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We all know exercise is good for our bodies. But did you know that regular workouts can be anti-ageing too? Read on to explore the many benefits that keeping fit can have on our skin.

Exercising often, whether it’s aerobic, strength, flexibility or balance training has been proven by scientists to reduce the chances of falling ill as well as delaying the signs of ageing. While no lotion or potion can increase longevity and make you look younger at the same time, regular effort and a little sweat can work wonders for your skin’s appearance.

Skin Tone Improvement

Exercise can even out skin tone by flushing toxins and calming puffiness. After your liver, the skin is the biggest detoxifying agent in the body. Sweating removes toxins which not only makes you feel better, it rejuvenates your skin. However, be aware that there is some evidence that Bikram yoga and infra-red saunas may actually worsen pigmentation. (www.vogue.com.au)

Skin Glow Improvement

We have learnt that exercise promotes healthy circulation which helps clear your skin and keep it vibrant. When we push ourselves to the point of perspiration and looking red in the face – a result of increased blood flow to the dermis - our skin is being sent essential nutrients, hormones and increased oxygen. My clients who exercise regularly have more glow to their skin. Freshly exercised skin has an obvious rosy glow, however, it’s the day following exercise where we see the real benefits that oxygen-rich blood has on our skin.

Acne Improvement

You may have heard the old rumour that acne can be caused by sweat sitting on your skin. The science behind this disagrees: sweat is just a toxin secretion which doesn’t actually clog your pores. Exercise reduces inflammation which is one of the main causes of acne, plus it levels our stress hormone, cortisol, which can also trigger acne flare ups.  So perhaps sweat, or the way we create sweat, has more benefits to our skin than we think.

Exercise has also shown to ease stress: a key trigger of acne and eczema. Although researchers are still investigating the link between stress and skin studies show that sebaceous glands, which produce oil in the skin, are influenced by stress hormones.

When we sweat our pores open and release the build-up inside of them. Sweat purges the body of toxins that would otherwise clog up pores and cause blemishes (healthy human life.com), making it helpful in clearing acne.

Skin Ageing Improvement

We all know our skin changes as the years advance, resulting in wrinkles, crow’s feet and sagging. After about 40, most of us begin to experience a thickening of our stratum corneum, the outer layer of epidermis, the top layer of the skin. This is the portion of the skin that you see and feel. Composed mostly of dead skin cells and some collagen, it gets drier, flakier and denser with age. At the same time the dermis, which sits below the epidermis, begins to thin. It loses cells and elasticity, giving the skin a more translucent and often saggier appearance (NYTimes.com)

Scientists have found that men and women who exercise frequently had markedly thinner, healthier strata cornea and thicker dermis layers to their skin. Of course, diet, genes and lifestyle also contribute to the outcomes.

Keeping the skin hydrated

It is important to add the unbelievable difference drinking water has to the skin – especially when exercising. It is essential to hydrate before and after exercising, to keep the skin looking smooth and to get rid of the under-eye bags (which are a sure sign of dehydration). After all, our bodies are made up of 75% water so staying hydrated is extremely important.
 
Article by Holly Mason of The Skin Investment Clinic with contributions from Personal Trainer, Belinda Andrews

www.theskininvestmentclinic.com
holly@theskininvestmentclinic.com
T: 07887855539

There are rising obesity levels across the world with an estimated 2.7 billion adults who will be living with it by 2025. Yet, many suffer from its effects in silence. 

Obesity is a chronic disease

The effects of obesity, both physical and mental, can be devastating.

It can affect anyone and at any age, from any background and any ethnicity, and its causes are complex.

Modern-day, high-energy diets packed with unhealthy fats and sugars, such as processed and fast food, coupled with our increasingly sedentary lives are often blamed. But genetics and the environment around us can also play a role.

Either way, obesity IS a complex disease. And it can lead to health issues if left untreated.

The risks of obesity

If your BMI is over 30 then you’re classed as being obese, (though it’s worth noting this is not an exact science- Arnold Schwarzenegger in the prime of his bodybuilding career had a BMI of 31- because muscle weighs more than fat). If you don’t know yours you can calculate your BMI here.

https://www.nhs.uk/live-well/healthy-weight/bmi-calculator/

Living with obesity puts you at a higher risk of early-onset type 2 diabetes, stroke, heart disease, liver disorders, certain types of cancers and orthopaedic problems as well as back pain.

But these are just the physical issues...

Living with the stigma

Obesity can also cause mental health issues due to the stigma and discrimination around the disease.

It is often assumed in Western cultures that obese people are ‘lazy’ and should ‘eat less and exercise more’ but this oversimplifies a deeply complex condition that often presents alongside other health challenges which further muddy the water, such as metabolic syndrome and type 2 diabetes.

It also overlooks the challenges that people who have struggled with weight for a long time have experienced. The repeated failures with diets and injuries acquired from starting intense exercise regimes before they have strengthened their joints.

Low self-esteem and wanting to isolate yourself from the rest of the world are common feelings, which can amplify the challenges you face if you’re prone to overeating when you feel depressed or stressed.

The lack of healthy dialogue and prevalence of flawed outdated approaches propagated in our communities further hinders its prevention and treatment.

So how can you treat obesity?

The main thing to consider is that it takes time to become obese - and it will take time to effectively treat it. There’s no quick fix, but there is a solution that can be customised to your needs.

By taking a holistic approach to treatment, where you look at lifestyle, dietary and environmental changes, you’re more likely to form and maintain healthy, good habits that last for life.

For example, a good weight loss management programme will help you form a balanced, calorie-controlled diet that you’re likely to stick to, especially if you have realistic goals to work towards.

These don’t include so-called ‘fad’ diets, which restrict certain food groups or include fasting – you may lose weight quickly but you’re not forming sustainable healthy habits that will last long-term.

What’s more, adding more active time into your week, whether it’s walking, swimming or jogging, all helps. The recommended time spent on activities is between 2.5 and 5 hours a week.

