Your Health - October 2023

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plus articles on Menopause and Dyslexia

In this issue, our team of physiologists and physiotherapists give their top tips for back care, including preventing problems from arising in the first place, with posture and work-related advice in support of Back Care Awareness Week. In support of Dyslexia Awareness Week, our Workplace Adjustments and Neurodiversity team take a look at what dyslexia is and what reasonable adjustments you may wish to consider at work to help you be at your best. And we start the issue off a detailed article on menopause. Enjoy!

Menopause

The menopause literally means the last menstrual period. Perimenopause means “around menopause” and refers to the time during which a woman’s* body makes the natural transition to menopause, marking the end of the reproductive years.

Natural menopause is recognised to have occurred after 12 consecutive months of no periods, for which there is no other obvious pathological or physiological cause. Menopause happens from the final menstrual period known with certainty, only in retrospect a year or more after the event.

Physiologically, it is characterised by a change in hormones: oestrogen levels diminish, and there is an increase in the production of certain ovarian stimulating hormones such as Follicular Stimulating Hormone (FSH).

An adequate biological marker (blood test) for the event does not exist; however, the National Institute of Clinical Excellence (NICE) recommends measuring the levels of FSH in women aged 40 to 45 years with menopausal symptoms, including a change

in their menstrual cycle, and in women aged under 40 years with whom menopause is suspected. For healthy women over the age of 45 years with menopausal symptoms, the menopause can be diagnosed without a blood test.

On average, the menopause occurs at 51 years of age in the UK, although it can vary between 40 and 58 years of age and it is slightly earlier among smokers by about two years. Sometimes it may be difficult to define precisely when the menopause occurs, especially if the woman begins to take hormone replacement therapy during the menopause.

Menopausal symptoms are thought to affect around two thirds of women and some 10- 20% describe the symptoms as distressing. The duration and severity of symptoms varies and cannot be predicted.

The effects of the menopause may be considered in terms of:

n Vasomotor symptoms/hot flushes

n Psychological effects

n Urogenital disease

n Cardiovascular disease

n Osteoporosis

n Breast disease.

VASOMOTOR SYMPTOMS: An uncomfortable hot flush or feeling of warmth. It affects up to 85% of menopausal women but fewer than half are seriously disturbed by them. About 20% of women first notice symptoms while they are still menstruating regularly. The flush may be accompanied by nausea and sweating and be followed by a chill and palpitations.

Symptoms can be particularly troublesome at night interfering with sleep.

For most women, flushes are brief, improve within a few months and resolve within about five years, as the body adapts to the new level of oestrogen. In 90% of cases, hormone replacement therapy (HRT) will relieve symptoms and other medications can also be effective.

PSYCHOLOGICAL SYMPTOMS: a wide variety of psychological symptoms are noted in menopausal women, including irritability, confusion, lethargy, memory loss, loss of libido and depression. It is uncertain whether these are primary effects of oestrogen deficiency or simply manifestations of other processes. Insomnia, for example, is probably due to night sweats.

In general, a trial of HRT may be beneficial before a woman is prescribed specific psychological medication, e.g. antidepressants.

UROGENITAL SYMPTOMS: the vagina, urethra and bladder are oestrogendependent and gradually atrophy/waste away after the menopause. The absence of oestrogen results in thinning of the vaginal skin, resulting in painful intercourse and bleeding, an increased risk of infection and a reduced elasticity of the bladder, which produces urinary frequency, urgency and pain.

Treatment is with a topical oestrogen cream or a short course of oral oestrogen replacement. Vaginal bleeding after menopause is an ominous sign and you should speak to your GP as soon as possible.

CARDIOVASCULAR DISEASE: this is unusual in women before the menopause, but post- menopausal women are at much higher risk. This is thought to be due to the withdrawal of the protective effect of oestrogen, although this explanation is not universally accepted. Around the menopause, many women experience obesity, high blood pressure and a rise in cholesterol levels; collectively these will

contribute to the risk of cardiovascular disease.

POSTMENOPAUSAL OSTEOPOROSIS: during and after the menopause women are at an increased risk of bone fractures and osteoporosis.

BREAST DISEASE: the risk of breast cancer increases with age but the rate of increase slows after the menopause. A woman who has a menopause in her late 50s has twice the risk of developing breast cancer as one whose menopause occurred in her early 40s.

TREATMENT: despite the controversy surrounding the risks and benefits, HRT is the mainstay of treatment in this condition.

