New treatment for menopausal hot flush

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Sej bara till om du också behöver en hjälpande hand. Och så får du mer än bara inredning. Du får rådgivning hela vägen. Välkommen till AGI-produkter. Hello there and welcome to the Inside Health Podcast with me, James Gallagher. Today we'll be analysing my farm. Don't worry, we won't be silent or deadly on this important issue, and if you can't tell, yes it's the last episode in the series, and we're going out with a bang. Or maybe just a gentle toot.

We're also chatting to a hospital that's tackling superbugs by getting rid of sinks.

But first, menopausal hot flushes, because a new drug treatment has been approved for NHS use, it works in the brain to reduce hot flushes, and it can be taken by women who can't use hormone replacement therapy or HRT. We'll talk to our resident GP doctor Margaret McCartney about it in a moment, but first I was invited to experience a hot flush.

I'm Leslie Salem, I'm founder of Over the Bloody Moon and we are here today because you're going to try the Menovas which simulates menopausal hot flushes. So are you up for the challenge? I am up for the challenge. Okay, let's get this on. Mae'n rhaid i'n rhaid. Mae'n rhaid i'n rhaid. Mae'n rhaid i'n rhaid i'n rhaid i'n rhaid i'n rhaid.

So we'll just start here putting your arm in that. There we go. So if you want to zip it up and we're going to I'll just hold that in so it doesn't get caught all the way up to the neck. So super tight. It's like a polo now. Yeah, you're gonna get nice and Zipped in. Um I'm just gonna connect you now to Yeah. yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw Oh no, I can feel it in my night now. I didn't realize you'd actually swim. Oh okay, yeah. So how hot how quickly, Leslie?

So you should feel the first hot flush straight away. It will last for a couple of minutes, but the second hot flush has been randomly programmed and that will be even hotter. So can you start to feel... Only in my neck at the moment. Because yeah, the collar where I am not wearing a T. Yeah. is very definitely warm against my skin. I know I can feel it as I'm moving around. Yeah, it's definitely in my back as well. How many people have a hot flush as part of their menopause or something?

Eighty percent will experience hot flushes at some point. I think it's cooling down again. Is this to be expected? It is. So um obviously with a hot flush it it as the name suggests um it just comes on and can be quite rapid, a rising of heat from usually the upper torso um up to the face and the head. and it can last for a couple of minutes and then it disappears and some people can also feel chills afterwards as well How close a simulation do you think this is?

though because I'm very aware that I'm wearing a vest. I am being heated up, it's not my body doing it. But also, you know, some of the statistics are that you would anticipate On average, women may have hot flushes for four years. Ooh, I'm I'm warming up again. That was that was sooner than I expected, Leslie. I thought I'd have a moment of peace. Um

Yeah. This is quite distracted. That completely took my attention away. Oh y you're smiling. Your your devices won't exactly as planned. Um what was I gonna say? Um that I'm experiencing this for what? We're gonna do this for half an hour, an hour, not for the average of four years. Yeah. So usually what we take these into workplaces and someone would wear it for around an hour and they would do their usual work tasks, whatever that be. It's designed as an empathy tool.

yn ymwneud â'n ymwneud â'n ymwneud â'n ymwneud â'n ymwneud â'n ymwneud â'n ymwneud â'n ymwneud â'n ymwneud â'n ymwneud â'n ymwneud â'n mynd. It was very much the moment that it started was the biggest bit for me so far of just like everything's fine and almost suddenly Yeah. So I mean, imagine being on on air and you don't know, you never know when you're gonna get a hot flush. What what do you think it would be like? Awful radio.

Um in all in all I I I think it would be quite hard because I it definitely distracted me completely in the moment that I was trying to ask you a question and then suddenly all I'm thinking about is Yeah. So um we can only simulate surface heat. Um in real life people describe sort of an inner furnace and then it kind of radiates and also stress. If you were in a public-facing, high-stress role, you're more likely to get a trigger of a hot flush.

Exactly, just when you don't want it to happen. But in terms of the type of flush, the intensity, it it it's close. I've noticed another effect of wearing this vest. So I it's not heating up at the moment, but my brain is waiting for it to happen again. Yes. And rather than paying one hundred percent everything you say is fascinating, Leslie. But rather than paying one hundred percent

Attached to you. A bit of my brain is just going, When's the next one coming? When's the next one coming? When's the next one coming? Exactly. And a a and that is is very relevant to how people might be feeling, particularly if they're in this situation where they don't want to have a hot flush. It's just kind of like, you know, always on edge. Rydyn ni'n ymwneud â'r hynny'n ymwneud â'r hynny'n ymwneud â'r hynny'n ymwneud â'r hynny'n ymwneud â'r hyn.

Leslie, thank you so much for coming in and letting me have a little bit of time in your world. Thank you for having us.

Well I'm lucky I've just taken off the menovest, so my hot flushes are completely gone. Many women choose to go on hormone replacement therapy to manage their symptoms, but not everyone can take HRT. And that's where this new drug comes in. Phasolinitant, or vioza, is a non-hormonal option and around half a million women could be eligible. Well, to discuss, I'm joined by our resident GP, Doctor Margaret McCartney. Hello, Margaret. Thank you for having me, Jim. So phesolinitant, is that right?

I think that's how we're pronouncing it. How does it work? Well, it's a drug that's been trialled and is recommended now for use to treat hot flushes that women experience when they're going through the menopause. And the the interesting thing about it is that it works in a different way from the usual treatment of hormone therapy.

It works in a different way. It works in the brain to modulate the way that the brain regulates your temperature. So it's a completely different non hormonal way of trying to treat the hot flushes that are usually associated with menopause. ...and how good is it at doing the job?

So the trials that have been done so far does show that it reduces the amount of hot flushes that women are experiencing. Women were reporting just over ten daily events on the trial that's just been published not long ago in the BMG. And that had fallen down to two point six events by week twenty five when they were using this drug, but this is compared to four point six events in the placebo group.

So you can see it definitely is decreasing it down, but it's not decreasing it down to zero and it's actually when we look at the placebo effect, that actually has quite a good effect as well. And that's suggesting that things are maybe getting better over time anyway.

So the placebo effect brings the number of hot flushes down anyway, but this drug has been approved because it it it does even more than the placebo effect. Do we know how it compares to hormone replacement therapy, which is still going to be the main treatment for most women? Yes, so that's a really good question because I haven't been direct head to head trials that I can find that have been published that are looking at um comparing one to the other.

And the argument for that is that, well, we're not expecting to use this drug in a woman that can use or whose first choice would be um hormone therapy. And I think that gets round the fact that actually we know that this is not going to be as effective as hormone therapy will be. for in treating hot flushes during menopause. And one key difference here, Margaret, in comparison to HRT, which obviously hits many symptoms of the menopause, is that this is just about hot flushes, yeah?

Mae'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n. And are there side effects to taking phessylinotant? Yeah, there's there certainly are. Um so the big issue from the trials so far seems to have been changes in liver tests. So um liver testing is recommended before, during and the of this drug and there are stipulations about having to stop it if the liver tests are particularly elevated.

There's also more common um problems, abdominal pain, diarrhea, insomnia. There have been some signals about carcinoma of the lining of the womb. The jury's still a bit out about that. But what the company are saying and what NICE are saying is that it's not recommended for those with current breast cancer or other estrogen-dependent cancers or of course liver disease.

I think the hope had been that new medication would come along that's suitable for youths and women that do have oestrogen-sensitive cancers, but the advice and guidance is that this shouldn't be used in that circumstance. But this is a welcome development for those people that can't take HRT though, yeah?

