Monthly Archives: July 2020

Sniffles, sneezing and cough? How to tell if it’s a simple allergy rather than The Virus

Sniffles, sneezing and cough? How to tell if it’s a simple allergy rather than The Virus

July 28, 2020 6.01am AEST


  1. David King Senior Lecturer in General Practice, The University of Queensland

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David King does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.


University of Queensland

University of Queensland provides funding as a member of The Conversation AU.

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We’re told to stay home if we feel unwell during the COVID-19 pandemic. But what if your sniffles, sore throat or cough aren’t infectious? What if they’re caused by hayfever or another allergic reaction? You may be doing a lot more isolating than you need to.

Although it can sometimes be challenging, there are ways to tell apart respiratory symptoms caused by a virus and those caused by an allergy. This approach may help prevent Australia’s COVID-19 testing capacity from being overwhelmed.

Read more: Health Check: what’s the right way to blow your nose?

What causes hayfever?

Around one in five (21%) of Australians suffer seasonal allergic rhinitis – more commonly known as hayfever. If each of these experiences a few episodes of hayfever annually, that would require between 10 million and 20 million COVID-19 tests to exclude infectious causes from allergies alone.

Hayfever has many of the same symptoms as viral respiratory infections, such as colds and mild flu-like illnesses, as well as COVID-19. This is because rhinitis refers to inflammation of the nose, which has many causes.

Hayfever is caused by your nose and/or eyes coming into contact with microscopic allergens in the environment, such as pollens (from grasses, weeds or trees), dust mites, moulds and animal hair.

Your immune system identifies these airborne substances as harmful and produces antibodies against them. The next time you come into contact with them, these antibodies signal your immune system to release chemicals such as histamine into your bloodstream, causing the inflammation that leads to hayfever symptoms.

Hayfever traditionally has a seasonal spike in late winter and spring, when pollen counts are highest from flowering trees and grass seeds.

But in many areas of Australia, there may be more hayfever in autumn, due to two common sources of allergies: moulds, and an autumn spike in indoor dust mites.

A warming climate has also been linked with increased levels of pollens and environmental allergens, and a rise in asthma and hayfever severity.

What are the symptoms?

Whether you have seasonal hayfever, longer-term perennial or vasomotor rhinitis), or a viral infection, you’re likely to have similar cold and flu-like symptoms.

You’ll have either a runny or stuffy nose. Other symptoms include sore throat; sneezing; cough; post-nasal drip – nasal mucus going down the back of your throat; and fatigue.

But there are two classic hayfever symptoms that can help you tell allergies and viruses apart. Hayfever can cause you to have an itchy nose or throat; and when it’s more severe it can cause swollen, blue-coloured skin under the eyes (called allergic shiners).

Dark circles under your eyes can be a classic symptom of hayfever.

Can we tell them apart?

Fever, sore muscles or muscle weakness

Hayfever, despite its name, does not cause increased body temperature. Flu-like illnesses do cause fever, and sore muscles (myalgia), malaise and fatigue.

Allergies such as hayfever may cause a slight malaise without the other symptoms, probably due to a stuffy nose and poor sleep.

Snoring, dark circles under the eyes and sleep

The nasal congestion from hayfever and other types of rhinitis often increases the potential to snore during sleep. And if you have those dark circles under the eyes, that’s likely down to chronic poor-quality sleep, as nasal congestion and snoring worsen.

Itchy nose and eyes, plus sneezing

An itchy nose and eyes are classic hayfever symptoms, as is intense, prolonged sneezing.

You can sneeze with a cold or flu, but usually only in the first few days of the infection.

Longer-lasting symptoms

Allergic reactions tend to come and go from day to day, or even from hour to hour, particularly if some environments are the source of the offending allergens. Perennial rhinitis can be present for weeks or months, far longer than any viral cold or flu.

It is rare for a cold to last more than a week, as the body has fought off the virus by that time. Exceptions to this are the cough and sinus symptoms that were triggered by the virus but persist for other reasons.


If your nasal symptoms improve with antihistamine medication, then you likely have an allergy or hayfever. Antihistamines do not alleviate symptoms of the common cold.

However, if your allergic reaction is more severe, antihistamines alone, even in larger doses than stated on the packet, may be insufficient to fully control symptoms, and a variety of nasal sprays may have to be added to the treatment.

Read more: Coronavirus or just a common cold? What to do when your child gets sick this winter

Why do we need to differentiate viral from allergic causes?

In “normal” times we usually treat the symptoms of viral infections. However, amid the COVID-19 outbreak we need a clearer picture of what might be causing our symptoms so we get tested when it matters, and not for undiagnosed hayfever.

But it’s not easy to tell viral and allergic rhinitis apart. People with hayfever also get viral colds and flus, further complicating the picture.

