Family history of breast cancer: Should I take HRT? This factsheet is for you if you have a family history of breast cancer and are wondering whether HRT poses any particular risks for you. If you would like to know more about your personal risk of inheriting breast cancer because you have a family history, speak to your doctor/GP/Clinician What is HRT? HRT stands for Hormone Replacement Therapy and this is the umbrella term for hormonal treatments that work to relieve symptoms of the perimenopause and menopause. HRT replaces the ‘missing’ hormones that decline in the years around the time of the menopause. Low levels of hormones can cause symptoms such as hot flushes, night sweats, anxiety, mood swings, brain fog, and vaginal dryness and discomfort. Living for years with low hormones increases your risk of the bone weakening disease osteoporosis, and heart disease, as well as other conditions such as type 2 diabetes, dementia, bowel cancer and depression. HRT helps improve symptoms of the perimenopause and menopause, and it also helps prevent the diseases mentioned from developing in the future. What is in HRT? There are different types of HRT and different ways to take it. The two main hormones that make up HRT are estrogen and progesterone. Estrogen is the key hormone to help improve your symptoms (as most of them are usually caused by a lack of estrogen). The preferred way to take estrogen is through the skin in a patch, gel or spray. Progesterone (or a progestogen) is usually recommended for women who still have their womb and are taking estrogen, this is to help keep the lining of the womb thin and healthy (as estrogen can thicken it). You can take this hormone in tablet form or have a Mirena coil inserted into your womb which can remain for 5 years. Testosterone is a third hormone which some women will need for additional help with symptoms of low libido, lack of energy and poor concentration. Taking micronised progesterone (the body identical progesterone) has not been shown to be associated with an increased risk of breast cancer. Even for women taking the synthetic progestogen, the risk is very low and is actually less than the increased risk of breast cancer associated with drinking a couple of glasses of wine each night, or from being overweight. No studies have shown that any type of HRT increases the risk of a woman’s death from breast cancer. If you have had a hysterectomy in the past, and are just taking estrogen without a progestogen, you actually have a lower risk of breast cancer than if you did not take HRT at all. There is also no increased risk of breast cancer in women who take any type of HRT when they are under the age of 51 years. If you take estrogen in tablet form, you have a small increased risk of developing a blood clot, but this risk is not present if you take estrogen through the skin in a patch, gel or spray. Should I take HRT if I have a family history of breast cancer? Most women will have a family history of breast cancer in their family because it is a relatively common disease. However, it is estimated that only about 10% of the breast cancers that are diagnosed every year have a genetic or familial cause. Women with a family history of breast cancer should discuss it with their doctor if they are considering HRT. A woman’s lifetime risk of getting breast cancer is 1 in 7. This means that 1 in 7 women taking HRT will get breast cancer – not because of the HRT, but because they would have developed it anyway. There is no strong evidence that having a family history of breast cancer puts you at any higher risk of getting breast cancer if you take HRT, compared to women who do not have a family history of breast cancer. There is some evidence that women with a family history of breast cancer who take HRT actually have a lower future risk of developing breast cancer compared to women not taking HRT. This means that women with a family history of breast cancer, including those women with a BRCA gene, can still usually take HRT safely. As there are many health benefits of taking HRT, women can usually take HRT for ever, so do not have to stop taking it at a certain age or after a specific length of time Most women who have a family history of breast cancer do not go on to develop breast cancer, regardless of whether they take HRT or not. Some final advice to remember… To lower your risk of breast cancer: ­- Stay a healthy weight – ­Take regular exercise ­- Don’t smoke ­- Limit alcohol to as little as possible And remember to look at and feel your breasts regularly, for anything that’s different to normal.