The following can, however, be used as alternative therapies to HRT in the management of menopause symptoms:

n Lifestyle measures: regular, sustained aerobic exercise can improve several menopause-related symptoms. Avoidance/reduction of alcohol and caffeine intake may also help to reduce the severity and frequency of hot flushes

“Cognitive behavioural therapy may help to alleviate low mood or anxiety.”

n Pharmacological alternatives: certain medications, which need to be prescribed by a GP, can help to reduce hot flushes

n An injection of local anaesthetic into the collection of nerves in the lower end of the neck can be effective against hot flushes and sweating where a person cannot take HRT/other treatments don’t work

n Diet and supplements: calcium and vitamin D supplements and exercise for prevention of osteoporosis

n Complementary therapies: the efficacy and safety of these are not proven and some may be possibly harmful, so it is best to speak with your GP before using these

n Psychological support: cognitive behavioural therapy may help to alleviate low mood or anxiety that arises because of menopause.

HRT: this aims to replace oestrogen in postmenopausal woman and so reverse the adverse effects of lack of oestrogen. The aim is to improve a woman’s quality of life. The appropriate type of HRT depends on several factors: whether or not an individual has had a hysterectomy, the woman’s menopausal status (perimenopausal versus postmenopausal), preference for type of treatment (oral versus non-oral) and the individual’s past medical history and current prescribed medication.

SOME ASSOCIATED RISKS

BREAST CANCER: A new study has shown that an increased risk of breast cancer with HRT is similar, whether HRT is taken orally or delivered via patches or gels or implants. There is no increased risk of breast cancer associated with the use of intravaginal preparations.

In the UK, about one in 16 women who never use HRT are diagnosed with breast cancer between the ages of 50 and 69 years. This is equal to 63 cases of breast-cancer per thousand women.

Over the same period (ages 50 to 69 years), with five years of HRT use, the study estimated that there would be about five extra cases of breast cancer per thousand women using oestrogen only HRT, about 14 extra cases for women using oestrogen combined with progestogen for part of each month (sequential HRT) and about 20 extra cases for women using oestrogen combined with daily progestogen HRT continuously (continuous HRT)

The numbers of extra cases of breast cancer above would approximately double if HRT was used for ten years instead of five. In other words, the risk of breast cancer increases further with longer duration of HRT used.

CARDIOVASCULAR DISEASE (HEART DISEASE

AND STROKE): If you start HRT before you are 60, it does not increase your risk of cardiovascular disease. However, HRT tablets (but not patches or gels) slightly raise the risk of stroke. The presence of cardiovascular risk factors is not a contraindication to taking HRT, as long as the risks are optimally managed

BLOOD CLOTS

(VENOUS

THROMBOEMBOLISM): Postmenopausal hormone therapy has been associated with an increase in the risk of venous thromboembolism (including deep-vein thrombosis and pulmonary embolism/clots on the lungs.

UTERINE DISEASE: unopposed oestrogen replacement therapy is associated with an increased incidence of uterine carcinoma.

Side effects of HRT include:

n Nausea and breast tenderness;

n Weight gain and fluid retention;

n Premenstrual syndrome type symptoms;

n Headaches;

n Bloated sensation;

n Leg cramps;

n Very occasionally, there may be an increase in blood pressure.

TESTOSTERONE THERAPY: testosterone is an important female hormone. Approximately half of the testosterone made by women is derived from the ovaries and half from the adrenal glands. Testosterone levels naturally decline throughout a woman’s lifespan.

Testosterone contributes to libido, sexual arousal and orgasm and also helps to maintain normal metabolic function, muscle and bone strength, urogenital health, mood and cognitive function. Reduced levels of testosterone in women can lead to a number of distressing sexual symptoms and can also contribute to a reduction in general qualityof-life, tiredness, depression, headaches, cognitive problems and osteoporosis.

NICE recommends that testosterone replacement in menopausal women is used if HRT alone is not effective. Testosterone gel is used in this setting.

If you would like more information on the menopause, please visit www.imsociety.org/

“NICE recommends testosterone replacement if HRT alone is not effective.”

“The key to back pain is prevention – it is not an inevitable part of life.”

Back Care Awareness

60% of people will have back pain at some point in their lifetime. Whilst most episodes improve without assistance after 6-12 weeks, 20–30% of those with back pain will develop chronic symptoms lasting more than three months.