If you think your symptoms may be due to allergy, it is safe to try a double dose of non-sedating antihistamine. Sedating antihistamines should be avoided in young children, and taken with caution in adults. If your symptoms improve significantly within an hour, your symptoms are likely hayfever or another allergic reaction.

However, if your symptoms are different to previous hayfever episodes, or your symptoms don’t improve after taking an antihistamine, that’s another matter. Stay at home until you can get tested for COVID-19.

Anyone with only partially treated and controlled hayfever will need to realise that your sniffles and sneezes are going to be distressing to your fellow commuter, diner or shopper. So you may need some medical assistance to more fully manage your allergic condition.

Prof John Studd Newsletter.

Prof Studd would be the most knowledgeable person in the world on the menopause. Have a look at his CV for evidence of this. His latest newsletter here is very interesting. His web-site is worth a look.

Newsletter February 2020

My apologies for this late newsletter but there has not been a lot to report as HRT is now accepted as safe and useful maintaining a woman’s health in the menopausal years and also has a proven value in treating depression in younger women who still having their cycles and suffer with the cyclical depression of PMS . There was some anxiety in July when the Oxford Epidemiology group again reported the increase in breast cancer on HRT preparations, but this was really an extension of their previous much criticised work about 10 years ago. If there is any increase in breast cancer it almost certainly is related to the continuous progestogen found in some preparations. Every paper that has looked at estrogens alone has shown no increase or even a decrease in breast cancer. My research team first described the use of continuous estrogen and progestogen 30 years ago in order to avoid a monthly bleed I never use it now. That is a clear message.Cyclical progestogen or better still the natural progesterone Utrogestan should be used for 10-12 days each month for endometrial protection but even then progesterone / progestogen can have a depressive effect (as in PMS ) and a shorter duration of 7 days can sometimes be used or a Mirena coil inserted to avoid these progestogenic side effects.

AVAILABILITY OF HRT PREPARATIONS The only problem these days appears to be fear of lack of availability which has become headline news in the press and BBC. This is surprising because there is no reason why there should be a shortage of any HRT preparation. There has been anxiety that the Evorel patch is not available but a virtually identical preparation Estradot is. I’m not sure about oral because I never used them as there is a tiny increase risk of heart attacks and strokes with all oral estrogens whether it is the form of all oral contraception in younger women or HRT in older women. Oral estrogens pass straight to the liver where hepatic coagulation factors are stimulated. There is no such thrombogenic risk with transdermal estrogens. There is no shortage of the testosterone gels that I frequently prescribe.If you have any problems obtaining your HRT I suggest you contact Madesil pharmacy at 20 Marylebone High Street Phone 02079353078 They have reassured me that they have everything in stock and would even post the medication to the patient once they receive the usual prescription.


Many years ago I published a paper “10 reasons to be happy about HRT “ It can be found on my website but a brief summary is –1. HRT will stop your hot flushes and sweats

2. HRT will stop vagina dryness and the many causes of painful intercourse and loss of libido

3. HRT increases bone density and prevents osteoporotic fractures

4. HRT protects the intervertebral discs 5. HRT does reduce the number of heart attacks

6. HRT helps depression in many women

7 HRT improves libido

8 HRT improves the texture and quality of the skin

9. ”I am a nicer person to live with “

10 HRT is safe The full text of this paper can be found can be found on my website There is perhaps another

#11 advantage to add to this list. There is increasing evidence that HRT decreases the risk of Alzheimer’s disease. This is logical because the earlier the menopausal the greater the risk of Alzheimer’s in later life but it’s difficult to prove this to everybody’s satisfaction. Certainly, population studies particularly the huge Utah study suggest a decreased risk, but the demands of precise epidemiology insist that a randomised controlled trial with the placebo group is conducted. The problem is at what age should this huge study begin – at the age of 60 ,50, 40 or even earlier and what happens to the placebo group when the patient begins to suffer hot sweats insomnia and depression. She will then move on to estrogens. The problem will never be solved by a vastly expensive and impossible study, so we have to rely on the population data that we have at the moment. It is worth remembering that when Sir Richard Doll’s observation that lung cancer was 13 times more common in smoking doctors than non-smoking doctors was criticised for the absence of a trial, he famously replied that you don’t need a randomised trial to prove the bleeding obvious.


