Re: teaching herbal medicine for W.E.A

[Guest guest]

If any one is interested in teaching an adult education herbal medicine eveing class, in Tottenham, please contact me off line.

son BSc(hons) MNIMH@...www.herbalbarge.co.ukwww.herbalsnuff.co.uk07736966197

post menopausal bleeding

Hello again everyone, second post of the week.

This patient came to see me initially 2 weeks ago. She did originally phone me 2 years ago re post menopausal bleeding and at that time I advised her strongly to visit her GP for investigations. She was (and is) absolutely terrified of Doctors, hospitals, investigative procedures and modern medicine. She eventually did see her GP last year and was ref'd to Gynaecologist in Oct. She would only have an ultra sound scan and refused any internal examination/hysteroscopy etc - so clinical findings are incomplete. Her GP is aware that she's coming to see me.

She is 69 and the bleeding started 3 years ago - it is variable and usually consists of orangey discharge on the toilet paper post urination. But at times she has bright blood on the sanitary pad during the day and night, with occasional small clots. The ultra sound scan last Oct revealed a 57mm x 32mm fibroid - the position of which is not noted on the report. Report continues that "posterior uterus and endometrium not identified...neither ovary was positively seen...no masses seen... no free fluid in pelvis". The patient feels that the Gynaecologist's interpretation of the scan results was that the fibroid is causing the bleeding. At the moment I am gently trying to persuade her to attend for a follow up appt which has been offered to her in April this year - but she is "terrified" of this and can't think about it at the moment.

So, I feel as if I'm working blind here. She has been taking, prior to coming to see me, some herb capsules that she's been given by a local independant health food shop - Equisetum, Rubus and Vitex.

She has no pain with the bleeding, no dyspareunia, no offensive discharge, no vaginal soreness or dryness, no back pain, no urinary frequency.

Does not know her family medical history.

MH - Underactive thyroid dx 3 years ago (interestingly around the same time as the bleeding started) - 50mcg thyroxine daily.

Hypertension dx 5 or 6 yrs ago - takes bendroflumethiazide, losartan and felodipine daily

Has taken 1x hypericum perf tablet daily taken for 12 years for low mood - subsquent to breakdown that she had after being defrauded out of life savings 13 yrs ago.

Polio aged 13yrs

She is overwieght. Non smoker always.

Until the beginning of this year, she was drinking spirits daily. She has now stopped alcohol completely. Used to work as agent for dancers, spent much of time in "clubland" and drunk a lot of alcohol regularly for many years. Liver function tests in Dec NAD

She is an extremely anxious person.

She has bowels open once daily and has occasional bright blood on paper from haemorrhoids. I queried whether she's sure that the vaginal bleeding is separate to this - she feels that it is and that the bleeding that started 3 years ago is vaginal and not urethral or from her bowel.

She has a small appetite and has always eaten small, regular meals. Diet not brilliant, and she has 3 - 4 coffees daily (which she's very reluctant to give up). Her weight is stable.

She was keen for her original herbs to stay in her mix, so against my better judgement (re the Vitex) I included a small amount to encourage complaince and confidence (I planned to remove this fairly quickly). I gave an original mix of

Carduus 25

Astrag 20

Rubus 20

Equisetum 20

Achillea 15

Arctium 2.5

Vitex 2.5 5ml tds ex aq ac

On the first day, before receiving the mix, the patient rang to say that she'd had a show of bright red blood in the evening after the consultation. She then rang after 3 days of taking the mix to report nocturnal bleeding, not filling a pad or leaking onto night clothes or bedding, but heavier than she had experienced for some time. Although I suspect that this was not related to her medicine, we decided to stop the herbs and resort to taking her capsules again. The bleeding has now settled down to the same pattern as previously, ie some spots of bright blood and orangey, watery discoloration of toilet paper daily.

Has anyone any experience or suggestions to make. I am continuing to encourage her to have further investigations, clearly potentially serious pathologies need to be ruled out, but it would be helpful to know if the fibroid is the cause of the bleeding. It's hard to know exactly what is the cause, polyps/vaginal atrophy/endometritis/cervicitis/cervical erosion. I wondered about possible continuing oestrogen influence on the fibroid (or endometrium) via peripheral oestrogen as she is overweight. Also, having underactive thyroid probably means she'll have less SHBG.

Sorry for the length of this posting.

I'd be most grateful for any ideas.

Best wishes

Sue Salmon

Huddersfield