This is partly explained by differences in their efficiency at absorbing and metabolising the hormones used in HRT. The slower these processes are, the longer the hormones have to cause adverse effects. Individual differences in responses to oral HRT may also be due to medical conditions — gastric problems, chronic diarrhoea, vomiting or pernicious anaemia, for example – or to interactions with other medications like antibiotics and anti-epileptic drugs.

Your body build also affects the dosage required. Menopausal women who are overweight or have considerable muscular development may need less oestrogen than slim women, because they are producing considerable amounts of oestrogen in fat and muscle tissue, in addition to receiving a small but steady supply of oestrogen from their ovaries.

*117\38\8*

Occasionally menopausal women who use oestrogen develop a skin disorder called chloasma when exposed to the sun. The development of patches of darker skin on the face, legs and hands is similar to the skin reaction that sometimes occurs during pregnancy. The cause of the problem is uncertain, but deposits of melanin in the skin are involved. The discoloration usually becomes less noticeable when oestrogen therapy ceases, but it may become more noticeable on exposure to the sun, even after stopping HRT. Wearing a hat and applying a maximum-protection sunscreen should become part of your outdoor routine. Your doctor may have some suggestions about the most appropriate sunscreen in your particular case, and forms of treatment that may remove the discoloration.

Skin irritation or rash can occur when hormone patches are used and, less commonly, women report a more generalised allergic response. As we saw in the case of Margaret in chapter I, this can be severe enough to cause the abandonment of patch therapy. The problem appears to be worse in hot climates, and the reported incidence varies from 5 to 40 per cent in user groups worldwide. Occasionally there is also a severe local allergic response to the patch adhesive.

*83\38\8*

The relationship between psychological symptoms and the menopause is evidently far from straightforward. A complex interplay of factors affects psychological functioning – among them personality, hormone changes, alterations in social and family stresses, the presence or absence of physical illnesses, and perhaps also feelings of loss and grief at entering the final third of life and realising the inevitability of death. To make the situation even less clear, there will always be a small group of women with severe psychiatric illnesses, who just happen to be menopausal at the time their illness comes to prominence.

Additionally, psychological symptoms blamed on menopause are inclined to show placebo responses: as we explained earlier, the symptoms may be relieved almost as well by a dud pill as by a prescribed product, arguably because part of the ‘healing therapy’ is the extra support and interest the patient is receiving.

The medical literature is probably best summarised by stating that whereas there is little evidence for an association between menopause and fully developed psychiatric disease, such as clinical depression, less severe psychological upsets seem to affect some women as they approach menopause or soon afterwards. HRT seems to relieve this state of affairs and to heighten a woman’s sense of wellbeing. Thus many women on HRT experience improvements in their psychological functioning, (concentration improves, confidence is restored, decision-making seems easier) and regain a spring in their step.

*48\38\8*

The menopause is a time of transition, a nudge that sets us thinking about what is behind us and what we want from the years ahead. Both the internal changes of our bodies and their interaction with other factors in our lives seem to influence the symptoms of menopause that we experience.

HORMONE LEVELS There is no doubt that problems such as hot flushes and vaginal dryness are associated with the sex hormone changes of the menopause. Hot flushes have been linked with rising levels in a brain hormone called luteinising hormone and falling levels in the most powerful form of oestrogen, oestradiol. The changed balance of hormones also helps to explain symptoms of vaginal dryness and urinary frequency. Hormones are not the only controller of symptoms, however.

ANXIETY Sudden bouts of anxiety seem to be linked with hot flushes in some women. The more anxious you feel the more likely you are to have hot flushes.

SEXUAL ACTIVITY Even though vaginal dryness and painful intercourse are often blamed for reduced sexual activity and arousal in women after menopause, it is not clear which is the cause and which the effect. Research suggests that women who don’t often have sex tend to have more problems with vaginal dryness than those who have it frequently. In addition, the more often a menopausal woman is sexually aroused and active, the more easily natural vaginal lubrication is achieved, and the more comfortable and enjoyable sex tends to be.

The use of vaginal lubricants and ‘male dew’, or hormone therapy, may break the cycle of discomfort that is sometimes associated with sexual activity, and result in the release of natural lubricants. This is not to suggest that arousal is merely a physical matter; psychological influences to do with mood, touch, words and images are also important. Libido is not merely a matter of hormones. What is in your head and heart will also affect your interest in sex, and such things are not dependent on HRT. Interestingly, sex may have an influence beyond stimulation in preventing genital dryness as, according to research conducted by family planning authority Professor Egon Diczfalusy from the Karolinska Institute in Sweden, semen itself- absorbed through the vaginal walls — is a rich source of oestrogen.

STRESS Extreme demands on physical and mental energy, loosely termed stress, increase the tendency to flush. Hot and stuffy rooms, excessive amounts of alcohol and caffeine, a poor diet, sleep deprivation and thyroid disorders are common stress-related triggers of hot flushes.