Many benefits of Metformin aside diabetes For decades we’ve known that metformin does more than just help lower blood sugar in people with diabetes. It also offers them cardiovascular benefits, including lower rates of death due to cardiovascular disease. And it sometimes helps people with diabetes lose excess weight. Metformin may also have health benefits for people who don’t have diabetes. Doctors have long prescribed it off-label — that is, to treat conditions outside its approved use, including: Prediabetes. People with prediabetes have elevated blood sugar that isn’t yet high enough to qualify as diabetes. Metformin may delay the onset of diabetes or even prevent it among people with prediabetes. Gestational diabetes. Pregnant women may develop elevated blood sugar that returns to normal after delivery. Metformin can help control blood sugar during pregnancy in such women. Polycystic ovary syndrome (PCOS). This disorder tends to affect young women whose ovaries develop multiple cysts. Menstrual irregularities and fertility problems are common. Although the results of clinical studies are mixed, metformin has been prescribed for years for women with PCOS to help with menstrual regulation, fertility, and elevated blood sugar. Weight gain from antipsychotic medicines. Antipsychotics are powerful medications prescribed for psychiatric diseases such as schizophrenia. One common side effect is significant weight gain. Metformin may lessen weight gain among some people taking these drugs. In addition, researchers are investigating the potential of metformin to Lower the risk of cancer in persons with type 2 diabetes. These include cancers of the breast, colon, and prostate. Lower risks for dementia and stroke. Some studies have noted less cognitive decline and a lower rate of dementia, as well as a lower rate of stroke, among people with diabetes taking metformin compared with those who were not taking it. Slow aging, prevent age-related disease, and increase lifespan. Preliminary studies suggest that metformin may actually slow aging and increase life expectancy by improving the body’s responsiveness to insulin, antioxidant effects, and improving blood vessel health.

There are an estimated 5 million people at risk of type 2 diabetes in England . Prediabetes (or Borderline diabetes) is a term that is used to signify that an individual is at risk of developing type 2 diabetes (2). Diabetes UK and NICE CKS state the HbA1c and fasting glucose measurements that classify an indivual as having prediabetes as : fasting plasma glucose: 6.0 mmol/L to 6.9 mmol/L HbA1c: 42 to 47 mmol/mol (6.0 to 6.4%) The elevated blood sugar seen in prediabetes may also damage the blood vessels in the back of your eye (a condition called retinopathy), which can lead to blindness. A high risk of diabetes If it's not treated, prediabetes often progresses to full-blown diabetes, a condition in which your body's cells are not able to properly absorb glucose (sugar) from the blood. The resulting rise in blood sugar levels can lead to even more health problems. In addition to heart attacks, strokes, and blindness, people with diabetes are also more prone to kidney problems and infections. People with prediabetes may develop diabetes within five years if left untreated or no lifestlye modifications.. Identifying your risk So, how do you know if you're at risk for prediabetes and should be screened? Anyone with any of the factors below should get tested: - a body weight categorized as overweight or obese - a family history of type 2 diabetes among first-degree relatives, such as a parent or sibling - a significant history of irregular, infrequent periods, sometimes associated with a condition called polycystic ovarian syndrome - signs of insulin resistance on your skin, including dark patches in your armpits or the creases in your neck (which signals a condition called acanthosis nigricans) or numerous clusters of skin tags - gestational diabetes during pregnancy -delivery of a baby weighing more than 9 pounds. Testing for prediabetes typically takes two forms. Postmenopausal women, who are at particularly high risk for both prediabetes and diabetes, should ask their doctor to measure their hemoglobin A1c. This test measures the amount of sugar on molecules inside your blood cells, and can give your doctor an idea about your blood sugar levels over the prior three months. Diabetes is not inevitable If you do have prediabetes, developing diabetes is not a foregone conclusion. You can prevent it. The best way to do so is by adopting a healthier lifestyle. I post lot of information about lifestyle medicine. The National Diabetes Prevention Program showed that people with prediabetes who adopted intensive lifestyle changes reduced their likelihood of developing diabetes over the next three years by 58%. The most effective approach is a weight management program that combines nutrition counseling, at least 150 minutes of exercise per week,( 30 mins a day for 5 days) and a variety of cognitive behavioral modifications, such as learning stress-reduction strategies and adopting healthier eating habits that you can sustain over the long term.- Learn more about lifestyle modifications- at fellywellness on instagram You don't need to lose a lot of weight to make a difference in your diabetes risk. High-risk adults who lost just 5% to 7% of their starting body weight — that's approximately 8 to 11 pounds for a 160-pound woman — lowered their risk of diabetes by 58%. Self care summary/ take home message Eating healthy food, especially those low in fat and calories, and high in fibre Being more active, increasing physical activity of at least 30 minutes per day Stop smoking Losing excess weight, even losing 5- 10 percent can reduce risk of developing prediabetes into diabetes type 2

