Feeds:
Posts
Comments

Archive for the ‘Condition News’ Category

You mention joint pain, weight gain, and food cravings in addition to hot flashes as symptoms of menopause. Menopause has such a variety of symptoms, depending on each individual. Lifestyle matters more; exercise is more important; adequate sleep and good nutrition—all of these have a greater impact to quality of life now than they did previously.

I wish I could tell you there is good data suggesting vitamins have a favorable impact on menopausal symptoms, but the trials looking at the specific supplements you mention and others suggest no benefit greater than placebo. But, hey, placebo has about a 30-percent response rate in any trial, so there is certainly no harm in using them. They provide some general vitamins that will not be harmful, and may help if you aren’t getting them in your diet.

The symptoms you mention could all potentially benefit from hormone therapy (HT). The loss of estrogen is huge for most women, and the loss of progesterone to some extent as well. For many women the only way to address symptoms adequately is to consider HT. More and more data suggests that HT is beneficial for women specifically with weight gain; that was a lead article in one of my journals just this week.

It’s a complicated journey that is nuanced, and each woman needs to assess her own symptoms and goals and determine the best approach to managing through menopause. It’s difficult to address all of the treatment options in a single Q&A. You might find the North American Menopause Society (NAMS) website helpful: menopause.org. They cover many issues related to menopause.

Good luck!

Read Full Post »

Maybe you were that girl. The last one to get her period. Maybe it’s déjà vu all over again as you wait… and wait… to cross the reproductive finish line. Menopause. It’s certainly been a thing for your girlfriends, but you only know about it secondhand.

Do not fret. Recent studies confirm a few educated guesses about women who begin menopause late, and most of it is good news for you.

Most women reach menopause between 45 and 55; the average age is 51. Menopause officially occurs one year after your last period. Late onset is considered anytime after age 55, at which point, a woman has been producing estrogen for at least 40 years, depending on when she began menstruating.

Factors that affect when a person begins her reproductive years and reaches menopause have a little to do with heredity and occasionally may be related to do with environmental factors. Those who smoke or live at high altitudes, for example, tend to begin menopause early. Most often, it occurs… well, when it occurs.

As any menopausal woman knows, estrogen is an important hormone that regulates lots of systems in your body, from your brain to your skin to your reproductive organs and keeps them running smoothly. That’s why the absence of estrogen in menopause sends you into such a tailspin and requires several years to adjust to.

We know that estrogen has protective effects on our bones and our heart. Two large-scale, recent studies confirm that women who reach menopause late, and thus are exposed to estrogen for longer, also tend to have fewer cardiovascular problems, such as strokes or heart attacks.

For example, one very recent study looked at longitudinal data for over 3,000 women, specifically examining the reproductive years—the total number of years from first menstruation to menopause—in women age 60 or over. They determined that “every one-year increase in reproductive duration… was associated with a 3% reduction in a woman’s risk of angina or stroke.”

Women with more reproductive years are also at lower risk for osteoporosis and have fewer fractures. Since estrogen keeps skin smooth and supple, late menopause tends to keep your skin smooth and your vagina lubricated.

If you are still menstruating at 55, please continue your diligence with regular gynecological exams and screenings, while you enjoy your supple skin and healthy heart. I’ve seen more vulvar cancers in the last three months than in the previous 15 years, and these were among women who hadn’t had a pelvic exam in years.

Overall, you’ll probably live longer, according to two large-scale studies. A 2005 study followed 12,134 Dutch women for 17 years and found that, when all the risk and protective factors were considered, “the net effect was an increased life span.”

Another study examined the effect of late menopause on the chances of living to age 90. These researchers selected a diverse group of post-menopausal women from the Women’s Health Initiative, the massive study of 16,251 women that ran from 1993-1998, and followed them until 2014. Of the 55 percent of women who reached age 90, odds of survival for those with over 40 reproductive years were 13 percent higher.

Neither lifestyle, weight, reproductive factors, contraception use, nor hormone therapy nor significantly altered these survival rates. The determining factor was the number of reproductive years.

“Later age at menopause is associated with better health, longer life and less cardiovascular disease,” said Ellen B. Gold, a professor emeritus in public health at the University of California, Davis, School of Medicine in this article.

So buckle up, late bloomers, it might be a smoother, longer ride than you thought.

