Posts by Liz

Musings: Menopause ain’t nothing but a…

Posted by Liz on Dec 10, 2010 in menopause, musings | 2 comments

Number?

Sometimes it is just that. And sometimes it’s not.

I’m reposting this piece, which first ran in June 2009, because a reader recently challenged me on my consistent opinion that menopause is not a disease.

“Menopause is truly a disease. There are many so called true diseases that cause far less damage to a womens body.”

Actually, the conditions that wreak the most havoc on a woman’s body as she grows older appear to more closely associated with aging than with menopause. Theoretically, this would mean that our best strategy to address prevention or risk reduction, right?

Here are the facts:

Australian researchers suggest that many of the more common complaints of menopause may be possibly related to aging in general and not specifically the transition. In fact, in a study presented during last month’s 8th European Congress on Menopause, they reported that menopause is strongly associated with some but not other common complaints.

So what about the other symptoms? After reviewing data from 58,724 women (ages 45 to 50) participating in the Australian Longitudinal Study on Women’s Health, the strongest associations were seen between menopause and hot flashes/night sweats. These findings remained after adjusting for age during the study, age at menopause, smoking history, body mass index, sociodemographics (i.e. education, income, marital status and geographic location) and other factors that might influence outcomes. Other symptoms, including difficulty sleeping, stiff/painful joints and poor or fair self-reported health were also associated with menopause but to a much lesser extent. Headaches, migraines and incontinence appeared to be more strongly related to the aging process.

The researchers say that treatment (in this case, HRT) should be geared primarily towards alleviating vasomotor symptoms. Less clear, however, is how long therapy should be continued, since some symptoms can last for more than seven years. This study is scheduled to appear in Menopause.

Last September, I wrote a post about a survey being reported at the North American Menopause Society’s Annual meeting suggesting that women can actually discern the symptoms of menopause from those of aging.  Interestingly, many of the symptoms overlapped; in fact, 84%, 72%, and 77% of respondents associated vaginal dryness, urinary stress incontinence and weight gain, respectively, strictly with menopause, even though they can also be caused by aging as well.

So, what’s the primary point? It can be difficult to tease apart the effects of aging and the effects of menopause. Clearly, these new Australian data add a bit more to the confusion, and reinforce the point that more research and funding is needed in this particular area.

When I write that “menopause is not a disease and should not be treated like one,” what I am really saying is that disease, especially when it’s chronic can stigmatize, frighten and even create self-loathing. By offering up hormone replacement therapy as the only viable “solution” to preventing and ameliorating the symptoms of menopause and outrightly dismissing gentler alternative strategies, the medical community takes on the stance that Author Louise Foxcroft has written about:  “fear of the menopause is something we have learned, and it has grown out of a general, male and medical distaste for the idea of the menopause perceived as an end to viability, fertility, beauty, desirability and worth. Since the French physician de Gardanne coined the new term ‘ménépausie’ in the early nineteenth century, an onslaught of opinion, etiology, treatments, and not least and lest we forget, profit has followed. Women need to unlearn their dread and recognize that menopause is not, of itself, dread-full; that we are merely the victims of our biological process.”

So which comes first? Menopause and disease or aging and disease? Regardless, we can go out fighting or we can give in.

in all, a good thing, right?

Wednesday Bubble: Don’t Pause!

Posted by Liz on Dec 8, 2010 in menopause, musings, new approaches | 0 comments

Hey, stop the presses! There’s a brand new, one-size-fits-all solution to menopause – Don’t – as in,  Don’t Pause. Billed as a breakthrough advancement in treating early menopause symptoms (according to the press release), Don’t Pause contains a proprietary mixture of pomegranate extract, green tea, chromium and selenium especially geared towards helping you ‘grow young responsibly.’

Um, okay. So what does that mean? It appears to mean that this wonder formulation will not only halt symptoms of menopause but also improve youthfulness and sexuality, reduce the risk of cancer, osteoarthritis, heart disease and epilepsy and enhance the effects of exercise on weight distribution. Wow! All that in a single pill. Have I mentioned that it’s also Hallal and Kosher?

