detection through screening such as mammograms that allow us to find invasive breast cancers earlier, increased awareness about breast cancer itself and the types of screening available to assist us with finding it earlier and improved treatments for breast cancers themselves with targeted treatment oftentimes available for specific types.

Bouldin said that decreasing risk means changing lifestyle habits like maintaining a healthy weight, abstaining from alcohol or decreasing to moderate consumption or less and staying physically active.Postmenopausal women may lower some risk by avoiding Hormone Replacement Therapy, and women who breastfeed their child for a year can lower some risk, she said.

Early detection decreases risk of death from breast cancer and increases options for treatments, Bouldin said. The best protection is early detection.

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Take strides to raise awareness of breast cancer - Theredstonerocket

Breast cancer is the most common type of tumor in the world (excluding non-melanoma skin tumors) and the leading cause of cancer death among females in Brazil, according to data from the National Cancer Institute (INCA). For Brazil, the number of new cases of breast cancer is estimated at 66,280 for each of the 2020-2022 triennium. (INCA). Female breast diseases are the most common in all Brazilian regions.

It does not have a single cause, since several factors are associated with its development, the most famous of which are: age, genetic, hereditary, hormonal, environmental factors, as well as reproductive history.

In Brazil and in the world, the incidence of cancer has been increasing in recent years. Case proportions among women under 35 have also increased: the incidence, which was historically 2%, is now between 4% and 5%.

Hormonal factors are mainly related to the stimulation of estrogen, whether it is produced by the body itself or obtained through hormone replacement. This hormone is responsible for stimulating breast cells until the end of menopause. From there, care comes in regarding hormone replacements.

The well-known hormonal therapy is recommended for women experiencing climacteric age primarily to help relieve symptoms typical of this phase, such as hot flashes, mood swings, insomnia, memory loss, joint pain, dizziness, decreased libido, and genitourinary symptoms. However, the main concern for many women is whether menopausal hormone replacement therapy can cause breast cancer.

According to the Inca, hormone replacement therapy, especially one that combines estrogen and progesterone, increases the risk of breast cancer.

Treatment is not recommended for those with a family or personal history of breast cancer, endometrial cancer, thrombosis and/or cardiovascular disease, precisely because it increases the risk of these problems.

The hormones used, the dosage and the time of treatment are determined by the specialist doctor after a careful assessment of the condition, taking into account the specifics of each patient.

The current British meta-analysis, i.e. an analysis of several studies conducted on the topic, was published in The Lancet and included data from more than 108,000 users who contracted the disease.

According to the research, while the overall risk for women between the ages of 50 and 69 years of developing breast cancer is 6.3%, those who used a combination of estrogen and progesterone one of the most common hormone replacement therapies for five years had an 8.3% risk increase. .

The study also showed that the risk persists even 10 years after stopping the use of the hormone, information that was not previously agreed upon among doctors. What drew attention in the current British study is the fact that HRT may have greater risks if it is used by women who are overweight or obese or by those who drink alcohol excessively.

After a certain age, it is expected that breast cells sensitive to female hormones no longer have this hormonal stimulus to reproduce. Alternative therapy will continue with this stimulation. If there are any cancer cells, it is like a trigger for those cells.

Even in the absence of an abnormal cell, continuity in the stimulus increases the chances of eventual emergence of some mutations that lead to tumorigenesis.

It is important that the woman is informed so that she can take this into account when deciding whether or not to undergo treatment. The patient needs to know that it is desirable that the replacement lasts no more than five years, since after this period the risks increase. Each patient should be individualized in the continuity of treatment beyond this period.

It is necessary for the woman and her doctor to assess the real need for the use of hormones at this stage of life, and if it is really necessary, in the window of opportunity, the application is made for the shortest possible time. There are other ways to try to deal with the effects of menopause on health and quality of life, such as physical exercise and diet control. The use of hormones must follow strict standards.

Thus, hormonal replacement, if necessary, should be judicious, discrete and of short duration, respecting the family history, the persons disease and lifestyle.