Read Full Post »

What with slow but steady treatments for menopausal issues trickling into the marketplace (OsphenaDuavee and Brisdelle, for example), my toolkit is getting bulky. That’s good news.

Now another pharmaceutical option is on the market. The FDA approved Intrarosa last year for treating “moderate to severe pain during sexual intercourse (dyspareunia)” caused by thinning and drying of vaginal tissue during menopause. It’s been distributed in the US by AMAG Pharmaceuticals since July 2017.

Intrarosa is an interesting drug. It’s a synthetic version of a steroid naturally produced in our adrenal glands, called prasterone or dehydroepiandrosterone (DHEA). Prasterone is considered a “precursor hormone” because it is inactive until it comes in contact with vaginal (or other) cells, where it stimulates the production of both estrogen and testosterone. By interacting with vaginal cells to produce estrogen, elasticity and pH levels in vaginal tissue are improved, ideally making sex less painful.

If the term DHEA rings a bell, that’s because it’s commonly used as a nutritional supplement made from wild yam and soy. Sometimes called the “youth hormone,” DHEA is said to improve aging skin, aid in weight loss, and improve mood, among other health claims. While DHEA has been studied for many years, data on dosage or long-term safety haven’t been established.

Intrarosa is a suppository inserted into the vagina once daily at bedtime where it dissolves overnight. The effectiveness of Intrarosa was tested in two, 12-week trials of 406 women between the ages of 40 and 80 who had troubling symptoms of dyspareunia. They were randomly assigned to receive either Intrarosa or a placebo. Two additional 12-week trials and one year-long trial attempted to establish the safety and side effects of Intrarosa, according to the FDA press release.

Clinical trials support the effectiveness of Intrarosa, and FDA approval has been a high bar: “Intrarosa, when compared to placebo, was shown to reduce the severity of pain experienced during sexual intercourse,” said Audrey Gassman, MD, FDA spokesperson. One source said that Intrarosa seemed about as effective as a very low-dose topical estrogen.

Side effects appear to be relatively mild: six percent of women experienced vaginal discharge, which could be related to suppository itself, and a very few experienced abnormal Pap tests, the significance of which is unknown. Intrarosa doesn’t come with a black-box warning, and there is no warning against using it with breast cancer patients, which we’re happy about (it hasn’t yet been specifically trialed with that population). However, blood levels of circulating estrogen after taking Intrarosa were “below the threshold” of a post-menopausal woman.

Currently, AMAG Pharmaceuticals is offering an introductory program to “commercially qualified customers” of a zero-dollar copay for the first prescription and no higher than a $25-dollar copay for refills during the initial launch. After that, it’s anyone’s guess. Because vaginal cells tend to regenerate quickly, you should know within a few days to a couple of weeks whether Intrarosa will work for you.

Painful sex caused as a condition of menopause is incredibly common. Aggregating the data from many surveys indicates that about 32 million women have some symptoms of vulvovaginal atrophy. Of those, between 45 and 80 percent—quite a range, obviously—report having painful intercourse. Half of those women say they aren’t seeking treatment for it. You do the math. I’m just saying that in my experience, painful sex follows menopause like spring follows winter.

So, having another treatment option makes me happy. Is Intrarosa the magic bullet we’ve all been hoping for? Time will tell! I’ve been prescribing this fairly frequently already. If you suffer from dyspareunia, a conversation with your doctor about the potential risks and benefits of Intrarosa would be worthwhile. I’m interested to explore its effects with vulvodynia and the testosterone component. It’s a solid option with relatively low risk that may help many women.

Read Full Post »

Humankind has been trying to cover up its natural odor ever since we crawled out of the cave. Maybe this made sense when bathing was considered dangerous and soap was made from animal fat and wood ash. But in our obsessively hygienic and more enlightened time, why all the fuss about odor, specifically that of our nether regions? And why all the products meant to make our bottoms smell like a spring breeze, whatever that means? (Watch this Saturday Night Live clip for a hilarious take on the topic.)

As far as I can tell, these products follow a long, inglorious line of more or less successfully convincing women that they stink. In a 1930s ad, the “Love Quiz” asks why her man is avoiding his lovely wife’s embrace. The answer is that he’s no longer happy in the marriage because she’s neglected “proper feminine hygiene.”