Well it's not a tool and toolbox, absolutely. But it's just not perfect. What I'm kind of surprised about is um the kind of level of feeling and particularly in social media about this drug. You know, it's almost like people are in different camps.

you know, that if you think this drug is reasonable then somehow you're against HRT. But I think it's just another option for women who have got a lot of symptoms and who might get a bit of relief from it. But it's not what people call a silver bullet, shall we say? Margaret, thank you so much for coming on. Thank you for having me, James. And I have a statement from the National Institute for Health and Care Excellence, or NICE, which is the body that decides

which drugs the NHS in England's going to pay for. It said, yes, there were uncertainties in the evidence, but overall more people taking the drugs saw meaningful reductions in their night sweats and hot flushes. and said this drug addressed a genuine need for people who can't use HRT.

Now you may have heard our interview two weeks ago about how conflicts like in Iran and Ukraine can drive the emergence of drug resistant superbugs. If you missed it, you can catch up on BBC Sounds. But for now we're going to talk about a risk much closer to home, your local hospital. Well, Wexham Park Hospital in Berkshire is trying something different to tackle superbugs.

It's getting rid of sinks which can harbour nasty bacteria. Let's find out more with Dr. Manjula Medder, a consultant clinical microbiologist for Frimley Health NHS Foundation. and the current chair of the Healthcare Infection Society. Manjula, welcome to Inside Health. Thank you, uh James. Cass, first of all, what's wrong with Saint? So um I think the most significant risk that modern medicine faces today is the raise and spread of antimicrobial resistant bug.

And what we know from hand wash basins or any wastewater system that is there in hospitals is harboring these bugs and there's always a splash zone. It's not just the water that's landing there, it's also the bugs. And if they land on patients' wounds or patients devices, such as a water jug or a b bowl of water that they're using to clean patients, then you know patients acquire these bugs and the very vulnerable patients then can go on to develop an infection from these bugs.

So are those hand washing basins the main source of how antimicrobial resistant superbugs are spread in hospitals? Is that the number one Yes, it it's not just the hand wash basins. It is the m it is because the hand wash basins are so numerous in hospitals nowadays because we thought uh in the last twenty years we have problems with CDEF and various other bugs.

C diff is a bug which uh is not inactivated by alcohol hand sanitizer. So you ha we have always said you have to wash your hands to clear that. So we've put too many hand washed patients in a way in hospitals. And sometimes these are very close to patients within the two-meter splash zone, for example. And hence they are the number one high-risk areas where wastewater come into contact with patients.

So what are you doing differently? Because obviously you still need to be in a hygienic environment, people still need water to drink, etcetera. So what we started this project a few years ago was use the uh Wexim Park Hospital intensive care unit as a prototype to create a better design of the hospital environment where we take the risks of water and wastewater away from patients.

So there are hand wash basins in the unit, but they are not in that two-meter splash zone. We have m many different innovations that are used within those hand wash basins that prevent that splash risk and those bucks coming out of the drains. and also ha making sure that the water that we use is ster as sterile as we can get. So Wexham Park is actually my local hospital. There there's a little surprise for you. Um what's different when I walk in compared to going into any other hospital?

How would I notice the difference? You may not actually notice too much of a difference because you will still have sync. in toilets, for example, because after you use the toilet you would expect that you'll have bodily fluids on your hands and so your hands are contaminated heavily enough to be washing your hands. But what we also say is use a hand sanitizer after having washed your hands.

What you'll also find is hand sanitizers throughout the hospital. And you may find different types of hand sanitizers as well, depending on the risk that we think there is in certain areas and the different bugs that we need to combat in those areas. How will you know if it's working? 'Cause it it sounds like a nice idea, but but everyone wants evidence, right?

Exactly. You know, even before we started this project, we set in parameters that we could monitor. We've been tracking um many different infections in hospital. What we could have shown with all of this is that we have reduced a huge number of different infections.

that these were actually originating from wastewater or water systems. So we never knew that this these were actually originating from these. But since we have done these interventions, many of these infections that were being acquired in hospital by patients have reduced. So because of very reassuring results that we had from intensive care units,

it was almost um uh mandatory for us that we protect patients in other areas as well. So we have we have started to roll this out in many other areas of the ward. So we've we've done this in s for example, care of the elderly wards. We've used similar principles in any areas of the hospital where there's a refurbishment happening.