Webmed weight management service

We can provide a medicated weight loss service that will reduce your appetite considerably enabling you to make healthy food choices leading to a sustainable reduction in your weight.

To help you on your weight loss journey we provide some very useful NHS links that provide lots of tips and support on healthy eating and lifestyle habits. We also give you access to our app where you can record your success and ask for advice from a healthcare professional.

Find out how we can help

References

Saying Goodbye to BMI | In Body USA [accessed 18/11/21]

Causes of Obesity | World Obesity Federation [accessed 18/11/21]

Obesity - Treatment - NHS (www.nhs.uk) [accessed 18/11/21]

Author: Gemma Boak

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 02/11/21
 

Before you skip straight to wanting a cure for erectile dysfunction, you might be wondering why it’s happening to you. Here we’ll talk through the most common causes.

First thing’s first, you’re not the first and by no means the last to have problems getting or maintaining an erection. Most men will experience it at some point in their lives and it’s nothing to be embarrassed or ashamed about.

A lot of men put off getting help or treatment (some for around two years), when there are simple and effective erectile dysfunction treatments out there that can help straight away, without you needing a prescription.
Here are some of the causes…

Age

It’s extremely common in men aged between 40 and 70 (though that’s not to say it can’t happen at any age). In fact, just over half of men in this age bracket will suffer from erectile dysfunction to some extent, and 26% of men under the age of 40.

That doesn’t mean you should accept it as a way of life – there are treatments suitable for any age, which we’ll go through later on.

Lifestyle

A few simple changes to your lifestyle, for example being more active and changing your diet can all have an effect. It’s also recommended you drink no more than 14 units of alcohol a week and stop smoking or using recreational drugs. It’s worth checking your BMI and losing weight if needed.

Psychological causes

When erectile dysfunction happens suddenly (and/or only with your partner), it’s often thought to be due to psychological causes.

Stress (could be work, financial or personal issues) can be a trigger, as well as anxiety, depression or an after-effect of sexual abuse in the past or present. If it’s happened once, then you may feel a fear of failure for it happening again.

Physical causes

If erectile dysfunction comes on slowly over time, then there may be an underlying health condition that’s causing it, which your GP can help diagnose.

They will check hormone levels for reduced testosterone and thyroid disorder, and for signs of vasculogenic conditions, for example high blood pressure, high cholesterol and diabetes, which can affect blood flow.

It’s worth mentioning that erectile dysfunction can be an early warning sign (up to 3 to 5 years) of heart problems.

Other neurogenic conditions such as Parkinson’s disease, a stroke or multiple sclerosis can also cause ED.

Side effects from medications/surgery

Certain medications for depression and heart disease are known to cause erectile dysfunction. What’s more, surgery and/or treatment for bladder, prostate and rectal cancers can also have an effect.

Treatment for erectile dysfunction

If you identify with any of the above causes, then you may be able to make some simple adjustments to your lifestyle or it may be worth seeking additional advice from a healthcare provider to get to the bottom of it. Bear in mind it can also be a combination of factors.

Buy erectile dysfunction treatment online There are erectile dysfunction tablets available without a prescription. We offer a discreet service with next day delivery – our friendly pharmacist Margaret can help you decide which is best for you.

Or if you prefer to read more about your options first, these may help you decide:

What are the best value erectile dysfunction pills in the U.K?

What’s the best erectile dysfunction treatment: Sildenafil or Tadalafil?

Stay safe when buying medicines online

References

Erectile Dysfunction - Sexual Advice Association [accessed 16/09/21]

Erectile dysfunction (impotence) - NHS (www.nhs.uk) [accessed 16/12/21]

One Patient Out of Four with Newly Diagnosed Erectile Dysfunction Is a Young Man - The Journal of Sexual Medicine [accessed 20/09/21]

Author: Gemma Boak

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 13/10/21

Saxenda Weight Loss Injections

Saxenda weight loss injections, also known as ‘the skinny pen’ burst onto the U.K market back in 2017, with exciting results for people who need help with weight loss.

In one study of 3,731 people, 3 out of 5 achieved significant weight loss of 5% or more, and 1 in 3 achieved weight loss of 10% or more (1).

But how much does the weight loss pen, Saxenda weight loss injections, cost in the U.K? and is it worth it?

The truth is… it depends where you are in your weight loss journey right now.

If you need to lose a little weight and you’ve read about ‘the skinny pen’ then you may have been sucked into hype and need to be very, very careful. Saxenda weight loss injections are unlikely the best option for you if your Body Mass Index (BMI) is less than 27. Speak to your doctor.

If your BMI is over 27 and you have a weight related medical condition OR you’re living with obesity (have a BMI over 30) and have tried and failed at calorie controlled diets before… then this weight loss supporting injection may be the right next step for you (2).

How Saxenda works (and why we only recommend it if hunger is holding back your weight loss dreams).

Saxenda is the brand name for the active ingredient, Liraglutide. Liraglutide is an appetite suppressant that mimics the hormones in your brain that regulate hunger (3).

There is no guarantee that reducing hunger will delete extra weight, but reducing hunger pangs should help avoid the urge to overeat and to snacking in between meals.

Saxenda weight loss injections arn’t a miracle cure (though we wish it was).

It’s a tool which should be used alongside a calorie deficit diet and a doctor approved exercise program. This is why we’ll send you an access code to the Liva Healthcare app when you buy from us, so you can track and monitor your health and lifestyle goals.

You’ll also have access to a Liva health coach to ask questions within the app.

How much does Saxenda cost in the U.K?

To get the best results from Saxenda, you need to slowly increase your dose until you reach 3mg per day.

It’s easy to change the dose, you can see a simple dial mechanism at the top of the pen.

This means when you start, your pen will last much longer, because you are using less each time you inject than you will be when you are up to the full dose.

Here at our family owned pharmacy, we keep our prices as low as possible, and we help you with discounts to enable you to successfully continue on your weight loss journey..