The solution? “Every wife can hold her lovable charm simply by using ‘Lysol’ disinfectant as an effective douche.” Yeah, that Lysol.

You can’t make this stuff up.

Eighty-odd years later, have we really come such a long way? We may not be squirting floor cleaner up our yoni, but there are no lack of products on the market to camouflage our natural odor. Now, just as back in the day, the intent is to make us feel self-conscious and embarrassed about ourselves. To shame us into buying products we don’t need and that sometimes aren’t good for us.

Dr. Barb's book, Yes You Can: "Sound, reassuring, medically approved advice."Our vaginas don’t smell like a spring breeze, nor should they. Our vaginal smell comes from a delicate balance of certain bacteria called lactobacill—the same bacteria found in yogurt. When you think about it, a natural vaginal odor has that same slight pungency. In the vagina, lactobacilli produce lactic acid and hydrogen peroxide, to give us a slightly acidic garden that works with our bodily ecosystem to keep out bad bacteria and the fungi (yeast) that produce the really smelly stuff, sometimes accompanied by a ferocious, burning itch.

While our vaginas are quite resilient, if enough lactobacilli are killed off by medication, those nice-smelling douches, excessive sugar in our diet (encouraging sugar-loving yeast), trapped moisture in our crotch, or even blood or semen, which are fairly alkaline, the resulting bacterial mash-up can cause both odor (fishy or foul) and itch.

In that case, your doctor may advise treating the bacterial or fungal infection or using an over-the-counter product, like Balance Moisturizing Personal Wash, to restore the natural pH balance in your vagina.

Vaginal smell can also be affected by:

  • Sweat glands. We have a lot of them in the crotch area—the same kind as those in our armpits. Just so you know, sweat is basically odorless, but the bacteria living on our skin like our sweaty selves and produce yet another substance that gives sweat its distinctive odor. Wear cotton panties, take a shower, and change underwear after a workout. Let your crotch breathe—don’t wear tight clothes or pantyhose; go pantless when you can.
  • Medications. Obviously, antibiotics can change vaginal flora. If you take antibiotics, ask your doctor about replacing vaginal (and gut) flora with probiotics, yogurt, or RepHresh. Antihistamines can dry the vagina. Some herbal therapies can change vaginal odor.
  • Foods. If certain foods, such as asparagus, garlic, or curry, make your urine smell, they could also affect vaginal smell. No reason not to eat them, they just create a temporary odor.
  • Hormonal changes. The vagina is exceptionally sensitive to hormonal changes, as you probably know all too well. Menstruation, hormone therapies, birth control, even sex can change the bacterial garden. Loss of estrogen during menopause makes vaginal tissue thin and dry, thus more susceptible to bacterial and yeast infection. With menopause, we may have to adjust our vaginal housekeeping somewhat with regular use of vaginal moisturizerstopical estrogen, and sexual lubricants.

Left to its own devices, our vaginas are hardy and self-sufficient. They wash away dead cells and grow new ones. They don’t require special hygienic measures—just the normal shower wash of the external parts with warm water and a gentle soap. Just make sure the soap is fragrance-free and not antibacterial.

I’m betting that by now most of us have grown comfortable enough in our own skins and with our own natural smells not to be overly influenced by commercial messaging. Not that it is any less relentless, nor is there any lack of products and procedures to alter our appearance. By and large, we’ve just become wiser and less susceptible to the barrage. So maybe pass along the message to our younger sisters that they are beautiful and smell fine just the way they are.

Read Full Post »

Recently I had the privilege of interviewing Dr. Joan Vernikos for my podcast series “Fullness of Midlife,” which are conversations with interesting people about health, love, life, and meaning. Dr. Joan was director of Life Sciences at NASA until 2000 when she “retired” to write and speak (some retirement!) about some of the groundbreaking research she had conducted from her special perch at NASA.

You can listen to the entire interview here, but I wanted to also distill the pertinent bits for MiddlesexMD readers.

As you might imagine, the effect of gravity, or lack thereof, is a fundamental concern for scientists at NASA. Astronauts are exposed to low-gravity environments, sometimes for months at a time, which has wide-ranging and deleterious effects on bones and organs, blood and cardiovascular systems. During her time at NASA, Dr. Joan specialized in the effects of gravity on the human system.

