Menopause is defined as not having periods for at least 12 months due to declining hormone levels. It usually affects women between the ages of 45 and 55, and the average age of menopause in UK is 51 years. Some women can have menopause earlier than 45 years of age.
Menopause usually occurs naturally with increasing age. It can also be caused by various other reasons such as surgery to remove ovaries and uterus, chemotherapy, or genetic disorder.
Perimenopause is when there are symptoms of menopause but the periods have not stopped. Perimenopause ends and menopause starts when there has not been a period for 12 months.
The periods usually become irregular initially before they stop altogether. Sometimes the symptoms of menopause can start years before the actual menopause occurs and can continue afterwards for some time.
The common symptoms of menopause are irregular periods, hot flushes, sweating, mood swings, anxiety, brain fog or problems with memory and concentration.
The other symptoms include sleep difficulties, palpitations, headache, muscle and joint pains, weight gain, dry and itchy skin, reduced sex drive, vaginal dryness, pain or itching during sex, recurrent urine infections, sensitive teeth and painful gums.
Regular contraception such as the pill, hormonal coil, contraceptive implant or injection can make it difficult to know with certainty if menopause has been reached as these can affect the periods.
The combined pill can also mask or control the symptoms of menopause, particularly hot flushes and night sweats.
Contraception can be stopped at the age of 55 as natural pregnancy is not common after this age. The combined pill should be stopped at the age of 50 and it is best to switch to mini pill (progestogen-only pill) or other methods of contraception. This is to prevent various issues associated with the combined pill.
The main treatment for menopause is HRT (hormone replacement therapy) to replace the hormones that are low during menopause. This is a safe and effective treatment for most people.
HRT usually contains oestrogen, and this can come in different forms such as tablets, implants, skin patches, and gel or spray to put on the skin.
If the uterus is still present, progesterone will be required as well as oestrogen, and this is called combined HRT. Progesterone is available as patches in combination with oestrogen, IUS coil, and tablets.
HRT can help with symptoms of both menopause and perimenopause including hot flushes, brain fog, joint pains, mood swings and vaginal dryness. It can take weeks to months to see improvement in menopausal symptoms.
Testosterone can be offered for low sex drive if HRT doesn’t work. Vaginal oestrogen remedies can help with vaginal dryness. These can be used for life as they do not enter the bloodstream to cause complications. Vaginal oestrogen can be used with HRT.
There are several over the counter vaginal treatments that can be tried without a prescription from a doctor.
If HRT is not an option or tolerated, there are various other treatments that can be used to treat the symptoms of menopause. Medications such as clonidine and gabapentin can help with severe menopausal symptoms such as hot flushes and night sweats.
Antidepressants could help with depression, anxiety and mood swings. CBT (cognitive behavioural therapy) can help with low mood, anxiety, sleep problems, hot flushes and joint pain. It is also recommended to get plenty of rest, exercise regularly and do relaxing activities to help with these symptoms.
To help with hot flushes, it is advised to wear light clothing, to keep the bedroom cool at night, to take cool showers, to reduce stress, and to exercise regularly.
Regular exercise, healthy eating, vitamin D supplements, and avoiding smoking and excess alcohol can help prevent weak bones or osteoporosis that can occur with menopause.
Complementary or herbal remedies are not usually recommended as it is not clear how safe and effective they are.
However, some women find evening primrose oil, vitamin E supplements, black cohosh, and red clover helpful. Getting plenty of rest and sleep, eating healthily, having calcium-rich foods like milk and yoghurt, doing regular exercise, trying yoga and meditation, avoiding smoking and excess alcohol can be beneficial as well.
The medical term for heavy periods is menorrhagia. A lot of women suffer from menorrhagia and this could be normal for them if heavy periods do not affect their daily lives.
Heavy period can be defined as having the need to change a pad or tampon every 1 to 2 hours, to require 2 types of period products together, to have periods lasting more than 7 days, to pass blood clots larger than 2.5 cm, to bleed through the clothes or bedding, to avoid daily activities due to bleeding, and to develop symptoms such as fatigue or breathlessness.
Periods can be particularly heavy when they first start to happen, after pregnancy and during menopause.
The other causes of menorrhagia are fibroids, endometriosis, adenomyosis, polycystic ovary syndrome or PCOS, pelvic inflammatory disease, blood disorders such as Von Willebrand disease, certain medications such as chemotherapy and anticoagulants or blood thinners, and rarely uterine cancer.
It should be noted that smoking and alcohol can increase the blood loss.
