Give me a P!
P, as in “progesterone.”
I get a lot of questions on Flashfree about progesterone and whether or not it’s use is as dangerous as estrogen and combined hormone replacement. I have stayed away from the subject for some time now because the evidence has been pretty scarce, at least as far as natural progesterone goes.
Fortunately, a new review has appeared that provides a comfort level for a brief discussion. But is all progesterone alike? A good place to start, right?
Progesterone is a reproductive hormone produced after ovulation and during pregnancy; it is also produced by the nervous system and adrenal glands. It occurs naturally. Progestins are synthetic and manufactured outside the body and work differently depending on their structure. Progestins are often combined with estrogen therapy.
Although experts know that levels of progesterone decline as a woman transitions to menopause, the relation between this decrease and symptoms has not been well understood, thereby limiting practitioner’s — at least those who specialize in Western therapy — ability to make decisions regarding its use in ameliorating symptoms.
Following is what researchers learned by scouring the literature:
- In most cases, progesterone is prescribed as an oral pill ranging from less than 20 mg daily to more than 200 mg daily, or as a patch that delivers more than 50 mg daily. It is also available as a topical cream (the most reliable standardized formulation is manufactured by Emerita (Pro-Gest).
- High dose, oral progesterone and patch forms appear to provide the greatest benefits for lessening hot flashes.
- How well women respond to progesterone patches appear to be related to how severe their symptoms are; those women with the worst symptoms appear to gain the most benefit.
- Use of progesterone may help reduce bone loss, although more studies are needed.
- Use of topical progesterone may possibly help reduce the effects of aging on the skin by increasing elasticity.
- The oral forms have also been shown to hell women whose sleep is disrupted by increasing time spent asleep.
- Most importantly, low dose progesterone treatment, including oral agents, does not appear to increase heart disease risk. Even better? There is some indication that when combined with estrogen, progesterone may counteract negative effects int terms of breast cancer risk. Progesterone formulations also appear to be well tolerated, will only minimal side effects associated with their use.
The key take-away is the natural progestogens (progesterone) appear to safely alleviate many of the most troubling menopausal symptoms. The rub here is that the evidence for this be fit comes from small studies. Still, it is refreshing to learn that there are safe hormonal options for women who desire that route.
Read MoreWednesday Bubble me this: end the ‘silent suffering’
Bubble me this. When you think “chronic health condition,” what do you think of? I think heart disease, diabetes, multiple sclerosis or cancer. I don’t automatically think vaginal atrophy. And yet, it’s what’s for World Menopause Day.
The International Menopause Society (IMS) joined forces this year with Novo Nordisk FemCare Ag (marketers of Activella®) to ‘end silent suffering’ and promote recommendations for the management of vaginal atrophy during the menopause. A key problem, they say, is that results of a phone survey show that women are not discussing vaginal atrophy with their practitioners, who in turn, are not openly asking questions about vaginal health.
Vaginal atrophy refers to the thinning of the vaginal and vulvovaginal tissues due to a decline in estrogen, and can lead to pain, burning and soreness during sexual intercourse. Recent estimates suggest that vaginal atrophy affects about 50% of menopausal women. Symptoms can be mild or severe, and unquestionably, the more a woman feels pain, the more she is likely to be distressed during intercourse or lose interest in sex altogether. What’s more, according to survey results, the majority of postmenopausal women incorrectly attribute vaginal atrophy symptoms to urinary tract and yeast infections. More importantly, the report notes that roughly 63% of surveyed women did not realize that vaginal atrophy was “a chronic condition requiring ongoing treatment of the underlying cause.”
A chronic condition requiring treatment?
Granted, a chronic condition is defined as a health problem lasting three years or longer. And depending on how long a woman’s menopause lasts, well, vaginal atrophy theoretically fits into that category. But aren’t we being a bit alarmist about the ‘silent suffering’ of women with this chronic condition?
Mind you, I am not mocking or doubting the horrible impact that vaginal atrophy can have on a woman’s life. In fact, aging and its accompanying aches and pains aren’t fun. Neither are hot flashes, night sweats, mood swings or vaginal pain. And I am heartened to see that the IMS has published recommendations for recognizing and managing vaginal atrophy. They include:
- Greater collaboration and open discussion with postmenopausal women about their vaginal health
- Early detection of vaginal atrophy
- The value of estrogen therapy in treatment, including HRT or preferably, vaginal tablets, cream or rings
According to these recommendations, lubricants and moisturizers are not universally recommended for use by themselves because they can be irritating and offer only temporary relief of symptoms. However, as Dr. Diana Hoppe points out in her book, Healthy Sex Drive, Healthy You, “to get the vagina adequately lubricated, I initially recommend lubricants [e.g. Replense or Astroglide]. If lubricants do not work to make sex more comfortable, I prescribe vaginal estrogen therapy, which comes in different forms.” The point that she makes is that it is important to consider lubrication issues (and the resulting atrophy) as something that can be addressed in a step-wise fashion. Nor does she discuss atrophy and dryness as if they are symptoms of a chronic condition. In fact, like Dr. Christine Northrup, Dr. Hoppe emphasizes that women’s health issues, in particular desire, are multifaceted and emotionally and physically related. Toward that end, is it possible that by focusing solely on the physiological aspects of atrophy, practitioners might miss other important factors?
