My hot flushes and night sweats have lasted for 22 YEARS

I am 72 and have had hot flushes and night sweats for more than 22 years. At first I went on HRT for eight years. Since then I have tried homeopathic remedies and a special magnet. It seems this nightmare is never going to end. Is there any more I can do?

Lorraine Johnson, North East Lincolnshire.

Hot flushes are a common problem for many women, and can be very unpleasant and distressing.

On average, they come to an end about four years after a woman has her last period.

But about one in ten women will have them for 12 years in all. And 9 per cent are still experiencing hot flushes at the age of 72, so you are not alone. However, in most people they do stop eventually.

Hot stuff: One in ten post-menopausal women will have hot flushes for 12 years – and 9 per cent still experience them at the age of 72

Hot flushes occur post-menopausally when the ovaries have stopped producing the hormone oestrogen. Body temperature is regulated by part of the brain region called the hypothalamus — it does this by causing blood vessels to widen or narrow. However, this brain region cannot carry out this function as effectively when oestrogen is withdrawn.

Episodes typically begin with a feeling of extreme heat, which triggers sweating. This then results in heat loss, and may be followed by shivering. They often occur at night and may be accompanied by chills, heart palpitations, or even a feeling of agitation and anxiety.

Hormone replacement therapy (HRT) helps ease the symptoms by restoring oestrogen to the nerve tissues of the hypothalamus.

However, the potential for side-effects or complications (such as a small increased risk of breast cancer or blood clotting problems) limits how long a patient can remain on HRT, the maximum usually being five to seven years.

It is unclear whether you were free from symptoms while you were taking HRT, but in general it is remarkably effective. There are non-hormonal medications that can be used to treat hot flushes. Most commonly these are antidepressants of the SSRI (such as citalopram) or SNRI group (such as venlafaxine), and the anticonvulsants, gabapentin and pregabalin. These drugs work in different ways, but all have an effect on the brain.

These medicines can be used in patients who are either unsuitable for HRT, or prefer not to have it. They are also of value in those who find the hot flushes return after they stop HRT. Many studies confirm the benefits of the antidepressants I mention; they can take some weeks to work for treating depression but it may take only five to seven days for the benefit to be seen with hot flushes.

GOT A PROBLEM? 

To contact Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or via: [email protected] – including contact details.

Dr Scurr cannot enter into personal correspondence. His replies cannot apply to individual cases and should be taken in a general context. 

Always consult your own GP with any health worries. 

If one antidepressant is ineffective it is worth trying a different one as responses vary; the same applies to the anticonvulsant drugs. These options must be discussed with a GP, as prescription and careful dosing is essential.

Many women try complementary or alternative therapies for post-menopausal hot flushes. Cognitive behavioural therapy, hypnosis and mindfulness have all been studied, as have plant-based treatments — on the basis that many fruits and vegetables (such as soya beans, chickpeas and lentils) contain compounds that behave like oestrogen, but for most of these there is little good quality evidence of effectiveness.

The same applies to herbal therapies such as black cohosh and Chinese herbal treatments. The evidence for acupuncture and reflexology are also conflicting. You mention that magnetic therapy has not been helpful (and there is no scientific reason why it would be).

I would recommend that you talk to your doctor about trying one of the antidepressants that studies have shown to be effective (and I stress that this does not mean you have depression). If that fails then a trial of the anticonvulsant medications may still give you relief.

My poor son has scabies, and they are inside him. He’s seen doctors but nothing seems to work. It is driving us mad. He is 47.

Name and address supplied.

I am sorry to hear you have this great worry. Scabies is a skin infestation caused by a mite, an insect that is only just visible to the naked eye, and which burrows just under the surface of the skin.

Symptoms include an intense itching, often worse at night — this is thought to be caused by the body reacting to the mite.

Scratch: Scabies is a skin infestation caused by a mite, an insect that is only just visible to the naked eye, and which burrows just under the surface of the skin

Patients will also have a rash of small red bumps and burrows in the skin — which resemble small lines — typically seen in between the fingers, on the wrists, elbows, armpits, and feet.

However, it is not always easy to be sure of the diagnosis. I know that I have missed it at least twice in my career, though dermatologists quickly reached the correct diagnosis later. On both occasions the patient had fiercely itchy skin but little obvious sign of a rash. You don’t need a prescription for most available treatments. One is a cream containing 5 per cent permethrin, an insecticide. One application should be enough, taking care to coat the entire body.

The procedure should be repeated after seven days, as there may be residual eggs that have not hatched yet. An alternative is malathion lotion, 0.5 per cent — again, the entire body should be coated.

Any itching usually continues for a few days after treatment, but can be eased by taking an antihistamine tablet once or twice daily, such as Piriton (chlorphenamine). There is also a drug available in tablet form, ivermectin (an anti-parasite medication), which studies show is as effective for scabies, or even slightly more so, than the two topical preparations I have described.

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Although it is not licensed in the UK for the treatment of scabies, some doctors may be prepared to prescribe it ‘off licence’. This drug can be helpful for patients worried that the topical treatments have not worked (there may be a psychological element — some people are more convinced by tablets than a cream).

In your letter you state that your son is convinced that the scabies mites are inside him.

This is true to the extent that they burrow, superficially, in the skin. However, the scabies mite does not venture further inside the body. My concern is that your son may have delusional parasitosis, where someone has a strong but false belief that they are infested by bugs or some form of parasite.

This is classed as a psychiatric illness, although patients may have no other mental health problems or history of mental illness. Unfortunately, it can be difficult to persuade people with this condition to see a psychiatrist because to them their symptoms, such as itching, seem very real.

If your son’s doctor, or a dermatologist, have excluded scabies as a cause of the symptoms, then delusion parasitosis must be considered as a potential diagnosis.

The correct step would be for him to be seen by a psychiatrist. I hope this helps.

BTW, it’s time to play ping-pong – and get dancing! 

At this time of year, it is customary to reflect on key news stories of the past 12 months. This has certainly been an eventful year.

But when it comes to scientific research, there is little doubt in my mind about what was the most important story of 2016.

And it concerns the wonderdrug that is freely available to us all: physical exercise. In August, a paper in The BMJ (British Medical Journal), distilled information from 174 articles into one simple conclusion: exercise can considerably reduce your risk of breast and colon cancer, heart disease, strokes, and diabetes.

However, to achieve these benefits, the review found, you have to do more than the recommendations by the World Health Organisation of a 30-minute walk five times a week. For the best effect you would need to do the equivalent of 45 minutes of vigorous cycling on an exercise bike every day, researchers said.

As it happened, my copy of that month’s BMJ was delivered at the same time as a table tennis table.

I’d ordered it after reading that table tennis is proven to increase the blood flow in a region of the brain called the hippocampus, which shrivels in patients with Alzheimer’s disease.

I have also recently read research showing that dancing is protective against dementia. Like table tennis, dancing integrates several different brain functions at once, which may be why such activities help protect the brain. So why not achieve this higher level of exercise, not only by walking, but also by playing table tennis (somewhere, somehow) and attending a dance class or two?

One problem is that people can be rather lazy (I certainly am) and, second, they do not make the time (I know I don’t). But deep down I think most of us have the motivation. Anyone with an eye on the ball has concerns about developing dementia in old age, dementia having overtaken heart disease as the biggest cause of death in England and Wales.

So the answer is: use that motivation to change your life in the New Year, and get active, very active.