Acute stress, Episodic acute stress and Chronic stress and Post-traumatic Stress

Recent statistics show that 1 in 5 employees are stressed. But, what is stress? Is it just related to work and how can you cope if you’re feeling it? Everybody feels stress but very few think about what stress actually is and how it can really affect us. Stress can be a negative or positive condition that has an impact on a person's mental and physical well-being.  Stress is our body’s response to specific situations and there are many different symptoms associated with stress and stress itself can fall into four categories -

  • Acute stress

  • Episodic acute stress

  • Chronic stress

  • Posttraumatic stress (PTSD)

Acute stress

Acute stress is the more common form of stress and is associated with things to do with our everyday lives such as losing bills, rushing to meetings or making deadlines. These kinds of demands and pressures tend to be short term stress related issues that don’t have time to do any damage that long term stress could. Acute stress can actually be exciting and thrilling but too much can make you feel exhausted. Symptoms of acute stress can include emotional anguish, headaches, back pains and general muscular problems. They may also include irritable bowel syndrome (IBS), dizziness, and shortness of breath and chest pains and heart palpitations which can often be triggered by adrenaline.

 Acute stress can affect anyone but it is very manageable.

Episodic Acute stress

Episodic acute stress is the stress which affects those who suffer from acute stress more frequently. People that tend suffer from this always seem to be in a rush, They take too much on and tend not to be able to organise themselves to deal with demands and pressures. Episodic Acute stress can affect interpersonal skills and can make sufferers hostile towards others causing a deterioration of relationships at home and the workplace. Its symptoms include prolonged over stimulation, persistent tension, headaches or migraines, hypertension and chest pains. Episodic acute stress can be helped with certain lifestyle changes but professional help may also be needed before any chronic problems develop.

Chronic stress

Chronic stress is the stress that can wear a sufferer down making them feel “burned-out”. Chronic stress is stress that someone can feel when they can’t see a way out of the demands and/or pressures that are making them feel depressed, miserable and disheartened on a continual basis. Factors of chronic stress can be the feeling of being trapped in an unhappy marriage or career and tends to be associated with ill health, alcohol excess, violence and can even be associated with suicide. Chronic stress can be helped with professional and medical help such as special forms of counselling and targeted behavioural therapy.

Post-traumatic stress disorder (PTSD)

Post-traumatic stress (PTSD) is the stress associated with frightening or distressing events. These can be traumatic experiences from someone’s childhood, wars, poverty, sexual or violent abuse. Sufferers of PTSD tend to feel on edge and can relive traumatic events through nightmares and flashbacks. They struggle with concentration and have trouble sleeping. Sufferers can have strong feelings of guilt, emotional numbness, constant worry and depression. Symptoms associated with PTSD can often be very severe and have a huge negative impact on a person’s day to day life. (Through the depletion of physical and mental attrition).   Stress is not always bad nor is it the same for everyone.  There can be different symptoms for different people all of which should be addressed early on. If you’re beginning to feel stressed, it’s good to try and make adjustments to your lifestyle such as designating times to be active, becoming more social and safeguarding relaxation time. Watch out for the physical symptoms of stress such as persistent headaches, muscle tension, irritable bowel symptoms and insomnia. If these develop, speak with your GP and get advice and don’t be afraid to talk about. Further information on stress can be found on: HSE Mind NHS  

Facts about the menopause

Immediate menopausal symptoms can include hot flushes, night sweats, vaginal dryness. These are definite symptoms of oestrogen deficiency. Other symptoms may include irritability, depression, poor concentration and forgetfulness, lethargy, loss of confidence and aching joints. Although these symptoms often occur around the time of the menopause, if they do not respond to HRT then they are probably not caused by oestrogen deficiency and further investigations may be required. The menopause can have more long-term effects. The loss of oestrogen can lead to a hardening of the arteries thus increasing the risk of heart attack or stroke. It can also cause osteoporosis (brittle bones) in some women.

Hormone replacement therapy?

Hormone replacement therapy (HRT) aims to replace the female hormones that are lacking in the body after the menopause.  It aims to reduce the symptoms of the menopause (see above) both in the short and long-term. There are three basic types:

  • Oestrogen – for women who have had a hysterectomy
  • Oestrogen plus progesterone – for women with a womb
  • Tibolone – for women who have had at least 12 months without natural periods.

There are many methods of administration – tablets, skin patches, run-in gels, vaginal pessaries, cream, or as a pellet implanted under the skin every few months.

