16 Older Women’s Health Women are living longer, staying healthier longer and enjoying a better quality of life than ever before. However, there are still some health conditions which concern older women especially. Most of these can be treated easily if caught early enough. By knowing more about what to look for and what to do if you experience any symptoms, you will have a better idea of when to seek help and how to take care and protect yourself. Contents Section 1. Staying fit and healthy Section 2. Health services Section 3. Menopause Section 4. Vaginal dryness Section 5. Health conditions – Osteoporosis – Pelvic order prolapse – Cancer – Incontinence – Cystitis – Thrush – Depression Section 6. Useful contacts ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Section 1. Staying fit and healthy Taking better care of yourself is important and, after a busy lifetime of work, childcare or raising a family, people deserve to enjoy their retirement to the full. Having a healthy mind and body will help you to do this. There are many things you can do to improve your mental and physical health and it’s never too late to start. Giving up smoking Everyone knows that smoking is not healthy so the most effective thing you can do to improve your health is to stop. However, it can be difficult, especially if you’ve been smoking for a long time but, if you can, you will be able to feel the benefits very quickly. There is a lot of help available for people who want to stop smoking and NHS treatment is free. If you need help, visit your doctor or contact one of the organisations listed in the Useful contacts in section 6. Eat healthily and controlling your weight Maintaining a healthy weight may reduce the risk of many chronic diseases. It may also help you move better, stay mentally active and help you fight off minor illnesses such as colds. It is very important that you eat a healthy diet in order to remain as healthy as possible. Eating a poor diet can make you feel tired and depressed. Healthy eating, however, doesn’t mean that your meals will be boring – you should eat a variety of different foods and enjoy what you eat. For more information on eating well, see our free advice leaflet, Healthy Eating. Take regular exercise Whatever your age exercising is important if you want a healthy lifestyle. It will help you to maintain or lose weight if you need to, protect your heart, keep your bones and muscles healthy and help you to relax and sleep better. Exercising doesn’t have to be a chore, it can be fun and enjoyable. If you are not used to taking regular exercise though, you should start slowly and build up gradually. Make sure you talk to your doctor before you start exercising, especially if you have an existing medical condition such as heart disease or arthritis. For more information about staying fit, see our free advice leaflet, Keeping Mobile and our free information sheet no. 25, Leisure Ideas, which has information about different types of exercise including finding clubs and keep fit classes. Help the Aged produces a book of graded exercises called Exercise for Healthy Ageing, which is priced at £4 plus postage and packing. We also produce a video called Be Strong, Be Steady which features a range of chair-based and standing exercises for people with mobility difficulties and a video/DVD called Step to the Future which is for people who are more mobile. Both feature a range of aerobic endurance and strength exercises designed specifically for older people. Both the videos and the DVD cost £12 plus postage and packing each. Contact Help the Aged Publishing Department; tel: 020 7239 1946; web: www.helptheaged.org.uk/en-gb/WhatWeDo/Publications/ Drinking alcohol Drinking alcohol is a good way to socialise and relax but drinking too much can be harmful. If you regularly drink more than the Government’s recommended daily limits, your risk of developing many conditions, including heart disease, liver and digestive problems, a stroke and cancer, will be increased. You will also be at more risk of having an accident. For a woman, the sensible drinking limits are two to three units a day. A glass of wine is the equivalent of two units of alcohol whilst one unit is half a pint of standard strength beer or lager or a pub measure of spirits. You should try not to drink alcohol every day as this is bad for you too. If you are taking regular medication you should check with your doctor to make sure that it is safe for you to drink alcohol. If you need more information about sensible drinking or alcohol misuse, contact the organisations listed in the Useful contacts in section 6. Avoiding falls and accidents Falls and accidents can result in serious injury or disability. As you get older, changes such as worsening sight or hearing combined with slower reaction times can make even the most everyday activities less safe. These changes may happen so slowly over time that it may not be noticeable until you have a fall or an accident. But it is never too late to take action to prevent falls. Taking regular exercise can improve your strength and balance and reduce the risk of falling and hurting yourself. For more information about avoiding falls, see our free advice leaflet, Staying Steady. Try to avoid accidents by taking precautions and being careful at home: for example, make sure that trailing wires are tucked away safely, and rugs