The next challenge is to clarify the role of estrogens in the treatment of depression in women. Depression is twice more common in women than men with more hospital admissions for depression the use of antidepressants and suicide attempts. The clear message is that depression in women is often different from depression in men because there is a massive hormonal component in women not occurring in men. Depression occurs at times of hormonal flux often beginning within a few years of the first period becoming worse with age. Significantly this depression usually disappears during pregnancy when there are no hormonal fluctuations only to recur as post-natal depression after delivery when estrogen levels fall. This post-natal depression can be delayed if the woman breast feeds for a long time but when she stops breast feeding the periods return and depression returns as PMS often becoming worse with age particularly in the few years before the menopause in the period called the menopausal transition. Thus, we have a combination of Premenstrual depression, postnatal depression and premenopausal depression occurring in the same woman. This is Reproductive Depression , Unfortunately psychiatrists are not aware of this and do not want be bothered with this new information . I have tried!!Rather than accept a hormonal component they will misdiagnose many women with severe PMS as having “bipolar disorder” when the treatment and prognosis is very different. Alternatively, they have a diagnosis “drug resistant depression ‘not being aware that the depression is resistant because treatment is wrong. They also use the frequent diagnosis of ‘borderline personality disorder’. This is an ongoing tragedy for many women with “reproductive depression “related to hormonal changes it is very treatable with transdermal estrogens and women can avoid the inappropriate treatment by antidepressants antipsychotics tranquilizers and even ECT which can all have a devastating effect upon there long term health. I summarised here the simple differences between PMS curable with oestrogens and bipolar disorder which is not helped by hormones. This is a summary of the characteristics of PMS but in some cases, there is an overlap. Once again, the full paper can be found on my website 1 There is a history of mild or severe PMS is it teenager 2 There is relief of depressive symptoms during pregnancy 3 Depression started or recurred postpartum as postnatal depression. 4 Premenstrual depression recurred with menstruation returned months after delivery. 5 Premenopausal depression became worse with age blending with the menopausal transition and becoming less cyclical 6 In PMS there is often coexistence of cyclical somatic symptoms such as menstrual migraine, abdominal bloating or mastalgia 7 These PMS patients usually have runs of 7 to 10 good days per month 8 These PMS patients have recurrent episodes of depression we rarely have episodes of mania


Most women are aware of the dangers of osteoporosis and broken bones after the menopause and this is why we have a Hologic bone density machine to 46 Wimpole Street for women who may be at risk. It is of course well known that low bone density occurs after the menopause, but it can occur much earlier. A healthy lifestyle and exercise can to some extent reduce the risk but there is a danger of putting too much confidence in lifestyle. Osteoporosis occurs more commonly in women you are thin and not overweight as estrogens are produced in the body fat and being fat is to a large extent protective of the bones. Such patients develop more diabetes, heart attacks and strokes but they will have good bones. It is therefore a false sense of security in healthy women who walk the dog for 2 hours a day or exercise addicts who spend an hour a day in the gym as these are just the women who if slim have a higher risk and there is no way of diagnosing this than by measuring bone density or waiting for a fracture to occur . Then the patient can have transdermal estrogens by gels patches or implants which is by far the most effective and the safest way of protecting the skeleton I wish you all a healthy symptom free and fracture free 2020 so continue with your HRT

John studd

Calcium-Rich Foods and Calcium Sources

I meant to add this to the previous post today. This also has the references mentioned in the previous post.

Calcium-Rich Foods and Calcium Sources

  • Dairy products
  • Leafy greens (Are OK, but not as bioavailable as dairy)
  • Cruciferous vegetables (good bioavailability)
  • Seeds and almonds
  • Canned, bone-in fish

Dairy Products

  • Dairy products generally correlate with better bone health.
  • The vast majority of clinical studies have shown that drinking milk or consuming other dairy products leads to a positive calcium balance. 

Other Bone Health Synergists

  • Weight bearing exercise, weights
  • Magnesium is especially important
  • Collagen
  • Glycine, lysine, and proline with vitamin C: good sources are animal proteins, organ meats, bones, joints, and tendons.

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Non-Nutrition Bone Health Supports

  • Balance hormones
  • Reduce inflammation
  • Support sleep (melatonin is involved with bone density)
  • Reduce stress
Resources & Links (click to expand)
References (click to expand)
  1. Anderson JJ, Roggenkamp KJ, Suchindran CM. Calcium intakes and femoral and lumbar bone density of elderly U.S. men and women: National Health and Nutrition Examination Survey 2005-2006 analysis. J Clin Endocrinol Metab. 2012;97(12):4531-4539. doi:10.1210/jc.2012-1407
  2. Bischoff-Ferrari HA, Dawson-Hughes B, Baron JA, et al. Calcium intake and hip fracture risk in men and women: a meta-analysis of prospective cohort studies and randomized controlled trials. Am J Clin Nutr. 2007;86(6):1780-1790. doi:10.1093/ajcn/86.5.1780
  3. Li K, Kaaks R, Linseisen J, Rohrmann S. Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition study (EPIC-Heidelberg). Heart. 2012;98(12):920-925. doi:10.1136/heartjnl-2011-301345
  4. Bolland MJ, Avenell A, Baron JA, et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ. 2010;341:c3691. Published 2010 Jul 29. doi:10.1136/bmj.c3691
  5. Xiao Q, Murphy RA, Houston DK, Harris TB, Chow WH, Park Y. Dietary and supplemental calcium intake and cardiovascular disease mortality: the National Institutes of Health-AARP diet and health study. JAMA Intern Med. 2013;173(8):639-646. doi:10.1001/jamainternmed.2013.3283
  6. Michaëlsson K, Melhus H, Warensjö Lemming E, Wolk A, Byberg L. Long term calcium intake and rates of all cause and cardiovascular mortality: community based prospective longitudinal cohort study. BMJ. 2013;346:f228. Published 2013 Feb 12. doi:10.1136/bmj.f228

Calcium Supplementation Does Not Improve Bone Health

I have had blogs about this topic before. Look up “Harm from calcium”on my web-site search option. I agree with most of what is written here, and once again we come up with the power of pharmaceutical companies to promote their wares, even when women don’t necessarily need them. Look at the Independent research. (not pharmaceutical company sponsored)

Calcium Supplementation Does Not Improve Bone Health

Written by Dr. Michael Ruscio, DNM, DC on July 22, 2020

And may increase heart disease risk with Chris Kresser.

Calcium Supplements May Be Harmful

  • 10% of American women have osteoporosis, and many women supplement with calcium to avoid risk.
  • While dietary calcium is important to prevent osteoporosis, calcium supplements have been shown to increase risk of heart attack or stroke.

Calcium Supplements Don’t Improve Bone Density

  • Several studies suggest calcium supplements increase the risk of osteoporosis.
    • A 2012 analysis found calcium intake beyond recommended guidelines provided no benefit at all for hip or lumbar vertebral bone mineral density. [1]
    • A 2007 study published in the American Journal of Clinical Nutrition found that calcium supplements don’t reduce fracture rates in postmenopausal women, and may even increase the rate of hip fractures. [2]
    • Calcium supplements get absorbed into the bloodstream quickly which may lead to distribution into soft tissues instead of into the bones.
  • Dietary Calcium Does Increase Bone Density
    • Foods may have a more bioavailable form, perhaps due to more gradual absorption

Calcium Supplements Increase Risk of Cardiovascular Disease

  • A 2012 study in the British Medical Journal found that calcium supplements heart attack risk by 140%. [3]
  • A 2010 meta-analysis in the British Medical Journal found calcium supplements was associated with a 31% increased risk of heart attack, a 20% increased risk of stroke, and a 5% increase of risk of death from all causes. [4]
  • A 2013 study published in the Journal of the American Medical Association found that 1,000mg/day of calcium supplementation was associated with a 20% increase of death from cardiovascular disease. [5]

Cancer and Kidney Stones   

  • A Swedish study reported a significantly higher risk of death among men and women with much higher calcium intakes. Some of those deaths were from prostate cancer, and there was also an increase in kidney stones. [6]

Do Vitamin D and Vitamin K2 Reduce Calcium Risk?

  • Using Vitamin D and Vitamin K2 with calcium might diminish risk, but we don’t know.
  • Some evidence suggests adequate doses of vitamin D and K reduce the dietary need for calcium.
  • 700-900mg calcium per day may be adequate.
  • Calcium should probably be consumed with vitamin D (or safe sun exposure) and K2 (fermented foods).

How to prevent heart disease without breaking a sweat

How to prevent heart disease without breaking a sweat

Connie Capone|July 24, 2020

Better cardiovascular health is usually boiled down to a simple philosophy: eat right and move often. But new research endorses an even easier, less strenuous method of preventing cardiovascular disease: getting in a good stretch.stretching improves heart health

Regular stretching can improve cardiovascular function.

For those looking to make a difference without breaking a sweat or trying out another crash diet, here’s how you can stretch your way to better heart health.

Why stretching is important

Stretching is all about placing parts of the body in positions that help lengthen or elongate the muscles and soft tissues. There are several variations, including dynamic (involving motion) and static (not involving motion). The most basic form is passive stretching, in which a position is held for a period of time with the assistance of another part of the body, another person, or a stretching apparatus.

Commonly regarded as an important precursor to aerobic exercise or as a cool down after a workout, stretching also has plenty of merits as an activity of its own. Incorporating stretching into your daily routine keeps your muscles flexible, strong, and healthy, which allows for a greater range of motion in the joints. Muscles that aren’t stretched regularly are more prone to strains, tears, and other injuries.

Stretching also relieves stress and promotes increased blood and nutrient flow throughout the body—this is where the benefits to your heart come into play.

How stretching helps the heart

Passive stretching can help decrease the risk of vascular issues, according to a new study published in The Journal of Physiology.

For this study, the researchers randomly assigned 39 men and women to either a stretching regimen or doing no stretching (control group). The stretching regimen included five sets of four leg stretches done for 45 seconds each. After the 12-week study period, the group that stretched saw a decrease in blood pressure, a reduction in arterial stiffness, and an increase in vascular function—in other words, a reduction in three risk factors for cardiovascular disease.

“This new application of stretching is especially relevant in the current pandemic period of increased confinement to our homes, where the possibility of performing beneficial training to improve and prevent heart disease, stroke, and other conditions is limited,” said Emiliano Cè, PhD, one of the study’s authors and an associate professor, Department of Biomedical Sciences for Health, University of Milan, Italy.

These findings support prior research published in the International Heart Journal, which found that just one stretching session improved vascular endothelial function and blood circulation in patients who had a recent heart attack. This suggests that stretching could be a drug-free way to preserve vascular health in patients, especially those with low mobility, even when they’re hospitalized or after surgeries.

Another study, published in the American Journal of Physiology-Heart and Circulatory Physiology, found a link between poor flexibility and arterial stiffness. Researchers measured the flexibility of over 500 adults and found that participants who could not reach to or beyond their toes in a sit-and-reach test were more likely than flexible participants to have higher systolic blood pressure.

Stretching can also be a valuable tool for relaxation, with an ability to relieve the physical symptoms of stress, which manifest as tense muscles, rapid breathing, and neck and back pain. In a review published in the Journal of Behavior Therapy and Experimental Psychiatry, study participants who engaged in stretching reported decreases in diastolic blood pressure, lower self-reported levels of muscle tension, and even lower levels of sadness.

Ways to get started

Whether you’ve been a gym regular for years or you’re dealing with low mobility, there are plenty of basic stretching movements that you can incorporate to increase your flexibility, blood flow, and energy, while lowering your risk of cardiovascular disease

The good news is that you don’t have to stretch every single one of your muscles to reap the benefits. “The areas critical for mobility are in your lower extremities: your calves, your hamstrings, your hip flexors in the pelvis, and quadriceps in the front of the thigh,” said David Nolan, PT, DPT, clinical specialist at Mass General Sports Physical Therapy, in the Harvard Health Letter.

Here are a few tips to consider before you get your stretch on:

  • Be mindful: Make sure that you’re performing your stretches correctly to avoid injury. If you’re already injured, be cautious about the muscle groups you’re stretching. (Check out this handy lower extremity guide to ensure you’re using proper technique.)
  • Don’t bounce: Hold a stretch for 30 seconds and don’t bounce. Bouncing while stretching can slightly tear muscles which will only further tighten the muscle and decrease flexibility. Stretching should only produce mild tension, so do not force yourself into a position that causes pain.
  • Stretch warm muscles: It’s best to stretch after a short session of physical activity, when your muscles are warm. Stretching cold muscles can result in injury. If you’re about to do a serious workout, take a quick walk or a warm-up jog before you begin your stretching.
  • Set a time: Your stretching session doesn’t need to last hours. Pick a brief 10-minute window, 2 to 3 days per week.
  • Breathe: Avoid holding your breath. Maintain a regular breathing rhythm as you stretch.

Make your morning stretch a daily ritual or tack on a stretching session after a workout. However you choose to incorporate stretching, your body (and your heart) will thank you.

Daily chocolate consumption may be linked to better insulin levels in adults

Daily chocolate consumption may be linked to better insulin levels in adults

American Heart Association News, 03/09/2016

Eating chocolate on a daily basis may improve insulin levels and liver enzymes in adults, according to a study presented at the American Heart Association’s Epidemiology/Lifestyle 2016 Scientific Sessions. Researchers studied 1,153 adults, ages 18 to 69 years between 2007 and 2009. Of all the participants, 81.8 percent were classified as chocolate consumers. They found that consuming 100 mg of chocolate daily was associated with lower levels of insulin resistance, serum insulin and liver enzymes, markers associated with heart disease risk. Chocolate consumers were more likely to be younger, physically active, affluent people, who had higher education levels and fewer chronic health issues.

Will a hysterectomy cure my endometriosis?

Will a hysterectomy cure my endometriosis?

There are many myths about endometriosis that make it hard for people to know what’s true and what’s a myth about this disease.

Firstly there is currently no definitive cure for endometriosis, however there are treatments available that aim to address the symptoms and can make live worth living again; some of those treatments are discussed here.

In some cases, hysterectomy may offer a significant control of the problem and removes pain, but this depends on the location of the endometriosis. Taking out the uterus and ovaries is the last choice in treatment.


Endometriosis by definition is a disease outside of the uterus, and removing the uterus alone will not cure endometriosis. The likelihood of endometriosis recurring depends on factors such as whether or not there is any endometriosis left behind and how severe and advanced the disease is. It can spread to the fallopian tubes, ovaries, bowels, bladder, peritoneum, appendix, and sometimes in very rare cases, the diaphragmlungs, or the brain.

