The progesterone that most women get is synthetic, but bioidentical micronised progesterone, made from plants, is also available on the NHS. The advice from the NHS is that each woman should sit down with her GP and talk through the options, based on what they know of her individual risk. There are no easy answers. Women at high risk of breast or ovarian cancer or those who have had them will not be advised to take HRT. For everyone else it is something of a guessing game.
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The odds of cancer are low and reduced if a woman takes the pills for a shorter length of time no help to those who have symptoms for 20 years , but the risk exists. There is a glimmer of hope on the horizon though. Maybe more than a glimmer. In April this year, the results of a trial of a new drug were published by Imperial College London. Oestrogen deficiency causes a chemical in the brain called neurokinin B to increase and this causes menopausal flushing - the drug blocks neurokinin B from working, eliminating menopausal flushing. But Big Pharma can now see the potential and has swooped to develop the molecule.
Professor Waljit Dhillo, an endocrinologist and one of the leaders of the trial at Imperial, said they have been inundated with emails from women wanting the drug since news emerged of the results. HRT works and is very effective, he said, but there is a huge interest in an alternative for those who cannot or will not take it. It will be a couple of years before the new drug is on the market, but if the results of further trials are as good as theirs, it is going to do very well indeed.
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Mood swings, hot flushes, night sweats and other unpleasant symptoms of the menopause are caused by the loss of oestrogen in the body as the ovaries run out of eggs in mid-life and stop producing it. HRT replaces that oestrogen. Too much oestrogen can cause endometrial cancer so to protect the lining of the womb, combined HRT is given which contains progesterone as well.
None of the alternatives offers an instant and complete end of the symptoms. They help some women and not others.
They fall into three groups: the non-drug options, medicines designed for other conditions which have been found to reduce menopausal symptoms as a side-effect and alternative therapies, which are largely untested. The combination of relaxation and exercise helps some women, particularly with the mood swings that the menopause can bring and also in coping with what are technically called vasomotor symptoms — in other words, the surges of heat that cause the body to sweat and the skin to flush red.
Stress makes the symptoms worse. Several studies have shown that CBT can help women cope and reduce the symptoms. Getting fit, taking exercise and becoming healthier helps all medical conditions. Losing weight is good for bone health, which can be impaired by the loss of oestrogen during the menopause.
Caffeine, alcohol and spicy foods have all been known to trigger sweating and flushes. Giving up smoking can also help, according to NHS Choices.
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This is a pill to treat high blood pressure, ADHD and anxiety, but among the side effects that have been found is a small reduction of menopausal flushing. These are said to help reduce hot flushes, in a lower dose than is used for depression. This is a drug against epilepsy. As a side-effect, it has been found to help hot flushes in some women but may cause tiredness and other side effects. Nice mentions that there is some evidence for black cohosh and isoflavones, like soy, which are derived from the bean family and are phytoestrogens. But it warns that in the different strengths and packs available, their safety is uncertain and that they can interact with conventional medicines.
A study last year found that it cut the numbers of hot flushes some women experienced, but not others. The alternatives Mood swings, hot flushes, night sweats and other unpleasant symptoms of the menopause are caused by the loss of oestrogen in the body as the ovaries run out of eggs in mid-life and stop producing it. Topics Menopause. Reuse this content. When available, the committee drew on information from evaluations of those programs that is relevant to children with disabilities, but the discussion in this section also includes findings from studies accessed directly from the research literature.
Interventions designed to support parents of children with developmental disabilities fall into four overlapping areas: family systems programs, instructional programs, interactional programs, and positive behavior support. Each is discussed in turn below. Singer and colleagues conducted a meta-analysis examining the primary and secondary effects of parenting and stress management interventions for parents of children with developmental disabilities. Among the 17 studies with experimental or quasi-experimental designs that qualified for the analysis based on the quality of their research methodology, the authors identified three classes of interventions: behavioral parent training i.
They found that interventions in all three groups had significant effects on reducing psychological distress among mothers and fathers of children with developmental disabilities. In a randomized controlled trial involving 70 families of children with ASD, for example, Tonge and colleagues provided parent education and behavior management training in group and. They found significantly positive outcomes for parents on the General Health Questionnaire postintervention and in follow-up.
Feldman and Werner provided behavior management training with follow-up over a 3- to 6-month period for parents of children with developmental delays and found significantly lower levels of depression for parents randomized into the treatment group. In their summary, Singer and colleagues note that interventions occurring over a longer period of time and having multiple components e.
In a recent randomized controlled trial of 59 parents of children with autism, parents received six individual sessions in a problem-solving education program, adapted from the well-known problem-solving treatment PST Feinberg et al. Each session focused on working through a problem identified by the mother using the steps of PST goal setting, brainstorming, evaluating solutions, choosing a solution, and action planning. A more recent trend has been the application of mindfulness training for parents of children with developmental disabilities, with the goal of reducing stress and potentially increasing self-efficacy.
Benn and colleagues conducted randomized controlled trials to examine the effects of mindfulness-based stress reduction techniques, and found significantly positive effects on stress reduction and associated variables e. Collateral effects of these techniques are seen in caregiver competence as reported by parents Benn et al. Instructional programs A large literature documents the effectiveness of programs designed to instruct parents in implementing approaches that promote the skills e. Roberts and Kaiser , for example, found strong positive effects on the receptive and expressive language skills of young children with intellectual disabilities in a meta-analysis of 18 studies of parent-implemented language training programs that utilized a control group.