Giovanna Fortunato is an obstetrician-gynecologist and specialist in endometriosis and infertility, a professor at HUJM and a member of the Eladium Clinic team.

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Its not every day that the ones at Marshall Medical Centers employed to provide care to patients find themselves on the receiving end, but during an annual mammogram screening performed by Kerrie Washburn, MeLissa Sims-Smiths breast cancer journey began.

The 43-year-old Marshall North CT Technologist had her annual mammogram set for April 8.

It was my third mammogram, and I just went because it was my yearly one, Sims-Smith said. I never thought anything was wrong.

Immediately following the screening, Washburn requested additional pictures and an ultrasound.

When we looked at the pictures further, you could see something wasnt right, Sims-Smith said. The radiologist and I just cried together.

Following her biopsy, she was diagnosed with Invasive Mammary Carcinoma, Stage 1, Progesterone positive in her left breast. Sims-Smith underwent a bi-lateral mastectomy on April 26.

Theyre just boobs, she said laughing. You know you can order boobs on Amazon.

She said the mastectomy was not the hardest part about her journey. The hardest part for her is being strong for her eight-year-old daughter, Kylie, two older sons, and husband, Bobby.

She (Kylie) hasnt missed out on any of her activities, Sims-Smith said. She knows mama is sick and tired, but I have only missed one Girl Scout event, and Bobby was able to take her to that.

Sims-Smith married Bobby Smith on August 1, 2021, just 8 months before her breast cancer diagnosis.

Bobby is amazing, she said. I have only had to go to one chemo treatment by myself because he had just started a new job and couldnt get off that day, but all my other treatments he has been right by my side.

Following her second chemotherapy treatment, doctors warned her she would begin losing her hair.

Right after my second treatment, I went straight to the salon to shave my head, she said, and he (Bobby) shaved his head too.

Sims-Smith has worked with doctors at the Marshall Medical Cancer Care Center in Albertville to receive her treatment.

You know, Ive worked with and know most of the nurses and doctors at the cancer center, she said, and every time I go up there they are always so nice, not just to me but every patient they see.

She also appreciates how close the Cancer Care Center is to her home.

Going through treatment is so tiring for me, she said. Its really nice to not have to drive so far.

Her customized treatment plan involves weekly chemotherapy treatments for 12 weeks. She currently has seven more treatments left. To balance her work and treatment schedule, she works 10 hours Monday- Thursday and has treatment on Friday.

Im really looking forward to having Fridays off, she said. I cant wait to sleep in and for my hair to grow back.

She never misses a day of work, Washburn said. Shes been going through chemo and shes at work every day in one of the busiest modalities we have.

Sims-Smith has worked with the hospital for 17 years.

A lot of the patients I see are cancer patients, she said, and you see them every year. You really get attached. I really love people.

Washburn has been with the hospital for 20 years and said Marshall Medical Centers has made breast health a top priority.

A breast cancer diagnosis is very scary but with the help of modern technology and screening detection there is a higher chance for a successful outcome than before, Washburn said.

I feel like at a lot of places breast health may get pushed aside sometimes, she said, but Marshall Medical Centers stays on top of all the latest research and advancements so we can do more to treat it.

In 2017, Marshall Medical Centers installed the latest 3D mammography technology for better, faster detection.

With the help of 3D technology, we are able to visualize the overlapping breast tissue and find abnormalities sooner than before, Washburn said.

The American Cancer Society suggests all women should start annual mammogram screenings at age 40. Washburn recommends those who have high risk factors, such as a family history of breast cancer, and are currently taking hormone replacement therapy, should establish a baseline at age 35.

Washburn said Sims-Smith is constantly thinking of others before herself and you would never know she is battling cancer. Sims-Smith said she has one goal for this story.

I hope this story encourages women to come get their mammogram, Sims-Smith said. You couldnt feel my lump, nothing hurt, and I had just gotten one the year before and it was clear. Doing the mammogram is what saved me. If I had waited until I felt it, it would have been way too late.

I feel like if you keep a positive attitude it really helps in your recovery, Washburn said, and MeLissa has remained so positive. Shes just wonderful!

