Mens Health Blog. Medical Blog

Depending on what newspapers and magazines you read, you might have seen headlines like those above. Certain parts of the press seem obsessed with the idea that taking HRT is about nothing more than having the looks and sexuality of a TV star. Every year, dozens of interviews are conducted with television and screen personalities who are now in their fifties and sixties ‘and look twenty years younger’.

In some ways, this can be a thoroughly good thing. For too many centuries, the older woman has been neglected, and treated as almost invisible. As far as The Real World is concerned, she just doesn’t exist. Newspapers and magazines seldom feature older women in their own right; if they are mentioned at all it is usually as the wife or mother of a man who is making the news. Books end when the beautiful heroine marries the hero; sometimes the story extends to the years of bringing up children, but how many novels can you think of in which the principal character is a woman of 50 or 60? It has been said that ‘Sensitive treatment of the ageing woman … is not a dominant theme in Anglo-American literature.’ Too true! Once you are past child-bearing years it is almost as if you move, in one swift step, to being an unimportant old crone.

Now all this is changing, and HRT can take some of the credit. Suddenly many older women look and feel younger. They don’t mind giving their age, because it provokes the response, ‘Goodness, are you really? You don’t look a day over 45,’ and that makes them feel good. Well, it would, wouldn’t it? Being more energetic, more confident and still looking youngish, they are visible once more, and that has got to be a good thing. Good for the individual woman and her own self-esteem, and good for womankind in general.

However, this book will not be plugging hormone replacement as an elixir for eternal youth. You will not read in these pages that you, too, can be a sex-kitten forever. If your husband is glancing sideways at younger women, your elderly parents are driving you mad, and your daughter looks how you would like to look, HRT will not magically put your world to rights. It may help mend a breaking marriage, or increase your sex drive, or make you feel 10 years younger, or it may not do any of these things. But it will make you feel better able to cope with what the world is throwing at you, and give you a better feeling about yourself.

One of the problems of the ‘sex kitten’ image is that it actually puts many women off taking HRT. Or they become reluctant to tell their friends they are on it in case they get comments like, ‘Oh, is your husband going off with someone else?’, as if the only reason a woman takes HRT is to keep her husband in her bed. And many doctors wonder if a woman is enquiring about taking it just so that she can remain ‘youthful’. Yes, there are reasons why it can help you maintain a satisfying sex life for many years but, as you will have read so far, it has many other advantages, too, and to concentrate on the Eternal Youth image is to trivialise HRT and to diminish women.

‘After I am waxed old shall I have pleasure, my lord being old also?’ Sarah (wife of Abraham) in Genesis 18:12.

“I finally plucked up courage to see my doctor. He seemed surprised that a woman of my age (I’m 53 and happily married) should be reluctant to stop having sexual intercourse. He made me feel a freak, the female equivalent of a Dirty Old Man”.

The menopause is thought of by many (especially by men and by younger women) as ‘the beginning of the end’, a time of decline and degeneration, especially sexually. But it needn’t be like that. The end of fertility doesn’t mean the end of sexuality, let alone the end of femininity. With 30 years or so left, that’s just as well! The woman reaching the menopause now is unlikely to view this time as the end of her sexual years, and nor should her doctor, nor society in general. If she has sexual difficulties, they should not be pushed aside.

Many men and women are reluctant to talk to their GPs about sexual problems, as he is quite likely to dismiss it as an unimportant matter in older people. The average young doctor might be quite surprised that a couple in their sixties should still be having an enjoyable sex life, and wanting to continue for many more years. Even couples in their fifties are often considered ‘over the hill as far as all that sort of thing is concerned’.

As you have read at various points in this book, one of the symptoms of the menopause is vaginal dryness. Reduced levels of oestrogen diminish the sexual response and cause the cervix to secrete less mucus, so the vagina becomes dry, intercourse is more painful, and you get less pleasure from it.

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Information about recovery after hysterectomy is sometimes neglected in discussions between women and their doctors. Compared with the decision to have the operation and the demands of surgery, recovery may seem straightforward. Often, however, this does not prove to be the case.

The process of recovery from hysterectomy is extremely variable as illustrated by the experiences of Rosa and Denise, neither of whom had any postoperative complications. The day after her hysterectomy Rosa helped make beds in the hospital ward and, five days later, she was ready to leave. Within a few days she was doing all the housework and three weeks after surgery she was swimming and cycling. In contrast Denise was unable to leave her bed for fourteen days after her hysterectomy. She convalesced slowly at home and finally returned to work thirteen weeks after surgery. The variation in the physical recovery of Rosa and Denise demonstrates why it is difficult for a surgeon to provide a fixed schedule for post-operative recovery.

To do so might put the brakes on the recovery of some women and unduly tax the capabilities of others.

Women recover from hysterectomy at different rates for many reasons. These include the nature and severity of the problem for which the operation was carried out, the type of operation performed and the extent to which it interfered with various organs of the body, the skill of the surgeon, the general physical and psychological health of the woman pre-operatively and the effect of anaesthetic agents on her.

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Every morning when we wake up and open our eyes we see the sun shining through the window. The light/dark cycle appears to be very important in the resetting of our circadian rhythm. When we open our eyes in the morning, the light stimulates the light-sensitive part of our eyes, the retina. The retinae from both eyes convey the light message along the optic nerves to a central point called the optic chiasma, which is in the middle of the brain stem adjacent to the hypothalamus. Half of this light message crosses the optic chiasma and is relayed to the rear part of the cerebral cortex. Scientists now believe that part of the light message is also relayed to a group of nerve cells in the hypothalamus adjacent to the optic chiasma. This area is called the suprachiasmatic nucleus (SCN) in the hypothalamus and is the site of master control of the circadian rhythm. In animals destruction of the SCN abolishes the circadian rhythm.

It is thought that the SCN possesses an endogenous oscillating mechanism which in free running conditions in man is 25 hours. The SCN is the master oscillator, and it is believed that there are other suboscillators which control hormone rhythm, body temperature rhythm, etc. Hence in cases of jet lag or shift work, the phase maps of the different suboscillators are thrown out of phase with each other. By resetting the master oscillator, the SCN, the circadian rhythm, and the suboscillators are put back into place.

Chronobiologists have recently studied the SCN in detail, both in animals and in man. They have found that if a strong light message is received in the SCN at an hour different to normal sunrise, the SCN is reset into a new circadian rhythm after a few days. Chronobiologists call the light signal the Zeitgeber, synchronizer, or time giver, and the resetting process the entrainment.

The Zeitgeber for crabs that are flown from one coast to the other in the USA is the light/dark cycle of the new location. The Zeitgeber for Dr Charles Czeisler to entrain his jet lag patient to a new circadian rhythm is artificial bright light Dr Thomas Wehr of the National Institute of Mental Health in the USA has been using light treatment and sleep deprivation to treat certain kinds of depressive illness. It is believed that, by adjusting the master oscillator, its suboscillator that modulates mood and depression will also be adjusted and lead to recovery from the depressive illness.

At present, in Australia and New Zealand, a great deal of research is being conducted on the chemistry of the biological clock. Melatonin, a chemical secreted from the pineal gland situated at the base of the brain, has been shown to be closely related to the circadian rhythm. During the night, the SCN relays impulses to the pineal gland and melatonin is secreted into the blood. In the day, sunlight has an inhibitory effect on the SCN, and this stops the pineal gland from releasing melatonin. The concentration of melatonin in the blood hence becomes a good marker of the circadian rhythm.

Melatonin comes from the word melanin, which means skin pigment. In some lower animals, skin colour changes according to the amount of sunlight. At night, there is more melatonin and this contracts the melanophores of the skin, making the skin pale in colour, whereas in the day, with plenty of sunlight, the skin becomes darker. This skin colour change is controlled by the light/dark – , of the circadian rhythm through melatonin.

However, in man, the exact role of melatonin is stillunknown. It has been suggested that there is a melatonin stimulates the SCN to secrete even more melatonin and a rise in melatonin concentration speeds up the resetting of the biological clock. A group of volunteers were asked to travel from New Zealand to London and back, and were given melatonin capsules to take for a few nights on arrival at their new destination. It appears that this increase in the concentration of melatonin at night speeded up the resetting of their biological clock to the new local time. They felt more alert in the day and their sleep pattern was reset much sooner than if they had not taken melatonin capsules. A new company, called Circadian Technologies, has recently been set up in Melbourne. It plans to produce melatonin capsules on a commercial scale. Of course, this has yet to be approved by the Food and Drug Administration in the USA. Perhaps, one day, overseas travellers will regularly be taking melatonin capsules to minimise their jet lag. Or there may be coin-operated bright light machines available at all major airports to entrain the travellers’ biological clock to the new local time.

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