But here’s the thing: Dr. Joan came to understand that gravity operates on earthbound humans in similar ways! When we are upright and moving around, we are subject to the full effects of gravity pulling us to the center of the earth vertically. But when we are horizontal, lying in bed, for example, gravity’s pull is spread evenly throughout our bodies and is much less intense—similar to the experience of astronauts. “…The changes that accompanied lying in bed… 24 hours a day… are very similar to those we see in astronauts. Granted, maybe a little less intense,” said Dr. Joan.

Interestingly, these metabolic changes don’t happen when we sleep at night. Normal sleep appears to have a restorative, “detoxing” effect on the body and the brain, which is also important to good health.

The body is designed to move all day long...Since the few astronauts who actually spent time living in micro-gravity were harder to find than subjects willing to lie in bed, Dr. Joan began studying the effects of long stretches of time spent horizontally. She found, for example, that after about four days “very significant changes” began to happen in the way her subjects metabolized fluids, in the cardiovascular system, and in stress responses. Of course, as with astronauts, these changes mostly were reversed when the test subjects got up and walked around or the astronauts came back to earth, and gravity took over.

Then, Dr. Joan visited a friend’s elderly mother who was bedridden, and she realized the low-gravity changes she’d been studying looked a lot like aging. Was there a link between our increasingly sedentary culture and the symptoms of early aging? Dr. Joan feels that the chronic diseases of the elderly—diabetes, cardiovascular problems, obesity, bone loss and muscle wasting—are happening at younger ages, even in childhood, because we no longer allow gravity to do its work. We sit too much and move too little.

Dr. Joan hypothesized that the body is meant to move all day long, and in the not-so-distant past, that happened pretty naturally. Our grandparents “…bent over and reached up and made beds and cleaned and washed and gardened. And went and bought groceries and walked home or rode a bicycle, or whatever.”

Following several studies, Dr. Joan feels that simply standing up is “fundamental” to countering the effects of inactivity. Simply standing up and then moving around reverses the micro-gravity effects of lying in bed—or of aging. Trouble is, we don’t live like our grandparents. More likely, we sit for hours in front of one screen or another in the office and at home. Then, if we’re disciplined, we might exercise a few times a week.

Exercising, while good in itself, isn’t enough to counteract the effect of sitting around for hours every day. Our bodies are designed to move, to work against gravity. That, not sitting, is our normal state, the result of eons of evolution.

After her 2011 book, “Sitting Kills, Moving Heals,” was published, a slew of new research supported the hypothesis she’d developed from her work at NASA: Long periods of inactivity have deleterious health effects. “…sitting makes worse absolutely everything. Whether you’re talking about cancer—prostate, breast cancer, cardiovascular conditions, stroke, metabolic conditions, diabetes, obesity—you name it, it makes it worse,” said Dr. Joan. (Here, for example, is NPR’s report on recent studies of aging subjects. The conclusion? If you don’t walk now, you might not be able to later.)

So, what should we do, especially if we’re still working and chained to a desk all day—but even if we’re retired and reading or knitting? Fortunately, the solution is simple. “Stand up!” says Dr. Joan. Go to the water-cooler, the bathroom, just take a break every 30 minutes or so. You don’t need to hop on a treadmill or take a 30-minute walk, just stand up and move for a few minutes. You won’t lose weight or tone your muscles with this regimen; it isn’t meant to take the place of exercise and a healthy diet, but it’s a good habit to develop if you regularly sit for hours every day.

Gravity is your friend, says Dr. Joan. Embrace it!

Read Full Post »

In a sense, the most “natural” replacement for lost estrogen is estrogen, which is a prescription product (like Premarin or Estrace vaginal cream, Estring, Vagifem, or the non-estrogen Osphena).

You asked. Dr. Barb answered.If, for a number of reasons, you prefer not to take that path, the next-best option is to maintain vaginal tissues by using a moisturizer regularly, two to three times a week. Moisturizers are designed to bring more moisture–no surprise–into the vagina to prevent the progressive dryness that occurs in menopause with the absence of estrogen.

Both Emerita and Prevaleaf Oasis are natural vaginal moisturizers.

One more option might be an oral nutritional supplement, Stronvivo, which some research shows improves vaginal moisture. It does this by improving blood flow, and that circulation also supports tissue health.