and carpets are secure. For more information about staying safe and avoiding accidents see our free advice leaflets, Fire, Your Safety and Your Security. Looking after your mental health Feeling fit, mentally and emotionally, can help you cope better with day to day living. Try to keep yourself busy by getting out and about and relax by listening to music, reading, doing puzzles and crosswords, and socialising with friends. Going to the local shops, visiting the hairdresser or walking the dog can help you feel more positive. Even if you are not as active as you used to be or if health problems make it more difficult for you to go out, there are still plenty of things you can do at home to keep yourself occupied. For more information about leisure ideas, see our free information sheet no. 25, Leisure Ideas. If you are finding it difficult to cope or you are feeling sad or depressed you could talk to a friend or relative, or visit your doctor. For more information, see our free information sheet no. 11, Beating the Blues, or contact one of the organisations listed in section 6. ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Section 2. Health services Whilst many women continue to enjoy good health in later life, it is still important that you are registered with a local doctor. You may not have any health problems at the moment but if there is an emergency, you may need to call out your doctor. If you have health problems, you may need to be referred to another service: for example, chiropody or occupational therapy. If you feel unwell, you should never ignore symptoms and think they will go away. If you don’t feel comfortable about going to see your doctor, because you would be embarrassed by seeing a male doctor or because you don’t want to seem like a nuisance, you could consider: * arranging to see the practice nurse instead of the doctor; * seeing a female doctor at the same practice if your own doctor is a man; * going to a different doctor at a new surgery; * finding out if there is a Well Woman Clinic at your surgery; or * taking up the offer of an ‘over 75s check’, if there is one at your practice, where you will be able to discuss your health with a practice nurse. For more information about finding a doctor or other health services, see our information sheet no. 30, Your Health Services: Where to Start. ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Section 3. Menopause All women go through the menopause at some time in their life. You may have already experienced this but, if you are still going through the menopause, the decision on how you manage it depends on a number of factors including your age, any symptoms you may have and how these affect your quality of life. Symptoms can include: * irregular, lighter or heavier periods * hot flushes * night sweats * insomnia * palpitations * mood swings * vaginal dryness * headaches. Hormonal treatments Hormone Replacement Therapy (HRT) is the artificial replacement of the female hormones oestrogen and progesterone in women who are going through the menopause. HRT can help to reduce the symptoms of the menopause, but it can also have serious side effects. You should discuss the risks and benefits fully with your doctor before making a decision on whether to take HRT. You should also talk to your doctor if you have a family history of breast cancer. Non-hormonal treatments Eating a healthy diet, stopping smoking and taking regular exercise can be beneficial if you are going through the menopause. If you are experiencing hot flushes you may find it helpful to avoid some foods and drinks such as alcohol, hot or spicy food and caffeine. You could also try avoiding warm environments and wearing breathable, cotton clothes instead of synthetics such as nylon and polyester. There are several herbal treatments such as soya, black cohosh and agnus castus available which may also help. You could ask at your pharmacy about non-hormonal treatments for menopause symptoms. However, make sure you speak to your doctor before taking any herbal treatments. Herbal products can interfere with other, prescription medicines you may be taking. ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Section 4. Vaginal dryness Vaginal dryness is something which mainly affects women after the menopause. One in two women is affected in some way and as many as seven in ten women aged over 70 have some symptoms. It is mainly caused when the ovaries stop producing oestrogen after the menopause. Common symptoms can include: * soreness and discomfort * infection with a smelly, unpleasant discharge * itching * urinary problems * pain when having sex. If you notice any of these symptoms you should go to see you doctor as there are several treatments available which may help. ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Section 5. Health conditions Women can experience a wide range of health problems. In this section we focus on the most common conditions and concentrate on those which mainly affect women only. It looks at the symptoms of the conditions, what you can do to help yourself and where to get further help and support. The Useful contacts in section 6 contains details of helpful organisations for all the conditions mentioned in this information sheet as well as for some other conditions common to older people. Osteoporosis Osteoporosis mainly affects women after the menopause. In the UK one in two women over the age of 50 will experience a fracture. The first sign of osteoporosis is often when a minor bump or fall causes a bone fracture. This may result in pain, disability, loss of independence, and, in some instances, death. Osteoporosis may cause people to 'shrink' as they get older. If you start experiencing unexpected fractures after minor falls or bumps, go to see your doctor who will be able to send you to a hospital for specialist assessment. As well as an examination and blood tests, there are a variety of tests which can give you a more definite assessment of your bone density. Once you have been tested the specialist will be able to tell you whether you have osteoporosis, or are at risk, and will suggest treatments. You can lessen the risk of getting osteoporosis by: * taking regular weight-bearing exercise – brisk walks, at least three times weekly can help, as can other forms of weight bearing exercise, such as dancing, keep fit classes and running; * maintaining a steady body weight and avoiding extremes such as being under or overweight; * eating a balanced calcium-rich diet. See our free advice leaflet, Healthy Eating; * avoiding excess alcohol and caffeine; and * giving up smoking. For more information see our free advice leaflet, Healthy Bones. Pelvic Organ Prolapse Pelvic organ prolapse is a very common condition, particularly amongst older women. It's estimated that half of women who have had children will experience some form of prolapse in later life. The symptoms of pelvic organ prolapse include: * bladder and/or bowel incontinence * feeling a lump or heavy sensation in the vagina * lower back pain that eases when you lie down * pelvic pain or pressure * pain or lack of sensation during sex. If you have any of the symptoms of a prolapse, particularly if you can see or feel something near or at the opening of your vagina, go to see your doctor. One of the most effective things you can do to reduce your risk of a prolapse is to exercise your pelvic floor muscles. Doing regular pelvic floor exercises throughout your adult life helps to keep the muscles toned and strong. See our free advice leaflet, Bladder and Bowel Weakness, for more information about pelvic floor exercises. If you are significantly overweight, try to lose weight; this will remove some of the pressure from your pelvic area. If you smoke, try to cut down or stop, as this will help reduce strain when you cough. Don't lift heavy objects; this can damage your pelvic muscles. Eat a diet high in fibre: for example, fresh fruits, vegetables and bran, to help prevent constipation and reduce straining. For more information on how to maintain a balanced diet, see our free advice leaflet, Healthy Eating. Cancer Breast cancer Breast cancer is common amongst women of all ages but 80 per cent of cases occur in women after the menopause. The earlier it is found and treatment begins, the better. The main symptoms of breast cancer include: * a lump in the breast * breast pain * nipple discharge * changes in appearance or how your breasts feel * dimpling. You should examine your breasts regularly, once a month is recommended. Always do your examination at the same time each month. You need to become familiar with how your breasts look and feel so you can spot changes more easily. If you are unsure about how to do a self examination, your doctor or practice nurse, or a Well Woman Clinic can show you how to do this. You should also have regular mammograms (an examination of the breast by xray) – ask your doctor about this. Mammograms are currently available to all women aged between 50 and 70. If you are aged 70 or over you can continue to have regular screening by making your own appointments at the breast screening clinic. The Department of Health produces a publication called Over 70? You are still entitled to breast screening. This leaflet explains that women over 70 are entitled to request breast screening every three years. It explains the risks of breast cancer and encourages older women to be breast aware. Contact the Department of Health publication orderline: 08701 555 455; web: www.cancerscreening.nhs.uk Don't worry about making a fuss, and do remember that most breast changes will not be cancer, even if they need treatment or a follow-up appointment. Ovarian Cancer Ovarian cancer mainly affects women after the menopause – 90 per cent of cases occur in women who are over 45. The symptoms of ovarian cancer are not easy to identify but things to watch out for include: * frequent or unusual indigestion, bloating or nausea * unusual vaginal bleeding * pelvic or stomach discomfort. If you experience any of these symptoms you should go to your doctor. You can ask your doctor for an annual pelvic examination. Genetic screening is also available if two close female relations, including your mother, have had ovarian cancer as you may be at a greater risk. Cervical Cancer Whilst cervical cancer is most likely to occur in women between the ages of 25–65, it can occur later. Just like breast cancer, the earlier it is found and treatment started, the better the outcome can be. The main symptoms you should watch out for include: * bleeding after the menopause * bleeding after sex * unpleasant smelling vaginal discharge. If you notice any of these symptoms you should go to your doctor immediately. You may need to have a smear