There is one bit of messaging surrounding this wonder product that I believe is responsible and right on: the time to start addressing menopausal symptoms is before they start. That means you – 30 some year-olds and 40 some year-olds – there is no time like the present to build bone and preserve bone health, get into shape and start managing your weight, eat healthy, address stress and build those support networks. These are the type of steps that can go a long way to addressing menopause symptoms and also to take poetic license, truly help you grow older responsibly.

Don’t pause? What do you think?

Danger! Danger! HRT prescribing lagging behind recommendations

Posted by Liz on Dec 6, 2010 in HRT | 0 comments

[youtube=http://www.youtube.com/watch?v=RG0ochx16Dg]

Here’s a disturbing piece of news:

Stanford University School of Medicine researchers are reporting that when it comes to prescribing practices, physicians across the country continue to lag behind recommendations from FDA and other organizations cautioning that hormone replacement therapy (HRT) should be used at the lowest dose and shortest period of time possible or only as a last resort. This, despite accruing evidence warning of the dangers of hormone therapy.

While use of hormonal therapy has gradually declined ,some 6 million women continue to place themselves at risk annually. This risk appears to be somewhat exacerbated by the fact that that their doctors, especially ob/gyns, have not changed their prescribing habits very much. Indeed, less than a third of hormone therapy users surveyed in the IMS National Disease and Therapeutic index (which formed the basis for this latest bit of information) were given prescriptions for lower-dose hormone pills, vaginal suppositories or patches. Especially at risk are women old than 60 years in whom the risk/benefit of HRT is very unbalanced, more than a third of whom continue to use hormonal therapy to address symptoms. Thankfully, however, women younger than 50 and up to age 59 appear to be paying attention to the headlines and giving up hormones altogether.

Although the reasons that doctors aren’t paying attention are unclear, the researchers suggest that perhaps clinical practice has not caught up with data or that older women in particular, are satisfied with symptom control and don’t want to rock the boat.  Or perhaps many women in this age group remain unaware of the increased risk of heart disease and breast cancer (among others) associated with menopausal hormonal therapy. Regardless, the message isn’t getting through.

How do you change prescribing habits when there’s a breakdown in communications or when study investigators suggest that “it takes a huge event to change clinical practice?”  A huge event? I don’t know about you but I think that increases in heart disease and cancer risks are pretty big events. Ladies – it’s time to take this matter into your own hands. Speak up. Work with your doctor, discuss the treatment strategy he or she is recommending and especially when it comes to HRT, ask the hard questions.

Right now, like Robot from ‘Lost in Space,’ I don’t think that we can accept any other course of action other than to take action.

The B’s have it – bursting the belly and bones myth

Posted by Liz on Dec 3, 2010 in bone health | 2 comments

When it comes to aging and women, bone health is a big deal. As I’ve written time and again on Flashfree, women are at a particularly high risk for bone loss as they age because of declining estrogen levels, and in turn, a reduced ability to prevent an increase in net bone resorption (i.e. bone loss due to the activity of bone cells). And while we’ve been told that excess body fat actually protects against bone loss, novel research is putting that myth to rest. This news may affect the millions of women who are considered obese based on their body mass index (BMI > 30), who, although at greater risk for heart disease, diabetes and joint disease, were at least believed to have a weapon against osteoporosis.

In a small study that was presented at this week’s Radiological Society of North America meeting, an assessment of the abdominal and total fat and bone mineral density of 50 premenopausal women of varying BMI showed surprising results. According to the lead researcher, Dr. Miriam Bredella, “the general consensus has been that increased body fat protects against bone loss and obese women are at decreased risk for developing osteoporosis. However, we found that visceral fat — the deep belly fat — makes bone weaker.” In fact, the researchers found that women with more belly fat had significant declines in their bone mineral density and increases in the degree of fat within their bone marrow, but that total body fat or fat existing right below the skin had little impact on bones.

