Giving voice
Did you know that the female larynx is sensitive to sex hormone changes? Evidently, along with some of the better known symptoms — sleep disturbances, mood swings, hot flashes, night sweats, weight gain, etc — vocal quality may also change in some women.
Experts say that fluctuating sex hormones, i.e. estrogen, progesterone and androgen, can result in a thinning and dryness in the vocal folds (or vocal cords). Because it takes greater effort to make sounds, voice changes can occur. Notably, studies have shown that not all women are affected by these changes nor are they affected in the same ways. However, when women are affected, their voices may get rougher/huskier, lose stability, lose their top notes and vocal range, and change their timbre. Professional singers or actors, or even consultants on the lecture circuit, all of whom rely on their voices to earn a living, are especially affected.
Researchers acknowledge that further study is needed to distinguish between vocal changes that occur as a result of menopause versus those that occur as a direct result of aging. Yet, regardless of the cause and degree that each factor contributes, voice changes can affect almost half of postmenopausal women.
Treatment options include:
- Hormone replacement therapy. Study results have been mixed, with some findings showing improvements in voice complaints and voice function/vocal quality and others, demonstrating none. Further research is needed that evaluates the effect of HRT on the larynx as well as its ability to prevent voice changes if instituted early. Of course, HRT is wrought with other dangers that might make its use, prohibitive or not worth the risk/benefit ratio.
- Voice therapy. Although many questions remain unanswered, vocal coaches and speech pathologists say that voice therapy can help relieve vocal fatigue. There are exercises that work well to address aging vocal cords, rebuild muscle tone and help women learn how to use their voice more efficiently.The American Speech-Language Hearing Association has a great resource for finding a local professional in your area that specializes in vocal deficiencies.
- Vitamin therapy. Research has shown that multivitamin therapy that includes magnesium, mineral salts, vitamins B5, B6 and E may improve vocal quality and help keep the vocal folds moist. Although experts say that there is not enough evidence for the role of vitamins in voice, vitamins, minerals and anxioxidants play an important role in health regardless of whether voice changes occur.
A quick search on PubMed turned up numerous articles on voice changes during the menopause and the article I sourced for this post (cited below), specifically references nine of these.
I am wondering how many women who are in the menopausal transition are experiencing these problems and are seeing clinicians who might not be aware of the potential link.
What about you? How is your voice quality? Have you noticed any changes?
[Source: D’haseleer E et al. The menopause and the female larynx, clinical aspects and therapeutic options: a literature review. Maturitas (2009) In press.)
Read MoreWednesday Bubble: Better living through chemistry? Your aging skin
Still thinking that hormone replacement therapy (HRT) can improve the appearance of aging skin? You may want to think again.
This past March, dermatologists at the American Academy of Dermatologists’ annual meeting once again debunked claims that HRT can improve the appearance of aging, photo-damaged skin. Although I’ve written on this topic previously, the subject is interesting (and relevant) enough to revisit.
Undoubtedly, certain areas of the body are more receptive to estrogen than others, e.g., cells comprising the skin on the face. And while estrogen can increase collagen, help the skin retain water and promote elasticity, its ability to reverse the effects of aging remain questionable.
Dr. Margaret Parsons, assistance clinical professor of dermatology at the University of California-Davis, says that she does not prescribe estrogen to improve skin’s appearance because data have not consistently shown any benefit. Not only doesn’t she believe that topical or oral estrogens offer any sort of long-term solution, but she also points to the risks involved in their use, such as breast cancer.
Consider the evidence (or lack, thereof):
- In a study published last year in the Journal of the American Academy of Dermatology, researchers evaluated whether or not low-dose HRT could improve the appearance of fine lines and wrinkles, skin dryness/texture and sagging. Study participants were 485 women who had been menopausal for about five years. No significant improvements were seen after 48 weeks of treatment, although researchers suggested that longer use of hormones or different doses might lead to better results.
- In another study, which I wrote about last year, applying topical estrogen to sun-damaged skin, likewise, did not improve the skin’s appearance, although it did appear to promote collagen production in areas that had not seen the light of day, i.e. the hip.
- A third study, published in the early 90s, suggests that use of a topical cream early in menopause and for a longer period of time, may improve the appearance of aging skin. However, this study was only conducted in 18 women over a period of six months, making it difficult to reach any definitive conclusions.
It appears that the jury is still out but deliberations don’t look too promising.
Think about it: are you willing to risk the adverse effects of HRT – cancer, death from lung disease, heart disease – for your appearance?
If you are deadset on erasing a few lines and a few years, there are effective therapies that dermatologist regularly suggest to improve skin’s appearance, for example retinoids, glycolic acid or procedures such as chemical peels, lasers, botox and skin fillers. While they might hit your pocketbook harder than HRT, most do not come with the same degree of health risks. You can learn more about taking care of mature skin in this issue of the American Academy of Dermatology’s SKIN e-newsletter.
Obviously, the best advice is to wear sunscreen regularly, avoid smoking and use a topical retinoid. We may not be able to turn back the clock but we can preserve what we have more responsibly. Estrogen might not be the ounce of prevention that works best.
Read MoreThree’s a charm…breast cancer, lung cancer deaths and ovarian cancer
More news on the hormone therapy horizon. Not only has HRT been shown to increase breast cancer risk and death from lung cancer, but now researchers are reporting that it also increases the risk of ovarian cancer. Wow – three’s a charm, eh? And yet, many in the medical community continues to support its use in perimenopausal and menopausal women.