So let’s look at a typical example.

The recommended dosage for Saxenda when you start is 0.6mg once a day, which increases by 0.6mg each week (2).

A typical dosing schedule works like this:

• Week 1: 0.6mg once daily for 7 days
• Week 2: 1.2mg once daily for 7 days
• Week 3: 1.8mg once daily for 7 days
• Week 4: 2.4mg once daily for 7 days
• Week 5: 3.0mg  once daily ← this is the full dose and you will stay at this dose for as long as you need to.

How does the dosage schedule affect the cost?

When you’re starting out, a single pen will last you 17 days.

If you buy a pack of 5 then they’ll last you 44 days…

...so a 5 pack will take you through to week 6.

Once you are at the optimum dosage (3mg/day), the 5 pen pack should last you 30 days.

In terms of investment… it depends how many pens you buy at a time. One pen works out at £75, but if you buy the 5 pen multipack, this is reduced to £60/pen (2).

How long do I need to take this for?

You’ll know pretty soon if this solution is working for you.

You should lose 5% of your starting body weight by week 12. If you have not achieved this using Saxenda, then you should stop the regime (always talk to your doctor or qualified pharmacist first). (2)

In terms of when you’ll stop, it depends on you and your progress. Some people stop when they hit their target weight, and some people continue to help them maintain their weight loss (1).

Here at Webmed Pharmacy, our lead pharmacist Margaret, is available during office hours to chat about your progress and answer any questions you have.

In fact, the manufacturer of Saxenda, Novo Nordisk, said this about us:

“Webmed's service is so supportive and ethical, it definitely stands out from the others”

Check out more about Saxenda

1. Benefits of Saxenda [cited 12/08/21] Available at: https://www.saxenda.com/about-saxenda/benefits-of-saxenda.html

2. Saxenda  [cited 12/08/21] Available at: https://webmedpharmacy.co.uk/buy/saxenda

3. How Saxenda Works  [cited 12/08/21] Available at:  https://www.saxenda.com/about-saxenda/how-it-works.html

Author: Gemma Boak

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 04/10/21

Reaching menopause can wreak havoc on your skin. Skin elasticity, acne, pore size, and pigmentation can all be affected by the natural decline in reproductive hormones most women experience in their forties and fifties, which results in the end of menstruation.

But menopause and perimenopause do not have to be miserable when it comes to skin woes. There is no denying that skin changes during menopause can be both uncomfortable and distressing, so read on for insight into what these changes might be, why they happen, and potential treatments available to you.

Menopause equals low collagen

I often see patients complaining of jowls, slack skin, and wrinkles when perimenopausal or menopausal.  During this time, the production of collagen, elastin, and hyaluronic acid exponentially decreases, and skin becomes thinner and drier. Research shows women’s skin loses about 30% of its collagen during the first five years of menopause, followed by a further 2% of collagen every year for the next 20 years.

The structural components of the dermis decrease, fat and bone are reabsorbed from the mid-central face, muscles relax, and fat deposits increase in the lower face. Clinically this translates in the shape of the face changing from an upright triangle to a downward triangle. Dynamic lines become more evident (crow’s feet, frown lines, and forehead lines), jowls appear, lines running from the tip of the nose to the corners of the mouth deepen. Smile and frown lines become visible all the time. Later, the tip of the nose dips, and you can see pouches under the eyes. But there are steps you can take to reduce these effects of collagen decline.

Most of these events are due to chronological ageing which is mainly genetic and difficult to prevent.

The skin also starts to show all the damage accumulated from sun exposure (mottled pigmentation, facial broken veins, skin coarseness, fine lines, and wrinkles) during the early decades.

What are the treatments for low collagen:

• Always protect the skin from the sun to reduce visible wrinkles, using a sun protection factor (SPF) of 30 or higher.
• Consider skincare products that contain retinol or peptides to increase the skin’s collagen level. 
• Other options available are Botulinum Toxin (commonly known as Botox), dermal fillers and injectable anti-ageing treatment ‘Profhilo’, or potentially surgical options such as a face lift.  A Dermatologist or Aesthetic Practitioner can explain these options to you and provide you with a consultation or referrals where needed.

Menopause and acne

Experts estimate that 25% of women aged 40 to 49 experience acne and, with many of those, it is related to menopause. In most cases, adult acne is caused by a hormonal imbalance impacting our skin’s natural defences. This is common when the body produces too much testosterone (male sex hormone) or increases sensitivity to normal levels of androgen within the skin.

These fluctuations can increase inflammation of the skin, cause a rise in oil (sebum) production, encourage the clogging of sebaceous glands, and stimulating the growth of the acne-causing bacteria Propionibacterium acnes.

Perimenopausal acne develops in women for much of the same reason that it curses our skin in puberty. It certainly does not seem fair to battle wrinkles, menopause symptoms, and acne all at the same time. Dealing with all of this can also increase stress which is another acne trigger. Stress increases the levels of cortisol in the body, which increases breakouts through increased oil production.

 
What treatments are there for menopausal acne:

Because a women’s skin is thinner and drier, treatments for teenage acne can be too harsh.

• Talk to your doctor or dermatologist about prescription medication.
• Hormone replacement therapy (HRT) is the most effective treatment for adult acne. However, you can still experience menopausal acne even if you are using HRT. This is because some HRTs use an influx of the hormone progestin to replace the oestrogen and progesterone your body loses. Introducing this hormone can cause your skin to breakout. 
• Natural treatments are usually free of the side effects sometimes caused by prescription options.
• Speak to a Dermatologist or Aesthetic Practitioner about a treatment plan if you cannot get your acne under control.

What can I do at home to clear hormonal acne?

