August 2003

Women's Health- Talking Taboos

Many women feel embarrassed or sensitive when it comes to talking about some of the most common everyday healthcare problems that women face. The sheer mention of thrush, cystitis, pre-menstrual syndrome or period pains can send us running for cover. The morning-after pill? Many are too scared to ask the pharmacist when an accident happens. Finally, pregnancy is a natural state that many women will embrace, perhaps more than once in their lives-but few know what medicines they can actually take to alleviate everyday healthcare problems when suffering. The Consumer Health Information Centre* breaks the taboos to talk about treating women's everyday healthcare problems.

Thrush

• What is it?
  Thrush is one of the most common forms of vaginal infection caused by fungus or yeast. Almost all women are known to get vaginal yeast infections from time to time. Roughly 50 per cent of women aged between 16 and 60 suffer from vaginal thrush, and nearly one-third will have at least one episode a year.
• What causes it?
  Our digestive and reproductive tracts always house a yeast, Candida albicans. This is normally suppressed by bacteria and tends to proliferate only when the bacteria are reduced in number. Known aggravators of thrush include the contraceptive pill, ill-fitting or tight clothing, perfumed vaginal deodorants and bath salts, Diabetes, antibiotic treatment, oral corticosteroid treatment and pregnancy.
• What are the symptoms?
  Vaginal thrush commonly causes a thick, white, curd-like creamy discharge. It could be odourless, or there may be a bad odour, especially during menstruation. The onset of thrush can cause a lot of itching and irritation both inside and outside the vagina. The vulva (vaginal lips) may look very red and inflamed, and may burn, sting, or itch. This irritated and inflamed tissue is fragile. Scratching or sexual activity may cause small cuts. In very severe cases, ulcers may form, and other bacterial infections may occur in the damaged tissues.
• What is the treatment ?
  An anti-fungal capsule or cream is the most common form of treating vaginal yeast. Treatments are usually used for a few days. A number of products are available over-the-counter for treatment of thrush including fluconazole, clotrimazole and miconazole. These medicines prevent yeast from producing cells resulting in yeast cell death. Oral fluconazole is taken in capsule form for the systematic treatment.
  Clotrimazole and miconazole are available as creams or as vaginal pessaries or tablets. These are inserted high up in the vagina to eliminate the yeast that is the source of the infection and so stop the discharge. The cream for intravaginal use comes in a prefilled, single use applicator tube. A single over night treatment with pessaries or cream is usually effective. These treatments should help relieve the sufferer within a day or two. If not, then the sufferer should consult a GP.
• Self Help Tips
  Wear loose, comfortable clothing and avoid tights and tight trousers
  Maintain good hygiene
  As Candida albicans also lives in the gut, wiping after a bowel movement is recommended

Cystitis

• What is it?
  Cystitis is an inflammation of the urinary bladder. Over two million women are known to suffer from Cystitis every year in the UK alone.
• What causes it?
  Bacterial infection is the most common form of cystitis. Bacteria in the urine makes the urine more acidic than normal, causing stinging and burning. Women are more susceptible to cystitis than men because the vagina and uterus provide warm, humid conditions, which are an ideal environment for bacterial growth and multiplication. Also, having open external genitalia makes them more susceptible to infection. Women also have a shorter urethra than men, which enables rapid infection of the bladder.
• What are the symptoms?
  Mild: Burning sensation during urination, frequent, urgent need to urinate, only a small amount of urine is passed.
  Severe: Frequent, urgent need to urinate and a burning sensation during and after urination. Urine may be dark and cloudy and it may smell offensive. Sometimes there is lower back pain or a raised temperature.
• What is the treatment?
  Treatments work to make the urine more alkaline and render the conditions less favourable for bacterial growth. The majority of over-the-counter treatments for cystitis contain **sodium citrate, potassium citrate, **sodium carbonate or **sodium bicarbonate which neutralise the acidic affect caused by the bacteria. However, antibiotic treatment may be required in severe cases. Alternative remedies containing herbal extracts are also available. Some of the commonly used herbs in such extracts are bearberry, Buchu Leaf, Couchgrass, Equisetum, Shepherd's Purse and Uva Ursi.
• Self-help
  Fluids, fluids and more fluids! Fluids should not be in the form of tea, coffee and citrus fruit juices, though. However, cranberry juice is considered very good. The intake of fluids dilutes the urine, thus increasing the volume produced. The extra fluid can then help to 'flush out' the bacteria.