So in all of those areas where we have done this work, we found the same results that there's an overall reduction in the amount of healthcare acquired infections that we're seeing that patients used to acquire in hospitals.

Majula, does this need to be done as like part of a randomized controlled trial where you have one ward where you do it in this new way of designing the ward, in a in another one you keep the traditional lots of hand basins everywhere approach'cause you will often find the some places there's a hand basin next to every bed. Do you need that level of evidence to prove that it is making a difference for the whole of the NHS to go, yeah, this is what we're going to do?

There I mean, there is already quite a lot of evidence out there which hopefully shouldn't delay what we are doing. So for example, there was a big study in in Germany which showed that if you had a hand wash basin within a patient's room, then the risk of you uh of a patient getting a h a hospital acquired infection was much higher.

than if you didn't have a hand wash basin in that room. And these such studies are increasing day by day. But what we've already talked about with the UKHSA is having a multi-center trial within the UK. you know, looking at what the rates of hospital acquired infections are based on design of the hospital. Was this an easy thing to do within the hospital?

It wasn't easy at all. It's it's bring it's trying to bring about behavioral change in staff acor across an entire organization, which can be very big. So you have to think through every single area where water or wastewater comes into contact with patient, we had to think through every single pathway to figure out how we can make that safe.

So it's not an easy thing. Behavioral change is never easy and it takes time. But what we have shown here is that it's possible and importantly it's necessary to combat th this threat of antimicrobial resistance because we do not have another solution. Can you just describe for me how big the threat is of acquiring these types of infections in hospitals? Because we're all like a walking colony of bacteria all the time. I mean like that that that is w no human being is completely sterile.

Um so how much greater is is the threat in hospital in comparison to just going down the supermarket and everyone you bump into in your day to day life? Yeah, so comparing hospital to homes or maybe your hotel is maybe a better comparison because you've got handwashed basins there and you come into contact with wastewater in these other settings.

uh rather than in a supermarket. Um, in a hospital because you're using tons and tons of antibiotics in patients and you're throwing a lot of chemicals into your hospital drains, those drains forms sort of super reservoirs where these bugs dominate and even proliferate and and acquire new resistance mechanisms.

So so the yeah, the risk of acquiring these infections is therefore very high in hospitals. So at the the peak of this investigation, when we started screening huge number of patients, we were finding about four patients acquiring these bugs almost on a a daily basis. Since we have put these interventions in, we have had periods of uh twenty eight days when no patients have acquired these boxes.

So we know that these interventions are working, whereas you don't you th this is very rare to occur in a hotel building or a commercial building or a or in your own home. But but for a day to none for a month. That's amazing. Yes. And this is this is remember this is just antibiotic resistant bugs that we can try.

Whereas bugs that are not resistant, that are also present in your hospital drainage systems, bugs that we already carry in our s you know, in our in our gut that are also transmitting from wastewater systems. Does this save money? The good thing about this project is that it not only saves lives, but it also saves money.

because each of these drug resistant infections is super is is hugely expensive, exorbitantly expensive because of the antibiotic costs alone can run into hundreds of thousands of pounds. So the the cost adds up significantly. And also, you know, in terms of hospital design

If we do not get the hospital design of the plumbing and wastewater systems right at the start, it's almost impossible to fix it afterwards, as you know. But the good thing is, if you get it right, it actually reduces the cost of your building project itself. You're gonna have to explain one thing for me now, Manjula. So if this reduces the number of infections, it reduces the cost of treating those infections, which can be really expensive, it saves lives.

Why isn't everybody doing it? What's the missing piece of evidence that is like this is what everybody should be doing? That's what I don't get. Yeah, I think within infection prevention and control, to gather scientific evidence like we discussed, randomized controlled trials, is very difficult because there are so many variables in such studies.