• Wash your face every morning and evening. Adding salicylic acid and/or glycolic acid into your routine can help to unclog pores.
• Apply no more than a pea sized amount of acne product. Applying too much can dry out the skin and cause irritation.
• Wear sunscreen every day and avoid tanning. 
• Replace old, oil-based cosmetics with mineral-based ones.
• Think about making a few changes to your diet. Overdoing it on certain foods may lead to inflammation, so you might consider limiting dairy products, sugar, refined carbohydrates, and red meat.
• Kivu Anti-oxidant Mist is ideal for oily and combination skin. It helps to maintain essential moisture in the skin and its anti-oxidant properties assist in decreasing UV damage. This mist contains 70% Helix Aspersa secretion and bitter orange peel extract. It has astringent properties and is effective in healing acne blemishes.
• The combination of these two active ingredients has inflammatory, anti-microbial, anti-oxidant, and healing properties.
• Kivu Hydrating Elixir combines Helix Aspersa secretion with hyaluronic acid and has exceptional hydrating properties and a light texture. This product helps to moisturise dryness caused by acne-specific medical therapies (ie. retinoids).

Dry menopausal skin

One job of oestrogen is to stimulate the formation of the skin with smoothing collagen and oils. That is why when menopause approaches and oestrogen production diminish, skin can become dry and itchy. This is also exacerbated by the skin losing some ability to hold water. Pores often look larger when oil production drops, and hyaluronic acid levels also decrease, causing fine lines to become more visible.

Treatment for dry menopausal skin:

• Wash with a mild cleanser
• Apply moisturiser containing hyaluronic acid. 
• Apply products containing Vitamin A derived molecules and glycolic acid to help the skin regenerate.
• Speak to a skincare specialist about treatment options such as Microdermabrasion.
• Kivu Anti-ageing face and eye cream is designed for mature skin, this unique 2-in-1 face and eye cream, uses the best active ingredients to improve skin hydration, skin brightness and elasticity. It will decrease the appearance of fine lines and blemishes as well as reducing puffiness under the eye. It combines Helix Aspersa secretion with peptides. It particularly has a high concentration of Acetyl Octapeptide-8 and Acetyl Tetrapeptide-5. Acetyl Octapeptide-8 has water binding properties hence it is able to hydrate, smooth and rejuvenate the skin, and Acetyl Tetrapeptide-5 reduces puffiness by changing the micro-circulation in the skin of the periorbital area, promoting lymphatic drainage.

Hyper-sensitive skin during menopause

At around the age of 50, the PH level of our skin changes. With this change, skin becomes more sensitive and, women are more likely to develop rashes and easily irritated skin. Existing skin conditions such as eczema and rosacea could worsen, and you may need the help of an Aesthetic Practitioner or Dermatologist.

Treatment for hyper-sensitive skin:

• Use a fragrance-free moisturiser to reduce irritation. 
• Use very mild cleansers.
• See a Dermatologist if your skin condition worsens.
• Kivu Firming Serum is effective for those who suffer from redness, rosacea or have sensitive skin. The product which combines the benefits of Helix Aspersa secretion and Witch Hazel and has a long-term soothing effect on the skin. Witch hazel is derived from the hamamelis virginiana plant and has the ability to soothe the skin and reduce inflammation.

Age spots and sun damage

If you have spent ample time in the sun without skin protection, you will likely see the effects during menopause. Age spots (solar lentigo) can appear on all photo-exposed areas, but the face, hands, arms, legs, and chest are usually the areas of most concern.

Another frequent condition that concerns menopausal women is the appearance of a condition due to chronic sun exposure called Poikiloderma of Civatte. It is a combination of thin skin, hypo or hyperpigmentation, and a net of dilated blood vessels that typically appears on the sides of the neck and characteristically doesn’t affect the skin under the chin and the top middle part of the neck. Many women think it is caused by the application of perfume, but this still hasn’t been fully demonstrated.

Actinic keratosis (precancerous lesions due to chronic sun exposure) starts manifesting. They are scaly, pink lesions that never heal.

Treatment and prevention of age spots:

• Apply a broad spectrum SPF30 (or higher) sunscreen every day before going outdoors. This can help fade age spots and prevent new spots from forming, which reduces your risk of developing skin cancer.
• Vitamin C and Vitamin A-derived molecules applied topically can help reduce pigmentation over time.
• Make an appointment to see a Dermatologist for skin cancer screening as the risk of skin cancer increases with age. The earlier you find skin cancer and pre–cancerous growths, the more treatable they are.
• Ask your Dermatologist to recommend treatment. Before you buy any products for age spots, see your Dermatologist for a skin examination.

Only really coming to mainstream awareness now, the effects of menopause on the skin are wide-ranging and can be tricky to handle. Now that you know what to expect, you are equipped to seek help or try our recommended at-home treatments to diminish these changes.

Whatever age you are, you do not have to live with dry, hyper-sensitive, inflamed skin, acne, or age spots.

The Menopause

Natural menopause (when your periods stop) occurs at an average age of 51, but symptoms can start many years before.  The medical definition of menopause is when your periods have stopped for a year. It occurs when ovaries stop producing eggs, which results in low levels of oestrogen, progesterone, and testosterone.

The impact of menopause is under-recognised, with more than 75% of women experiencing symptoms, a quarter having severe symptoms which may last seven years or more, and a third having long-lasting symptoms. A quarter of women have considered leaving or reducing their working hours due to symptoms.

What are the symptoms of menopause?

Symptoms of menopause are mainly due to fluctuating oestrogen and progesterone levels.

Periods start to become irregular. They can be more frequent or more spaced apart, heavier, or lighter. This disruption can go on for several years with or without other symptoms.

Most people are aware of hot flushes and poor sleep during menopause, but many other systems of the body are affected. Insomnia may happen due to night sweats or without them and, it is often one of the earlier symptoms. Some ladies suffer from restless legs that also affect sleep.  Many women suffer from poor concentration and memory loss, as well as the inability to think clearly, also known as "brain fog."  Anxiety, irritability, palpitations, and low mood are common.