In such cases, removing only the uterus with hysterectomy has a high risk for recurrence. A high recurrence rate of 62% is reported in advanced stages of endometriosis where the uterus was removed and the ovaries were left. Removing both ovaries (bilateral oophorectomy) along with the uterus means patients will go through surgical menopause that will have side effects, and this is still no guarantee for a cure.

Hysterectomy is not an ideal option for women who wish to maintain fertility, and there are many steps in modern endometriosis treatments to take before this option.

There is also a myth that getting pregnant will cure endometriosis. How one woman reacts to the hormones during her pregnancy may not be the same for another woman. Some women claim that their pregnancy helped, while others have said their condition worsened. Women should not be told to become pregnant as a medical treatment.

So when is a hysterectomy a good option to treat endometriosis? A hysterectomy can be an appropriate recommendation to a patient when pain is the major factor affecting her quality of life, she has completed her family, all other conservative treatments have not stopped the pain, and who might have accompanying conditions like adenomyosis. Removal of the uterus will help Adenomyosis sufferers as it is based inside the uterus (in the muscles) not the outside of the uterus, such as the case is with endometriosis.

Consider your hysterectomy decision carefully because the decision is not reversible.

The Role of Screening Mammography in the Era of Modern Breast Cancer Treatment

The Role of Screening Mammography in the Era of Modern Breast Cancer Treatment

A B Miller  1 Affiliations

Review Climacteric

. 2018 Jun;21(3):204-208. doi: 10.1080/13697137.2017.1392503. Epub 2018 Jan 17.


The evidence is reviewed on the efficacy and effectiveness of mammography screening derived from randomized screening trials and from the surveillance of populations where mammography screening for breast cancer has been introduced. Nearly all the trials were performed in the era before modern adjuvant therapy for breast cancer was introduced, apart from the Canadian National Breast Screening Study and the UK Age trial. The former found no benefit from annual mammography screening for 5 years in women age 40-59 years, the latter, a non-significant benefit from screening women by annual mammography for 7 years from ages 39 to 41 years. The evidence from population-based surveillance is mixed, most such studies having failed to consider the benefit gained from improved therapy. It is concluded that we have reached the point of negligible benefit from mammography screening for breast cancer in women at average risk, and that we should concentrate on early diagnosis of breast cancer and the application of modern therapy according to clearly defined sub-types of breast cancer.

Keywords: Breast cancer; mammography; screening; treatment.

Is makeup bad for your skin?

Many people cover their face with makeup every day, potentially causing irritation. from

Health Check: is makeup bad for your skin?

September 4, 2017 12.27pm AEST


  1. Cara McDonald Consultant Dermatologist, St Vincent’s Hospital Melbourne

Disclosure statement

Cara McDonald consults to La Roche Posay.


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CC BY NDWe believe in the free flow of information

Makeup is an everyday item for many people and non-negotiable for some. Is it bad for our skin? As always, the answer is not clear-cut and depends on the individual, their skin type, and the products they use.

With an overwhelming choice of cosmetic products available, most people don’t even know where to start with makeup. Organic? Natural? Fragrance free? Hypoallergenic? Non-comedogenic? Paraben free? What does this all mean, and are they any better?

The term makeup generally describes the group of cosmetics that are used for beautification. Other cosmetics include products that are used to cleanse, treat or protect the skin and hair. These days, though, we commonly see all-in-one products, such as BB or CC creams, which combine makeup for coverage together with other ingredients to provide sun protection and skin benefits. Reducing the total number of products can be helpful for those with problematic skin, but may complicate things for some.

What does makeup do to our skin?

While in most cases makeup is harmless, certain products may cause problems for some individuals. It’s very important to use makeup and cosmetics that are suitable for your skin type or skin condition.

Skin types are broadly classified into four groups:

• oily – excess oil production, large pores, blackheads and acne prone

• sensitive – tight, stinging, intolerant to many products and prone to redness

• dry – dull, rough or flaky and prone to itchiness

• normal/combination – may be oily in the T-zone (forehead, nose and chin) but problem-free elsewhere

Although most people have a good idea of their basic skin type, they may fail to recognise the existence of an underlying skin disorder. Conditions such as eczema, contact dermatitis, rosacea and sun damage may cause inflammation and disruption of the skin barrier.

Inflammation causes itchiness or tenderness, redness, lumps and bumps, while barrier disruption results in tight, sensitive, dry and easily-irritated skin. These symptoms can be identical to those caused by reactions to cosmetics, and therefore should be considered before assuming makeup to be the cause. Conversely, an ongoing reaction to products being applied to the skin may explain why the skin is not responding to regular treatment.

Skin irritations can cause itchy, scaly red rashes. from

Skin problems caused by cosmetics

Acne cosmetica is a form of acne triggered by the use of certain cosmetic products. It is linked to certain ingredients that cause comedone formation (a blockage in the pore) and typically presents as small rash-like bumpy pimples. A common misconception is that the makeup physically blocks the pore, whereas actually the block is made of dead skin cells.