Breast Health 1 Breast cancer is the uncontrolled growth of abnormal cells in one of several areas of the breast, including the ducts that carry milk to the nipple, small sacs that produce milk (lobules), and nonglandular tissue. Sometimes breast cancer stays in the tissue in which it began. Bit it can also move into other nearby tissue or lymph nodes. Breast cancer does not discriminate . It affects mothers, daughters, working women, celebrities — and even some men. For women, the lifetime risk of developing breast cancer is about 1 in 8; for men it is 1 in 1,000. Some women are more likely to develop breast cancer than others. They include older women; those who have a mother, sister, or daughter with breast cancer; those who have previously had breast cancer or a benign breast condition; women with dense breasts; those who have had radiation to the chest or breast; and women who drink a lot of alcohol. Having several risk factors doesn't mean a woman will inevitably develop breast cancer. Likewise, having few risk factors doesn't offer 100% protection against it. Treatments for breast cancer include removal of the affected breast (mastectomy), removal of the tumor and small amount of surrounding tissue (lumpectomy), radiation therapy, chemotherapy, and hormone therapy.

Do you need a thyroid test? Undetected low levels of thyroid hormone may underlie subtle changes that can increase your risk of cardiovascular disease. For a gland only two inches in size, the thyroid has a huge influence on our health. It produces a hormone that is carried in the bloodstream to all parts of the body. Thyroid hormone plays a major role in regulating metabolism—the process by which body cells convert nutrients into energy—and thereby helps regulate body temperature, heart rate, and even brain function. So when thyroid hormone levels fall, the body slows. You're probably aware of the common symptoms of low thyroid hormone—fatigue, fuzzy-headedness, weight gain, cold hands, and dry skin. But if you're like most of us, you're likely to blame your diet and exercise regimen instead of your thyroid if your cholesterol levels and weight are creeping up, especially if you don't have any of the other symptoms of low thyroid. Symptoms are often nonspecific, and since women over 60 generally have more of these nonspecific symptoms, their doctors may not think to test for hypothyroidism.. How the thyroid works Just as the thyroid gland communicates with other organs through the hormone it produces, the pituitary gland in the brain communicates with the thyroid through a hormone it makes—thyroid-stimulating hormone, or TSH. When the pituitary senses that thyroid hormone levels are too low, it releases more TSH to coax the thyroid into action. When the thyroid is nudged by TSH, it produces thyroid hormone—a large proportion of which is thyroxine (T4) and a smaller proportion triiodothyronine (T3). The T4 is eventually converted into T3, the "active" form that is taken up by receptors in body cells. Why you may need a thyroid test Women of all ages are more likely than men to have low thyroid hormone levels. However, many of their symptoms are attributed to other conditions or written off as a consequence of aging. A blood test for levels of TSH is the most sensitive test for determining whether you have hypothyroidism. Most laboratories use 0.45 – 5.00 mIU/L as a normal reference range for TSH. People with TSH between 5.00 and 9.99 mIU/L often have no symptoms (known as subclinical hypothyroidism), but some do. Another test called T4 will be done if your TSH is in this range. A low level of T4 usually means you will benefit from thyroid hormone replacement. Many people with hypothyroidism or subclinical hypothyroidism aren't aware anything is wrong because they haven't been tested. Treating subclinical hypothyroidism with synthetic thyroid hormone may reduce the risk of developing more serious problems like cardiovascular disease. They note that low thyroid hormone can cause a high cholesterol level and treatment with thyroid hormone may make statin therapy unnecessary. What you can do If you have definite symptoms of hypothyroidism, you should talk to your clinician about being tested. If your LDL cholesterol has been advancing or your weight has been creeping up unexplainably, you'll want to discuss getting a test. If you're 60 or older and generally healthy, it's still a good idea to check with your doctor to see whether your medical history suggests you might benefit from testing.