Some ladies have joint and muscle aches and pains (even with regular exercise, menopausal women lose 2% of their muscle mass without extra oestrogen).

Most women eventually suffer from vaginal dryness. This can cause itching and discomfort (especially during sex) and bladder irritability that can lead to frequent urine infections. Loss of libido is a huge problem.

Skin becomes dry, loses elasticity, and may be itchy. Hair becomes thinner, and less shiny and dry eyes are common.

Migraine sufferers often find they get worse around menopause, again due to the fluctuation in hormones.

What are the longer term problems associated with low oestrogen levels?

Osteoporosis is a medical condition associated with bone fractures with minimal trauma and happens to many women after menopause due to low oestrogen levels. It is responsible for the loss of height many women experience with age and the stooping posture or Dowager's Hump. 

Heart disease also increases in women after menopause. Before this, the incidence of heart attacks and angina in women is significantly less than in men, but this increases after menopause, and heart disease is the leading cause of death in women.

Treatment options

Many lifestyle changes can reduce symptoms: hot flushes can be reduced by cutting down alcohol and caffeine, weight loss and exercise are encouraged, and stopping smoking is always beneficial.

Herbal remedies

Herbal remedies such as soya, red clover, black cohosh, and St John's Wort have been found to help anecdotally, although the scientific evidence for them is not great. They are also generally not advisable to use in women who have had breast cancer, as they can interact with prescribed medications.

Prescribed Medication

Non-hormonal methods for reducing hot flushes include a blood pressure tablet called Clonidine and antidepressants such as Sertraline, Citalopram, or Venlafaxine. Some ladies also have good symptom relief with anti-epileptic medication such as Gabapentin and Pregabalin, although side effects are common.

Hormone replacement therapy (HRT)

Both oestrogen, and progesterone if required, are the most effective treatment for symptom control and will also address long-term conditions due to low oestrogen. These include maintenance of bone density and a consequent reduction in osteoporosis and fractures, protection against heart disease and vascular dementia (if started within ten years of the last period). HRT also reduces insulin resistance, and as a result, Type 2 Diabetes; it reduces osteoarthritis and bowel cancer; it improves vaginal dryness and bladder irritability (reducing the need to pass urine frequently).

The two main risks with HRT are breast cancer and blood clots.

The risk of breast cancer is increased with combined HRT (oestrogen and progestogen) but probably not by oestrogen alone. The increased risk is similar to that of smoking, taking the combined pill, or drinking two units of alcohol each day. It is much less than the risk of breast cancer due to being obese. 

There is evidence that although the risk of getting breast cancer rises, the chance of dying from breast cancer is no greater than for women not taking HRT.

The risk of clots is not increased by using transdermal oestrogen (either a gel, spray, or patch so the oestrogen is absorbed by the skin), but it is increased by oral oestrogen.
 

What are the side effects of HRT?

Generally, HRT is well-tolerated, but one of the more common side effects when starting is some irregular vaginal bleeding. Bleeding should settle within three months or so, and if it does not, you should discuss it with your doctor as further investigations may be necessary.

Some ladies experience breast tenderness, fluid retention and bloating, headaches, nausea, and there may be an increase in vaginal discharge.

Some also have progesterone intolerance, and symptoms of this are similar to those with premenstrual syndrome.

Side effects are managed by changing the dose or type of HRT, and invariably women can find a regime to suit them.

How to take HRT

If you still have a womb you will need to take oestrogen (for symptoms) and progestogen to protect your womb, as oestrogen on its own can thicken the lining of the womb and increase the risk of cancer of the womb.

If you are still having periods or are within a year of your last period, then you take what is known as sequential HRT that is oestrogen every day, and progestogen for 12 -14 days every month.

If your periods finished more than a year ago, then you take continuous HRT that is both oestrogen and progestogen every day. However, if you have had a hysterectomy, you only need to take oestrogen.

HRT does not act as a contraceptive, so it is important to remember a woman needs to use contraception for a year after her last period if she is over 50 when they stop or for two years if she is under 50. If unsure of the final period, then contraception is needed up to the age of 55. One of the best ways to address both contraceptive need and the progestogen component of HRT is to use the Mirena coil, a device inserted into the womb.  You can also take certain contraceptive pills with HRT or use barrier methods.

What are the different types of HRT?

Oestrogen comes in a patch, gel, or spray form (transdermal) or tablets, and as mentioned previously, the transdermal methods are the safest long term and have the lowest side effects.

Usually, we use Oestradiol which is a body-identical oestrogen. Some ladies also benefit from adding vaginal oestrogen to improve dryness and bladder symptoms.

Progestogen is available as the Mirena coil or as Utrogestan capsules (a body identical micronised progesterone), taken orally or sometimes vaginally. Micronised progesterone is the safest form of progestogen. Evidence shows a lower risk of breast cancer than with other types of progestogen, and also a beneficial effect on cholesterol. Progestogen is also available as a tablet either on its own or combined with oestrogen and, also as a combined patch.

Some women benefit from the addition of testosterone.  This has been proved to help with low libido and sexual satisfaction, and some women also feel more energetic and notice an improvement in brain fog and muscle strength. We would not usually start testosterone until women have been on a good dose of oestrogen for several months. Testosterone is not licensed for women in the United Kingdom however, it is widely used by menopause specialists and some GPs.  Side effects include acne and increased body hair, but there is no evidence of any long-term harm.

Generally, blood tests need to be done before starting and to monitor treatment with testosterone.

We do not usually do routine blood tests to diagnose menopause unless a woman is under 45.  However, we may do blood tests when monitoring response to treatment, particularly if symptoms are not being controlled.

It may take some time to find a regime to suit you, but usually, a woman's quality of life is significantly improved by taking HRT. HRT can be continued long term after discussion with your doctor to fully understand the individual risks and benefits and effects on quality of life.

The risk of osteoporosis increases by smoking, lack of weight-bearing exercise, excess alcohol, and having a family history of osteoporosis.

