Weight loss and diet plan for a healthy lifestyle.

Imagine you are quietly going about your normal life, when suddenly you trip and fall. You stretch out a hand to save yourself, and the next thing you know you have fractured your wrist. Unfortunately, most Accident and Emergency doctors are so busy that they just don’t have time to explain that your Colles’ fracture is probably caused by osteoporosis, even less to explain what you might do about it. An X-ray will have shown up the fracture, but osteoporosis does not show up on an ordinary X-ray until one-quarter or more of the bone density has been lost, so if you have lost less than that so far the chances are that no one will notice that die cause of your fracture was osteoporosis, let alone tell you about it, and what you can do to stop it getting worse. A Colles’ fracture should be seen as a warning sign about die state of your bones, while still giving you time to do something about it.

Sudden or severe backache in the years after the menopause can have many causes, and it may not occur to your doctor that osteoporosis could be the cause in your case. He may arrange an X-ray (which doesn’t show anything wrong), possibly physiotherapy, probably painkillers, but eventually you get the message that you will ‘just have to learn to live with it’.

It needn’t be like that. Dual energy X-ray absorptiome-termachines, known as DEXA (or DXA) for short, are the best way to screen bones for osteoporosis, and are now becoming available all over the country, both on the NHS and privately. DEXA scanning is quite painless, and involves no undressing or embarrassment. DEXA machines scan your hip and spine, and produce a reading of your bone density, which will give a good idea of whether or not you have got osteoporosis, how severe it is, and what your chances are of getting a fracture; the lower your bone density, the more likely you are to sustain a fracture. Bone mineral density at the time of the menopause is the best predictor of osteoporosis, so in an ideal world, all women who are at risk of developing this disease would have a DEXA bone scan when they reached the menopause, and if their bone density was lower than it should be they would be advised on ways of reducing their chances of getting a fracture, including information on HRT. Until this happy day comes, don’t ignore any back pain you get, or a Colles’ fracture of the wrist, or loss of height – ask your doctor about osteoporosis.

You may see advertisements offering private screening for osteoporosis, and if this is on a DEXA bone scanner and will scan your hip and vertebrae, the reading will give your doctor a clear idea of your bone density and therefore of how likely you are to develop osteoporosis. Some companies are jumping on the osteoporosis bandwagon and offering screening that is less reliable; if you are in any doubt, ask your doctor. As a general rule, the only way to tell what the bone density is in your hip is to scan the hip, and the same with the vertebrae; scanning other parts of the body (such as the heel and wrist) does not give a truly accurate impression of your bone density in the important hip and spine areas. However, such a scan will show if your bone density is very low or very high; it’s those people in the middle who will need more precise measurement.

Scanning poses a difficult dilemma for the National Health Service. To scan all post-menopausal women would be prohibitively expensive, and large-scale dials have shown that it is not cost-effective to do this. To scan all women who are at risk of developing osteoporosis is still expensive, but if it can reduce the number of osteoporotic fractures (which currently cost the NHS over ?600 million a year) by identifying women who have a low bone density and offering them treatment, such as HRT, to reduce their chance of having a hip fracture, then considerable savings can be made. On the other hand, if millions of women take HRT for many years, that, too, is very expensive.

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More than 25 000 Australian women had hysterectomies in 1975 and at that rate it was estimated that at least four out of every ten would have this form of surgery by the time they turned sixty-five. Twenty years later, with an ageing population that includes a high proportion of older women, it is estimated that 30 000 hysterectomies are performed in Australia annually.

Current evidence suggests that 20-30% of Australian women will have a hysterectomy during their lifetime, usually between their mid-thirties and mid-fifties. About three-quarters of these are performed before women go through a natural menopause, that is, before their menstrual periods stop of their own accord. The Melbourne Women’s Midlife Health Project is documenting the situation in 2000 randomly selected Melbourne women aged from forty-five to fifty-five. The Project, undertaken by the Key Centre for Women’s Health in Society at the University of Melbourne, has found a 22% rate of hysterectomy among the women, and a peak age for the operation of just over forty years.

Another study, conducted by the Australian Institute of Health and Welfare, suggests that one explanation for an apparent downward trend in hysterectomy rates in Australia is the rapid introduction of the surgical procedures known as endometrial resection and ablation. This study has found that approximately 4000 Medicare benefit payments were made for endometrial resection in 1991-92, and in the same period the rate of hysterectomy (for heavy, uncontrolled bleeding) in public hospitals in Australia declined by one-third. Although the effects of endometrial resection on bleeding patterns are still being evaluated and the technique itself is still undergoing development, it appears to offer a credible alternative to hysterectomy for some women. Equally, it is fairly certain that hysterectomy will never be eliminated completely. For the several thousand women in Australia each year who are diagnosed as having cancer of the cervix or of the endometrium, survival itself may rely on a hysterectomy.

Recently, there has been a surge of interest in new treatment alternatives to hysterectomy, some of which are surgical, while others are psychological, medical and lifestyle-oriented. At the same time as we applaud the effort that is going into developing new or revamped treatment approaches, we believe that significant information gaps remain about their long-term safety and effectiveness. Research needs to continue and women must be informed of the current gaps in medical knowledge when making treatment decisions.

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Are there any other reasons for not taking sleeping pills? Pregnant women run the risk of deformity and other harm to the foetus. The tragedy of Thalidomide is well documented, in which babies born to a mother taking Thalidomide sleeping pills had deformed or non-existent limbs. Women who are breast-feeding should not take sleeping pills either, as most drugs pass through the breast milk to the baby. The elderly who have to wake a few times at night to go to the toilet are also advised not to take them, as they can be very drowsy with sleeping pills and can injure themselves with falls easily.

Sleeping pills in Australia:

1. Chloral hydrate—Noctec, Dormel, Chloralix.

2. Barbiturates—now very few doctors prescribe them.

3. Benzodiazepines: Temazepam—Euhypnos, Normison, Temaze Oxazepam—Serepax, Murelax, Alepam, Benzotran Diazepam—Valium, Pro-pam, Ducene Nitrazepam—Mogadon, Dormicum, Alodorm Flunitrazepam—Rohypnol, Hypnodorm

5. Antihistamines-Phenergan, Avil, Piriton, Polaramine.

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