Premenstrual Syndrome / Tension & Period Pain

• What is it?
  Premenstrual syndrome or tension is the term used to describe a group of symptoms occurring just prior to and in some cases during menstruation. Period pain, also known as dysmennorrhea, is the pain and discomfort women may feel associated with menstruation.
• What causes it?
  Menstrual problems can have many causes, but most symptoms such as mild-moderate pain, bloating, mood changes are caused by hormonal imbalances. In particular late luteal oestrogen excess and mid-luteal progesterone deficiency have been linked to PMS. The cramps are probably caused by overactivity in the smooth muscle of the uterus, due to these hormonal changes.
• However, if there is extreme pain, menstruation is irregular (oligomenorrhea) / absent (amenorrhea) or there is bleeding between monthly menstruation (metrorrhagia), this could reflect an underlying problem such as polycystic ovary syndrome, endometriosis, fibroids or other pathologies so in these cases further advice from a GP should be sought.
• What are the symptoms?
  Premenstrual syndrome / tension symptoms include: depression, irritability, anxiety, crying, lack of energy, sleeplessness, faintness, fluid retention, acne, sore breasts and/or nausea. Period pain tends to feel like cramp-like pains 24-48 hours prior to menstruation, persisting for variable periods of time.
• What is the treatment?
  The classic analgesics such as paracetamol and ibuprofen will help menstrual pain. Ibuprofen may also work directly on the uterus to prevent spasms as well as reducing bleeding. Some remedies combine these classic analgesics with codeine for additional pain relief. The smooth muscle relaxant, hyoscine can also be found in some pain relief remedies specially developed for menstrual pain***.
• There is a great deal of debate around the appropriate treatment for PMS/PMT. However, diet seems to play a strong factor. Deficiency in vitamin B complex, vitamin B6, antioxidants-vitamin C or E, essential fatty acids, calcium and magnesium have all been linked to the condition. Lethargy experienced is likely to be caused by a deficiency in iron. Therefore, common treatments include supplements in these vitamins and minerals. Evening primrose oil or starflower oil, which contain gamma-linoleic acid, to address the hormonal imbalance are often used. To cope with the mood swing and depression some have found St. John's Wort useful.
• Self-help
  A balanced diet, avoiding refined carbohydrates or simple sugars, rich in whole-grains, nuts and pulses to avoid overburdening the adrenal gland is recommended.
  Stress can heighten PMS, physical exercise or meditation such as yoga can aid reducing stress levels.
  Heat provides an effective pain reliever so a warm hot bottle or a warm bath will soothe those cramps and pains
  Excess coffee can exacerbate the symptoms so is best avoided.

The 'Morning-After' Pill- Emergency Hormonal Contraception (EHC)

• Why do women need EHC?
  There are a range of reasons women may require emergency contraception, from having had sex without using a contraceptive to their usual method of contraception having failed - e.g. a burst condom, or missed pills. Nonetheless, emergency contraception is not a substitute for a regular method of long-term contraception and emergency contraception will not protect against sexually transmitted infection.
• What is EHC and how does it work?
  Commonly known as the 'morning-after pill', the only EHC available over-the-counter contains a progestogen called levonorgestrel, which is one of the hormones commonly found in the contraceptive pill. The first of the two pills must be taken within 3 days (72 hours) of having unprotected sex, and the second pill 12 hours after the first. Over-the-counter EHC will prevent 95% of expected pregnancies when taken within 24 hours.

Pregnancy

With pregnancy comes a whole host of everyday healthcare problems such as morning sickness, backache, congestion, as well as the coughs and colds we all suffer. However, pregnant women commonly complain that they don't know what they can and can not take for relief. There are a number of over-the-counter (OTC) and nutritional remedies considered safe and beneficial that can be taken pregnancy.

• Coughs, Colds & Congestion
  For dry coughs and sore throats, non-medicated pastilles containing honey/glycerol or a simple linctus can be soothing. Steam inhalation can give relief from chesty coughs
  Inhalation of oil-based decongestants can be effective
• Headaches
  Paracetamol is considered safe in pregnancy and a simple massage can provide great relief!
• Morning Sickness
  For milder cases, eat small, frequent meals with high carbohydrates and low fat
  Ginger and peppermint teas are worth considering
  Barley sugar, boiled sweets or peppermints can be helpful when travelling
• Heartburn and indigestion
  Antacid preparations are licensed for over the counter use
  Calcium carbonate has the greatest neutralising capacity
  A combination of aluminium and magnesium salts are also useful
• Backache
  Paracetamol is considered safe
  Avoid standing or sitting in one position for too long
  Lying with legs raised can be helpful
  Support the pillow when sitting
  Wear flat shoes
• Constipation
  Increase the fluid intake and the amount of fibre your diet
  Bulk-forming laxatives such as ispaghula husc or lactulose can be tried
  One or two doses of senna, the stimulant laxative, can be tried. Although avoid Senna in the later stages of pregnancy because, theoretically, it could cause uterine contractions
• Haemorrhoids/Piles
  For mild cases, a bland haemorrhoidal cream or ointment can help
  An ice pack can provide much relief
  A topical bland astringent preparation may also be recommended
• Varicose Veins
  An increased intake of calcium and potassium is known to reduce the incidence of leg cramps
  Avoid high-heeled shoes. Massage and stretching the affected muscles during an attack can provide relief
• Finally, adequate intake of folic acid is essential in pregnancy, particularly during the formation of the neural tube. This can significantly reduce the chances of the baby having a neural tube defect.

It is recommended to take folic acid prior to conception and to continue taking folic acid supplements until the 12th week of pregnancy
In the UK, women who are planning or who may become pregnant are advised to take a supplement containing 400mcg folic acid every day

REMEMBER: If in doubt, women should seek advice from the pharmacist before taking any OTC medicines. Always read the label.