An important challenge for women is not only that metabolism slows and the risk for obesity increases as we age, but also, a natural increased risk for redistribution of fat to the abdominal area. And unfortunately, it’s one of the most challenging areas to address, requiring significant increases in physical activity and decreases in caloric intake. Some data suggest that isoflavones might help reduce waist circumference as well, although they are hardly definitive at this point. Still, a word to the wise: that belly fat is not going to protect your bones. Time to start moving and eating correctly; your bones will thank you.

Wednesday Bubble: all juiced up and ready to go

Posted by Liz on Dec 1, 2010 in heart disease, physical fitness, weight | 0 comments

Did you catch last week’s news about pomegranate juice and kidney disease? It seems that pomegranate juice just might be the next best thing… or not. The same holds true for orange juice, weight loss and heart disease. So before you get too excited about the wonders of the orange, let’s take a look at what research is telling us.

Middle-age is associated with a slow down of metabolism, distribution of weight and of course, an increase in risk for certain diseases, in particular heart disease. For women specifically, hormonal changes – namely a steeply progressive increase in testosterone, can contribute to a risk of developing metabolic syndrome (i.e. the cluster of risk factors — abdominal fat, high blood pressure and cholesterol levels and insulin resistance –that increases the likelihood of developing heart disease and diabetes). In fact, data from the Study of Women’s Health Across the Nation has shown that women have a a 1.45 times increased risk of developing the metabolic syndrome in perimenopause and a 1.25 increased risk after menopause. So, the cards are automatically stacked against us. Let’s add overweight and obesity, poor eating habits and sedentary behavior to the mix and we have a veritable “heart condition in the making” cocktail.

Wondering where this is going?

Across the board, the key ways to improve one’s risk of developing disease include a balanced diet rich in fruits, vegetables, whole grains and good fats and regular physical activity. The formula isn’t a magic one and but it’s been shown time and again to improve the odds. However, we are a society of instant gratification so it’s easy to fall into the trap of a quick fix, whether that entails botox, diet pills, diet plans, sweating or the like without paying much attention. Hence, when I saw a study setting the stage for the latest and greatest answer to our problems, i.e. orange juice, I had to take a closer look.

Like pomegranate juice, orange juice is rich in flavonoids, naturally-occurring plant and vegetable compounds that have both antioxidant and anti-inflammatory properties. Orange juice is also an important source of vitamin C, folate and potassium, which have been shown to help protect cells from bad, LDL cholesterol, reduce the risk of atherosclerosis and possibly help lower blood pressure. But, can drinking orange juice help prevent heart disease in middle-aged women who are already at risk?

When researchers compared 26 premenopausal women between the ages of 30 and 48 who were considered overweight or obese, and asked them to engage in a 1-hour aerobic exercise (running) 3 times a week and either drink 2 glasses (16 oz) of orange juice daily or not, they observed the following:

• Regular aerobic exercise led to an average loss of 11% to 15% of fat and 1.2% to 2.5% of BMI depending on the group that women were assigned to.
• Women who drank orange juice along with their thrice-weekly exercise had as much as a 15% decline in LDL-cholesterol and an 18% increase in HDL (good) cholesterol.
• Daily orange juice intake also led to less muscle fatigue and better overall responses to aerobic training.
• Although drinking orange juice added to daily caloric intake, it actually led to a decreased consumption of other foods.

Should you start drinking orange juice to lose weight and save your heart? Not so fast. This study simply shows an potential associated benefit and does not prove that drinking orange juice causes a reduced risk in heart disease,; mind you, these women were only studied for three months. Moreover, the study was small and a much larger group is needed to demonstrate proof of a benefit. Additionally, the results did not show which components in orange juice are specifically linked to a potential risk reduction, or if there are components in the juice that are shared by other juices. On a more positive side, it did demonstrate the benefit of a balanced diet, regular physical activity and improvements in performance, perhaps as a result of extra nutrients and energy provided by the juice.

Time to juice up? Nope, just time to start opening your eyes a bit wider when you see headlines touting the amazing benefits of a quick fix. Rule number 1? There are no quick fixes.