“Beauty’s but skin deep…
Nay, it is not so…” John Davies, Hereford, 1616
I was at the hairdresser this morning reading a trashy mag and ran across an advert for Curel Lifestages Moisturizing Lotion for Menopause and Beyond. If you interested in checking out the product, web page copy claims that studies have shown that this product increases hydration and skin elasticity.
Hmmm. Menopause skin. I’ve never heard of it. Sure, I’ve heard that the skin loses its elasticity as we age and becomes thinner and dryer. In women in particular, the decline in estrogen levels has been linked to dry skin mostly around the vaginal area and also within the vagina. Obese women appear to be at risk for developing thickening, itching skin on soles of their feet and palms of their hands.
Dry skin in older women occurs as a result of a decline in the amount of sebum, or the surface film of natural oils and broken down cells; this occurs as a result of declining estrogen levels. Sebum slows down the evaporation of moisture from the skin. Note that men don’t experience a similar decline until they are in their 80s.
So what can you do about it? Sure, moisturizing can temporarily help skin appearance but aging is aging and there’s little we can do about the inevitable. Hormone replacement therapy can definitely assist with vaginal thinning if that is what ails, but if you’re like me and can’t “do” hormones, well, it seems that the option is a slippery slope.
I suspect that there are many desperate perimenopausal sisters out there willing to try anything. Me? I’ll stick to the devil I know!
Read MoreLet’s talk about sex
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I’ve heard that menopause is often linked to problems in sexual functioning.
Now mind you, this is one issue that many of my gal pals, present company included, have yet to experience but I believe that it’s an important topic nevertheless. Indeed, other women have expressed issues around desire, capacity for orgasm, and frequency of intercourse. The question is, are these problems related to menopause and hormones or to aging? Well, apparently both.
For example, some studies have found that the sharpest decline in sexual interest for women occurs around the mean age of menopause, while others have found that menopausal status (i.e., the point of the transition) negatively affects sexual function independent of age.
Interestingly, one of the largest studies – the Melbourne Women’s Midlife Health Project – which followed 438 women through menopause for more than 10 years, found significant declines in female sexual functioning, responsiveness, frequency of sexual activity and libido. When the researchers compared women who went through the transition during the study to those who remained pretty much in the same phase, they found that only sexual responsiveness declined. What this implies is that our ability to respond to sexual activity is paired with aging, while all the rest of the issues, are affected by menopause.
Interestingly, among the variety of factors that may contribute (e.g. quality of intimate relationship, degree of stress, general well-being) androgen levels (i.e., testosterone) may play a role.
In a fairly recent review of 14 controlled trials in women undergoing natural or surgical menopause, researchers found a benefit from “adding back” testosterone, in terms of sexual desire, frequency, pleasure, and satisfaction. Testosterone was administered via patch, a gel, and inhaled, among others. While some of the benefits may be attributed to the so-called “placebo effect,” the results are interesting and lend promise for future studies.
Read MoreNavigating the Maze, Part 2
In my last post, I wrote about navigating the maze of perimenopause symptoms and treatments. This is a continuation of an interview I had with NYC-based acupuncturist and Chinese Medicine Specialist, Elaine Stern.
When I last left off, we were discussing useful Western herbs for addressing perimenopausal symptoms.
Are there other herbs than black cohosh that are helpful for perimenopausal symptoms?
Chaste tree berry is a very useful herb for perimenopause since it targets the “luteal phase” of the menstrual cycle. It helps the body become more efficient in terms of ovulation and progesterone production, and may be useful for women experiencing irregular cycles or PMS symptoms.
You mentioned nutrition earlier. How is this different than herbal medicine? Afterall, we’re taking supplements, right?
Nutrition, like acupuncture and herbal medicine, is a fairly diverse field. However, unlike the literature has not caught up with its practice. It’s also confusing because we may read the newspaper one week and see a study saying we should take vitamin X, and then the next week, see that it’s been linked to cancer.
When it comes to nutrition, it’s important to understand the body’s physiology and biochemisty and focus on nutrients to increase natural function and actions. With regards to perimenopause, you may recall that we discussed the build-up of excess estrogen. Vitamin B6 has been shown to be very important in helping the liver clear the estrogen out of the body. While things like diet are undoubtedly the most efficient way to obtain B6, well, the way that we eat and the way that our food is grown can interfere with the ability to get as much as is needed. With a little extra, we can assist the body’s ability to clear the estrogen, thereby addressing water retention and other PMS symptoms.
Do women need to stay on treatment the entire menopausal transition?
Well, it’s important to stay on some sort of program for a period of time. This will vary from person to person.
What should women look for in a practitioner?
With Chinese medicine and acupuncture, the practitioner should be licensed and have national board certification. If their specialty is nutrition, it’s helpful to inquire about education and experience. And most of all, find out if the practitioner has a specific interest or area of practice that focuses on gynecology and internal medicine.
Anything else you’d like to add?
I want reiterate that herbal and nutritional products are completely unregulated and there’s a huge variety in quality. Whatever you can learn about the way that a product is manufactured and with what type of oversight, the better. So, I’d recommend that women look at the labeling for buzzwords like “standardized,” “good manufacturing of products,” things like that, but with the knowledge and understanding that there is no oversight with regards to the marketing of these substances. Again, this is a good reason to see a practitioner, at least to get started as he or she can be useful for creating a program and guide you to good sources for herbs and nutritional products.
Finally, this is medicine. Women need to understand that they are tinkering with their hormonal balance and even if the products aren’t toxic, it’s important to look beyond the symptoms and understand what’s going on physiologically. So, I truly believe in the importance of speaking to someone who can understand your individual changes and then recommend something. At the very least, women should see someone at least once to insure that they are on the right track.
