menopause

The more things change…

Posted by Liz on Jun 27, 2011 in menopause | 0 comments

Wednesday Bubble: Depression and midlife – “overmedicalizing” the menopause

Posted by Liz on Jun 15, 2011 in depression, menopause | 4 comments

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?

Wednesday Bubble: wrinkles and bone density – what’s the connection?

Posted by Liz on Jun 8, 2011 in bone health, menopause, osteoporosis | 5 comments

There’s a connection between wrinkles and bones? When I caught wind of the research, I thought immediately of a Wednesday Bubble. But this one appears to be the real deal.

Researchers presenting at The Endocrine Society’s Annual Meeting this past weekend say that severity of facial wrinkles during the early years of menopause may indicate a low bone density (thereby leading to an increased risk for osteoporosis). Wow!

This information comes out of the ongoing Kronos Early Estrogen Prevention Study (KEEPS), which is looking at the effect of oral and transdermal estrogen therapy on measures of the carotid artery that might indicate thickening of the arteries (and eventual heart disease) as well as the build up of calcium in the blood. A subgroup of 114 women in their late 40s and early 50s and within three years of starting menopause were examined for this part of the trial.

The researchers looked at and scored severity and depth of skin wrinkling based on number of sites on the face and neck. They also measured skin rigidity (or firmness) on the forehead and cheek. Additionally, they evaluatd total body bone mineral density as well as at the lumbar spine and left hip.

The findings? Higher wrinkle scores (meaning more severe wrinkles) were associated with lower bone density measures at all sites, while firmer skin on the forehead and face were related to greater bone density, especially at the hip and spine.

The connection? Pun unintended but the researchers say that collagen, protein that naturally occurs in connective tissue in tendons, ligaments and even bones, is the common factor. They add that as women age, changes in collagen not only contribute to sagging skin and more facial lines but may also negatively affect both the quality and quantity of bone.

Although more research is needed, it might be worthwhile to obtain a dermatologic and bone density assessment at the start of menopause to see where you stand. And then speak to your health practitioner about the need for regular follow up and monitoring to insure that fragile bones don’t lead to fractures. Ultimately, if the link between wrinkling and bone quality is proven, it might eliminate or at least lessen the need for costly DEXA ( dual energy X-ray absorptiometry)  that are currently used to measure how tightly calcium and other minerals are packed into bone.

Who would thunk that wrinkles could actually be useful?!

To everything, there is a season

Posted by Liz on May 16, 2011 in menopause | 1 comment

[youtube=http://www.youtube.com/watch?v=W4ga_M5Zdn4]

We know that certain aspects of the menopause, in particular hot flashes can be influenced by weather. But did you know that menopause onset may also be seasonal?

In my weekly scan of the news, I ran across an older but interesting study that had been published in Maturitas in 2005. In it, researchers discuss how human reproduction is seasonal in order to optimize fertility and tends to correlate to the most favourable environmental conditions, including light and temperature. This fact led them to evaluate the medical records of over 2,400 white women who had attended outpatient menopause services in order to determine if entering menopause is also a seasonal phenomenon. The following were taken into account:

• Age
• Race
• Education
• Weight/BMI
• Smoking history
• Major illnesses that may have required surgery or chemo
• Number of pregnancies
• Type of menopause, last menstrual period, years since menopause
• Use of hormones
• Occupation

On average, the majority of women were 52, had been in menopause for 2 years, weighed about 143 pounds and were right on the BMI cut off of normal and overweight. Amongst this group of women, onset of menopause occurred significantly more often in winter than in spring, summer or autumn, respectively (although a minor peak in onset of menopause was also observed in smaller numbers of women during summer). When the researchers compared this timing to reproduction, they found that it was concentrated between the highest and lowest points of reproduction. Moreover, none of the other factors appeared to influence this seasonal variance of menopause onset.

However, like all studies, there are limitations, such as the fact that the women were of one race and were evaluated retrospectively. Or, that only two other studies have had similar findings and both of these were in monkeys. Still, it is rather interesting and I’d love to take a poll with those of you readers who have fully entered menopause and whose period has stopped for at least 12 months. If you are willing, leave a comment as to which season your menopause started. Meanwhile, the intrigue remains: is menopause a seasonal phenomenon and are there factors other than environment that influence its start?

Menopause: outlook and outcomes. Is it you? Or them?

Posted by Liz on May 6, 2011 in appearance, hot flash, menopause | 2 comments

When you start flashing and sweating, the whole world, especially the world under the age of 45, is watching and judging, right?

Not so fast. In fact, what I think you think, may not be what you think at all. In other words,  personal attitudes about menopause and its symptoms could be shaping how well or poorly it’s experienced. And this experience may be based in beliefs, moods and perceptions, not reality.

According to research, many women say that menopause makes them feel “stupid, embarrassed, incompetant, unattractive, etc.”

However, more importantly, these women believe that others have the same thoughts about them, which researchers say are likely to influence the types of strategies women use to manage their symptoms, strategies that range from “keeping up appearances” to avoiding social situations altogether.