And it takes time, often many years to decades, just to establish such studies and get these results. And as scientists and doctors we're often waiting for such results to put these things into action. you know, if we don't do anything, these bugs are just going to spread uh uncontrolled in hospitals. And I think we have the evidence we have sufficient ev evidence to start acting now.

Especially for example the new hospital program in England, which is set out to build fourteen new hospitals. If we wait another ten years when an AMR will be at its peak. We may have built all our hospitals with a design that we can't change. Majula, thank you so much. That was really interesting. Du som sitter och kobil nu, känner du du träffad? Om du har ett stenskott i vindrutan med antyden till spricka så är det viktigt att laga eller byta rutan innan den spricker mer och försvagas.

Så om du sitter i en folksvagen, gör det hos de som är experter på din folksvagen. Fox. Wagen. Vi på AGI-produkter ger det alltid sju års garanti. Det är tillräckligt länge för att dricka 5000 koppar kaffe på jobbet. Kör nästan fyra varv runt jorden med trycken och odla ett alldeles eget consagrä i repan. Hos oss får du mer än bara inredning. Du får alltid sju års garanti. Välkommende Lagiprodukter! Thank you.

You're listening to Inside Health with me, James Gallagher, and now it's farting time. I promised you it at the beginning of the programme and I have to say of all the things I've done for Inside Health, wearing a fart monitor is probably the weirdest. I should say this is a serious project called the Human Flatus Atlas.

We're not just completely weird on this program. And it's trying to work out what's a normal amount of flatulence and why some people barely ever break wind. And my son Oliver was all over. Right then, shall we open this box? Yeah. What does it say on the front? Flatte Atlas That's weird. Yeah. Yeah. There it is. I got to stick it onto the back of my pants. Who does the biggest farts in this house? Who does the stinkiest far? Hugh. I don't. I think you do the stinkiest farts. No? Bye!

Right. I'm gonna go wear my fart sensor for three days. More freedom. Yeah. So that I can get a recording of all my farts and then we'll find out how much of a farter daddy is. Oh, that's gonna be crazy. Yeah, let's do it. Oliver! Hey, no it's not me, that was Daddy! That was James Gallagher.

So now I've been wearing this thing discreetly in my pants for three days. We can chat to the brains behind the so called fart bit. Dr Brantley Hall from the University of Maryland. Brantley, welcome to Inside Health. Thank you. What did you learn about me? You had a very normal pattern of flatulence activity. In fact your profiles were, you know, to be expected is normal. And what was my P? You max out at thirty one flatus per day.

So is that telling you a lot of information about how much I'm breaking wind? I mean, like there's a difference between a gentle little pop and like a big rumbling long protracted fart in terms of the quantity that's coming out. We can give you both a count, but also a volume. And we call that volume the microbiome activity into. So how how do I look when you do the complete picture?

Fortunately for you and your family, you look very normal. Um, we've captured people with more than two hundred flatus per day. Whoa. Ha ha ha. So you're you're very normal. Okay. Because there are people that claim they do not fart at all. And this is one of our most interesting discoveries. We call these people Zen digesters, and they do exist, although they're rare. We have one special person who eats a vegan diet and they have their entire life.

And they eat far maybe three times a day, despite eating an extremely high fiber diet. So This is a scientific mystery. We don't know how they do it, but um that's one of the things we're trying to study. Healthy to not farm. As long as you're not experiencing negative GI symptoms, it's probably okay. In this person's case, we hypothesize they have a microbiome configuration that just leads to very low gas production. What about two hundred times a day? Is that healthy?

Some people that are farting that mic. don't report GI distress, which is kind of interesting to me, but some of them do report, you know, excess bloating and intestinal gas. And they need to see a doctor. I I can't diagnose them with a medical issue, but um I can say that's above the average for sure.