Heavy periods do not require treatment if there are no other symptoms or negative impact on daily activities. If treatment is required, the available options are combined contraceptive pill, IUS coil, tranexamic acid, anti-inflammatory medications such as mefenamic acid and naproxen.
If these treatments do not work, the next step is to see a gynaecologist. This specialist doctor can arrange further tests to determine the underlying cause of menorrhagia.
Depending on the underlying cause, a specialised treatment may be required such as endometrial ablation where the lining of the uterus is removed, fibroid removal surgery, and total or partial removal of the uterus.
If there are heavy periods and these are having a negative effect on the daily activities, it is advised to see a doctor in person for further assessment.
Milia are very mall, white or yellowish bumps that appear on the skin. They form when a protein in the skin called keratin becomes trapped under the surface of the skin.
They can occur anywhere on the skin, but they are more common on the face, especially around the eyes and eyelids, forehead, cheeks, nose and chest.
Milia are very common in newborn babies but they can occur in people of any age.
Milia are benign and harmless and typically resolve on their own without requiring any treatment. In some people, they may take longer to clear and persistent cases may require treatment.
There are different types of milia.
Neonatal milia are seen in newborn babies and they are very common. They usually occur around the nose area but can develop in other parts of the face such as the scalp, cheeks and upper body.
Since they are very common in babies they are considered normal and often called milk spots. They are not related to milk and thought to arise from sweat glands that are not fully developed. They usually go away by 12 weeks of age.
Primary milia is another type that can occur in both children and adults. These are harmless and usually resolve on their own.
Secondary milia occur on an area of skin that has previously been damaged or injured. The exact cause of this is not fully understood and it is thought to be related to damage to the sweat glands during the healing process.
Milia en plaque type is extremely rare and develops on an inflamed patch of skin called a plaque. These usually affect middle-aged women. The exact underlying cause of this type is not fully known.
Multiple eruptive milia is another very rare type that appears in crops over a period of weeks or months. This type usually affects the face, the upper arms and the upper trunk.
Milia do not normally cause any symptoms and do not require treatment. However, they can be removed for cosmetic reasons.
Gentle exfoliation with a skin product containing glycolic or salicylic acid can help remove the milia. Retinoid creams like tretinoin can help promote skin cell turnover and these can be beneficial.
A more specialised treatment option is cryotherapy which uses liquid nitrogen to freeze milia.
Laser therapy, chemical peeling, and dermabrasion are other methods that can be considered.
Primary milia cannot be prevented, but the risk of developing secondary milia can be reduced by avoiding excessive sun exposure and prolonged use of steroid creams, and by regular skin exfoliation and cleansing.
It is not recommended pick or squeeze milia as this can lead to scarring or infection.
A skin mole is also known as a naevus. A mole is a normal skin growth that develops when pigment-producing cells in the skin called melanocytes grow in groups. This causes moles to appear as small, coloured marks or spots on the skin.
Most people develop moles over time, and they are usually benign and harmless unless they change size, shape and colour.
Most benign moles have clear borders and are round or oval-shaped with a smooth edge.
Moles on the skin can be flat or raised and can feel smooth or rough. Some moles can have hair growing from them. It should be noted that moles are usually darker on brown or black skin.
Moles can appear at any age, and this does not mean they are dangerous or cancerous. Some babies are born with moles and this is normal. It is also normal to develop new moles, for moles to fade or disappear with increasing age, and for moles to get slightly darker during pregnancy.
Sometimes a mole can be due to a type of skin cancer called melanoma. Melanoma is more common in older people, but younger people can also get it.
This type of mole may change colour over time or have more than 2 colours. The moles that are due to cancer usually have uneven edges or borders, and they may bleed, itch or be crusty or raised.
The general rule is that if a mole has been present for a long time and it has not changed in any way, this is likely to be benign.
However, if a mole has been present for a long time and it has changed in size, colour or shape, it is advisable to see a doctor or dermatologist in person for further assessment.
It is also recommended to see a doctor if the mole becomes painful, itchy, inflamed, crusty or starts bleeding. A new or unusual spot or mark on the skin that does not disappear after a few weeks should be checked.
Although skin cancer is rare, it is important to catch it as early as possible so that it can be treated promptly. Catching skin cancer early before it spreads can greatly increase the chances of full recovery.
Benign moles do not require any treatment. However, they can be removed for cosmetic reasons.
Suspicious looking moles or melanomas usually require surgery to remove them. A sample from the removed mole or biopsy is analysed to confirm the diagnosis.