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Early detection matters | Marshall Medical employee recounts her breast cancer journey - Sand Mountain Reporter

When deciding whether to havehormone replacement therapy (HRT), it's important to understand the benefits and risks.

Many studies on HRTpublished over the past 15 yearshighlight the potential risks. As a result, some women and doctors have been reluctant to use HRT.

But recent evidence says that the risks of HRT are small and are usually outweighed by the benefits.

The main benefit of HRT is that it can help relieve most menopausal symptoms, such as:

HRT can also help prevent thinning of the bones, which can lead to fracture (osteoporosis). Osteoporosis is more common after the menopause.

The benefits of HRT usually outweigh the risks for most women.

The risks are usually very small, and depend on the type of HRT you take, how long you take it and your own health risks.

Speak to a GP if you're thinking about starting HRT or you're already taking it, and you're worried about any risks.

There is little or no change in the risk of breast cancer if you take oestrogen-only HRT.

Combined HRT can be associated with a small increase in the risk of breast cancer.

The increased risk is related to how long you take HRT, and it falls after you stop taking it.

Because of therisk of breast cancer, it's especially important to attend all yourbreast cancer screening appointments if you're taking HRT.

The evidence shows that:

HRT does not significantly increase the risk ofcardiovascular disease (includingheart disease andstrokes)when started before 60 years of age, and may reduce your risk.

TakingHRT tablets is associated with a small increase in the risk of stroke, but the risk of stroke for women under age 60 is generally very low, so the overall risk is still small.

Page last reviewed: 09 September 2019Next review due: 09 September 2022

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Hormone replacement therapy (HRT) - Benefits and risks - NHS

What is thyroid hormone replacement therapy?

Thyroid hormone therapy is the use of manmade thyroid hormones to raise abnormally low levels of natural thyroid hormones in the body. Thyroid hormone is usually given in pill form and is often used to treat an underactive thyroid that is secreting little or no thyroid hormones. The most commonly prescribed thyroid hormone replacement is pure synthetic thyroxine (T4).

Thyroid hormone therapy is generally prescribed when your thyroid is not making enough thyroid hormone naturally. This is a condition referred to as hypothyroidism. Other reasons for using thyroid hormone therapy may rarely include:

To control the growth of the enlarged thyroid gland (also called goiter)

To control the growth of nodules on the thyroid gland

Treatment after the removal of the thyroid for benign or malignant disease

After treatment of hyperthyroidism by radioactive iodine ablation

Healthcare providers do careful blood testing to find the proper dose of hormone replacement therapy for each person.The blood tests reveal levels of thyroid hormones in the blood, as well as thyroid-stimulating hormone (TSH)released by the pituitary gland. The pituitary gland plays an integral role in the functioning of the thyroid gland. It controls how much thyroid hormone is released by making TSH that "stimulates" the thyroid. Increased levels of TSH may indicate that you have an underactive thyroid or that thyroid hormone replacement needs to be increased.

You will have lab tests to measure levels of thyroid hormones and TSH. Hypothyroidism can be a progressive disease. This needs dosage increases over time.

To make sure that your thyroid hormone replacement works properly, consider the following recommendations:

Maintain regular visits to your healthcare provider.

Take your thyroid medicine at least 1 hour before breakfast and any calcium or iron medicines you may take. Or take at bedtime, or at least 3 hours after eating or taking any calcium or iron medicines.

Tell your healthcare providerof your thyroid hormone treatment before beginning treatment for any other disease. Some treatments for other conditions or diseases can affect the dosage of thyroid hormone therapy.

Let your healthcare provider know if you become pregnant.

Tell your healthcare provider of any new symptoms that may arise.

Tellall healthcare providers of your thyroid condition and medicine dosage.

See the article here:
Thyroid Hormone Replacement Therapy | Johns Hopkins Medicine

Two in three perimenopausal women may not report headache, so doctors are urged to ask patients about symptoms.

A headache specialist has urged doctors to ask perimenopausal patients about headache symptoms, because migraines are often undiagnosed and poorly managed in these women.