When I read this, I started to wonder if menopausal women are actually stacking the deck against themselves and contributing to societal attitudes about aging and menopause. What’s more, do women misperceive how younger adults feel when they start flashing around them?

To answer these questions, researchers polled 290 young men and women between the ages of 25 and 45. Almost two thirds were female. The questionnaire was geared towards answer the following:

• How are hot flash symptoms, namely redness and sweating, perceived when they occur?
• What types of beliefs exist around menopause?
• Is there any relationship between age, gender and perception about menopause?

Importantly, over half of those polled attributed a red face to emotions, e.g., embarrassment, anger or stress. However, while younger women tended to attribute redness to an increase in body temperature, younger men tended to believe that redness was related to physical exertion. Similar responses were provided for sweating, with women attributing sweating to a health problem and men, to environmental temperature. Hormonal factors and menopause were reported by less than half (41%) of men and women polled.

Also important was the fact that overwhelmingly, both men and women indicated that they felt empathy or neutral about symptoms and not at all uncomfortable, and almost all (97%) would inquire if a woman was feeling well or ill.

These responses truly suggest that menopausal women tend to overestimate the extent to which others are able to judge their menopausal status. Moreover, young men and women tend to empathize and show concern and compassion, emotions that are inconsistent with expectations that others will react negatively to a public hot flash or associated redness. Even more important, age did not appear to influence general beliefs about menopause, which researchers suggest implies that “the experience of menopause, or seeking information about menopause in mid life, might lead to more neutral or positive beliefs.”

So, what does this all mean? Granted, the sample in this study was primarily female and self selecting, meaning that they chose to participate or not. Therefore, it is possible that these findings do not accurately reflect the views of a broader population, especially men. However, the researchers do point out that they attempted to find participants from a variety of occupations that were more specific to setting where women might report a higher degree of social embarassment.

Nevertheless, what these findings do suggest is that real life might actually contradict how women feel others feel about their menopause, and that reactions might actually be tempered or non-existant in social settings. This should encourage a broader population of menopausal women to overcome their fear of embarrassment or to no longer resign themselves to “coping” but rather, empower them to take charge.  On a larger level, they also show that there’s a need to step up and negate stimatizing or negative views of menopause, even amongst ourselves. This can be achieved through sharing of experiences, not only with similarly aged women but also, with younger women and men who can gain a lot of life experience at a considerably younger age.

The next time you start flashing in public and looking around to see who’s staring, just remember that it may be you, not them. And your ‘tude will truly rule the day (and those flashes), if you let it.

How dry I am…

Posted by Liz on Feb 25, 2011 in health, general, menopause | 1 comment

Bet you think I’m talking about vaginal dryness or dry skin. I’m not.

Actually, I am referring to another dry condition that affects women in peri and postmenopause: dry eye.

Yikes. Do women really need more dry in their lives?!

Dry eye affects almost 5 million people over age 50 and is one of the most common reasons for an eye doctor visit. It  is related to an imbalance in the tear system that interferes with the ability to produce tears, tear quality (meaning that it’s mostly water and less lubrication needed to moisturize and protect the eye) and function (meaning that the three layers of oil, water and mucus surrounding and protecting the eye — the tear film — starts to thin and loses its stability). This imbalance can lead to symptoms like itching, burning, irritation, redness, tearing, light sensitivity and blurred vision, as well as infection and injury.

Sounds like fun, right?

Even worse? Recent estimates suggest that dry about twice as common in women than in men, especially as they age. And while environmental factors like insufficient intake of fluids, excessive alcohol, excessive exposure to air conditioning or forced hot air and excessive bathing all contribute, one of the most important factor are the sex hormone receptors in the eye.

It’s true that sex hormones, namely estrogen, progesterone and testosterone, are produced by the ovaries in females. However, they are freely available to all tissues in the body, and in fact, regulate tissue in the eye as well. In fact, researchers are increasingly discovering that hormonal changes may directly influence certain eye disorders, and it is believed that the altered hormonal balance at and around menopause may affect tear production.

What can you do about dry eye?

Quite simply, the easiest way to combat dry eye is to hydrate! Lifestyle measures like drinking lots of water and other hydrating fluids, modifying alcohol intake, using humidifiers, avoiding too much air conditioned or heated air and not drying completely post-bathing before moisturizing can help. Practitioners also recommend the use of artificial tears, gels and ointments (not the type that “get the red out”) can help to increase the humidity of the surface of the eye and improve lubrication. If you are suffering from dry eye and using any medications, you should also speak to your doctor. Anticholinergic-containing drugs like Benadryl for example, can cause dry eye. Eyelid hygiene is also important as any offenders like infection or inflammation can just make things worse.

Importantly, taking hormone replacement therapy appears to worsen, not improve dry eye, especially as it relates to the ability to produce tears. This is especially true for women taking estrogen-only. Yet another reason to stay away from HRT.

There are prescription treatments for moderate to severe dry eye and at the extreme, surgery may required. The best course of action is to try some of the simpler measures and if they don’t work or if dry eye worsens, see your doctor.

I don’t know about you but I do see the humour in this, however deeply it may be hidden. Throughout menopause, many of us sweat and flash and produce all sorts of moisture. Except in the areas that matter most.