Read MoreNavigating the Maze, Part 1
I always enter mazes with great anticipation. The thrill of navigating the corners and moving forward without interruption, the intellectual aspect of the “game,” and the forced retracing of steps when I hit a wall.
Maybe we should think about perimenopause like that? Anticipate, analyze, and step back each time we hit a wall.
I spoke with New York City-based acupuncturist and Chinese Herbal Medicine specialist Elaine Stern last week. We talked about common perimenopause complaints, what’s actually going on in our bodies, and with the proper guidance, steps that might be taken.
I learned a few things and hope that you will also. Please note that it is neither mine nor Elaine’s intention to provide medical advice or replace personal consultation with a private practitioner. Rather, we hope that our conversation will help you understand some of the the changes you may be going through.
p.s. Because our conversation was so lengthy, I’ve broken it into two parts.
What are the primary perimenopausal complaints that you see consistently in your practice?
There are a core group of complaints that are very common. Beginning in perimenopause, women start to have a lot more PMS, and more mood swings that worsen just before the period and sometimes don’t get better right away after, as they did previously. Sleep disturbances may occur, especially in the second half of the cycle. Note that these peripheral problems are influenced by hormonal changes.
What exactly do you mean when you say the problems are “influenced by” hormonal changes?
From the time women reach age 36 or 37, they begin to ovulate less often, i.e. instead of 11 or 12 times a year, maybe they’re ovulating nine or 10 times. By the time they get to age 45, they might be ovulating every two or three months. Women’s hormones, that is, estrogen and progesterone, have an important relationship with one another and keep one another in check. A decline in ovulation means a decline in progesterone production, leaving, for all intents purposes, an imbalance.
What happens as a result of this imbalance?
Women in perimenopause may have a low progesterone level, which leaves the estrogen in relative excess in comparison. If the estrogen is in excess in relation to progesterone, the body tends to retain water, metabolism slows, and the liver becomes more sluggish and this affects the digestive system. They may gain weight because they are not burning food as efficiently. Estrogen stimulates breast cells, meaning that breasts may feel more tender than usual. Additionally, it stimulates endometrial growth, so periods may be heavier. And because estrogen stimulates the nervous system, it can also cause anxiety.
What types of treatment do you recommend for women experiencing these types of symptoms?
I believe it’s important to consider three modalities: acupuncture, herbal medicine, and nutrition.
So, let’s talk about acupuncture. Why is it helpful and what are the drawbacks, if any?
Acupuncture is helpful for women in perimenopause because it has a very good effect on the regulatory system; it smooths things out so to speak. It can help lessen anxiety, promote the immune system and can even out digestive problems. It helps rebalance areas that are out of balance. But what it can’t do is reverse the process of moving towards menopause. And you have to go quite regularly to keep the effects going.
Meaning what? Do you have to continue treatments throughout the entire menopause?
Well, this is why I find it helpful to combine herbs and acupuncture. Because herbs stay in the system all the time, they can keep a woman at an optimal level or balance in between acupuncture sessions.
Speaking of herbs, the whole issue can be very confusing for lots of women. One study may say that they are effective,and another, that they’re not. And, there’s often a lot of product selection. Can you clear up the mystery?
It’s important to separate the idea of Chinese herbs and Western herbs. Simply speaking, Chinese herbs are based on a system of Chinese medicine diagnosis. So, they are prescibed in combinations that treat these diagnostic categories. In other words, there is no one-to-one correspondence between a single herb and a single symptom. Because they are almost always combined, you can’t simply pick something off the shelf.
Western herbs, on the other hand, tend to be targeted towards specific problems. And there are good ones available for menopause.
Can you touch upon some of those?
Well, for example, black cohosh is a terrific herb. It’s not as strong as hormones but its track record is very good. While there are some studies that show it’s not very effective and others that show it is quite effective, I think that that has to do with how the studies were done. The other issue is quality of product and the lack of regulation.
Then, how do you choose when you go to the drugstore or health store?
That’s one reason to see a practitioner. A good practitioner will have examined the studies and will understand a bit about the marketplace. In this way, she or he will be able to direct you to a good product.
But if you live in a rural setting and don’t necessarily have access to a good practitioner, what are your options?
Almost all the studies that have shown good results have been conducted using a particular blend. We refer to these herbs as “standardized” because they are created using a percentage of one or two specific ingredients that are essential to creating an effect.
Where can you learn more about which products have been used in studies?
I recommend looking at Medline or even searching for “standardized X extract” on the American Botanical Council websites. A simple rule of thumb is that the least expensive product is not always going to be the best. While it’s hard to generalize, if you can find the product that was used in studies, well, it’s a great start.
Tomorrow, I’ll post the rest of this interview, which includes more information on Western herbs, a brief discussion about nutrition, and some overall advice.
Read MoreIs it real? Or is it…
An interesting report from the American Herbal Products Association highlights the dangers of simply going into a drug store and buying an herb right off the shelf. A study in the Journal of Agriculture & Food Chemistry shows that 3 of 11 black cohosh supplements purchased did not contain black cohosh but rather, a less expensive Chinese herb called cimicifuga that do not have the same chemical compounds or uses as the North American variety (which contains cificifuga racemosa).
What this means is that when you go shopping for herbs, well, they’re not all the same. Indeed, the best rule of thumb is to try to find a product that has been tested in clinical studies, or is manufactured by a reputable company. I’ll have more to say about this later in the week. But in so far as black cohosh goes? Remifemin, which is manufactured by Enzymatic Therapy, Inc, has been studied in clinical trials and is standardized, meaning that it contains the chemical compounds proven effective in alleviating certain perimenopausal symptoms. It may be slightly more expensive than the generic brand, but at least you know what you’re buying.
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