The IMS recommendations also fail to mention selective estrogen receptor modulators (SERMS), which mimic the action of estrogen in the body but theoretically, without associated risks and side effects. Most importantly, while ‘localized’ estrogen (i.e. topically or vaginally applied) may have a better safely profile than systemic estrogens (which directly enter the bloodstream after being ingested or injected) it is not without risks; according to its package insert, Activella is associated with pain, headache, nausea, vomiting, irregular bleeding and thickening of the vaginal wall and and also has a boxed warning about heart disease, stroke and blood clotting.
There’s an inherent lesson here, which is why this piece is featured on Wednesday: by all means, seek help for vaginal atrophy but ask questions about the therapy your doctor or practitioner recommends. If your symptoms are severe, well, you might want to skip the lubricants and go for the big guns. And be sure to consider factors other than estrogen depletion that might be contributing to a declining libido. If there’s one thing that appears to permeate all women’s health issues, it’s this: nothing is as cut and dry as it seems.
I hardly believe that we’re on the verge of an atrophy epidemic or that we need to dramatize the “silent suffering” of countless women across the globe.
Bursting this one? Yeah, you bet.
Read MoreBuyer beware: on snake oil, false promises, male menopause and Michael Jackson
Snake oil. Can’t live with it.
Patented snake oil remedies have been around since the early 1700’s, lending credence to the hypothesis that preying on an individual’s healthcare needs is a well-honed art. For months now, I’ve been exposing various menopausal remedies that offer relief for anything and everything that ails. I’ve found supplements, chewing gum and magnets, audio tapes, creams, rubs and lotions… the whole nine yards. Mind you, some do contain ingredients that, on their own and in standardized formulations, may alleviate or prevent symptoms from worsening or peaking. However, I have long fought against the “one size fits all” proposition, instead arguing that the best therapeutic approach is individualized, evidenced-based, methodical, fluid and supervised by a licensed healthcare professional.
The menopause market is huge, with latest industry projections topping, if not exceeding $4 to $8 billion, depending on who you speak to. And this number is expected to grow as the population ages. So, it’s not surprising that there are increasing numbers of players who want a piece of the action. And, that the action is not just geared towards women, but to men as well.
Wait! Women are the only one’s who go through menopause, right?!
Readers of this blog know what I think about male menopause and I continue to question the terminology as well as its comparison to what women experience during the transition. Yet, regardless of my beliefs, I object to predators, period.
So, it troubled me when I ran across the following headline:
“Michael Jackson could have been going through ‘male menopause’ says SimplyAgeless411.”
Hmmmm. The rat is back. And he’s smelling even worse.
According to the two anti-aging consultants who are quoted in the press release, Michael Jackson, a “dark, troubled soul,” could have been suffering from male menopause for years, that the anxiety, depression, insomnia and fatigue that prompted his reliance on prescription medicines might have been easily treated had he gotten to the right doctor. The hook here is that if you “realize after taking a long hard look at the man in the mirror that male menopause might be sneaking up on you,” that you should talk to your doctor about hormone therapy. The close? That low hormone levels can be easily addressed through a regimen of tablets, and gels applied to the skin. Results they claim, are “dramatic and immediate.” Of note, a frequent contributor to this site’s Ezine is a Board-certified hormone specialist.
So, ladies and gents, gather round, the menopausal marketing circus is in town. And it appears that it’s here to stay. If the spotlight in the ring is on “dramatic,” “immediate,” “cure” or “guarantee,” money-back or not, you might want to avoid the big tent at all costs.
p.s. If you are looking for information about how to go about selecting an alternative therapy for menopause, Flashfree is the place. Throughout this blog and its various topics, I’ve explored many alternative therapies and the most current evidence that I can find supporting or disputing their use throughout the menopause; I encourage you to peruse the archives. You might also want to revisit ‘Navigating the Maze, Parts I and II,’ my interview with NYC-based acupuncturist and Chinese medicine specialist Elaine Stern, about what to look for. I also recommend that you check out the links on the Blogroll, as they will take you to reputable sources of information.
Special thanks to Andrew Scherer and Scherer Cybrarian LLC for assistance with some of the research for this post.
Wednesday Bubble: Rub-a-dub-dub
Is a youthful appearance only a rub-a-dub-dub away?
I ran across an interesting article in the UK’s Daily Telegraph on topical estrogen. Evidently, applying estrogen to the skin can stimulate collagen production and provide a more youthful appearance.
Seems like a great post for a Wednesday Bubble, right?
A closer read of the study on which the article was based suggests that it’s not quite that easy….or accurate.
Here’s what you need to know:
A University of Michigan research team evaluated the effects of applying various strengths of topical estrogen (estradiol) to the hip, forearm and face. Study participants comprised 40 postmenopausal women and 30 men (average age ~75 years). The cream, which varied in strength between 0.01% and 2.5%, was applied three times daily for two weeks. In addition to comparisons between the cream strengths, comparisons were also made to a placebo cream.
The results showed that topical estrogen applied to areas protected from the sun (i.e. the hip) increased production of procollagen I and III, and collagen I protein levels. For your information, pro-collagen type 1 is the precursor of collagen type 1, the most abundant form of collagen found in the body. Pro-collagen type III the precursor to the main component of the fibers that are found alongside the collagen.
However, no significant changes were observed in the photoaged skin of the forearm or the face, even though estrogen receptors were stimulated.
So, what’s the bottom line?
The study results suggest that while topical estrogen can stimulate collagen production in sun-protected areas, it does not affect the appearance of photo-aged skin, (i.e. skin that has been exposed to the sun or other elements).
In other words, topical estrogen is not yet a panacea for aging skin.
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