•     The causes of migraine are many. Some people are exceptionally sensitive to particular foods (typically cheese, citrus fruits, fried foods, chocolate, seafood or red wine). Others are sensitive to: stress; not enough or too much sleep; noise; certain smells; missed meals; excitement; bright and flickering lights; changes in daily routine; or the weather (especially thunderstorms and snowstorms). Migraines, and indeed all types of headache, are three times more common in women than in men. Perhaps a fall in oestrogen triggers an attack. Women taking the contraceptive pill often have headaches, and taking the Pill can make migraine worse.

•     Dehydration (too little fluid) is a common cause of headaches. Most people drink too little fluid and easily become dehydrated in hot surroundings or if they miss a drink or two.

•     Tension headaches are produced by anxiety and stress. They are often seen in people who are meticulous and fussy. Unlike with migraine the pain of tension headaches lasts all day. The sensation is described as being ‘like a weight pressing on the head’ or ‘a tight band around the head’. Sometimes the pain goes to the back of the head and down the neck. People who concentrate for long periods of time (such as lorry drivers) often get this kind of headache. A variation of this is the tense-jaw headache which is caused by the individual clenching the teeth.

•    Hangovers are a very common cause of headaches. They are the results of consuming too much alcohol, which overloads the body’s ability to detoxify the alcohol.

•     Foods cause headaches in certain susceptible people. Ice cream and very cold foods can cause pain in the head and throat. Cured meats often contain nitrates which make blood vessels around the skull wider and cause headaches. Monosodium glutamate (especially plentiful in Chinese food) causes a headache in some people-often accompanied by nausea, abdominal pains and dizziness.

•     Poor vision does not cause headaches but if you sit with your eyes screwed up, frowning to see better, you can easily get a tension headache.

•    Headaches are often a sign of an impending infectious illness or fever. A simple pain-killer usually tides the person over until the cause becomes obvious.

•     Head injuries are, undoubtedly, a cause of headaches but the cause is usually all too apparent and cannot readily be prevented (except for the obvious measures of driving carefully, and wearing seat-belts in cars and crash helmets on motorcycles).

•     Very high blood pressure can cause a severe, pounding headache which is worse in the morning and improves during the day. The pain improves with the head up and is worse when lying down.

•     Brain tumours certainly cause headaches and many people worry that they might have a tumour, especially if they have repeated headaches. However, brain tumours are very rare indeed. If your headache is worse on waking in the morning or if it is worsened by sneezing, bending down or exertion then you should see a doctor to discuss it. If you have double vision, vomiting, drowsiness or weakness in a limb and are not a migraine sufferer you should seek medical help at once.

*161/72/5*

Imagine you’re a telephone operator sitting in front of a huge console of blinking lights. Whenever a red light flashes, you’re supposed to plug a cord into a green socket. A blue light means to put the plug into a yellow socket. Orange light – purple socket. But what if you suddenly became color-blind? Imagine the chaos. Nothing gets connected No one can communicate with anyone else. Everything goes haywire.

In a sense, an eating-disordered person can be emotionally “color-blind.” When a bulimic feels angry-when the red light flashes-she plugs into the wrong socket. Instead of dealing directly with her anger, the signal gets diverted and triggers a binge. Similarly, an anorexic may fear intimacy, but her mind reroutes that feeling into a fear of fatness. The feelings are there, but the disorder causes them to short-circuit.

For years these people have denied or suppressed their feelings-”Angry? Me? Impossible.” Why does this happen? There are many reasons. Perhaps these people come from families that forbade emotional expression. They thus have no role models to follow when it comes to showing joy or pain. Or perhaps they were punished in some way for being emotional-”Don’t cry. Only babies cry. Go to your room.” They may think that a feeling such as anger, once it grabs hold, will hurl them out of control, and make them dangerous or bad.

Feelings become strangers, provoking strangely twisted responses. Recently I brought a seventeen-year-old bulimic and her parents into my office. I told them that she had to be hospitalized because, despite intense outpatient treatment, her severe bingeing and purging had put her in medical danger. “No!” she cried, throwing herself down, sobbing and pounding the floor with her fists. “I don’t want to go to the hospital! It’s not fair!” Despite her protests, the parents agreed to the plan and she was admitted. The next day, however, she was much calmer. She said, “To be honest, I’m kind of relieved you put me in here. I felt really terrible at home. Yesterday I thought that coming into the hospital meant leaving my mother to cope at home all by herself. I couldn’t let her know that I actually wanted to come into the hospital. She would think I was deserting her. I realize now that’s why I put on that little show in your office.”

Even a physical sensation such as hunger gets garbled in transmission. An anorexic says to herself, “Hungry? That’s not hunger, that’s, uh, nervous energy. I need to exercise more-exercise, yeah, that’s the ticket.” For a bulimic, the inner monologue might be: “Lonely? Nah. I’m just hungry, that’s what I am.”

*84/35/5*

Sharon Duke leaves nothing to chance.

The San Jose, California, resident meticulously plans out every detail of every day—from when and what she eats to where and how she exercises, from trips to the grocery store to trips out of town.

That may seem like a lot of work. But Sharon, 51, doesn’t want to leave anything to chance, especially in terms of maintaining a healthy weight.

What spurred this painstaking attention to detail? As her fiftieth birthday approached, Sharon noticed that her weight had crept up to 161 pounds—too much for her 5-foot-3 frame. She had been gaining a couple of pounds every year since her mid-forties. Because she ate healthfully and exercised regularly, she didn’t think that her lifestyle was to blame for the 35 extra pounds. Instead, she suspected that the combination of advancing age and menopause were stalling her metabolism.

Sharon decided that she’d have to be even more vigilant about her healthy lifestyle if she wanted to bring back her slim and shapely figure. “At the time, my health club was offering a 6-week nutrition-awareness class, so I signed up,” Sharon recalls. “I discovered that even though I was making good food choices, I was eating far too much. That’s what got me started on planning ahead.”

If she had a business lunch with colleagues, she found out in advance where they intended to eat and chose her meal beforehand. “I’d call the restaurant and ask if they offered a chef’s salad with grilled chicken, or a fruit salad,” she says. “If they didn’t have what I wanted, I’d eat before we went out, then just order a side salad at the restaurant.”

When her job required her to travel out of town, she called restaurants near where she was staying and inquire about their menus. “If I couldn’t find one with suitable menu items, I’d go to a grocery store and pick up some food to take back to my room,” she says.

Sharon applied her plan-ahead strategy to her exercise pro-•£ I gram, too. Before she traveled, she called the hotel to find out whether it had exercise equipment or if there was a gym nearby. If ^ \ not, during her hotel stay she got up early to take a 2-mile walk or she climbed stairs at the hotel.

Once she started mapping out her daily routine, Sharon lost the extra 35 pounds within 6 months. She has maintained her weight at 126 pounds since 1998.

WINNING ACTION

Prepare a daily plan. If you find yourself struggling to stick with your weight-loss program, Sharon’s strategy may work for you, too. You may even want to keep a daily planner, which you can buy in any office-supply store. Then each night, spend 15 minutes or so mapping out the next day. Include as much detail as you can, especially in terms of mealtimes ajid workout time. Of course, you can’t always anticipate what will happen every moment of every day. But a daily plan gives you a better chance of keeping your weight-loss efforts on track.

*138\89\8*

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*