There were also important considerations for women taking HRT, the headache and womens health specialist Professor Anne MacGregor told the Australasian Menopause Society Congress in Cairns last month.

Migraine symptoms become more common when women reach menopause and can have severe impacts on quality of life, but few women report migraine as a symptom of menopause. Among women who attended a menopause clinic, 62% experienced headache but did not spontaneously report it, Professor MacGregor told the conference.

And among women at the clinic who experienced migraine, 79% reported very severe or substantial disability, said Professor MacGregor, from the Queen Mary University of London.

Our research of women with migraine attending amenopauseclinic suggests that women are not receiving optimal treatment for symptomatic treatment of migraine attacks, she said.

Migraine with or without aura does not contraindicate the use of hormone replacement therapy, but transdermal HRT was preferable, Professor MacGregor said.

Hormone replacement therapy could help migraine symptoms, but only in the context of prescribing HRT for management of vasomotor symptoms in women with migraine, she said.

Migraine can be worsened by changes in hormones, so providing stable hormone levels using transdermal oestrogen and ideally continuous progestogen is best.

Professor MacGregor told the conference that if patients experienced a new-onset migraine with aura, doctors should firstly exclude transient ischemic attack and reassure the patient.

She then recommended changing the patients HRT to a transdermal form and prescribing the lowest effective dose of estrogen to control vasomotor symptoms, and consider non-hormonal options if aura does not resolve or increases in frequency.

Professor MacGregor told TMR there were several alternatives to HRT that may also be helpful when patients experience migraine.

Non-hormonal options that benefit both migraine and vasomotor symptoms ofmenopauseinclude losing weight if obese, exercise, cognitive behavioural therapy and prescribed medications including SSRIs and SNRIs, particularly venlafaxine.

Professor MacGregor told the conference that migraine was a risk factor for the onset of menopause and could predict more frequent vasomotor symptoms associated with anxiety, depression and sleep disturbance.

Professor MacGregor wrote in a review in Maturitas that perimenstrual estrogen withdrawal is implicated in thepathophysiologyof menstrual migraine, with increased prevalence of migraine in perimenopause associated with unpredictable estrogen fluctuations.

Professor MacGregor said general practitioners should ask women about migraine symptoms, particularly sinus headache.

Perimenopausal women should routinely be asked about symptoms suggestive of migraine bearing in mind that the most common misdiagnosis is sinusitis which should then be managed appropriately according to national guidelines.

Professor MacGregor said for most women, migraine developed during their teens and 20s, became more prevalent during perimenopause and gradually improved with time after menopause. A few women develop migraine for the first time during perimenopause, she said.

Migraine has a global prevalence of 19% in women and 9% in men, she wrote.

Migraine without aura is the most prevalent type, affecting 70-80% of people with migraine.

The three best predictors for diagnosing migraine without aura are photophobia, disability and nausea: people who report two of these symptoms have an 81% probability of migraine, with the presence of three symptoms increasing the probability to 93%.

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Prescribing HRT in women with migraine The Medical Republic - The Medical Republic

Carri Holton, MSN, WHNP-BC, Department of Pediatric & Adolescent Gynecology at Childrens Hospital Colorado, gave a presentation on gynecologic care for adolescent patients at the NPWH 25th Annual Premier Women's Healthcare Conference in Houston, Texas, from September 29 to October 2.1

Holton first outlined how health care providers can provide preventive health screenings and offer guidance to adolescents, teens, and parents in pediatric gynecology. Conditions such as pediatric vulvovaginitis, lichen sclerosis, genital injuries, labial adhesions, congenital anomalies in the reproductive system, menstrual suppression, tumors, premenstrual syndrome and premenstrual dysphoric disorder, and breast problems in youths are treated via pediatric gynecology, as is fertility preservation or hormone replacement.

During an office evaluation, there should be a welcoming environment for adolescent patients, according to Holton. Health care providers will require technical skills to complete hymen exams, single-digit exams, and smaller speculums. They will also need to have the patience to listen to adolescents and parents, along with learning the history of their patients.