In this latest study, published in the Journal of the American Medical Association, researchers evaluate data from 909,946 Danish women between the ages of 50 and 79 who had not previously developed hormone sensitive cancer or had had hysterectomies.
Compared to women who never took hormones, current hormonal therapy users had 1.38 greater incidence of all types of ovarian cancers and and 1.44 greater incidence of cancer affecting the surface of the ovaries (i.e. epithelial ovarian cancers) regardless of type of hormone therapy, administration or duration of use. Notably, risk declined with years since stopping hormone therapy.
Ovarian cancer accounts for about 4% of all cancers in women in the US. Yet, it is one of the most lethal types and often symptomless in the early stages. Roughly half of the women it affects die within five years. In this study, hormone therapy increased the risk for developing ovarian cancer by 38%.
Like any, this study had limitations that might have affected the results, such as not adjusting for age during menopause, or use of birth control pills (which have been shown to reduce ovarian cancer risk). Still, it is one of the largest studies to date examining this issue and the results do not fare well for use of hormones during menopause.
If I seem a bit angry about this; I am. Repeatedly, data show that hormone replacement, albeit an effective solution for declining hormones and their effects, is dangerous. I wonder how many women need to get sick or die before someone takes notice and removes hormones from the market.
Read MoreNews Flash: Hot hot hot
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Think that hormone replacement therapy is going to get rid of those hot flashes forever? Think again. Indeed, researchers have discovered that the majority women who start hormone therapy because of hot flashes and then stop, may experience a recurrence of symptoms!
In this study, which appears in the Ahead of Print edition of Menopause, 1,733 women between the ages of 53 and 54 completed a validated questionnaire looking at menopause, hormone therapy and vasomotor symptoms. Among the women who submitted completed surveys (~73%), 242 had previously used hormones and 69% indicated that they had vasomotor symptoms before starting therapy. Regardless of how long hormone therapy was used, symptoms returned in 87% women who stopped, even if they had completed menopause (although hot flashes were reportedly less frequent and bothersome).
The bottom line: Research has shown that disease risks, e.g. breast cancer, increase when hormone therapy is used more than five years. So clearly, remaining on hormones to address returning symptoms is not a wise option. Rather, safer and equally effective alternatives are needed to address return of symptoms as well as aid in disease prevention.
Read MoreShe’s so hot…and it’s so cold
I ran across a wonderful review and commentary on Louise Foxcroft’s ‘Hot Flushes, Cold Science’ in the Lancet journal this past weekend.
Writer Londa Schiebinger points out the Foxcroft details how western medicine took “a natural process” and made it into a disease. [The book] “tells a much needed story — it’s a must read for those who don’t know how western medicine has created dread and shame in menopausal women. Foxcroft reveals the underbelly of a history [of physician’s attitudes towards and treatments of menopause] rife with chauvinism, misogyny and collusion. It also reminds us of the need for good medical research in this area.”
Some of the more drastic treatments throughout the 19th through 21st Centuries have included:
- Removal of one or both of the ovaries (which was associated with a death rate of 45%)
- Radiating ovaries to restore femininity
- HRT and its associated cancer and heart disease risks
All of these, being sold to millions of women, of course, on the premise that menopause is truly a woman’s hell.
Even though the National Institutes of Health has specifically stated that menopause is not a disease, many western practitioners continue to perpetuate the myth and line the pockets of the pharmaceutical companies. However, Schiebinger reminds us that “women’s power, including the power to say “no,” may be their best defense against the maladies” that our culture associates with menopause.
I am inspired by the upsurge in interest and research into alternative approaches to address menopausal symptoms, by the strength that many women are now showing by refusing to start hormone therapy or insisting that they wean off of it, by writers like Foxcroft who are ballsy enough to confront the status quo and insist that women be encouraged to take control over their healthcare and their bodies.
I started Flashfree a little over a year ago with a mission to provide timely information about alternative approaches to menopause and to encourage women to create a new paradigm about midlife and its challenges. Undoubtedly, science has its place in helping us toward some of these goals. However, only by constantly challenging and pushing back will we be able to truly become masters over our own destinies.
Read MoreAnd the beat goes on
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More interesting news on the HRT front. Study findings reported in the May issue of the journal Medical Care suggest that a decline in the use of hormone replacement therapy (HRT) may be associated with a decrease in heart attacks among women.
In this trial, researchers examined data from various national databases on causes of death, hospitalizations and population size and combined it with information on HRT use.
Although declines in HRT use were not associated with decreases in stroke deaths or hospitalizations, the data did demonstrate 25 fewer heart attacks for every 10,000 women not using HRT. In contrast, findings from the Women’s Health Initiative (WHI) study found an increase of seven heart attacks for every 10,000 women on HRT. (Note, however, that a more recent analysis of the 2002 WHI data showed that heart attack risk from hormones may not be increased in women who start the hormones less than 10 years after menopause, but is increased in women more than 10 years out.)
In the press release distributed along with the study, a cardiologist from Total Heart Care is NYC is quoted as saying that lower heart attacks rates may be associated with better screening and greater awareness of heart disease in women, and attributable to declining HRT use. Study researchers say that more research is needed to verify their findings.
So far as I am concerned, it’s a win-win. Screening or less HRT. And the beat goes on…
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