Effect sizes ranged from. Smaller effects were found for studies comparing parent-delivered and professional-delivered treatment. This finding suggests that children receiving the treatment from parents and speech pathologists made comparable progress, which indicates in turn that, when appropriately trained, parents can be effective facilitators of the language development of children with disabilities.
Programs that have instructed parents in promoting the reading skills of their young children with disabilities have likewise documented positive effects. Two randomized controlled studies Crain-Thoreson and Dale, ; Dale et al. The What Works Clearinghouse has examined this literature and found that these studies meet their standards of acceptability. Particularly for children with ASD, interventions involving parents have generated positive outcomes. Many comprehensive treatment programs have been designed for children with ASD, and almost all have a parenting component Odom et al.
These comprehensive programs comprise a set of practices that are based on an organizing conceptual framework, address a variety of developmental needs of the child, and generally occur over an extended period of time e. These elements are detailed in program manuals. Some programs begin in a clinical setting, with the clinician taking the lead, and also are implemented at home by the parent.
Dawson and colleagues conducted an experimental evaluation of the ESDM, finding significant effects on cognitive developmental and adaptive behavior. They also found differences in brain activation for children in the treatment and control groups Dawson et al. In a review of eight intervention programs for toddlers with ASD, Siller and colleagues document the variety of approaches used by these programs, nearly all involving families and most employing experimental designs to document efficacy although this summative review does not include effect sizes.
Other studies have documented the positive effects of early intensive behavior therapy delivered by parents. For example, in a meta-analysis of 13 studies conducted in using experimental and other design types, Strauss and colleagues found that early intensive behavioral. In summary, it appears that involving parents is an essential element of early interventions for children with ASD and in some cases may produce stronger positive outcomes than such interventions in which parents are not directly involved. Interactional programs Interactional programs are designed to promote positive social interactions between caregivers and young children with disabilities.
They are based on research showing that some young children with disabilities have difficulty engaging in positive interactions with their parents and others Adamson et al. In these interventions, parents are taught how to set up play situations that encourage interaction and to respond in particularly encouraging ways.
In a number of randomized studies, Mahoney and colleagues employed a responsive parenting approach that resulted in increased social interactions among children with disabilities Karaaslan and Mahoney, ; Karaaslan et al. For many young children with ASD, joint attention—a specific form of parent-child interaction that is a building block for later communication development—is limited or fails to develop.
Several investigators have developed interventions designed to promote joint attention among young children with ASD and their parents that have demonstrated positive effects in randomized studies Kasari et al. A variety of approaches have been developed to promote parenting practices related to behavior management.
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One such approach—positive behavior intervention and support PBIS —is a multicomponent program involving problem-behavior prevention strategies and increasing levels of behavioral intervention Dunlap and Fox, In a randomized controlled study, Durand and colleagues examined the effects of PBIS on parents and their children with a developmental disability and serious challenging behavior.
They found significant improvement in challenging behavior, as well as reduction in parent pessimism. Effects of the PBIS model were stronger when it was paired with a complementary program of optimism training aimed at helping parents identify and restructure their parenting-related thought patterns. An adaptation of this program—Stepping Stones—has been used with parents of young children with disabilities. Individual randomized controlled studies Sofronoff et al.
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Similarly, the Incredible Years Program was initially designed for parents of school-age children with conduct disorders Webster-Stratton, , but has been adapted for and applied with parents of young children with disabilities. In a randomized trial, McIntyre found that the Incredible Years Program reduced negative parent-child interactions and child behavioral problems. In another study focused on parents of children with autism, investigators evaluated a pilot study of 16 families with children ages with a diagnosis of autism and parent-reported disruptive behaviors Bearss et al. There are significant research gaps in the area of interventions for parents of children with developmental disabilities, such as implementation of interventions in natural environments and support for child and family transitions.
Although a primary feature of early intervention programs funded through IDEA—a feature required by the federal government—is that they must occur in natural settings, and although IDEA encourages the creation of a transition plan for children moving from early intervention to preschool, the committee found that little or no such experimental research has been conducted, nor do these gaps appear to inform directions for future program development and research.
Behavioral and mental health challenges encompass a range of behaviors and conditions.
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The psychiatric, psychological, and educational professional communities use somewhat different terminologies, but they agree in identifying these behaviors and conditions as occurring in children who. In addition, attention deficit hyperactivity disorder ADHD , while overlapping to some extent with these behaviors, manifests more distinctly in high levels of physical activity, difficulty with attention, and difficulty in completing tasks American Psychiatric Association, Aggression and antisocial behavior in young children appear to reach a peak between the ages of 2 and 4 and then decline, only to reemerge in the adolescent years Wahl and Metzner, Lavigne and colleagues report that during the early years ages , the prevalence of such behavior problems in a sample of 3, children averages 8.
It is these children that are diagnosed as having oppositional defiant disorder ODD American Psychiatric Association, A number of interventions have focused on improving the knowledge, attitudes, and practices of parents of children with externalizing behavior. These interventions have included applications of general parent management training to parents of children with challenging behavior, as well as parent training developed specifically for this population.