Starting HRT

You can start HRT as soon as you experience symptoms of oestrogen deficiency. Treatment is sometimes not commenced until after a woman’s final normal period but it may be started before this if symptoms are particularly troublesome.

When HRT is not recommended

It is generally not a good idea to give HRT to a woman who has had cancer of the breast or endometrium (lining of the womb) as these tumours are oestrogen dependent. However, if such a woman has very severe menopausal symptoms which make her life intolerable then, providing she accepts the risk, HRT may occasionally be prescribed. A previous history of a blood clot, high blood pressure, smoking and obesity are not absolute contra-indications to HRT but they may influence the chosen route of administration. Possible side effects Tender breasts, nausea, leg cramps, fluid retention and mild abdominal bloating. There is NO significant weight gain.

Alternatives to HRT

Some drugs treat individual rather than collective aspects of the menopause eg Clonidine controls the hot flushes and night sweats and raloxifene protects bones against osteoporosis. Natural products such as vitamin B6 and evening primrose oil have helped some women with a number of menopausal symptoms. Some alternative therapies may help with some of the symptoms (reflexology, aromatherapy and acupuncture) but these treatments have not been medically proven and should be discussed with your doctor.

HRT : Some common questions and our answers

What regular monitoring and check-ups should I get on HRT?
We recommend 6 monthly checks of weight and blood pressure and a pelvic and breast examination every year. It is also recommended that all women over the age of 50 should have a mammogram and a cervical smear every 2-3 years whether or not they are on HRT. In addition if there is a history of cancer in a near relative (e.g. mother, sister, grandmother) it is probably better to have a mammogram annually and to consider starting mammography earlier. We also strongly urge all women to practice self-examination of their breasts.

Will HRT make me fertile again?
No. The menopause indicates cessation of ovarian function and therefore an inability to conceive. However, women who commence HRT before their natural periods finish are advised to use contraception until their early 50s.

After nine months on HRT I am still getting symptoms. What can I do?
There are 3 possible reasons for this. 1.    You may not be receiving enough HRT to control your symptoms; this is usually solved by increasing the dosage. 2.    You may be on the wrong type of HRT. Some women who take HRT tablets do not absorb them from their gut and therefore no active hormone reaches the blood stream where it is required to be effective. Such women usually improve when treated with either a hormone patch or an implant. 3.    Your symptoms may not be due to oestrogen deficiency at all (see “Facts about the menopause”).

My GP gave me six months supply of HRT, then stopped. Why? and what will be the consequences?
Unfortunately despite growing research into HRT and continued publicity there still seems to be a lot of confusion about the safety and benefits of long term HRT. The duration of menopausal symptoms (untreated) varies tremendously from woman to woman; they usually continue for at least 2 years and often last for considerably longer. Therefore stopping treatment after only 6 months will usually result in their recurrence. It is particularly important for women who are at risk of developing osteoporosis to take HRT for at least 5 years to get proper protection for their bones. As long as women undergo a regular medical check-up, practice breast self-examination and remain healthy there is no reason why HRT should suddenly be stopped after 6 months.

Will HRT help my sex drive during and after my menopause?
There are many reasons why women lose interest in sex at this time. However, HRT relieves vaginal dryness, a cause of painful intercourse, and consequently may reawaken your interest in sex. If after treatment with oestrogen your libido (sex drive) is still low then a small dose of the male hormone, testosterone is often helpful. However this is only available as an implant.

Is there any increased risk of cancer on HRT?
Although it is the oestrogen which produces all the positive benefits of HRT for a woman who still has her uterus (womb) it is important that she should take a small does of progesterone for a part of each month to protect against endometrial (womb) cancer. Providing a short course of progesterone is taken each month there is no increased risk on endometrial cancer. The effects of long term HRT on breast cancer risk are very controversial. With the low doses of hormones used on HRT there appears to be no increase in risk of breast cancer with up to 5 years of treatment. There may however be a slight increase in risk of breast cancer if HRT is taken for 10 years or more. However, not all studies have reported this; some have observed no increase in risk even with long term treatment. There is no evidence at present that HRT changes the risk of cancer of the ovary or cancer of the cervix.

Before starting HRT do I need any tests to check my hormone levels?
Not usually. Obvious menopausal symptoms such as hot flushes indicate low oestrogen levels and therefore no tests are necessary. Sometimes where there is some doubt as to whether symptoms are menopausal in origin a blood test may be carried out but even here a short trial of HRT may be undertaken. Blood tests are also sometimes taken in cases of suspected early menopause to confirm the diagnosis.

