ASK DR ZOE
I’m 47 and constantly suffer with constipation and diarrhoea, I’ve tried everything and don’t know what to do
Dr Zoe also helps a reader suffering hair loss
IT’S no secret that your diet plays a big role in your overall health.
Whether you are trying to lose weight, protect your memory or boost your heart health, it’s vital to watch what you eat.
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A study last week showed people who adopt “the Mind diet” had a lower risk of cognitive decline over ten years.
It’s a combination of the Mediterranean and Dash diet, which is designed to lower blood pressure.
The Mind approach recommends you eat five servings of nuts, one serving of oily fish, two portions of lean poultry, four of beans and two of berries per week.
Each day, you should aim for three servings of whole grains, such as quinoa, brown rice or oats, and at least two servings of veg.
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Adopting a healthier diet can be challenging, but the evidence does suggest the Mind diet might be worth a try.
Meanwhile, here’s a selection of what readers have asked me this week . . .
FEAR I’M MENOPAUSAL
Q: I’M almost 55 and the only period I have had since January was a very heavy one last month.
I seem to be experiencing all the usual menopause symptoms apart from the hot sweats.
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I suffer from chronic aches and pains and, last night, while having sex, I experienced a painful burning feeling.
Do you think these symptoms are hormone-related?
Video explains the signs and symptoms of menopause
I have asked my doctor about HRT (hormone replacement therapy) but he seems reluctant to prescribe it as I’m not having the sweats.
Any advice would be much appreciated.
A: You are describing classical symptoms of the menopause or, strictly speaking, perimenopause as you are still having some periods.
Not everyone has hot sweats.
We all experience a different array of symptoms during the menopause transition and some are lucky to experience none at all.
I wanted to make sure this question was included in the column as I hear versions of your story all the time.
Your GP or practice nurse SHOULD have a conversation with you about your symptoms and explore the options for managing them, which should include the various forms of HRT.
It may be necessary to rule out some of the other potential causes.
Abnormal thyroid function is an example of something that can cause changes to periods and other symptoms, but it can be checked for with blood tests if your clinician deems it to be necessary.
One thing I would say is that the topic of menopause does require its own protected appointment.
Tip of the week
AT this time of year the combination of sunny days and cooler temperatures make it the perfect time to get some outdoor exercise.
Why not make the most of it by going a long hike or cycle with the family or a friend this weekend?
Being in nature has been shown to improve mental wellbeing and stress levels.
I’m not saying that you did this, but sometimes women will mention it in passing at the end of a consultation.
This is often because they feel a little bit embarrassed or uncertain, but this makes it impossible for your GP to then deal with the topic properly.
So be upfront that the reason you are there is to discuss menopause.
It’s a good idea to speak to reception to ask their advice on which doctor or nurse would be best to see.
And if you have to wait a bit longer for an appointment with that person, it will be worth it.
In the meantime, keep a log of your symptoms and visit Women’s Health Concern and Menopause Matters websites for more information.
WHY’S MUM GETTING BALD PATCHES?
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Q: MY mum’s hair is normally nice and thick, but it’s now starting to thin out, leaving some bald patches.
She is 68 years old and she has tried Plantur 39 hair tonic for a couple of months, but it hasn’t really done anything to help.
Please can you suggest anything she can try?
She is on aspirin, atorvastatin, bisoprolol and takes folic acid.
A: Unfortunately, some hair loss is inevitable with ageing.
That said, you have mentioned bald patches and typically, with age-related hair loss, we’d see a thinning out rather than bald patches.
Aspirin can cause hair loss, but it’s fairly unusual.
You don’t mention how long your mum has been on her medication, but it might be worth seeing if there is a correlation between the length of time she’s been prescribed a drug and when the hair loss started.
According to studies, around one per cent of people report hair loss when prescribed statins such as atorvastatin, so it’s unlikely to be that – but there’s a slim chance.
Your mum is also on folic acid, which is prescribed for B9 deficiencies.
B9 and other nutritional deficiencies, in themselves, can cause hair loss, so it could be that now your mum is on folic acid, the thinning and the bald patches will lessen.
Hormonal changes can also result in the thinning of hair.
Female pattern hair loss (which is linked to hormones) is caused by our genetics.
And it tends to follow a particular pattern which is different to the one that we see in men.
It typically involves thinning of the hair over the crown and a widening of the central parting.
It tends to start at a younger age than your mum, though, with the first signs usually noticeable before the age of 40.
Whatever the cause, it’s definitely worth your mum seeing a GP.
I'VE HAD CONSTIPATION SINCE A BABY
Q: WHEN I was a baby, I had trouble going for a poo. My mum had to use suppositories to make me go.
I am now 47 years old and, over the years, things seem to have got worse and I am suffering with diarrhoea and constipation.
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I have been to the doctors to have tests for blockages, Crohn’s disease and bowel cancer, and they have come back negative.
But I still experience constipation and diarrhoea every three or four weeks.
I eat as much veg as I can and also plenty of beans and lentils.
So far I have tried medications like Fybogel, Senna and Lactulose, but nothing seems to work.
I go for walks as much as I can.
I have tried making a plan of what is upsetting my stomach and I have tried the FODMAP diet, but that doesn’t work either.
I don’t know what else to do. Is there anything that you can suggest?
A: You have already done a lot of the things I’d normally suggest for someone presenting with the issues you’ve got.
You have clearly researched it well and have been thorough in doing what you can to try to help yourself.
You’ve had medical tests too, which have ruled out the serious conditions that it would be highly important to diagnose and treat.
The fact that your problem has been present since you were a baby would indicate that your bowel has always, and may always, struggle to function well.
But I hear you when you say that these symptoms are causing you suffering, and therefore I don’t think you should just have to accept it, unless every avenue to help you has been explored.
If you have ruled out putting a label on what you have in the context of disease, it’s likely that it’s IBS-M, which is irritable bowel syndrome with mixed bowel habits.
There aren’t any specific medications for IBS-M, but there are medications to treat the symptoms, available both over the counter and on prescription.
Moving forwards, a dietician may be able to guide you further or, failing that, a psychological approach may help. Cognitive behavioural therapy for IBS is clinically proven to improve symptoms in two thirds of patients.
CARING READERS’ TIPS TO HELP EASE WOMAN’S ITCHY RED SKIN
EVERY so often, a reader’s health problem really resonates.
Earlier this month, a 65-year-old woman wrote to Dr Zoe seeking help for a skin condition that was causing red and itchy outbreaks on her face.
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She said she had spent hundreds of pounds on various creams, cleansers and moisturisers, but seemed to suffer a reaction to everything.
Dr Zoe replied: “It sounds from your description as though it could potentially be eczema or rosacea.”
After learning of the woman’s plight, two other readers shared their experiences and advice, having been in similar situations themselves.
Fiona wrote: “I, too, suffered from this and, no matter what I used product wise, my face would be itchy and red. It started in my early 40s. I tried all the creams for rosacea.
"However, after extensive research, I am now using a brand called MooGoo, which was originally designed for babies with eczema.
“I no longer have the itchiness or red face.
"I also noticed that if I used SPF on my face, it would irritate my skin, so I use MooGoo cream then Boots’ No.7 Protect and Perfect Intense factor 50 face cream.
“I will never again buy any other cream. These two brands really saved my skin.
“It’s also worth checking your shampoo and conditioner. If that seeps onto your face, it could cause redness, too.
“I switched brands and now use Garnier Ultimate Blends. I really hope this helps.”
Meanwhile, a second reader, Sharon, wrote: “I am 54 and, in 2019, I started experiencing problems with my skin – but only on my face.
"I also had a problem with one of the glands in my eye.
"My GP initially treated me for seborrheic dermatitis.
"However, after seeing an NHS dermatologist, they diagnosed me with pustular rosacea and ocular rosacea.
"Like the woman who wrote in, I spent hundreds of pounds trying different skincare products.
“In 2021, I eventually found a range by a company called Image Skincare UK.
“It has been a game-changer for me. I was able to stop using the prescribed medication and my skin has remained under control and stable ever since then.
“I also use La Roche-Posay Invisible Fluid factor 50 all year round. Image Skincare products are a bit pricer than the high street, but last me months.
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“The improvement to my skin is worth every penny. I also discovered Boots are really good at offering refunds if a product has been used and a customer has reacted to it.
“I really hope the woman in question finds what works for her.”
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