Article by Holly Mason of The Skin Investment Clinic with contributions from: Dr. Alex Standring (menopause and HRT) and Dr. Benedetta Brazzini (dermatology and aesthetics)
Contact holly@theskininvestmentclinic.com for further advice and consultations.

If you’re looking for emergency contraception right now then you’ve probably got a few questions like:

• Does it work?
• How well does it work?
• Are there any side effects?
• Where can I get this near me in the U.K.?

This article aims to answer all of these questions for you.

How does the morning after pill work? And is it effective?

The good news is the morning after pill is very effective. Though the effectiveness decreases the longer you wait after sex.

There are two standard drugs used in the UK as emergency contraception that can be bought over the counter without a prescription.

These drugs are Levonelle One Step and ellaOne.

Both prevent ovulation (egg release) by changing the levels of the female sex hormone progesterone. Preventing egg release means the egg cannot meet the sperm and fertilisation will not take place.

If you have already ovulated, these emergency contraceptive pills also thicken the mucus in the cervix (the neck of the womb), which makes it harder for sperm to cross from the vagina into the womb, and they change the lining of the womb so that any egg that has been fertilised, cannot implant into it.

The effectiveness of both options depends on whether you have already ovulated, and how many hours you wait before taking the morning after pill.

ellaOne is 98-99% effective if taken within 120 hours (5 days). The earlier you take it the more effective it will be.

Levonelle One Step and the cheaper product Levonorgestrel (on prescription), which has the same active ingredient, are more heavily time dependent than ellaOne. If you take Levonelle within 24 hours it is 95% effective, within 48 hours is 85% effective, within 72 hours it is 58% effective.

The effectiveness data is based on women taking the morning after pill before they have ovulated. And regardless of which option you choose, the faster you take the tablet after sex, the more effective it will be.

Morning after pill side effects

As with all medicines, ellaOne and Levonelle One Step (Levonorgestrel) may cause side effects, but neither medicine should affect your fertility in the long term.

The most common side effects for ellaOne

Side effects can include nausea, abdominal (stomach) pain or discomfort, vomiting, painful periods, pelvic pain, breast tenderness, headache, dizziness, mood swings, muscle pain, back pain, tiredness.             

The most common side effects for Levonelle One Step (Levonorgestrel)

Side effects can include feeling sick (nausea), irregular bleeding until your next period, lower abdominal pain, tiredness, headache.

Where can I get the morning after pill near me?

The easiest way to get the morning after pill is to visit your local pharmacy or to buy online from a reputable provider like us here at Webmed pharmacy.

Getting the morning after pill at your local pharmacy

You’ll be able to buy the morning after pill from a dispensing pharmacy. This is not something you can buy off the shelf.

You’ll have to answer a few questions so the pharmacist can check that you are buying the pill for the right reasons, and to check whether you need any support. This is usually done in a confidential room so you do not need to worry about being heard by anyone else. They do this all the time, so you don’t need to worry about feeling embarrassed or judged.

They will not sell the morning after pill to your partner.

If you can access a pharmacy today, this is your best option as ellaOne and Levonelle One Step are most effective the sooner they are taken after sex.

Getting the morning after pill online with next day delivery

You can buy ellaOne , Levonelle One Step and Levonorgestrel here at WebMed Pharmacy from our registered pharmacist Margaret or receive a prescription from our doctor Kate. You’ll still have to submit your medical details, but this is done via an electronic form.

And with discreet next day delivery if you order before 4pm to your home or a drop off location of your choice (not including Friday) this may be a more convenient option.

References

Levonelle patient leaflet: https://www.medicines.org.uk/emc/files/pil.133.pdf

ellaOne patient leaflet: https://www.medicines.org.uk/emc/files/pil.9437.pdf

NHS Where can I get emergency contraception?: https://www.nhs.uk/conditions/contraception/where-can-i-get-emergency-contraception/?tabname=getting-started

Webmed Pharmacy. Morning after pill https://webmedpharmacy.co.uk/buy/morning-after-pill

Author: Gemma Boak

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 12/12/21 

Period delay...because we’ve all complained “I don’t want to have my period on holiday”.

There are many options for managing your period on holiday, but for some of us relying on a tampon during outdoor swimming season isn’t a comfortable option.

Add to this the rare opportunity to wear floaty white linen dresses and pastel-coloured shorts…

...and your period becomes mildly terrifying when your adventures take you too far away from the toilets.

How period delay tablets work

Period delay tablets contain a drug called Norethisterone (also known as Primolut N). The drug has been designed to behave like the sex hormone progesterone.

The job of progesterone is to maintain a plush womb lining, ready for implantation of your baby-to-be. When progesterone levels drop, your womb lining breaks down and you get your period.

Norethisterone mimics the hormone progesterone, preventing breakdown of your womb lining. This delays your period.

When you stop taking the period delay tablets, progesterone levels drop and you’ll get your period within 2-3 days.

Period delay “pill” vs contraceptive pill

The contraceptive pill and the period delay pill are both based on sex hormones, but they are very different.

Here is the most important information you need to know about them both:

• Norethisterone will not prevent pregnancy so you need to make sure you have effective contraception in place.
• Women taking the combined pill for contraception have the option to take the combined pill packs “back to back” to prevent their period, so period delay medication is not needed and is not recommended.
• Women taking the progesterone only pill cannot delay their period in the same way as women taking the combined pill, and are able to apply for the period delay tablets.

Because you cannot buy period delay medication over the counter, your doctor will advise you whether Norethisterone is a good option for you.

Here at WebMed Pharmacy we have online doctors who will assess your suitability via an online medical questionnaire at no extra cost, making this process simple, fast and affordable.

Will the period delay tablet work for my two week holiday?

Norethisterone should be taken 3 days before the start of your period. You’ll take three 5mg tablets a day for the duration of your holiday, up to a maximum of 17 days.

For a week-long holiday, a 30 pack will last you the full 7 days.