Considering IVF- Paths to Parenthood via Embryo donation or Adoption Multicolored doors and glowing lights forming paths through the doors; the concept of different options Embryo donation — the process by which a family donates their "extra" embryos to a couple or individual — is a viable path to parenthood. People who consider their families complete after in vitro fertilization (IVF) might choose to donate embryos to people considering adoption, and individuals or couples who need donated eggs or sperm, or both, to achieve pregnancy. If you find yourself in one of these groups, here are some initial questions and issues you might consider as you make your decision. Embryo donation or adoption: A few points to compare Pregnancy. The opportunity to experience pregnancy draws some prospective adoptive parents to seek embryo donation. This may be important to you. It may be a life experience you always looked forward to, or hoped to share with a spouse or partner. Or perhaps you are concerned about having someone else carry your baby. For example, prospective adoptive parents often worry that their future child could be affected before birth by a birth mother’s choices around drugs and alcohol, or exposures to unavoidable stresses. Time frame and cost. The pandemic fueled already significant declines in the number of babies placed for adoption. If you are seeking to adopt a newborn, you are likely to face a wait of two years or more. By contrast, embryos are available, and an embryo transfer often occurs within six months of making the decision to seek donated embryos. The cost of embryo donation is considerably less than adoption. If you go through an agency there will be a fee, as well as costs related to moving embryos from one clinic to another and) costs associated with medications and with the embryo transfer. While costs are substantial and vary across the world, fees are much higher for infant adoption than for embryo donation. Although the short wait and lower costs are attractive when comparing embryo donation to adoption, it is important to know that embryo donation does not always result in a live birth, while adoption — with a reputable agency — will bring a baby into your home. Your child’s story. All of us want our children to feel good about their origin stories. Adoptive families have long recognized that some adoptees have enduring feelings of loss because their birth parents chose to make an adoption plan. Some people believe embryo donation mitigates these losses because the child is born into the family they will be raised in. However, others see it differently: they feel that embryo donation brings with it a more complicated origin story. How will a child make sense of the fact that they began as an embryo created by people longing for a baby, but an embryologist chose another embryo for transfer, making them "extra"? Might this lead to a greater sense of displacement, and perhaps to feeling like a bit of a science experiment? Choosing family backgrounds. If you pursue adoption, you’ll weigh in on the race of your child. You may be able to request birth parents who avoided drugs or alcohol during the pregnancy and/or have family histories free of serious physical or mental health problems. You will not be able to narrow your match to people you like or feel are compatible, people who feel familiar, and whose interests and values align with yours. If you pursue embryo donation, you and the donor family get to choose each other. Before anyone makes a commitment, you can confirm with the donor family that you have a shared perspective of how much contact you want to have, and what each of you believes is in the best interest of the children involved. Decisions tend to feel more collaborative than in adoption, where it may feel like "birth parents get to make all the decisions." Embryo donation or egg or sperm donation: A few points to compare If you are in a position to need sperm or egg donation, or both, you might be comparing this with embryo donation as a path to pregnancy. Below are key points to consider, and some questions that may arise as you sort through your options. Since pregnancy is your primary goal here, you are probably thinking about which option is likely to work best. With embryo donation, one might say you get a head start, since you begin with healthy embryos. However, the number of embryos you receive will be limited. You could decide to seek a second donor family if you don’t achieve pregnancy with embryos from the first donor, although this would be a long, discouraging path. By contrast, if you seek donated sperm and eggs separately and begin with a large number of eggs, you may have a larger number of embryos to work with. Time frame and cost. The good news is that each of these options can be available to you without delay. You can obtain donor sperm from a donor known to you, or from major cryobanks within days of choosing a donor. If you choose frozen eggs, these can be secured quickly also. Donated embryos take longer to locate and arrange for their transfer from one family to another. Sperm from a known donor usually is free. With egg and sperm donation from a cryobank, you will owe a fee to the donors. In the case of egg donors, fees can be high. With embryo donation, no fee is paid to the donating family. Your child’s story. If you opt for embryo donation, your child’s story began with another family planning to have a baby. You may wonder if your child will have feelings of displacement similar to what some adoptees report. Or, carrying and giving birth to your baby may make embryo donation feel fundamentally different from adoption. Double donation — conceiving a child with both donated eggs and sperm — also offers the connection that comes with pregnancy, although you may wonder how your child will make sense of being conceived by two people who never knew each other. A single donation of either egg or sperm offers a genetic connection to one parent, which some feel helps root a child in the family. Yet each of these origin stories is complicated, making it essential that you feel comfortable with the story before you move forward. Long before being able to understand the story, your child can sense that you feel secure in the rightness of your decision. Decisions like these abound worldwide If you are taking a serious look at embryo donation and comparing it to other parenthood options available to you, you are not alone. The arrival of IVF in 1978 has led to a series of new paths to parenthood. Each one drew pioneers who took a careful look before moving forward into new and unfamiliar territory. Making the decision with patience, thoughtfulness, and information has enabled them to embrace and celebrate the families that they have built. These resources may help you track down information you need to make a decision.