*14\38\8*

Irritable bowel syndrome or IBS (also called ‘irritable colon’ or ‘spastic colon’) is a diagnosis that means different things to different doctors. However, it usually denotes abnormal bowel function – either constipation or diarrhoea – without any sign of infection, or other physical cause (eg bowel cancer), and without any structural damage to the wall of the bowel. Within this group there is plenty of scope for variation – some patients suffer diarrhoea most of the time, others are usually constipated, while in others these symptoms alternate. Most patients suffer pain that is relieved by defecation, but not all do. In effect, IBS is little more than an umbrella term for various minor bowel disturbances of unknown origin. In some cases, there may be a more serious underlying problem, or a very simple problem that is easily cured.

Since there is no damage to the gut in IBS, there is no blood in the stools. Neither is there any weight loss or night-time diarrhoea – either of these symptoms indicate more serious conditions such as Crohn’s disease or ulcerative colitis. IBS is a fairly minor problem in the sense that it does not affect general health, does not usually get any worse as the years go by, and does not predispose the sufferer to any other illnesses.

*144\180\8*

The best medicines, money and possessions cannot take the place of sleep. When travelling it may overcome us on a train or plane, to the homeless it may come as a relief in open fields, and at night it gathers the more fortunate ones among us into its soothing arms on soft pillows. It is always necessary when it comes, and we should not drive it away; otherwise it may one day take revenge by avoiding us.

Do we really know what sleep means to our senses? Do we show understanding for its necessity? Have we ever stopped to think how it recharges our batteries by letting us rest and relax? While we are asleep we forget everything. When a day has been full of heavy burdens we can bring it to an end by means of merciful sleep. For the nerves, brain, muscles and blood vessels it is an important break. While we sleep, millions of our body cells can rest and renew themselves. In its wonderful effects sleep remains a mystery, a phenomenon of nature, in spite of all that has been written about it.

Since it is said that every cell is subject to a rhythm of tension and repose, it is astonishing to hear that millions of heart cells, from before our birth to the last moment of our life, never stop working. It is strange that not all cells have been given the same potential. While some require the regular rhythm of rest, others are capable of working throughout life with untiring pliability, without ever resting. What miracle makes this possible is known only to the One who put the building blocks of life together and imparted the life force to them in the first place.

*1220/28/1*

Many years ago I had an experience when, quite by chance, I applied the same breathing method. My lungs were damaged in a car accident and the resulting problem could have posed great difficulties for me.

I decided to go to the mountains for the sake of pure air, adopted a natural diet and was making satisfactory progress. The ‘finishing touches’, however, were provided by regular deep-breathing exercises. I concentrated on thorough exhalation, followed by equally thorough inhalation. I began these exercises in front of an open window in fairly cold weather. In time, my condition became so good that I was able to do the breathing exercises in a temperature of —10 °C (14 °F), in front of the open balcony door, with the curtains drawn and without clothes, for fifteen minutes. In spite of the cold, the strenuous exercise made me perspire.

At the same time I combined the breathing exercises with a relaxation exercise. While standing on a carpet, I tightened and loosened my muscles again and again, tightening when I inhaled and loosening when I exhaled. I then took a short rest before starting the exercise again. The air seemed to flow through my body like a warm, pleasant stream. If I had been breathing through my mouth, I would have undoubtedly caught a chill, with the possibility of pneumonia developing. Thus I became aware of the importance of breathing through the nose and could appreciate why this is recommended in all health books.

*1151/28/1*

In comparison with regular coffee, which I normally take with milk or cream and without sugar, the Arabic coffee did not cause me any trouble and seemed less stimulating. The unfavourable side effects of the coffee somehow appear to be eliminated by the Arabian method of preparation. After many observations and experiments I found that the grounds contain certain materials that, to a certain extent, neutralise the soluble substances in coffee, including caffeine, weakening its stimulating properties.

If you like the pleasant taste and aroma of coffee, why not try the Arabian method and take only a small cup, together with the grounds. However, you should only indulge if your nervous system

is in good working order; sensitive or nervous people should leave coffee alone.

*1082/28/1*

Infants and children, patients with a feverish condition, and seriously ill adults suffering from metabolic disorders should use only grape sugar, rather than white sugar, to sweeten their drinks. It oxidises in the system without any waste and does not impose any additional burden on the body. Unlike white sugar, grape sugar is not a calcium robber. It should be part of the diet of every convalescent and those with weak hearts or frayed nerves because of its soothing quality. Sleeping drops, lemon balm herb tea or heart tonic sweetened with grape sugar in a little water and taken at night encourage restful sleep. Grape sugar has only one drawback: it is relatively expensive. But this is not at all astonishing in view of the cost of grapes nowadays.

*1012/28/1*

As a change from fruit, a meal of sandwiches and salad can be very enjoyable. If you wish to drink something with it, have some cereal and fruit coffee (Bambu Coffee Substitute) with a little cream or milk. Liver patients should have a glass of carrot juice instead. For variety’s sake you might have a good vegetable soup.

So there are many variations possible; all you need is a little imagination and natural good taste. If you like, fresh tomatoes can be put on the table as well. A juicy tomato is always refreshing and will enrich the meal with its vitamins. Arthritis patients, however, should take great care to eat only the fully ripe ones.

*941/28/1*