Ultraviolet or UV light is the most common cause for developing melanoma. UV light comes from the sun and is used in sunbeds. This type of light can increase the chance of a mole becoming cancerous.
It is highly recommended to avoid excess sun exposure and to use sunscreen when out in the sun, particularly if there are lots of moles present on the skin.
It is advisable to avoid the sun and stay in the shade between 11am and 3pm, when sunlight is strongest, to cover the skin with clothes and wear a hat and sunglasses, and to regularly apply a high-factor sunscreen when in the sun and after swimming.
If there are lots of moles on the skin, it is best to avoid sunbeds or sunlamps as they use UV light.
It is also recommended to check the moles regularly for any changes. And if any changes are noticed, a doctor or dermatologist’s assessment is required.
Molluscum contagiosum is a benign skin infection that causes spots on the skin. Although it can occur in any age group it is more common in children.
Molluscum contagiosum may only cause a rash on the skin without any other symptoms. It is caused by a virus called pox virus.
Molluscum lesions are flesh coloured, dome shaped papules with central dimpling. These can measure anywhere from 1 mm to 1 cm. They can occur in crops of up to 20 spots.
The spots of molluscum contagiosum can be found anywhere on the body, although they are rare on the palms and on mucous membranes.
These spots are usually harmless and should not cause any associated health issues.
Any individual lesion may last a couple of months, but it can take up to 18 months for complete clearance of the lesions without needing treatment.
Occasionally, there could just be one lesion, but multiple lesions are more usual. Eczema sufferers can have hundreds of mollusca or lesions, due to problems with normal barrier of the skin.
Once the lesions have cleared, they do not usually come back.
Molluscum contagiosum is contagious and it can be passed on by direct skin to skin contact. However, there is no need to stop normal daily activities.
If there is dry and itchy skin with the spots, using an unperfumed moisturiser, having cool baths, and holding a damp towel against the skin could help. For adults, using a condom during sexual intercourse can prevent the spread to a partner.
It is best to not share baths, bedding, towels and clothes. The spots or lesions should not be scratched or squeezed as this can lead to secondary infection.
For symptomatic spots, Molludab 5% potassium hydroxide is available over the counter. It can be applied to each individual lesion or all over the affected area with a cotton bud or with the applicator.
Steroid cream for itchy and irritated skin, and a course of antibiotics for infected spots can be considered if needed.
Cryotherapy or freezing with liquid nitrogen and surgical excision are other options for more resistant cases.
If there is uncertainty about the diagnosis of a rash or if there are lesions close to the eyes, it is advisable to see a doctor in person.
Mouth ulcers are common, and they are not usually due to any serious underlying cause. They go away on their own within 1 to two weeks without needing any treatment.
They typically appear inside the mouth on the cheeks or lips and on the tongue. People can have one or more ulcers at a time.
Mouth ulcers are not contagious and so they cannot be spread to others.
These ulcers can appear without any obvious cause. However, there are certain avoidable things that can lead to the formation of an ulcer in the mouth. Biting the inside of the cheek, cuts or burns while eating or drinking, dental braces, rough fillings, sharp teeth or badly fitting dentures can cause mouth ulcers.
Tiredness, stress, anxiety, an allergy or food intolerance, damage to gums with a toothbrush or irritating toothpaste can also lead to mouth ulcers.
A vitamin deficiency such as iron, zinc, folic acid, vitamin B or vitamin D may be associated with mouth ulcer formation.
There are rarer triggers of mouth ulcers, and these include hormonal changes such as in pregnancy, genetic predisposition or positive family history, certain medications like non-steroidal anti-inflammatories or beta blockers.
There is not a quick solution to clear mouth ulcers as they need time to heal.
Avoiding any triggers or aggravating factors can help speed up the healing process, reduce pain and the chance of them returning.
It is recommended to use a soft-bristled toothbrush to prevent irritating the ulcers and causing bleeding.
Eating softer foods and drinking cool drinks through a straw can also help. It is advisable to eat a healthy, balanced diet as sometimes vitamin deficiencies may lead to mouth ulcers.
Eating very spicy, salty or acidic and rough, crunchy foods should be avoided as well as hot and acidic drinks.
Sodium lauryl sulphate containing toothpastes should not be used as this can irritate mouth ulcers.
There are various remedies that can be tried to speed up healing, prevent infection and reduce pain. Antimicrobial mouthwash such as chlorhexidine or a salt water gargle can help prevent infection. Corticosteroid lozenges may speed up the healing process. A painkilling tablet, mouthwash, gel or spray can reduce the pain and irritation from the ulcers.