Q. I had my last menstrual period four years ago, but I’m still having hot flashes and night sweats. Is this normal, and is there anything other than hormones that might alleviate my symptoms? A. Unfortunately, while menopausal symptoms are short-lived for many women, others can have symptoms for years after their menstrual cycles have stopped. These may include heart palpitations, vaginal dryness, night sweats, hot flashes, sleep disruptions, and mood disorders, such as depression and anxiety. There are some nonhormonal approaches that might help. Some of the best options for hot flashes and night sweats are those that help keep you cool. These include dressing in layers, so you can quickly remove clothing to adjust your body temperature; keeping a small fan nearby that can be flipped on as needed; using cool-water compresses on your skin; keeping your bedroom at a lower temperature at night; and wearing light clothing to bed (ideally made of fabrics designed to wick away moisture). In addition, try to get regular exercise. It’s been shown to reduce menopausal symptoms over all, and it may help to improve your sleep quality. Also, be sure to speak with your doctor. She may be able to offer you some additional treatment options and can also rule out other conditions that might be causing the problems you are experiencing.

Q. My eyes have been feeling scratchy and irritated lately. Is there anything that can help? A. While only a doctor can tell you what is causing your symptoms, you could be experiencing dry eye syndrome, a problem caused by declining tear production. With less of this natural lubricant, eyes may get irritated or sensitive to light, or vision may be blurry. Some people also experience a feeling of stickiness or fewer tears when crying. Dry eye syndrome becomes more common as people age, but it can also be caused by hormone changes, like the ones that occur during menopause, or certain medications, such as antihistamines and decongestants. There are strategies and treatments that can help. First, reduce eye strain by minimizing screen time or taking regular breaks. Also use a humidifier inside, particularly in the winter. There are many treatments for dry eye, including drops and ointments, which provide artificial lubrication, reduce inflammation, or stimulate the body to produce more natural tears. They’re not a cure, but can help ease symptoms.

Pelvic inflammatory disease is an infection of the uterus, fallopian tubes or ovaries. The infection can cause tissue inside the fallopian tubes to become scarred, which can damage the fallopian tubes or block them completely. The more often a woman gets this infection, the greater her risk of becoming infertile. The risk doubles with each bout of the disease. Researchers believe most cases of PID develop from sexually transmitted diseases (STDs), infections that are spread through sexual contact. The two diseases most likely to lead to pelvic inflammatory disease are 💢gonorrhea and💢 chlamydia. ✔✔Without treatment, the same bacteria that cause these diseases also can cause pelvic inflammatory disease. 💢✔Less commonly, pelvic inflammatory disease can develop if bacteria get into the upper portions of the reproductive tract after childbirth, after inserting an intrauterine device (IUD) or after an induced abortion. All of these procedures carry some risk of infection, especially if the patient also has an STD. Symptoms can be severe, minor or nonexistent. The most common symptoms include: 💢Pain in the pelvis and lower abdomen 💢Discharge from the vagina with an ✔unpleasant odor 💢Fever and chills 💢Nausea and vomiting 💢Pain during sexual intercourse The primary treatment for pelvic inflammatory disease is antibiotics, and in most cases, antibiotics alone can cure the infection. When To Call 📞 A Doctor/GP/Clinician If you experience any✅✔💢 symptoms of pelvic inflammatory disease