Sex, midlife and a sense of purpose
Sexual desire. In midlife, sexual function and sexual desire aren’t well understood, primarily because there are so many factors that enter into equation. This may be why certain silver bullets, like a female viagra, has failed to show any significant improvements in the desire department. And yet, researchers continue to accrue more information about the things that influence desire in women, ranging from the quality of intimate relationships to social support and overall wellbeing. The manufacturer who discovers a pill that addresses all of these will have struck gold. Meanwhile, back in reality, as many as 75% of women in midlife rate sexual health as important enough to warrant further exploration.
Fortunately, we may have another piece of the puzzle: ‘sense of purpose,’ which appears to be associated with greater wellbeing, happiness, life satisfaction, self-esteem, personal growth and optimism. A sense of purpose also appears to improve health, prevent certain diseases and may even improve cognitive function, thereby staving off mental diseases associated with aging. In a study that appears in the online version of Menopause, 459 menopausal women who were sexually active with a partner were followed over three years. Each year, they were asked about their emotional wellbeing (including their general mood, anxiety and depression as well as how often they engaged in and enjoyed sexual activity (specifically desire, type of activity and hugging and kissing). In the final year, they took a test that rated their sense of purpose on a five point scale ranging from ‘there is not enough purpose in my life’ to ‘the things I do are all worthwhile.’
The findings?
A greater sense of purpose equaled a great enjoyment of sexual activities, independent and regardless of other specific life circumstances. In other words, psychosocial functioning, e.g. social support, quality intimacy and overall wellbeing influenced the quality of these women’s sexual lives. On the other hand, menopausal status and use of hormone therapy did not appear to play a significant role in how often women engaged in sex or if they enjoyed it. This is important, as it means that psychosocial wellbeing may ultimately be more important than hormones.
In so far as the desire to engage? Women who were younger, had more social support, felt better about themselves and weren’t suffering from vaginal dryness tended to want sex more than their older peers who didn’t enjoy these factors.
Not surprisingly, many of the factors that researchers stress may help desire and engagement are associated with greater nitric oxide levels, which Dr. Christina Northrup says can help combat sexual dysfunction and improve pleasure.
When it comes to sex in midlife? It may help to think ‘sense of purpose,’ a real sense of purpose, now. (Poetic license, Chrissie!) I’m all for it if improves activity and desire without drugs.
Read MoreWednesday Bubble: Black cohosh – is it safe?
Back in 2009, I wrote a post regarding black cohosh (better known in scientific circles as Cimicifuga racemosa) and potential safety issues, namely harm to the liver. In it, I discussed a small case review that showed no link between ingestion of black cohosh and liver toxicity. And yet, in 2006 the European Medicines Agency and the Committee on Herbal Medicinal Products released a public statement alerting health authorities to 42 suspected liver reactions among women taking black cohosh. In the very same report, they noted how inadequately adverse reactions were documented. Indeed, only 16 of the cases were considered to have sufficient data to allow for proper assessment of a potential link, and of these, only four showed any sort of association, albeit, unproven. Regardless, the statement resulted in Italian health authorities requesting a precautionary withdrawal of black cohosh preparations from the market, and UK authorities issuing strict label requirements and warnings.
Hence, I was intrigued when I ran across a detailed review of black cohosh safety, both from perspective of over 107 patient cases and of published study findings. Following is the lowdown:
- An Italian clinic regularly prescribed 500 mg or 1000 mg daily black cohosh, either alone or in combination with other herbs (e.g. soy isoflavones, red clover or alfalfa) for treatment of menopause symptoms and disorders (e.g. anxiety, depression, hot flashes and joint pain). None of these herbs were prescribed to women with previous cancer of the breast, ovaries, uterus or pituitary gland. Moreover, the researchers say that they had not received any reports of any sort of adverse event.
- Still, following the European health statement, they contacted 107 women in good health and in different phases of menopause, took blood samples, underwent clinical examination and participated in phone interviews to evaluate if they were still taking the herbs. Of these women, only five had chronic but benign liver disease and one, hepatitis.
The findings? Despite the four patients suffering from prior benign liver disease, there was no additional sign of liver problems nor altered laboratories indicating a worsening condition or a new condition. Nor were there any clinical signs of liver damage after a year of using high dosages of black cohosh.