Arthritis Research UK estimates that nine million people in England live with back pain and it is the leading cause of disability in the UK.

So why do we get it and more importantly how can we take care of our backs to prevent it?

Most back pain is caused by the microrepetitive movements we do every day – slumped posture when sitting, frequent forward bending, sedentary lifestyles, being overweight and smoking, all of which, over time, affect the structures in the back and set of the pain cycle. Heavy lifting or manual work can also lead to back pain.

Structures such as muscles, ligaments, discs and nerves can all be affected, setting off the chemical pathway that results in pain. Even when the structural injury has recovered, the pathway can continue, leading to chronic pain.

Age-related changes such as osteoarthritis, stenosis or osteoporosis can also cause back pain. Less commonly, spinal infection, cancer or referred pain from internal organs can also cause back pain. This is why your physiotherapist or doctor will ask so many questions during a consultation, in order to get a clearer idea as to what is causing your pain and the best way to manage your symptoms.

TREATMENTS FOR BACK PAIN

Acute back pain, with no ‘red flag’ symptoms, can be easily managed with over-the-counter pain killers, ice or heat to the affected area and gentle exercise.

If you have sudden onset of severe pain, pain or numbness/tingling in both legs or changes to your bowel or bladder symptoms, please seek urgent medical care at your local hospital.

n Otherwise, try to stay active and continue with your daily activities.

n Take anti-inflammatory medicine, like ibuprofen, if you able to do so – paracetamol on its own is not recommended for back pain, but it may be used with another painkiller.

n Use an ice pack (or bag of frozen peas) wrapped in a damp cloth to reduce pain and swelling.

n Use a heat pack (or hot water bottle) wrapped in a tea towel to relieve joint stiffness or muscle spasms.

n Try doing some exercises and stretches for back pain such as these Exercises to help with back pain | NHS inform.

HOW TO LOOK AFTER YOUR BACK

The key to back pain is prevention – it is not an inevitable part of life.

Daily exercise such as walking, cycling or swimming, strength training, good posture when sitting, good sleep hygiene, managing stress, keeping a normal weight and avoiding smoking are all keys to preventing or reducing the risk of back pain.

If you work in a desk-based role, a DSE self-assessment can help identify any problems with your set-up or as per your organisation’s DSE policy. It is important that you take regular breaks away from your desk throughout your working day and discuss any discomfort you may be having with your line manager.

Sources

n Prevalence | Background information | Back pain - low (without radiculopathy) | CKS | NICE

n The State of MSK Health 2021 (versusarthritis.org)

n https://www.nhsinform.scot/illnessesand-conditions/muscle-bone-and-joints/ exercises/exercises-for-back-pain

n Campbell, J. and Colvin, L.A. (2013) Management of low back pain. BMJ 347.

Dyslexia Awareness

WHAT IS DYSLEXIA?

Dyslexia is a unique way of processing information. It is estimated that as many as 1 in 10 people may be dyslexic, meaning it is a fairly common. Rather than viewing it as a learning difficulty, we embrace the concept of the neurodiversity movement, recognising that dyslexic minds function in distinct and valuable ways.

Dyslexia primarily impacts areas such as reading, writing, spelling, and verbal information processing. However, it's important to note that dyslexia extends beyond literacy skills, influencing broader aspects like working memory and verbal information processing. It is estimated that up to one in every ten people in the UK have some degree of dyslexia.

Dyslexic individuals possess a wide range of strengths and talents that should be acknowledged and celebrated. Their unique perspectives and thinking styles often bring valuable contributions to various fields.

Creativity and ingenuity are commonly observed strengths among dyslexic individuals. Their ability to think outside the box and approach problems from unconventional angles can lead to innovative solutions. Moreover, dyslexic individuals often excel in visual and creative domains, utilising their vivid imaginations and visual thinking skills to excel in areas such as art, design, and other visual mediums.

It is important to note that dyslexia does not affect a person's intelligence. A dyslexic individual can have the same intellectual capabilities as anyone else. Dyslexia is considered a neurological difference, meaning it is rooted in the brain's functioning. This can impact education, employment, and daily life. However, it is crucial to recognise that each person's experience with dyslexia is unique. The

severity of dyslexic symptoms can vary from mild to severe, and it can co-occur with other learning differences or conditions.

Family history often plays a role in dyslexia, suggesting a genetic component. It is a lifelong condition that requires ongoing support and understanding.