Some examples of these include Bonjela, Benzocaine gel, Orajel or Dynexan.
It is advised to see a doctor or dentist if a mouth ulcer lasts longer than 3 weeks, there is an unusual ulcer, or if there are signs of infection such as bleeding, discharge and more redness.
Having ulcers anywhere else on the skin or genitals, and having painful, red or swollen joints also requires further assessment by a doctor.
A doctor or dentist may prescribe stronger medicines such as steroids, antibacterial mouthwash, painkillers or oral antibiotics to treat more severe, persistent or infected mouth ulcers.
Sometimes having several mouth ulcers and other symptoms may be associated with rare medical conditions such as lichen planus, hand, foot and mouth disease, coeliac disease, Crohn’s disease, lupus, weakened immune system, or mouth cancer.
This would require further assessment by a doctor in person and various tests.
Neck pain is a common complaint and it is usually not due to anything serious if there is no history of neck injury or other symptoms with it. Neck pain can last a few days to a few weeks before it goes away.
The most common causes of neck pain are awkward position while sleeping, muscle strain from bad posture or overuse, stress or tension in neck muscles, arthritis, herniated or slipped disc, pinched nerve, and whiplash injuries.
Neck pain can be improved with a few simple measures. If the underlying cause is bad posture or stress on neck muscles, these should be addressed first. A heat pack can help with muscle tension, and cold pack with pain and swelling.
It is advisable to use a low, firm pillow while sleeping, and to do gentle stretching and strengthening neck exercises to help with the pain.
If the pain is more severe or these measures do not work, painkillers like paracetamol or ibuprofen can be considered. It should be noted that ibuprofen is not recommended if there is history of asthma or stomach problems.
It is not recommended to wear a neck collar or keep the neck completely immobile. Any activities that may be dangerous or aggravating should be avoided, such as driving and cycling.
To prevent future neck problems, it is important to ensure that the head is the same height as the rest of the body when sleeping, and to have a firm mattress.
Keeping the neck in the same position for a long time and sleeping on the front should be avoided as these can cause or worsen neck pain.
It is advisable to see a doctor for further assessment if the neck pain does not settle down after a few weeks, if painkillers do not work, or if there are other associated symptoms such as swelling of the neck, numbness, or pins and needles in the arm.
Physiotherapy, stronger painkillers, muscle relaxants, or injections for more severe cases can be considered if conventional treatments do not work.
Oral thrush is usually not due to anything serious. It is common in babies and older people.
It is an infection caused by a fungus called Candida. This can grow more than usual due to various reasons leading to oral thrush. Taking antibiotics over a long time, using asthma inhalers, low immunity, and chemotherapy can increase the risk of getting oral thrush.
In adults, oral thrush presents with redness and white patches inside the mouth. There can be a white coating of the tongue and roof of the mouth. Wiping off the white patches leaves red spots that can bleed.
The other symptoms that can happen with oral thrush include loss of sensation of taste, unpleasant taste in the mouth, sore tongue and gums, and cracks at the corners of the mouth.
It should be noted that oral thrush in adults is not contagious, so it cannot be spread to others.
In babies, oral thrush causes a white coating of the tongue that may look like cottage cheese. This cannot be rubbed off easily. Sometimes it can present with white spots in the mouth.
Babies with oral thrush can have signs of discomfort or pain in their mouth and reduced feeding. They can pass oral thrush on through breastfeeding which can cause nipple thrush in mothers.
Oral thrush is normally treated with an antifungal mouth suspension like Nystatin or mouth gel called Miconazole.
Oral thrush can be prevented with a few simple measures. Good mouth and dental hygiene is important and it is recommended to brush the teeth twice a day. Dentures should be cleaned properly.
It is advisable to rinse the mouth after eating and taking medicine. For babies, it is important to sterilise the dummies regularly and bottles after each use.
Regular check-ups are important and should not be missed if there is a history of long-term conditions like diabetes.
Smoking should be avoided as it can aggravate the infection.
A white tongue that does not look like oral thrush could be related to anaemia, scarlet fever, lichen planus, or mouth ulcers. This would require further assessment by a doctor.
Geographic tongue is a benign condition where patches on the tongue lose their outer layer of tissue, creating smooth, red areas with white or light-coloured borders. These patches can change location, size, and shape over time, giving the tongue a map-like appearance.
Geographic tongue is usually harmless and asymptomatic but may cause sensitivity to certain foods or irritation. The exact cause of it is unknown, but it is associated with factors like genetics, stress, or other conditions such as psoriasis.