Q: I have been taking Microgynon for five months, and though I experienced premenstrual moodiness before, now I feel quite unstable and the mood swings are very severe. What do we know about how mood is affected by birth-control pills?
A: Premenstrual mood swings (PMS) are sometimes cured by the contraceptive pill, and sometimes they're not. Although the pill stops ovulation, the progestogen part of the pill can make PMS worse. Other options to reduce PMS include eating high-carbohydrate foods every three hours to keep blood-sugar levels stable, exercise and using vitamin and mineral supplements which include vitamin B6 and magnesium. The evidence for these strategies is limited but they may be worth a try. Evening primrose oil is good for breast tenderness and may help mood swings too. Anti-depressants such as Prozac or drugs to stop ovulation can be prescribed if you are desperate.
Lead in the water
Q: I have recently moved into an old Edwardian house with lead pipes and wonder whether we should replace them with plastic ones to avoid the risk of lead poisoning for our young children. How do I know whether it's necessary?
A: Too much lead in the water is bad for the developing nervous systems of unborn babies and young children. So pregnant women and young kids may be at risk if lead levels in your water are high. The water companies have a legal obligation to keep lead levels below 50 micrograms/litre. And there's a new EU directive to ensure that these levels are halved by 2003 and down to 10 micrograms/litre by the end of 2013, which makes you wonder how safe our current levels really are. There is a very good leaflet called Lead in Drinking Water, available from the Drinking Water Inspectorate (020-7944 5956) or from their website at www.dwi.detr.gov.uk.
Q: I'm 68 and my hearing's going. The TV is a mumble and I often find it hard to hear what people are saying to me if there's a lot of background noise. I hate the idea of sporting a hearing aid. Can you suggest anything?
A: If it's any comfort, half of all people over 60 have hearing loss due to advancing years. The fancy term is "presbyacusis" and it's due to deterioration of the tiny hair cells in the inner ear. It becomes hard to distinguish sounds so people seem to be mumbling, you may not catch names or phone numbers, noisy places become a nightmare, listening takes a lot of concentration and you may give up and withdraw into yourself. TV or music may sound very loud even though you can't differentiate individual words. On the positive side, the vast majority of those with presbyacusis benefit from a hearing aid. The first step is to get formal hearing tests (audiometry) via your GP, an ENT specialist or local hearing aid centre. There is a wide range of hearing aids now available, especially in the private sector. They can be fitted behind the ear, within the ear, buried deeply in the ear canal, or built into your specs so no one knows you're wearing one.
Is it safe to fly?
Q: I'm pregnant and want to go on holiday. Is it safe to fly?
A:There's no evidence that air travel is dangerous for your developing baby, despite the fall in oxygen that occurs during a flight. If you are very anaemic, this fall in oxygen could theoretically be harmful for mother and baby alike so you'd be well advised to wait until your blood count is near normal. Airlines don't want you to give birth mid-flight - they're quite busy enough pushing those trolleys up and down the aisles - so they won't usually let you fly beyond 34 weeks. You are at increased risk of thrombosis while pregnant, so you should take care to walk around at least once an hour, have plenty of non-alcoholic drinks and move your legs around while sitting. Don't take aspirin - it's not good for the baby.
If you're going somewhere exotic, you'll want special advice about vaccines and avoiding infections. British Airways Travel Clinics, tel: 01276 685040.
Q: My husband's getting slightly depressed about a serious deterioration in his memory (he is 67). His GP has prescribed anti-depressants, which may deal with the depression, but not with the cause of it. Is treating the memory loss too expensive, or does the GP think there is nothing he can do?
A: Memory loss due to dementia is relatively rare in men of your husband's age, whereas depression is more common. Both can cause memory loss, although in depression, the memory loss fluctuates depending on mood, and in dementia the memory loss is progressive. Depressed people are often very worried about memory loss, have been depressed in the past, may have been recently bereaved, and seem unable to enjoy life.
Dementia may start with short-term memory loss so that recent events are hard to recall, while childhood memories remain clear. But the gradual disintegration of personality gradually sets in with inability to get dressed, self-neglect, inability to recognise people and objects and eventually loss of language, continence and behavioural norms.
If you think your husband is not improving on the anti-depressants, that his memory is getting worse and that these other features of dementia are setting in, you should insist on a referral to a psychiatrist or neurologist who runs a memory clinic. They will be able to use a formal method of assessing memory such as the Mini Mental State Examination (MMSE) and order other tests if needed.