The researchers who reviewed and examined patients as well as the published literature point out that the liver is central to metabolizing most drugs and hence, there is a potential for an adverse liver event from taking nearly every medication that involves liver metabolism. They note that a step-by-step examination is also necessary to rule out other causes of liver damage, including infection, alcohol use and related conditions. In so far as herbs go, they write that “it is very important before an official statement about any adverse reaction referred to an herb based product to know the brand, dose of substance assumed, type of extract [and] content of possible contaminants.” They go on to state that it is their opinion the statement could actually be used as proof that black cohosh liver toxicity is scarce because despite over a million doses used worldwide annually, there is not any fully proven case of liver toxicity. Moreover, they claim that black cohosh safety has already been established in over 3,800 participants in clinical trials. Their conclusion? black cohosh should be considered safe, at least in so far as liver toxicity goes.
What should you do?
If you wish to try black cohosh, speak to a licensed practitioner well versed in herbal medicines. Look for a standardized form to insure that the pills contain what they say they do. And if you start feeling poorly while taking black cohosh? Stop immediately and contact the person responsible for your care.
Black cohosh and liver toxicity. This one appears to be a bubble bursting worthy.
Read MoreHot flashes and night sweats. Mind over matter?
[youtube=http://www.youtube.com/watch?v=LH8xbDGv7oY]
Hot flashes and night sweats, oh my! They hit like a ton of bricks when you’re least expecting them and then exit as quickly as they arrived. They affect up to 70% of women and tend to worsen in late perimenopause and in menopause. And while hormone replacement therapy may decrease how bothersome they are and good health diminish frequency and severity, it appears that how well women believe they are controlling their symptoms outplays all of these other factors, so much so that perceived control may actually beneficially affect emotional distress, prevalence and severity of symptoms and how often women engage in behaviors that benefit their health.
Findings of a new study that’s just been published online in Maturitas run counter to many that came before it, studies that have shown that smoking and body mass index and alcohol consumption, as well as marital status, age, professional status, parity, educational status and income may significantly influence hot flash prevalence, frequency and severity. However, this time, researchers found that among 243 women between the ages of 42 and 60 years, the most important factor was control.
Participants were first asked to assess the intensity and intensity of hot flashes and night sweats on a five point scale (i.e. never to daily to almost every day and not intense to extremely intense). They were also asked to estimate perceived control over their symptoms using a validated rating scale. Finally, menopausal status, i.e. pre-, peri- and post- were assessed. Additionally, common sociodemographic and lifestyle factors shown to influence hot flashes and sweats were accounted for.
Importantly, women who used no medications or used soy and herbal products had higher perceived control over their symptoms than women who used hormone therapy. Moreover, this distinction had nothing to do with how severe their symptoms were as the researchers say that severity was similar among all three. Additionally, women who drank greater amounts of coffee appeared to perceive their symptoms as less severe than those who drank less. While previous research has found the opposite, i.e. caffeine intake predicts the occurrence of hot flashes, it is possible that the stimulation associated with caffeine might have boosted coping mechanisms and strategies, thereby leading to fewer or less severe symptoms. Still, perceived control ruled the day, leading to a significant beneficial impact on severity of flashes and night sweats. The reason? It’s possible that feeling in control leads to other behavioral changes, such as dressing in many layers to allow for adjustments as the inner temperatures increase, avoiding spicy foods or effectively controlling stress. However, the results also imply that how much control we feel we have strongly influences how we ultimately feel.
Clearly, more research is needed. But when it comes to hot flashes and night sweats, mind over matter may play a strong role.
Read MoreCocoa loco? The lowdown on chocolate and heart disease
[youtube=http://www.youtube.com/watch?v=RZ-uV72pQKI]
If you are a chocoholic, I bet you’ve noticed the headlines linking chocolate to a reduced risk of heart disease. In fact, data from the Kuna Indians (a tribe indigenous to Panama) have shown that cocoa and in particular dark chocolate are associated with declines in blood pressure. More recently, a large government study showed an even greater benefit in terms of a significant reduction in coronary heart disease prevalence. And in women, who have an increased risk for heart disease as they age (not only due to the increase in abdominal fat or changes in their blood fat levels but also to loss of ovarian function), chocolate has ben shown to slightly lower the risk of dying from heart disease.
Sounds promising and quite frankly, awesome, right?