What is osteoporosis and how can HRT help to prevent it?
Osteoporosis literally means porous or brittle bones. It affects one woman in four (compared to one man in twenty) and develops over a period of years after the menopause. It is now known that bones are dependent on oestrogen and it is therefore very important, especially for women who are at increased risk of developing the disease (see below), to take HRT for a minimum of 5 years. It has also been shown from research that bone is lost at a greater rate during the first 2 to 3 years after menopause than in the following years. Therefore HRT should be started sooner rather than later.

Am I susceptible to Osteoporosis? 
All post menopausal women are at risk of osteoporosis and there is no simple way of telling which women are at increased risk. However, your risk is greater if you fall into any of the following categories: •    Thin, fair skinned, small boned •    Early menopause (before 45) •    If your mother or grandmother lost height because of bone fractures •    If you smoke •    If you have regularly consumed more than two alcoholic drinks per day Black people have a much denser skeleton than white people and therefore their risk of developing significant osteoporosis is reduced. One final comment: HRT can only arrest the process of osteoporosis, it cannot put backbone which has already been lost.

Do oestrogens change the risk of heart attack and stroke?
Numerous studies conducted in the USA have reported that HRT reduces the risk of “furring up” the major arteries in the heart and lower the chance of heart attack. Similar results are now becoming available for arteries in the brain with a reduced risk of stroke. These arterial diseases are the most common cause of death in women aged over 50 years and are much more common than breast and endometrial cancer. Most of the studies from the USA were conducted in women taking oestrogen by itself. It is not known whether combined HRT (oestrogen plus progesterone) has the same beneficial effects.

Can older women benefit from HRT?
Maximum benefits are derived from HRT by starting as soon after your menopause as possible, particularly for bone protection. However, even starting treatment many years after your menopause will maintain your existing bone thickness for as long as the treatment is continued. Many women who start HRT later on in life find they get other benefits. They feel more lively and sleep better and are less likely to be troubled by vaginal dryness. However, it is important to remember that HRT will usually lead to a return of a monthly bleed. The vulval and vaginal area of older women often becomes very dry and sore and short intermittent course of oestrogen cream can often relieve these symptoms and may reduce the feeling of constantly wanting to empty the bladder.

Can I have too much HRT and will it do me any harm?
Your body will alert you to oestrogen overdose by certain symptoms such as tender breasts and nausea. Although these symptoms are common they usually settle down after a few months.

Do I need HRT after a hysterectomy if I still have my ovaries?
So long as you were having periods before your hysterectomy (i.e. your ovaries were working normally) you will not need HRT. However, it is recognised that women who have undergone hysterectomy often develop menopausal symptoms at an earlier age than those who have not, and these women obviously need to start HRT earlier.

My hair is falling out and my skin is dry. Will HRT help me?
The relationship between oestrogen and hair is poorly understood at present. Hair loss is more likely to be age dependent, whereas dry hair may be due to oestrogen deficiency. Similarly, dry skin sometimes improves with HRT.

What can I do about incontinence?
This is a common female problem, especially in later life, and is often triggered by a sneeze, cough, laughter or playing sport. There is some evidence that some types of incontinence may be helped to some degree by HRT. Pelvic floor exercises may also help. These are done by tightening the muscles as if you were trying very hard to hold back your urine. Tighten, hold and relax at least 25 times on each occasion. Also, try to stop your flow of urine mid-stream. If there is no improvement despite HRT and exercises, you should see your doctor again.  

Who is Dr Kelly & Associates?

Dr Kelly & Associates is a team of dedicated professionals providing a range of Corporate Health services to some of the City’s largest institutions. With over three decades of experience in providing quality, independent healthcare, Dr Kelly’s has grown from strength to strength and is today recognised as one of the most established private medical practices in the City of London. As a Practice, we believe in providing a premium service from the moment you walk through the door. With four consulting rooms and a team of experienced, friendly doctors, the success and growth of the Practice are based upon the provision of high quality and immediately available medical care to meet the requirements of both companies and individuals within the City of London and surrounding areas.

What do we do?  

Provide Comprehensive Corporate Health Solutions. We provide occupational health services, employee health screening and pre-employment medicals, GP consultations, workplace flu and travel vaccinations and well-being awareness days. We strive to assist our clients in implementing the changes they need to ensure they have a fit and healthy workforce.


