Gotta go?! It may not be the ‘pause

Posted by Liz on Feb 1, 2013 in Uncategorized, urinary incontinence/stress incontinence/overactive bladder | 2 comments

Urinary incontinence, that is, involuntary leakage of urine, affects up to 30% of women in the United States and is expected to grow exponentially as the population ages. Usually classified by type, it can be devastating to quality of life and overall wellbeing. The three main types include:

• Stress urinary incontinence (stress incontinence), i.e. involuntary loss of urine caused by physical stress (coughing, lifting, heavy activity) and is often related to the weakening of the pelvic floor muscles after pregnancy.
• Overactive bladder (urge urinary incontinence), that is characterized by an urgent and mostly unavoidable need to urinate relating to a dysfunction of the bladder muscle and how it contracts.
• Mixed incontinence, i.e. a combination of the two.

In the interest of full disclosure, I was immersed in the topic for almost 5 years; I was acting in an advisory capacity to Merck Consumer Care who recently received marketing approval for Oxytrol For Women. Oxytrol for Women is an over the counter transdermal patch for overactive bladder. However, that’s not why I am writing about it; I have wanted to address urinary incontinence for a long time on this blog but could not do so since I had a conflict of interest. Now that that conflict is gone, I am finally able to share information, and more specifically, whether or not urinary incontinence is linked with menopause and hormone deficiency as estrogen starts to decline.  Reports suggest that roughly 8% to 27% of menopausal women suffer.

Until now, only a few studies have truly focused on women between the ages of 45 and 60, i.e. what I often call the ‘menopausal set.’ More importantly (and what you need to know): when French researchers conducted a thorough review of 29 studies, culled down from an initial total of 488, they found that the connection between menopause and urinary incontinence is tenuous at best.

In fact, in one of the largest studies that they looked at — the Study of Women’s Health Across the Nation (SWAN, which followed 1,529 women annually for 6 years– they found that the data show that during perimenopause, women have a one and a half times greater risk for urinary incontinence, but this risk disappears when they reach menopause. In an associated study, SWAN researchers reported that data linking menopause to a worsening of incontinence symptoms appears to be due to weight gain and not hormones. Ironically, other studies have linked the decline in estrogen to improvements in urine incontinence symptoms.

So, what about HRT? Where does it fit into the picture if the link between menopause/estrogen decline is weak? Well, when the researchers looked at that data, they found that type of incontinence and how HRT is administered does matter. Both the Nurses Health Study and the esteemed Cochrane Database have shown that oral HRT increases incontinence risk and worsens symptoms, while topical treatments may actually improve symptoms and number of episodes.

The researchers write that menopause has little if any impact on the risk of urinary incontinence in general, especially when other factors such as weight gain or age are taken into account. The good news for women with stress incontinence is that the condition appears to decline after menopause, although, granted, a mixed bag may take its place. And oral HRT? Buyer beware! If you’ve got either stress incontinence or overactive bladder, it may worsen your symptoms!

Urinary incontinence may be as much as taboo subject as vaginal atrophy. But it’s definitely one that needs to be talked about, especially as more and more women transition into midlife. Fortunately, it looks like menopause is not the cause, which should bring a sigh of relief. Meanwhile, gotta go? Talk to a health practitioner. Stress incontinence can often be successfully controlled through pelvic floor exercise, and overactive bladder symptoms may benefit through a combination of exercise and drugs. The main thing is to realize that you don’t have suffer alone; there’s a lot of leakage going on.

Wednesday Bubble: Are you facing a lifetime of burnout?

Posted by Liz on Jan 30, 2013 in stress | 3 comments

Stress. It can wreak havoc in so many ways. Researchers have shown that prolonged exposure to high levels of stress, especially when its source is work-related, can lead to burnout, i.e. emotional exhaustion, physical fatigue and a general weariness that affects thinking ability and focus. It can increase heart disease and metabolic syndrome, screw up the adrenal hormonal balance, cause systemwide inflammation and lower the ability to fight off disease and illness. It can lead to sleep disruption and significant mental health issues.

The bottom line is that stress hurts.

However, individual factors and characteristics also affect how vulnerable we are to burnout, and as I’ve written previously, active coping and attitude can often protect against the negative impact of daily stressors and protect health. More importantly, one’s orientation towards life, the way that the environment is perceived and whether or not it is manageable and meaningful is incredibly important; here, an ability to role with the punches can positively impact outlook as well as health.

But back to burnout; does it persist over time, never changing? Or do multiple factors influence the ability to b0unce back from the  burnout bonanza?

Findings of a nine-year study in almost 200 midlife women (ages 49 to 53) reveal some interesting findings demonstrating that some women with high levels of burnout can actually recover while others either stabilize or continue to worsen. The factors that influence this the most? Concurrent changes in life stress, work-related factors and coping ability/attitudes towards life. In fact, when women were divided into clusters reflecting patterns of burnout, the researchers found that high levels of life stress (e.g. concern for ailing parents, or concern for own health or their partner), coupled with a greater sensitivity to stress and job strain was a recipe for prolonged, worsening burnout. Women who had high levels of life stress but more control over their work environment were able to recover from burnout over time. Conversely, women with low levels of life stress, susceptibility to stress, anxiety and high levels of coping and a sense of control didn’t appear to be dealing with much burnout; the ability to draw on internal resources appeared to be protective in across a broad range of wellbeing indices.