Well…before you run out to the grocery or chocolate shop, you may want to read further…
Researchers have long been interested in flavonoids and in particular (at least in so far as menopause goes) in isoflavones. (See soy posts for more on isoflavones). The specific compound or molecule of interest in cocoa (the non-fat component cocoa bean extract or liquor) are flavanols, which are also found in lower concentration in apricots, peaches, apples, green and black tea, red wine and cider). Note that the quantity of flavanols in chocolate depends on manufacturing, including fermentation and roasting, and how much treatment is given to reducing bitterness and improving consistency. What this means is that dark chocolate has the highest concentration of flavanols and milk, the lowest.
What have researchers learned so far?
- Flavanols found in cocoa and cocoa powder may be powerful antioxidants and as such, help to mitigate certain factors that contribute to atherosclerosis, such as the formation of plaques in the arteries that lead to stroke and other coronary events. Thus, as antioxidants, they may actually neutralize toxic oxygen species circulating in the bloodstream.
- Experimental data suggest that ingestion of flavanols may help to regulate proteins and other compounds that encourage an inflammatory response to leads to heart disease.
- Flavanols may also help to stabilize the lining and muscular tone of the arteries and prevent them from narrowing.
- Additionally, flavanols may moderately protect against high blood pressures, although studies have been mixed.
- Finally, flavanols may help to maintain blood sugar levels and improve the ratio of good to bad fats in the blood.
Wow, this sounds fantastic! And all it takes is a daily diet of dark chocolate?
Here’s the great news. Researchers are devoting increasing amounts of time toward learning how certain foods affect (and benefit) health. However, in so far as chocolate goes? In a thorough review published online in Maturitas, they write that of the studies that have been conducted, it’s truly difficult to determine whether or not there is a causal relationship, i.e. eating A causes B, or eating chocolate prevents heart disease. In the case of chocolate in particular, factors like manufacturing can influence study findings. Moreover, researchers still aren’t sure if they should be focusing on flavanols or some other component of cocoa. It is also possible that only people who already have some sort of problem or condition will benefit from eating more chocolate.
The bottom line? Dark chocolate in moderation, won’t hurt you and may actually help you. However, you may want to temper expectations. At least a wee bit. Dare to dream though…perhaps cocoa will ultimately defy explanation!
Read MoreWednesday Bubble: Depression and midlife – “overmedicalizing” the menopause
What’s the lowdown on depression, midlife and women? And how does the menopause come into play?
I written previously that depression may affect as many as 20% to 40% of women during menopause. However, gender differences in depression evidently begin well before the menopause and women are 1.5 to 3 times likelier than men to report a lifetime history of depression. Moreover, these distinctions start as early as the teen years and continue until the mid 50s, which researchers say, corresponds to female reproductive. Hence, experts have connected waning and altered hormone levels to high rates of mood and anxiety disorders in women.
Is this hypothesis valid? And, where did it originate?
According to a review in the early online edition of the Journal of Affective Disorders, some research has suggested that premenstrual, post partum and menopausal mood disorders are linked and that women are especially vulnerable during certain time periods. This has led to a proposal that reproductive-related depression have its own classification, and that during midlife in particular, all women should be routinely screened for symptoms. Interestingly enough, however, it has also led some researchers to question if we are “overpathologizing the menopause?” Hallelujah! (If you want to read more on medicalizing the menopause, check out one of my favourite Flashfree posts.)
The key finding?
Although studies demonstrate that significant numbers of women in midlife report depressive symptoms, menopause is only one of a range of factors purported to lead to depression during this timeframe. Others include stress, family life, general health issues and a lack of exercise, as well as a history of some sort of anxiety disorder. What’s more is that how women perceived the effect of menopause on their physical health almost doubled the risk that they would first develop depression at the onset of menopause.
The researchers say that although women might score high on self-reported mood scores, these scales or instruments tend to exaggerate the rate of depression in women in midlife and menopause. They also note that if a score is only taken at one time point that is might indicate temporary distress rather than a long-term problem. They add that during menopause, certain symptoms, such as sleep disturbance and fatigue, may be easily confused with depression even though they have nothing to do with a mood disorder and everything to do with hormones.
The bottom line is that symptom overlap and environmental factors can confuse a diagnosis, and that depression is not necessarily more prevalent during menopause than during other periods in a woman’s life. Consequently, like many things, the studies that are out leave more questions than provide definitive answers. Hence, the call for all women to be screened for depression during menopause may be an example of extreme assumption and not based in true necessity.
Is it possible that depression is just the tipping point in the medicalization of menopause?
What do you think?
Read MoreArchives
Tags
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.