By acknowledging the impact dyslexia can have and promoting inclusive practices, we can create environments that empower dyslexic individuals to thrive and reach their full potential.

WHAT ARE THE SYMPTOMS OF DYSLEXIA IN ADULTS?

It's important to celebrate the uniqueness of each dyslexic individual and understand that their experiences are shaped by their own set of strengths and challenges.

While these experiences can vary, there are some common signs that may indicate dyslexia.

Take a look at the column on the right for some symptoms associated with dyslexia in adults.

DO YOU:

n Confuse visually similar words such as cat and cot;

n Spell erratically;

n Find it hard to scan or skim text;

n Read/write slowly;

n Need to re-read paragraphs to understand them;

n Find it hard to listen and maintain focus;

n Find it hard to concentrate if there are distractions;

n Feel sensations of mental overload/ switching off;

n Have difficulty telling left from right;

n Get confused when given several instructions at once;

n Have difficulty organising thoughts on paper;

n Often forget conversations or important dates;

n Have difficulty with personal organisation, time management and prioritising tasks;

n Avoid certain types of work or study;

n Find some tasks really easy but unexpectedly challenged by others;

n Have poor self-esteem, especially if dyslexic difficulties have not been identified in earlier life.

Take a look at the adult dyslexia checklist for a more detailed list.

You can also speak to your OH department or GP to find out more about dyslexia screening, which gives an indication of dyslexia and assessment, which is a formal identification.

“As each person is unique, so is everyone's experience of dyslexia.”

WHAT TO DO IF YOU ARE DIAGNOSED WITH DYSLEXIA

Dyslexia is covered by the Equality Act 2010, and as such employers have a legal duty to ensure employees are not discriminated against. Employers must make reasonable adjustments to the workplace to enable the member of staff to carry out their role to a satisfactory standard.

You do not need to have had a diagnostic assessment in order for reasonable adjustments to be put in place in the workplace. A workplace needs assessment will help to determine the reasonable adjustments which will best support you.

REASONABLE ADJUSTMENTS EXAMPLES:

Reading and writing:

n Be given verbal and written instructions;

n Use screen-reading software;

n Important points in documents are highlighted for you;

n Voicemail may be used rather than written memos;

n Printed resources on coloured paper or background colours of computer screens and presentations changed to allow for easier reading;

n Be given plenty of time to read and complete a task;

n Materials are discussed with you, highlighting summaries and/or key points;

n Information presented in other formats e.g. audio or video, drawings, diagrams and flowcharts;

n Mind-mapping software provided;

n Digital recorders provided;

n Speech-to-text software provided;

n Ask someone else to take the minutes of meetings.

Spelling and grammar:

n Spell checker on all computers;

n Assistive text software on all applications provided, where possible.

Computer work:

n Try different fonts to find what's most readable for you (e.g. Open Dyslexic);

n Change the background colour of your screen to suit your preference;

n Use screen-masking options to reduce eye strain;

n Anti-glare screen filter provided;

n Be allowed frequent breaks, at least every hour;

n Alternate computer work with other tasks where possible;

n Avoid continuous all day computer work.

Task planning:

n Create a daily task plan to stay organised and reduce stress;

n Consider colour-coding dccuments,

folders or calendars to enhance visual organisation;

n Divide complex tasks into smaller, more manageable steps.

Verbal communication:

n Be given instructions one at a time, slowly and clearly without distractions;

n Important information is written down;

n Be provided with a plan of action;

n Digital recorder to record presentations/ training provided;

n Opportunity to check understanding.

Concentration:

n Be allocated a private workspace if possible;

n Be allowed to work from home if appropriate/possible;

n Be provided a quiet space away from distractions;

n Use a “do not disturb” sign when tasks require intense concentration.

Communication with Colleagues:

n Share your dyslexia-related needs with colleagues;

n Foster understanding and support in the workplace.

Appointments and deadlines:

n Be reminded of important deadlines and encouraged to review priorities regularly;

n Be encouraged to use a daily calendar and alarm features on your computer or work phone.

Sources

• www.nhs.uk/conditions/dyslexia/

• www.bdadyslexia.org.uk/

NEXT ISSUE:

n Diabetes / Heart Health

n Seasonal Affective Disorder

n Alcohol Awareness

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Our commitment is total. We invest in our services, creating new ones and keeping in step with every client. We constantly explore new ways of working and make no compromises in the quality of our services.

Simply put, we are here to help people be their best.