Our Occupational Health Service can be a valued part of your company’s healthcare and sickness absence strategies and recruitment. Our Health Screens provide a thorough overview of our patients’ past and current health & wellbeing, with a view to identifying and anticipating any future health issues. Our doctors provide patients with detailed guidance to reduce the risk of future health problems improving their quality of life. A full range of services including GP Consultations, Referrals, Blood Tests, Sexual Health Testing and Travel & Flu Vaccinations are available. We aim to offer a premium service from the moment your walk through our door. With a full range of services and health screens, we are able to assess your lifestyle and identify potential problems. The results of which have a beneficial impact on your health.

Dr Kelly & Associates Corporate Healthcare Service

A healthy workforce is key to the recruitment and retention of staff and to the overall efficiency and profit margins of a company. Effective healthcare is increasingly seen as a crucial component of an employee’s benefits packages. As a healthcare provider we aim to look after both the physical and psychological health of your staff and to enhance their wellbeing and morale and we offer customised solutions to your healthcare needs. Following a thorough and detailed assessment of your company’s requirements, we work with you to create a comprehensive, flexible and cost-effective programme that will greatly benefit your company and your staff.

In-house facilities...let us come to you

Time spent out of the office is money lost to a company. We can help you minimise such losses through the provision of an in-house facility.

Our on-site medical provision enables us to bring our quality service to your office. These are doctor based so that we can provide speedy prescriptions and referrals and replicate the level of service provided at 65 London Wall. We are able provide any level of service including Occupational Health, Annual Health Assessments, GP Consultations, Annual Flu Vaccinations & Travel Vaccinations.

Pre – Employment Screening

Healthy Employees

Occupational Health & Employee Health Screening is vital to any corporate “wellbeing” strategy and employer benefits programme and a must for any medium to large business. We have extensive experience in creating and delivering private health care, corporate wellness plans, providing health information and promotion as well as personalised health screening programmes. We recognise the importance of employee health screening and the integral part it plays in a corporate health and wellness benefit package.

Our efficient and comprehensive pre-employment screens enable you to assess the health of employee.

  • On-line Pre-Employment Questionnaires

  • Pre-Employment Medicals (30 or 75 mins)

    Annual Medical Screening…a comprehensive well-being package

Effectively manage any health issues within your workforce at an early stage by offering pre-employment screening to all new employees and annual health screening to existing employees or management team…

Our range of health screens can last up to 2 hours and are extensive and detailed medical examinations carried out entirely by the doctor.

  • Full Medical History, Questionnaire & Personal Report & Results

  • Physical Examination

  • Lifestyle Discussion/Advice

  • Height, Weight & Body Mass Index

  • Urine Test

  • Resting ECG

  • Blood Test

  • Blood Pressure test

  • Lung Function

  • Hearing Test

  • Vision Test

  • Stool Test – a screening test for bowel cancer (over 40)

  • Chest X-ray (if indicated)*

Our Premier Health Screen also includes an exercise ECG to measure your heart function during exercise.

Additional Tests for Men:

  • Testicular Examination & Instruction

  • PSA – a screening test for prostate cancer (over 45)

Additional Tests for Women:

  • Cervical Smear

  • Pelvic Examination

  • Breast Examination & Instruction

  • Chlamydia Swab (if clinically indicated)

  • Digital Mammography*

       *available at extra cost

GP Consultations

The provision of Corporate GP services within the City of London is becoming increasingly popular. Our corporate clients combine our GP facility with other services and will make appointments available to their employees on either an open or restricted basis.

  • Less time is spent out of the office and employees can be back at their desks in as little as 30mins

  • We strive to provide a same or next day appointment

  • Where necessary, follow-up investigations can be undertaken or speedy referrals to leading consultant specialists can be arranged

…You can choose to pay per-capita or on a pay-on-usage basis…

  • Reduces time out of the office

  • Online booking available

  • Range of usage schemes available

  • Fully independent onward referral available


We are one of the few remaining independent practices in the City so you can be sure that when our doctors refer you to a Consultant it is because they believe they are the best for your situation…not because the consultant is linked to the Practice. A full onward referral service is available.

  • Fully independent referral process

  • Choice of top quality Consultants

Why Choose Us

Dr Kelly & Associates is one of the few remaining independent practices in the City and one of the only practices in London with a purely doctor led service. We don’t have a call centre style booking-in process and you are always greeted by experienced medical administrators and should there be anything HR needs to discuss, one of our management team will always be available for them to speak with. We are traditional in our core values but innovative and modern in our approach and we put the quality of service above profits and financial efficiencies.

“Take care of your body. It’s the only place you have to live.”