test. Women over 65 are not normally given regular smear tests unless their previous three tests were not clear or if they have never been tested. For more information about cervical cancer or smear testing contact NHS Direct on 0845 46 47 (in Scotland: call NHS 24 on 08454 24 24 24; in Northern Ireland contact your regional health and social services board, its contact details are in section 6). Incontinence Up to six million people in the UK have difficulty controlling their bladder but urinary incontinence is more common in women. Urinary incontinence can also be a sign of diabetes or may be as a result of a urine or bladder infection, or constipation. Symptoms can include: * leaking urine * a sudden, urgent need to go to the toilet * not always reaching the toilet in time * needing to get up and go to the toilet during the night. You may also experience bowel incontinence which can include having difficulty controlling your bowels or leaking from the back passage. A lot can be done to improve or even cure incontinence. If you experience any of the symptoms, you should go to see your doctor. You may be referred to see your local continence adviser who will be able to offer advice and support. For more information on incontinence, treatment and self-help, see our advice leaflet, Bladder and Bowel Weakness. Cystitis Many women experience cystitis or candida after the menopause. The first time you have cystitis you should see your doctor for advice. If you go on to have cystitis more than three times in one year, you should see your doctor again. Symptoms of cystitis can include: * pain, burning or stinging sensations when passing urine,  * a need to urinate frequently and urgently, but only passing small amounts,  * urine which is dark, cloudy, strong smelling or contains traces of blood, and  * pain directly above the pubic bone, or in the lower back or abdomen. Older women may have none of these symptoms, but may just feel generally unwell, weak and feverish. Mild cystitis will usually go away by itself in 2–4 days. If it doesn’t, you should go to see your doctor. Your doctor may give you a short course of antibiotics. The symptoms should start to improve after the first day of treatment. If your symptoms do not improve, go back to your doctor. If you have cystitis you should drink plenty of water – drinking at least two litres of fresh water per day is generally good for your health. You should also avoid alcohol. Drinking cranberry juice may also help prevent cystitis coming back, and some people use it to relieve the symptoms of an attack. Over-the-counter painkillers such as paracetamol or ibuprofen can also be taken to reduce discomfort. Thrush Thrush, also called a yeast infection or candidiasis, is an overgrowth of yeast that leads to a range of symptoms, such as itching and soreness around the vagina. Most women will have thrush at least once during their lives, and many will have more than one episode. But for some women, thrush keeps coming back. Even if you only have thrush once, it can be extremely uncomfortable. The symptoms of thrush include: * itching and burning * soreness * swelling of the vagina and vulva (outer area of the vagina) * a yeasty-smelling discharge. If you suspect that you have thrush, you should see your doctor. You can relieve the symptoms by wearing cotton pants and loose fitting clothes and using un-perfumed deodorants, soaps and bubble baths. Depression As you get older there are many things which can affect your mood. These can include stopping work and being at home all day or your husband or partner stopping work and getting ‘under your feet’; losing contact with friends and colleagues when you stop work; getting a physical illness which is difficult to cope with or losing old friends or family. Whilst it is normal to be sad about things like this, sometimes sadness can not be shaken off and becomes very intense, which can be a symptom of depression. Common symptoms of depression can include: * low energy * changes to your sleep pattern * difficulties concentrating * poor memory * lack of interest in sex. Although depression is common, it is not inevitable and you should not have to just put up with it. If you think that you are depressed, go to see your doctor, as there are effective treatments available. You might also want to talk to someone else or contact one of the organisations listed in the useful contacts in section 6. You could also contact the Samaritans on 08457 90 90 90. Its helpline is available 24 hours a day, seven days a week. For more information about depression and how to deal with it see our free information sheet no. 11, Beating the Blues. ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Section 6. Useful contacts Arthritis Arthritis Care 18 Stephenson Way London NW1 2HD Tel: 020 7380 6500 Helpline: 0808 800 4050 Web: www.arthritiscare.org.uk Cancer Breast Cancer Care 5-13 Great Suffolk Street London SE1 0NS Tel: 0808 800 6000 Textphone: 0808 800 6001 Web: www.breastcancercare.org.uk Cancerbackup 3 Bath Place Rivington Street London EC2A 3JR Helpline: 0808 800 1234 Web: www.cancerbackup.org.uk Jo's Trust Weedon Villa Everdon Northamptonshire NN11 3BQ Tel: 01327 341965 Web: www.jotrust.co.uk This organisation provides information about cervical cancer and a confidential medical enquiry service. The website has a "Let's Meet" public forum, where you can exchange experiences and information with other women who have cervical cancer. Ovacome 1st Floor Butler House 177-178 Tottenham Court Road London W1T 7NY Tel: 0845 371 0554 Web: www.ovacome.org.uk A support group for women with ovarian cancer and their families and friends. It runs a patient to patient telephone network for emotional support and encouragement. It also publishes a newsletter and has a website with more information about ovarian cancer. Cystitis and Thrush (candida) National Candida Society PO Box 151 Orpington Kent BR5 1UJ Tel: 01689 813 039 Web: www.candida-society.org The National Candida Society runs local support groups, publishes a newsletter, and keeps a register of practitioners specialising in candida. Depression Depression Alliance Suite 212, Spitfire Studios 63–71 Collier Street London N1 9BE Tel: 0845 123 2320 Web: www.depressionalliance.org Mind Granta House 15–19 Broadway London E15 4BQ Helpline: 0845 766 0163 Web: www.mind.org.uk Drinking Alcoholics Anonymous PO Box 1 10 Toft Green York YO1 7NJ Helpline: 0845 769 7555 Web: www.alcoholics-anonymous.org.uk Drinkline The National Alcohol Helpline Helpline: 0800 917 8282 Heart Disease British Heart Foundation 14 Fitzhardinge Street London, W1H 6DH Tel: 020 7935 0185 Heart Information Line: 0845 070 8070 Web: www.bhf.org.uk Incontinence The Continence Foundation 307 Hatton Square 16 Baldwins Gardens London EC1N 7RJ Helpline: 0845 345 0165 Web: www.continence-foundation.org.uk Incontact Satra Innovation Park Rockingham Road Kettering Northamptonshire N7 9DP Tel: 0870 770 3246 Web: www.incontact.org Menopause The Amarant Menopause Trust Gainsborough Clinic 80 Lambeth Road London SE1 7PW Web: www.amarantmenopausetrust.org.uk The Menopause Amarant Trust is a charity that aims to help women deal with problems they might experience while going through the menopause. Osteoporosis The National Osteoporosis Society Manor Farm Skinners Hill Camerton Bath BA2 0PJ Helpline: 0845 450 0230 Tel: 01761 471771 Web: www.nos.org.uk Pelvic Organ Prolapse Women's Diagnostic Cyber Web: www.wdxcyber.com Women's Diagnostic Cyber is a US-based website with a question and answer section plus information about prolapse, treatment options and pelvic floor exercises. Smoking NHS Smoking Helpline Tel: 0800 169 0169 Web: www.gosmokefree.co.uk QUIT Tel: 0800 00 22 00 Web: www.quit.org.uk Stroke The Stroke Association 240 City Road London EC1V 2PR Tel: 020 7566 0300 Helpline on 0845 3033 100 Textphone: 020 7251 9096 Web: www.stroke.org.uk Thrush see Cysitis Women’s health – General Women's Health Concern Helpline: 0845 123 2319 Web: www.womens-health-concern.org Women's Health Concern aims to help educate and support women by providing unbiased, accurate information on women's health issues. Women’s Health London Web: www.womenshealthlondon.org.uk Women's Health London has leaflets on women's health issues, which you can download from its website. NHS information and advice England: NHS Direct Tel: 0845 4647 Textphone: 0845 606 4647 Web: www.nhsdirect.nhs.uk Wales: NHS Direct Wales Tel: 0845 4647 Textphone: 0845 606 4647 Web: www.nhsdirect.wales.nhs.uk Scotland: NHS 24 Tel: 0845 424 2424 Textphone: 18001 08454 242424 Web: www.nhs24.com NHS Direct and NHS 24 are 24-hour advice and health information services run by nurses. They provide confidential information on what to do if you or your family are feeling ill; including feeling depressed. They also have information on local healthcare services, self help and support organisations. Northern Ireland: Local health and social services boards: Eastern Health and Social Services Board 12–22 Linenhall Street Belfast BT2 8BS Tel: 028 9032 1313 Textphone: 028 9032 4980 Web: www.ehssb.n-i.nhs.uk Northern Health and Social Services Board County Hall, 182 Galgorm Road Ballymena BT42 1QB Tel: 028 2531 1000 Helpline: 0845 762 6428 Textphone: 028 2531 1001 Web: www.nhssb.n-i.nhs.uk Southern Health and Social Services Board Tower Hill Armagh BT61 9DR Tel: 028 3741 0041 Textphone: 028 3741 4530 Web: www.shssb.org Western Health and Social Services Board 15 Gransha Park, Clooney Road Londonderry BT47 6FN Tel: 028 7186 0086 Web: www.whssb.org If you need information on an illness or condition which we have not covered in this information sheet, please feel free to contact us. Although we are not medical experts we may be able to find information on the topic or point you to a more specialist organisation who can advise. See page 20 for our address. For further information contact: Information Resources Team Help the Aged 207–221 Pentonville Road London N1 9UZ Tel: 020 7278 1114 If you have access to the internet you can download our advice leaflets and information sheets by logging on to www.helptheaged.org.uk SeniorLine is the free welfare rights advice and information service run by Help the Aged for older people and their carers. Trained advice workers offer free, confidential and impartial advice about: * welfare and disability benefits * care at home * residential care * housing options and adaptations * access to health and community services. Freephone: 0808 800 6565 Textphone: 0800 26 96 26 9am to 4pm, Monday to Friday If you are in Northern Ireland, contact SeniorLine on 0808 808 7575. IS (NO) 16 March 2008 (BV) Next update due: September 2008 Help the Aged is a registered charity No. 272786 registered in England at the above address. 16