Confidentiality was also discussed. Holton noted that adolescents must be made aware of instances when information is not confidential, such as suicidal or homicidal thoughts. Minor consent laws should be known, as many states allow minors to consent to family planning, pregnancy care, substance use related care, and outpatient mental health services. All states allow minors to consent to sexually transmitted infection testing.

When arranging and performing an adolescent exam, the decision should be between the adolescent and the provider, though there should be a chaperone present. Providers should explain all components of the exam to the patient and parent. Patients should be reassured that they are in control of their body and the exam can be stopped at any time.

When moving onto the next step, providers should ask permission to pull the sheet back. Holton reminded them to be explaining female anatomy with proper terms, educating parents and patients. Breasts and pubic hair should be examined for Tanner staging, and external genitalia should be examined for normal anatomy.

In the presentation, Holton discussed normal pubertal development along with abnormalities, and encouraged attendees to learn this information so that they may recognize signs of abnormal development. Providers need to first identify the cause then determine treatment. This could include hormone replacement therapy in cases of primary ovarian insufficiency.

Holton also outlined instances of physiologic anovulationwhen slow maturation occurs in anovulatory cycles. This can lead to noncyclic, unpredictable, and inconsistent bleeding. In cases where bleeding is too much, adolescents should see an oncologist for testing, especially in cases of concerning history with bleeding disorders in the individual or family.

In cases of mild bleeding without anemia, providers should reassure patients, provide them with prophylactic iron supplementation, and offer hormonal contraceptives if desired. In moderate bleeding with anemia, providers should give patients combined oral contraceptives, micronized oral progesterone, depo Provera injection, levonorgestrel (LNg) intrauterine device (IUD), and iron supplementation.

Further treatments, along with hospitalization and blood transfusion, may be needed in cases of severe bleeding. In all cases, Holton stated that iron supplementation should be given.

Holton also discussed polycystic ovary syndrome (PCOS), reminding attendees that every case is different. Holton also noted that PCOS is not caused by ovarian cysts or being overweight, and that much is still unknown about PCOS. Diagnoses may be given as irregular periods, and can present as amenorrhea, oligomenorrhea, and chaotic periods.

Treatment for PCOS will vary based on concerns, as it can lead to metabolic concerns, acne, dermatologic concerns, and nutrition concerns. When these concerns arise, screenings should establish a rapport in the first visit. Repeated screenings should at first take place every 3 months, then every 3 to 12 months depending on the patient.

Holton lastly talked about dysmenorrhea and endometriosis. Dysmenorrhea is painful menstruation, often increasing risk of anxiety and depression. It can be managed with dietary, vitamin, and herbal treatments along with exercise and yoga, or with pharmacologic interventions.

Dysmenorrhea is often caused by endometriosis. Risk factors of endometriosis include earlier menarche, nulliparity, shorter menstrual cycles, childhood sexual and physical abuse, and more. To treat endometriosis, Holton recommended both surgical and medical treatments. Complementary and alternative therapies may also reduce symptoms.

Reference

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Caring for the gynecologic needs of the adolescent patient - Contemporary Obgyn

EVEN if you like a bit of alone time, being lonely is very different, and can be very damaging.

In fact, loneliness can significantly affect your health and wellbeing and its something none of us should learn to live with.

2

Luckily, there is lots of help out there, and there are small changes you can make yourself to tackle it, from speaking to the Samaritans to joining a club to meet new people.

Youre never truly alone!

Here are this weeks reader questions...

Q: IS there help for someone in their late 30s starting to go through perimenopause?

A: Premature ovarian failure insufficiency is a condition that occurs when your ovaries are no longer working properly and youre under the age of 40.

This affects approximately one per cent of women. It usually means that your periods stop or become irregular, and you may also experience menopause symptoms.

The term early menopause is used when periods stop between the ages of 40 and 45.

You say that youre in your late thirties, so its possible that you could fall into either of these groups.

The most important thing is for you to seek medical help here and get a diagnosis.

While its not normally recommended for women over the age of 45 to have blood tests to look for menopause, for women under 45 who are having symptoms it is.