I feel the need to ask why are you doing this? What do you hope to gain from tracking hundreds of people's farts, not just mine? To establish a baseline for the normal patterns of human flatulence, even though this is a universal experience, the medical measurements of this phenomenon are very limited. Um, most of the the objective studies were done in the 1980s, 1990s, and used rectal tubes, which didn't really capture the normal day-to-day experience of flatulates.

And so we've taken advantage of the advanced and wearable technology and we can now kind of have people wear this device all day and capture true patterns of flatulence that we've never seen before. So just like other physiological metrics have a baseline and an abnormal and normal range, we're trying to establish that for flat lines. Simple question What is a fart? A fart is an eruption of gas from the rectum, then the gas is produced mainly by microbes living in your gut.

And what is it that the sensor is actually detecting? We measure predominantly hydrogen, which is a metabolite produced exclusively by gut microbes. So that gives us a really good signal of gut microbial metabolism. And and what are they producing it from? Like, um my my son would tell you beans, beans help your heart. The more you eat, the more you fuck. Microbes ferment both carbohydrates and protein.

And when they do this fermentation, they produce gases as their output. So they're they're basically consuming dietary fiber or excess protein in your diet and turning that into gases. And different um substrates produce different profiles of gas.

So for example, you know, beans have a little bit of protein in them. And so you might get some galacto oligosaccharide fermentation, but you also might get some protein fermentation. And what's really fascinating is that protein fermentation leads to malodorous flatulence. Well, if it's just carbohydrates, it leads to kind of voluminous but not malodorous flatulates.

Does that explain why I don't really eat ham sandwiches anymore? Because like I would generally say that my farts aren't particularly smelly, but I would always notice if I had a ham sandwich. that they would be pungent would be the delicate way of putting it. And I'm just wondering, is is that that combination of carbs, lots of gas, ham protein, stinky gas.

That is an extremely interesting antidote. I mean, the microbes in your gut were probably breaking down the amino acids and ham into volatile sulfur compounds like hydrogen sulfide and probably leading to that odor. Would you say it smelled like rotten eggs or rotten cabbage? Oh. It's it's it's been a long time, Bradley, to be honest. I I probably lean more eggs than cabbage. So that's microbial fermentation of the amino acids and in the hamb.

Bradley, when does farting go from something that all of us do every day of our lives into something that is a medical problem? I'm not a medical doctor, so I can't diagnose someone with a with an issue if they have like over a certain number of flatulents. But imagine you were trying to diagnose someone with high cholesterol, but you had never measured cholesterol in any people before. You wouldn't know whether that was actually high or not.

So we're trying to set the physiologic baseline so that doctors can make better decisions in the future. Do you see these taking off? Are are these likely to become one of those next wellness trends? I hope so. Um, I think there's a huge potential for people to better understand how what they eat influences how they feel. And tracking flatulence is one way they can do that, right?

It can be really awkward. Like I'm I'm in an otherwise silent studio with like not many other people in here. But if I were to let rip, it would be very awkward for everybody in this room. Can you change your bodies? Farting tendencies. I wish we knew how. Um it's one of the things we're trying to study at the moment.

And it's it's important for social reasons, but it's also important for health reasons. And one of the the biggest reasons why people don't switch from their unhealthy Western diet to a healthy high fiber diet is excess flatulence.

And so if we could figure out how to change microbial composition to reduce flatulence, it could really help people eat healthier and, you know, be happier in in social situations. So it's something we're trying to study, but at the moment, it's a scientific best trade. Brandy, thank you so much for coming on. Thank you so much. And that's the end of the series. So on that bum note, have a lovely Easter, and I'll waft back into your life in the summer. Smell you later.

You've been listening to Inside Health with me, James Gallagher. The producers were Alice Lipscomb Southwell and Jerry Holt. Inside Health is a BBC Audio Science Unit production created in collaboration with the Open University, and they've got a surprise for you, a quiz. Can you detect health fact from fiction? Go to bbc.co.uk slash insidehealth. And follow the links to the Open University to find out.

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