Read Full Post »

During menopause, weight is easy to gain (in fact, some weight gain is almost inevitable) and hard to lose, for all the reasons we mentioned in the last post: metabolic change, loss of muscle mass, hormonal change, sleep deprivation, and stress.

So, ladies, if you’re just entering menopause—heads up! Game-changer ahead! Women who enter menopause close to their ideal weight have a better chance of maintaining it; however, women who tend to yo-yo or who have a hard time maintaining a healthy weight will tend to end up at the high end of their weight range.

Don't eat anything your great-great grandmother would not recognize as food.Whatever you did in your 30s to keep your weight in check isn’t going to work anymore. You’ve lost about 20 percent of your muscle mass and you need about 200 fewer calories per day you enter your 50s and 60s. Forewarned is forearmed, as they say. Simply recognizing this fact may help you step away from the hamster wheel of yore and toward a regimen that actually works.

The good news is that the best weight management strategy—the one that will work for the long haul—will also keep you stronger, more flexible, healthier, and capable of maintaining an active lifestyle for far longer. You’ll be able to travel, garden, play with the grandkids, get up off the floor, carry heavier loads, and remain generally pain-free.

The bad news is that it’s hard. A realistic and effective strategy to maintain a healthy weight requires self-discipline and lifestyle change. For the rest of your life. As you’ve probably guessed, you have to get serious about exercise and your diet—how much and what kind of food you put in your mouth.

Sure, you can go on a killer diet; you can take medications that will help you lose weight. But you probably already know the drill here—without lifestyle change, you’ll put it right back on and then some. Only now, you’re much more vulnerable to a host of serious, life-altering ailments, such as joint problems, diabetes, and cardiovascular trouble.

So let’s talk about ways of eating that work for older women. We’re not talking about draconian measures that you’ll have a hard time maintaining. In fact, overly rigorous dieting can actually cause you to lose muscle mass and slow your metabolism even more, which is the last thing you need right now.

  • Focus on fresh, real, homemade food. You need to consume fewer calories, but they need to be high-quality, nutritious calories. Think whole grains, fresh fruit and vegetables, nuts, and legumes. Don’t go crazy on low- and non-fat foods, which are unhealthy in hidden ways. Instead, go for the unsaturated fats in olive or sesame oils, avocados, nuts, and salmon or tuna. “…[nutrient-rich, unsaturated fat] keeps your skin supple and your body from drying out. Basically, it’s like putting lotion on your body but from the inside out,” says Dr. Christine Gerbstadt in this article.
  • Speaking of calories: A sedentary older woman in her 50s and 60s should consume about 1600 calories per day. If you’re more active, bump that up to 1800 calories. To lose one pound per week, you need a daily 500-calorie deficit, either through diet or exercise. I’m thinking it’s better not to gain that weight in the first place.
  • Protein is important to replace muscle and protect bones—5 to 6 ounces of lean protein per day, such as that in dairy products, poultry, and fish.
  • The best diets for older women are the Mediterranean diet and the low-carb diet. Vegan and vegetarian diets are also good for weight loss and have been linked to greater longevity.
  • In the beginning, a structured meal plan is helpful. Write down what you’ll eat in the morning, so you don’t find yourself peckish in the mid-afternoon and absentmindedly reaching for the cookies. Later, you can mentally plan your daily menus. Try to establish a regular pattern, so you get used to eating at about the same time each day.
  • Avoid sugar, but don’t be obsessive about it. If you’re too rigorous, you may just be setting yourself up for a binge. An occasional treat is a nod to mental health.
  • Alcohol (even in red wine) is not your friend. Alcoholic drinks are full of sugar and high in calories. One 4-oz. (half-cup) wine or beer per day is the limit. 1.5 oz. for spirits.
  • If you slip up, it’s not the end of the world. Start fresh the next day. Just don’t give up.
  • Bariatric surgery is a highly risky last-resort. But it does work, and may be less risky than years of obesity,
  • Oh, and drink plenty of water.

“My body has changed, so I’ve got to change with it. I can’t do what I did 20 years ago and expect to stay slim,” says nutritionist and co-author of The Full Plate Diet Dr. Diana Fleming in this article.

Staying fit and trim after menopause is no picnic, but feeling healthy, capable, and in control of your life is worth every uneaten ounce of chocolate.

 

Read Full Post »

Older Posts »

%d bloggers like this: