Dry mouth may present  as  mucous  surface  discomfort in the mouth  , burning sensation or pain on the lips  or mouth, “ bad “ taste , halitosis, denture discomfort and  eating  discomfort.

Sufferers may have  a higher  risk of dental caries , dental erosion oral infection and  loss of teeth. Causes can be  medication side effects form including  some  prescription medications, anti- cholinergics , antihistamines and  sedatives . Age , diabetes  and  underlying auto immune  diseases may also be a cause of dry mouth.

Treatment is  to review for  underlying  dental disease , illness and  medication side effects. Adequate  hydration.. Regular  and  frequent  oral  hygiene  including  brushing  /flossing / interdental brushing.

Encourage   sugar free  chewing (eg  chewing gum)  between meals , artificial saliva lubricants.

Scientific  studies  over 7 years  extending from pre – menopause to  4  years  post  menopause  confirm the  tendency to modest  weight gain in association with   hormonal  changes..  Subsequent trials  have demonstrated  that   modest  lifestyle  intervention can   contain  or   reduce the  weight gain to a minimum  over  5  year trials post onset of menopause. This could be achieved by maintaining a diet of 1300 kcal/day and an increase in energy expenditure 1000-1500 kcal/week more than their usual energy expenditure. Diets with an emphasis on increased protein and   lower carbohydrate and fats were useful.

Women who were already overweight prior to menopause were more likely to have menopausal weight gain.

A common  recessively inherited   blood disorder resulting  in excess  iron in the  body due to increased  absorbtion from the  intestine. An incidence of about  1 in 200.

May be  manifested   by the  following  symptoms –

• Fatigue and lethargy
• Cirrhosis of liver
• Liver cancer
• Arthritis
• Skin pigmentation
• Cardiomyopathy
• Testicular failure
• Diabetes mellitus

Diagnosis  is usually  by a  combination of  blood film  , iron studies and  gene testing.

Treatment  is  usually by venesection  – draining  off  excess blood

Eye testing

All patients over  40  should be screened for  glaucoma  every  2 years  by an optometrist or  ophthalmologist.  Glaucoma is the  insidious painless   rise in internal eye pressure  that may lead to permanent  loss of  vision if  untreated.

All diabetics  should  have  regular 1-2 yearly  eye testing, to avoid having diabetic   retinopathy a treatable condition which may lead to  loss of vision .

All  circumstances  with all or part   loss  of vision  suddenly  in one or both  eyes  should be reviewed to exclude  diseases that  may  lead to  permanent   loss or impairment of  vision Also sudden onset of  flashing lights like lightning or a  camera flash,or single black or red spots as  these  may be associated with a retinal tear, vitreous haemorrhage or retinal vascular   occlusion.

1 in 6 couples have difficulty in achieving  pregnancy within 12 months.

Factors  involved alcohol intake , smoking , weight   extremes  underweight or obese , diet ,  exercise extremes under or over  , drug usage  – recreational or  body building or  increased female  age.

Medical fertility  investigations subsequently investigate ovulatory dysfunction , abnormal  semen, genito urinary  anatomical abnormality or  dysfunction