For a longer holiday, you’ll need the 60 pack.

It’s not recommended that you take this regularly. If you find you need to delay your period frequently then it’s recommended you speak to your GP to discuss longer term alternatives.

The side effects of taking period delay medication

As with all drugs, there is a risk of side effects but not everyone gets them. Potential side effects of Norethisterone are similar to the symptoms you may experience when you get your period. Things like bloating, breast swelling, breast tenderness, headaches and nausea.

I’m going on holiday in a couple of days… can I get this prescription now?!

We use DPD 24-hour discreet delivery, which means your order can be delivered to your home, place of work, the next working day, within a 1-hour allocated time slot or to one of over 5,500 pick-up shops for your convenience.

Order your period delay tablets here All you need to do is place your order and have it approved by our team of doctors before 4pm. Note that orders placed after 4pm Friday are processed Monday for delivery on Tuesday. Read more about our process here.

Author: Gemma Boak

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 18/06/21

The topic of acne doesn’t come up in everyday conversations that often, but when you suffer from it, it can be all-consuming and may have a lasting psychological impact.

There are acne treatments out there.

There’s no need to carry on suffering in silence.

A study showed that 54% of UK adults who experienced acne feel it affected their self-confidence[1], and 34% didn’t know what effective treatments there are for it.

The thing about acne is that while there’s no cure, you can control it with topical treatments and/or oral medication.[2]

What causes it?

It can affect you at any point, but 95% of people develop acne aged 11 to 30.[3] Whether you’re going through puberty or you’re an adult, hormone levels may be the culprit.

Acne starts when glands produce more sebum (or oil) than normal. Pore linings then become thicker and dead skin cells aren’t shed properly, causing follicles to become blocked. With a build-up of oil and bacteria, your skin becomes inflamed forming blackheads, whiteheads and/or papules (small red bumps), pustules (pus-filled spots), nodules or cysts.

Women are more likely to develop acne during adulthood - linked to periods, pregnancy or Polycystic Ovary Syndrome (PCOS) - but genetics may also play a part.[4]

What type of acne do you have?

The type of acne you suffer from will determine the best treatment for you. And remember, acne can show up on your back or chest as well as your face.

Comedonal acne – characterised by small, non-inflamed bumps.

Mild acne – you’ll notice mainly whiteheads and/or blackheads with a few papules and pastules.

Moderate acne – you’ll notice lots of blackheads and whiteheads with many papules and pustules.

Severe acne – is characterised by lots of painful papules, pustules, nodules or cysts that can lead to scarring. If you do have severe acne, we recommend getting advice from your GP as topical treatments may not be suitable.

What’s the best acne treatment?

Once you’ve determined the type of acne you have, you can pick from one of the following treatments:

• Differin, a cream or gel with the active ingredient adapalene is a topical retinoid for comedonal acne. It works by bringing skin turnover under control and reducing inflammation.[5]
• EpiDuo contains adapalene and benzoyl peroxide to reduce the number of bacteria in mild acne.
• If you have lots of pustules, then Duac, a topical antibiotic, is the best treatment for inflammatory acne.
• For moderate acne, there’s a combination treatment of EpiDuo and the oral antibiotic Lymecycline.

Unfortunately, there’s no overnight cure with these treatments - some can take up to eight weeks to begin working, while some may make your acne appear worse before making it better.

The most important thing is to buy your treatments from a trusted supplier so you know that you’re using the most effective treatment for your type of acne and have someone you trust to ask questions.

Margaret, our lead pharmacist is on hand during opening hours to give you advice and support Monday to Friday 9am to 5pm.

Find out more

[1] Acne Support. Over half of people who have ever had acne feel it has affected their self-confidence [cited 9/04/21]  http://www.acnesupport.org.uk/news/half-people-ever-acne-feel-affected-self-confidence/

[2 ] British Skin Foundation. What is Acne? [cited 09/04/21] https://knowyourskin.britishskinfoundation.org.uk/condition/acne/

[3] NHS. Overview Acne [cited 09/04/21] https://www.nhs.uk/conditions/acne/

[4] NHS. Acne causes [cited 09/04/21] https://www.nhs.uk/conditions/acne/causes/

[5] Differin. Acne: Get to know the enemy [cited 09/04/21] https://differin.com/learn/what-is-acne

By Holly Mason, founder of the Skin Investment Clinic, taken from her Ebook ‘Eliminating acne and acne scarring: proven secrets’

Whether you’re 15, 25 or 45, acne is unpleasant. When the pores of the skin become blocked with dead skin cells, grime, dirt, oils and excess sebum it causes pus-filled bumps to appear, which we call acne. These can appear on your face, neck, chest, back, shoulders or arms. Causes of acne include shifting hormones, incorrect skincare, bacteria, inflammation from intolerances or stress, cosmetics, diet and even the wearing of facemasks to help prevent Covid-19. Acne not only affects skin, it can also hugely affect your confidence, so tackling it is important for overall wellbeing too.

Treating acne is a long-term journey which requires patience. But the good news is there are many tricks to try at home or in a clinic which can work wonders on clearing up your skin before heading to the doctor.

Use a mild cleanser

The key word here is mild. It is crucial to wash your face twice a day with a mild, water soluble cleanser to prevent redness, help the skin heal and reduce sebum production. Stay away from bars of soap or aggressive cleansers as they dry out the skin and can block pores. Coarse scrubs can also irritate the skin and make the problem worse. And remember: you can’t scrub away spots and blackheads.

Exfoliate with salicylic acid

This removes dead skin cells and stimulates healthy cell rejuvenation, both on the surface of the skin and in the pores. Salicylic acid also helps with redness and inflammation and fights spot-causing bacteria.

Fight bacteria with benzoyl peroxide

Benzoyl peroxide comes in solutions ranging from 2.5% to 10% concentration which you can find over the counter at a pharmacy or chemist. Begin with a lower concentration as a lotion containing 2.5% benzoyl peroxide will be less irritating to the skin than a solution of 5% or 10% and may be just as effective.  Alternatively, speak with your trusted aesthetic practitioner or dermatologist about chemical peels such as salicylic and azelaic acid which can produce incredible results.

Protect your skin from sun damage

This cannot be emphasised enough: the skin cannot heal spots if it is also fighting sun damage. A good sunscreen with SPF of at least 30 will help spots to heal more quickly and protect the skin from further damage. I recommend using a gel cream as it will not clog pores.

Use a sebum-absorbing clay face mask regularly

It’s important to soak up excess sebum to help prevent future breakouts. I recommend using a natural clay mask which does not irritate or dry the skin too much.Make sure your skincare products do not contain irritating substances such as alcohol. They are very common in sebum-absorbing products for spots but can cause cause a dry, flaky and red skin.

Watch your diet

Good nutrition is key for your skin. As every body is different there is no definitive list of foods that cause acne, but attention can be paid to foods that cause inflammation and so are arguably best avoided. Sugar, dairy and alcohol can trigger inflammation and acne so experimenting with reducing those could help. Always talk to your doctor before changing your diet. Drinking plenty of water helps keep skin clear and taking in good levels of vitamin A, C and E can also help, so get munching on carrots, mangoes and melon. Antioxidants found in foods such as blueberries, blackberries, goji berries and cherries are great for skin, as well as Omega 3 fatty acids which you can get from animal protein, fish and eggs. Zinc, found in dark chocolate and oysters is a powerful acne-fighting nutrient, and red peppers and watermelons also contain lycopene which reduces inflammation and stimulates cell renewal.

Change your facemask daily

Since the start of the Covid 19 pandemic acne cases on chins, cheeks and around mouths have become more frequent due to the use of facemasks. This ‘maskne’ is caused by extra heat, friction, moisture and pressure on the face from covering the skin for long periods. This creates the ideal environment for bacteria, yeast and mites to grow while the mask blocks oil glands and hair follicles creating the perfect setting for skin irritation and spots. To avoid ‘maskne’, stay away from heavy make-up (nobody is seeing your lower face anyway), drink a lot of water, try to wear a silk mask if possible and, crucially, wear a clean mask every single day. Although it may be tempting, try to avoid abrasive face scrubs and exfoliants and instead use products that support the skin’s natural protective barrier such as hyaluronic acid, lactic acid, urea and niacinamide.

Consider clinical treatment

If at-home treatments aren’t producing the results you want, seeing an experienced aesthetic practitioner is a good next step before visiting your GP. Clinical treatments for mild acne include microdermabrasion, vacuum suction and oxygen treatment. These can all help with eliminating blackheads, reducing scarring and improving the look of the skin. For moderate or severe acne, chemical peels can work wonders. Salycylic acid or combination peels can release hardened sebum, calm blemishes, lift dark areas of scarring and exfoliate dead skin cells for a clearer complexion. Photodynamic therapy is another effective method of clearing the pores of skin debris, grime, dirt, oils and excess sebum to leave cleaner, brighter skin.

Find out more

For more information, check out the ebook from Skin Investment Clinic, ‘Eliminating acne and acne scarring: proven secrets’

https://the-skin-investment-clinic.myshopify.com/collections/acne-recommendations/products/proven-secrets-eliminating-acne-and-scarring-e-book

Click here to view our prescription acne treatments

This month we’re raising awareness around group B strep (GBS), which is carried by 20% to 40% of women in the UK.[1]

What exactly is group B strep and can it affect anyone?

The hard fact is that it can affect anyone.

It’s a bacteria that usually lives in your vagina or rectum and both men and women can have it. It’s normally harmless – most aren’t even aware they carry it – but it can put pregnant women and newborn babies at an increased risk.

It’s worth noting that it’s not a sexually transmitted disease.

FIND OUT MORE

What are the risks?

If you carry GBS then there’s a small risk you’ll pass it on to baby during labour, which can lead to serious infections like meningitis, sepsis and pneumonia.[2]

1 out of 1750 babies are diagnosed with early onset GBS, meaning that symptoms of infection will appear within 12 to 24 hours after birth.

1 out of every 2700 babies develop late onset GBS, developing an infection up to 3 months old.[3]

Every month in the UK, an average of 43 babies are diagnosed with early onset GBS: 38 will make a full recovery, three babies will survive with long-term physical and mental disabilities while two babies will unfortunately die from GBS infection.[4]

This is preventable. So why is it not routinely tested for?

The risk is only small, and most babies are born safely without developing an infection.

However, a simple at-home swab test known as an ECM (Enriched Culture Medium) can detect if you’re carrying GBS, which is best taken when you’re 35-37 weeks pregnant.

This easy-to-use test can protect your baby’s health.

Some maternity units still only use a standard test, which doesn’t detect up to half of cases, so an ECM test (the one we supply) is preferable.[5]

If you do get a positive result, try not to worry- this is easily treated. You’ll be given antibiotics during labour and your baby will be closely monitored after birth.

Taking the test

You’ll need to use two swabs – one vaginal and one rectal. Then all you need to do is fill in your details, send your samples off using the pre-paid envelope and you should receive the results within three days of the lab receiving your kit.

Margaret, our lead pharmacist is here to help you along the way, whether you have any questions before ordering, while you’re using your kit and afterwards.

Buy now You can call us on 0161 491 1899 for advice and support Monday to Friday 9am to 5pm.

References

1. Group B strep (strep B) and pregnancy | Tommy's (tommys.org)
2. Group B Streptococcus (GBS) in pregnancy and newborn babies (rcog.org.uk)
3. Group B Strep and pregnancy - Group B Strep Support (gbss.org.uk)
4. Group B Streptococcus (GBS) in pregnancy and newborn babies (rcog.org.uk)
5. Group B Strep and pregnancy - Group B Strep Support (gbss.org.uk)

Author: Gemma Boak

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 11/05/21