This is because its important to make the diagnosis because its vital that women receive the correct hormonal replacement therapy, or HRT.

We often talk about how HRT is safe for most women and the benefits outweigh the risks, but that calculation is different in women under 45, where almost definitely there are huge benefits to taking HRT that massively outweigh any risk.

The next step for you is to see your GP, and keep a log of the symptoms youve been having, and Id expect your GP to do a series of blood tests spread out over time to find out your levels of FSH, or follicular stimulating hormone.

If these levels are high, it would suggest youre experiencing premature ovarian insufficiency.

Q: MY metronidazole prescription finished today. Ive had two days of awful abdominal pain, sweats and now kidney pain.

A: It sounds possible youve had an allergic reaction to the metronidazole.

Serious side effects from this antibiotic medication are rare and happen in fewer than one in 1,000 people, however the symptoms you describe after taking metronidazole suggest an adverse reaction, and this requires medical attention.

If all of your symptoms have now resolved, it may be that your GP decides further tests arent necessary, but if your symptoms are still ongoing youll need blood tests to check things like the health of your liver and kidneys and you should be monitored.

Metronidazole is a slightly unusual antibiotic, as it affects our bodys ability to metabolise alcohol.

So whenever it is prescribed, you should receive information and advice not to drink alcohol when taking the medicine, and to wait for two days afterwards before drinking alcohol, as this allows the metronidazole to leave your body.

Q: NO one has helped me in a long time what should I do? Ive had cancer, I cant speak to my family about it, I have no help or support.

Im scared, alone and getting depressed.

A: Anybody who has cancer should be able to access help and support from the cancer specialist nurse.

The team looking after you for your cancer should be able to put you in touch if you havent been given their contact details already.

Usually there are also charities which provide peer support, such as online chat rooms. A diagnosis of cancer is a life-changing event which not only affects our physical health but our mental health too.

It impacts our relationships, our ability to do our jobs and every aspect of our social life.

Nobody should feel that they are on the cancer journey alone, as there is always help and support available.

The first port of call if youre feeling confused and overwhelmed is just to speak to your GP and let them help you in creating a support system, as you will need this.

It also opens up the conversation around loneliness, which we can think of as a health condition on its own now, thanks to new and ongoing research.

We know loneliness affects every aspect of a persons physical and mental health.

It has even been said that loneliness is as risky to a persons health as smoking.

Loneliness requires treatment.

Your GP will be able to let you know about what befriending services are available locally, and you can usually get some advice from the charity Age UK as well.

Please dont suffer alone or in silence. A problem shared is a problem halved I really believe that saying to be true.

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Q: CAN you give me some advice on how to treat adult acne?

Acne can be a real pain for adults.

We tend to think of it as a condition that affects teenagers, but especially in women it is quite common for acne to persist into adulthood.

Acne over the age of 25 is termed adult acne, while some people get it for the first time as an adult, and this is termed adult-onset acne.

It can range from a few spots on the face, neck, back or chest, to more severe cases, and acne which is causing scarring should be treated by a healthcare professional without delay.

For more simple acne which is white, and blackheads with no scarring, its fine to try over-the-counter remedies first.

But if these arent helping its a good idea to see your GP.It is caused by the glands in the skin producing too much oil and at the same time dead skin cells build up and plug the pores, causing blockages.

A type of bacteria which lives on everyones skin can then cause you some further problems.

Whenever treating acne, the first things to think of are the basics.

Simple things such as cleansing your skin well twice a day, eating healthy and nutritious foods, maintaining good hydration levels, and using a simple oil-free moisturiser are all important.

Depending on the type of acne you have, and the pattern whether it flares up during your period and what treatments youve unsuccessfully tried the treatment strategy will differ for different people.

Talk to your pharmacist, who can assess what would be a good next step based on what youve tried already and if this isnt helping, the next step is to see your GP.

Sometimes people require an oral medication called Roaccutane, which can only be prescribed by a dermatologist.

I cannot stress enough that if you have acne which is causing scarring, you should see your GP without delay.

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Im a GP heres the best way to treat acne and when to see a doctor... - The US Sun