Read more: Health Check: why do I still get zits?

Mild inflammation results in excess skin turnover and clogging of the pore, with mineral oils being the most common culprit. It’s not always possible to determine makeup is the cause simply from the ingredient list, as it may be influenced by formulation, quantity and delivery methods.

Irritant dermatitis accounts for the majority of reactions to makeup and other cosmetic products. It can occur in anyone but is more likely in those with pre-existing sensitive skin or in those with underlying barrier disruption caused by a condition like eczema or rosacea. It typically causes an itchy, scaly red rash but can even blister or weep. Symptoms can occur immediately but may take weeks or even months to develop with weaker irritants, making it difficult to identify the cause.

Allergic contact dermatitis occurs when a person has become sensitised to an ingredient that has been applied to the skin. A red, itchy rash sometimes associated with swelling or blisters develops 12-48 hours after exposure, and may become chronic with ongoing use. The allergen can be very difficult to identify, because in some cases the product is used for months or years before sensitisation occurs.

People put many different products on their face, isolating a cause of irritation can be tricky. from

Are there ingredients we should avoid?

Fragrances and preservatives are the most common cause of contact allergy resulting from cosmetics. There are over 5,000 different fragrances used in skin care products, many of which are natural plant extracts and essential oils.

Other common allergens include preservatives, lanolin, coconut diethanolamide (a foaming agent) and sunscreen agents. Preservatives, such as parabens, formaldehyde and Quaternium-15 are required in all liquid products to stabilise them and prevent the growth of microbes. A common misconception is that natural and organic ingredients will not cause allergy or irritation, but in prone individuals these can in fact be quite problematic.

Unless you have a known allergy or sensitivity, there are no specific ingredients that everyone should avoid. But looking for hypoallergenic, fragrance-free and non-comedogenic products is wise. Those with an oily skin type or a history of acne should also limit oil-based cosmetics.

Read more: Explainer: what is eczema and what can you do about it?

Those with a sensitive or dry skin type, an underlying inflammatory skin condition or history of contact allergy should try to avoid irritants and potential allergens. Foaming agents, astringent products (such as toners that remove oils), scrubs and acids (such as alpha hydroxy acids used in acne and anti-ageing) tend to be irritating. Hypoallergenic formulations and those targeting sensitive skin are a good choice.

What should I do if I think I might have a reaction?

If you develop a new rash or skin irritation, the first thing to do is to try to confirm the diagnosis. If you suspect you are reacting to one of your cosmetics but not sure which, then ideally you need to stop using all your current products in the problem area. You should try to simplify your daily routine, choosing products that have been specifically formulated for sensitive and allergic skin.

If the problem settles, you can reintroduce your cosmetics one at a time to see whether you can identify the culprit. It’s a good idea to test each one in a small localised area on the neck or face for a week or two before using it all over the face. This process is known as a “repeat open application test”.

If you can’t get to the bottom of it or find cosmetics that don’t irritate your skin, you may need to seek professional help to rule out other skin conditions and formally test for allergies if warranted.

How to take care of your vulva.

How to take care of your vulva.

This is a repeat of a blog I posted 5 years ago, but I have re-posted this due to the importance of this information to women. .

Sep 22

Posted by Dr Colin Holloway

By Celia Shatzman May 7, 2015

How to take care of your vulva

When it comes to your lady parts, you probably don’t know as much as you think you do. “Many women don’t even know what the vulva is,” says Libby Edwards, MD, chief of dermatology at Carolinas Medical Center in Charlotte, North Carolina. “They call everything down there the vagina, but the vagina is the internal organ and the vulva includes the vaginal lips, clitoris, and the opening to the vagina.”

As a vulvar dermatologist (yes, that’s a thing) Edwards specializes in caring for women with chronic vulvar symptoms like itching, pain, rawness, painful sex, and chronic discharge. (For more on the specialty or to find one in your area, visit the National Vulvodynia Association at

Why see one? The vulva tends to be an area that a general dermatologist will bypass during routine skin checkups, says Cynthia Rasmussen, MD, FACOG, director of vulvovaginal services at Harvard Vanguard Medical Associates in the Boston area. But you don’t have to schedule an appointment with a specialist to get their top tips on caring for your skin down there—they’ve shared their knowledge, below.

You clean too well.
The vulva naturally secretes thick oils that protect its delicate skin from the secretions and friction it’s exposed to on a daily basis, Rasmussen says. Scrub off those oils with harsh cleansers (think body washes or douches with dyes, fragrance, or surfactants), and your vulva will be more prone to irritation, she says. Worse, you’ll remove the good bacteria that help maintain a healthy pH and make room for odor- and infection-causing bacteria to move in. So keep it simple and clean your vulva with warm water, by hand, then leave it be.

