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Baby worries: One woman asks Dr Ellie if 46 is too late to concieve
I am a 46-year-old mother of a one-year-old child. I had hormonal problems for years, so was thrilled to conceive naturally and easily.
Now I can’t shake off the longing for another child. Am I too old?
I fear the chances of conceiving naturally are small and worry about complications if I did become pregnant. I’m also worried about what others would say.
You’re not too old, but you need to be realistic about the chances and aware of the facts. In the past two decades the conception rate for women in their 40s has more than doubled, with about 29,000 a year conceiving now.
As for worrying about what others might say – I wouldn’t. Many women now leave motherhood until later for medical or career reasons.
But fertility falls dramatically in your 40s, making getting pregnant much less likely. The ovaries’ capacity to provide eggs is at its maximum at birth – 100 per cent.
By the 30s, it is down to only 12 per cent, and by your 40s it is three per cent.
This significantly cuts your chances of success – we know that for every 100 women trying to get pregnant naturally at 40, only five per cent will.
To manage your own expectations, I would start with some hormone tests at the GP for oestrogen and follicle stimulating hormone (FSH) – to see if your ovaries are still functioning well.
If tests show you are entering peri-menopause, you will save the heartache of trying naturally. Perhaps you would consider surrogacy or adoption. You would not be considered for IVF at your age on the NHS.
Of course, there is a chance of getting pregnant – which is why we don’t advise a woman to stop using contraception until she has actually reached menopause.
Conceiving at 46 is high-risk for the baby and you – so is especially to be avoided in unplanned circumstances. If you get pregnant, you will have to be carefully monitored and screened for genetic problems in the baby as well as risks to you such as pre-eclampsia.
At your age, your chances of having a child with Down’s syndrome would be one in 30 compared to one in 1,250 at age 25.
Helping hands: Dr Ellie advises a woman with skin condition granuloma annulara
Seven years ago I was diagnosed by my GP with the skin condition granuloma annulara. Since then, I’ve been given little or no advice – other doctors at my surgery haven’t even heard of it.
It’s dreadfully unsightly, with huge ugly rings of raised, red spots on my arms and legs that mean I stay covered up all summer. I recently fractured my wrist and it got much worse. Is there anything I can do to rid myself of this horrible disease?
The problem with many skin conditions is that they don’t kill or do any physical harm, but they often don’t get much better. Causes are only hazily understood, so treatment is a lengthy process of trial and error.
Patients are often left to amble along with something unsightly. Granuloma annulara is benign, but if it’s distressing you, ask for a referral to a dermatologist. You have options: steroid creams, ointments, or injections may clear up the rash. Severe cases can be treated with ultraviolet light therapy or medicines to suppress the immune system. Try to manage stress.
Blue like Jasmine? Go see your GP
Oscar-winning: Cate Blanchett plays a woman with mental health problems in Blue Jasmine
Cate Blanchett’s Oscar-winning portrayal of mental illness in Blue Jasmine was profoundly realistic, and terribly sad. We should never underestimate the huge impact that traumatic life events – divorce, redundancy, bereavement, or even moving house – can have on mental health.
The trauma of such a mighty upheaval can trigger depression or even psychosis. Alcohol and tranquillisers – which seem to addle Jasmine – should not have to be the answer.
While Jasmine is an extreme case of wealth, fraud and adultery, we are used to looking after normal people going through difficult times: it certainly wouldn’t surprise a GP to hear a patient say: ‘I am having problems with my husband.’
Your GP surgery should have a practice therapist or counsellor, or refer to one locally who can offer help on the NHS with waiting times of no more than three months.
We also refer patients to couples counselling either on the NHS or through Relate. People often say they couldn’t imagine talking to a GP about this type of personal issue, but I assure you that we deal with these situations all the time.
A healthy lifestyle is still vital if your are on statins
I have lost track of the number of headlines relating to statins: it is hard to keep up when the advice keeps changing.
Statins lower cholesterol, and they are currently taken by those with a high chance of heart disease and strokes.
Now, the National Institute for Health and Care Excellence (NICE), is proposing that even adults with much lower risks of cardiovascular disease – ten per cent rather than 20 per cent – should be taking them.
This could mean large numbers of elderly people taking a statin. Estimates suggest the number could rise from five million to 12 million.
But for all medicines you have to weigh up the disadvantages and advantages. While preventing cardiovascular disease, statins cause side effects: muscle aches and pains as well as liver problems.
These could be considered worth it if you are at high risk, but less so if you are low-risk. And clinical and cost-effectiveness arguments don’t always take into account the quality of life of the patient.
I am cautious about starting any patient on statins.
Far from simply handing out prescriptions, doctors need to strongly promote exercise and the Mediterranean diet to prevent heart disease, and offer smoking-cessation tools and weight advice.
There is a tendency tend for patients (and doctors) to think that as long as they’re on statins, smoking or a poor diet doesn’t really matter. And it really does.
All you need is empathy
Empathy: In a bid to get staff to understand their patients situations better Yorkshire hospitals are providing their staff with age simulation suits
This week we learned that hospitals in Yorkshire are providing their staff with age simulation suits, so staff can understand how it feels to be restricted by frailty and dementia. As healthcare professionals, we can’t be expected to have experienced the entire range of symptoms and problems our patients go through. But that doesn’t mean we can’t understand. Surely, we don’t need training in good old-fashioned empathy?
High price of prescriptions
Last week I was perturbed that a patient hadn’t picked up the antibiotics I prescribed, resulting in a worsening of her condition and a further appointment.
The sad truth was she was waiting for payday to afford her treatment. Prescription charges were abolished in Wales in 2007, in Northern Ireland in 2010 and in Scotland in 2011.
In England, however, patients still pay £7.85 per item prescribed. Let’s hope a further increase in cost isn’t on the horizon for English patients.
Whatever they say about economic recovery, given the current climate, GPs at my practice have decided to refer patients to food banks if we suspect malnourishment due to poverty; we might also need to consider using cheaper over-the-counter treatments, if and where possible, so our patients can avoid the high charges.
Healthy chips are just EIGHT calories less
I had to laugh at Burger King’s attempt at healthy food with their new low-fat chip.
All well-intentioned, except when you realise a small bag contains only eight calories less than the classic fries.
For those who are visiting the fast-food chain frequently, I think the benefits are unlikely to be evident on the scales.
And while I’d give Burger King an A for progress, they are probably barking up the wrong tree: latest thinking tells us it is not fat that makes us fat. It’s carbohydrate. And what are chips made of?
DO YOU HAVE A QUESTION FOR DR ELLIE?
Email DrEllie@mailonsunday.co.uk or write to Health, The Mail on Sunday, 2 Derry Street, London W8 5TT.
Dr Ellie can only answer in a general context and cannot respond to individual cases, or give personal replies. If you have a health concern, always consult your own GP.
Keep Calm: The New Mum’s Manual: Trust Yourself And Enjoy Your Baby, by Dr Ellie Cannon, is published by Vermilion, priced £10.99. To order your copy at the special price of £8.99 with free p&p, call the Mail Book Shop on 0844 472 4157 or go to mailbookshop.co.uk.
Read more: http://www.dailymail.co.uk/health/article-2576306/ASK-DR-ELLIE-Am-I-old-try-second-baby-46.html#ixzz2vUv0PoX0
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