You use feminine hygiene products.
Products claiming to clean, deodorize, and groom the area are best left at the drugstore, Rasmussen says. The fragrances, dyes, chemicals, preservatives, and anti-itch anesthetics they contain aren’t necessary, and can cause allergic reactions. “Vulvar skin is extra sensitive because it’s thinner than skin on other parts of the body,” she explains. “Also, the vulva and vagina are hormone responsive tissues, and sensitivity goes up after menopause and may increase during parts of the menstrual cycle.” All you really need? You guessed it—water, Edwards says.

You haven’t discovered Vaseline.
Irritated vulva? Moisturize it, Edwards suggests. Just like other spots on your body, your vulva can get dry, even if you haven’t gone through menopause yet. But don’t reach for a regular body lotion, which are typically packed with drying alcohol and irritation-causing fragrances. Try a tiny dot of basic petroleum jelly, like Vaseline ($2,, which is free of fragrance, alcohol, and preservatives.

You don’t know how to deal with post-menopausal dryness.
Nearly every woman deals with some degree of vaginal dryness when she hits menopause. “Post-menopausal skin in the area is thinner, dryer, and more vulnerable to irritation,” Rasmussen explains. It can make sex hurt, predispose you to urinary tract infections, and cause urethral and bladder irritation. Luckily, vaginal moisturizers, available at drugstores, can help: “They help retain moisture, but are designed not to irritate the delicate mucous membrane of the vagina,” Rasmussen says. Still, it’s smart to look for an option with a simple ingredient list and dab just a small amount on your inner thigh to make sure it doesn’t cause burning or irritation before attempting full coverage.

You use fancy lubes.
Lube is a great option for women experiencing dryness, whether you choose water-based, silicone, or oil-based formulas, says Rasmussen. (Oil- and silicone-based lubes stay slippery indefinitely but can stain sheets and clothing, while water-based lubes wash off easily but can dry out and become sticky.) No matter which you prefer, avoid anything with dyes, perfume, fragrance, flavor, or ingredients that claim to give a tingling or warming sensation, all of which can be irritating. Yes certified organic personal lubricants ($7, come in both water- and oil-based versions made entirely of ingredients you can pronounce, like aloe, sweet almond oil, cocoa butter, and beeswax.

You’re using the wrong birth control.
Many women are allergic to latex or spermicides.

Many women are allergic to latex and spermicide, both of which are ingredients in most condoms. If you feel a burning sensation after using one, don’t brush it off. “Latex condoms can cause hives or rashes in women who are allergic to the material,” cautions Edwards. (If you suspect you’re allergic, try non-latex condoms made of polyurethane or polyisoprene.) But that’s not the only form of birth control that should be on your radar. “Some hormonal contraceptives, especially progesterone contraceptives such as Depo-Provera shots, can thin and dry the vagina, making sexual activity uncomfortable,” she adds. If you have sensitive skin or notice an increase in dryness, talk to your doctor about alternative birth control options.

You wear pretty lingerie.
“The way thongs rub your skin can cause tissue irritation,” says Rasmussen. “In general, you’re best off with full-coverage unbleached 100% cotton underwear.” Those with sensitive skin can have reactions to dyes and synthetic fabrics, and the elastic can aggravate women with rubber allergies. But you don’t have to stop wearing pretty little things in the name of health: all of Knock Out’s lacy, colorful underwear have a 100% cotton, dye-free liner (from $19,

You shave (or wax, or use depilatories).
Waxing incorrectly could burn the vulva.

“Most of us store our razor in the shower, a warm, moist environment where bacteria can multiply,” says Rasmussen. “That’s a recipe for infection the next time you nick yourself.” But you don’t have to entirely nix your razor: Just use a natural shaving lotion like Pacific Shaving Company All Natural Shaving Cream ($8,, which contains none of the irritating chemicals and fragrances found in traditional foams, and use a brand new blade each time you shave (try buying disposables). Alternative hair removal methods can get you into trouble, too: “The harsh hair-dissolving chemicals in depilatories are very irritating to the sensitive vulvar skin,” Rasmussen explains. Waxing, if done incorrectly, can also be risky because it’s possible to burn the skin. Your safest bets: laser hair removal or trimming hair with small scissors. (Read these 13 things you need to know before your next bikini wax.)

Your laundry smells amazing.
“When someone comes to me with distressed skin, I immediately ask them what they wash their clothes in,” says Rasmussen. That’s because laundry detergent with dyes and perfumes can irritate delicate vulvar skin. Choose detergents that don’t contain dyes and perfumes, and skip fabric softeners and dryer sheets, which are loaded with irritating chemicals. Look for detergents labeled “Free and Clear”, which means they don’t contain dyes or perfumes. One to try: Gentle Extra-Softening Pureturgent Liquid Detergent ($10,, an unscented, biodegradable formula with aloe vera.