It’s important to point out that the researchers did not have the ability to analyze private or individual stress separately from work stress and hence, these two factors are pooled. This means that the findings may have been affected. Still, studies have been fairly consistent in demonstrating the perils of stress and burnout in terms of health and overall wellbeing.

The lesson here is that if you are in extreme burnout, there is hope. Take a prolonged break to reevaluate your life, your decisions and your personal and social resources. If you don’t feel as though you have enough control in your worklife, and changing jobs or careers is an option, consider it; a new series on Flashfree –Reinventing Women — is profiling women who have made similar decisions to drastically change their lives. Exercise your prerogative to take better care of you; after all, you are only as good as the sum of your parts. And finally? Believe that things can change for the better. Nothing is forever and a lifetime of burnout is n0 life.

Newsflash! Lose the fat. Then break the fast!

Posted by Liz on Jan 28, 2013 in exercise, weight | 3 comments

I’m kicking this week off with a piece of provocative news: UK researchers are reporting that the best way to win the battle of the bulge and lose fat is to exercise on an empty stomach.

Mind you, the study (which appears in the online in the British Journal of Nutrition) is small. But, researchers say that by omitting breakfast before exercise, you might be more inclined to eat a more optimal balance of food throughout the day. In fact, when twelve physically active men participated in one of four scenarios — rest without breakfast, exercise without breakfast, breakfast followed by rest, or breakfast followed by exercise –that is actually what they found.

A bit of detail is in order here:

Men who exercised had a moderately intense run on a treadmill, during which time they expended approximately 700 calories. (Note that for the men assigned rest, an equivalent time was spent resting as on the treadmill). After exercising or resting, all the groups had a protein drink comprising approximately 444 calories. Ninety minutes later, they had lunch (pasta) and advised to eat as much as they wanted until they felt comfortably full. Then, the researchers measured energy and fat levels in the blood.

Interestingly, exercising in the morning (around 10 am) appeared to help balance out the day in terms of food and no attempts appeared to be made to compensate for the earlier activity in terms of caloric intake; appetite was also unaffected. But, here’s the critical piece: exercising in a fasted state appeared to increase the amount of fat burned by as much as 20%. And, while eating breakfast appeared to improve overall appetite throughout the day (helping to insure that it remained more balanced and did not lead to additional consumption), it tended to cancel out any appetite-suppressive benefits offered by exercise.

The bottom line is that by fasting before exercising, you may be able to accelerate fat loss. The question remains as to whether or not the same results can found in women and among larger numbers of individuals. And if these fat loss remains over time.

I’d love to hear from some RDs and fitness folks out there. What do you think?

Friday Folly: Be sure to exercise this weekend!

Posted by Liz on Jan 25, 2013 in aging | 1 comment

Between multiple pregnancies and aging, our pelvic floor muscles are frequently fighting for attention. Sometimes, you’ve gotta listen!

Wednesday Bubble: Lub(e)-a dub dub

Posted by Liz on Jan 23, 2013 in vaginal atrophy | 6 comments

Vaginal atrophy — thinning and drying of the vaginal tissues as a result of declining estrogen levels– leads to itching, burning, dryness, irritation and pain. And while it certainly isn’t the silent scourge overtaking women globally, it does affect roughly 50% of menopausal women and often goes unrecognized and undiagnosed. More importantly, unlike hot flashes and night sweats, vaginal atrophy does not go away; rather, in some women, may may progress to cause years of discomfort, so much so that quality of life is significantly impacted. Indeed, data suggest that the proportion of women experiencing vaginal dryness increases five-fold as women advance through menopause.

Importantly, results of a recent global survey indicate that most women choose over-the-counter lubricants and are not even aware that a low-dose, relatively safe topical estrogen treatment is available. Still, for many, over-the-counter options are enough, such as Replens, which theoretically goes beyond instant relief and actually provides ongoing protection. However, what should you do if sexual intimacy continues to be uncomfortable, your vagina feels increasingly uncomfortable and hormones are an undesirable choice?

Isoflavones baby!

Yup, soon, you may be able to leave the over the counter and hormone therapy options behind for a safer, effective treatment. Reporting in the online version of Maturitas, researchers state that they have been exploring plant-like estrogens in a topical gel format can deliver benefits similar to topical estrogen gel without p0tential safety issues. And, when they blindly compared 12 weeks of a 1 gm isoflavone gel to topical Premarin or placebo gel in 90 menopausal women, that’s exactly what they found!

At the beginning of the study, 100% of women reported vaginal dryness and pain, 82% said that they had itching and 72% complained of vaginal discharge. In women receiving the isoflavone gel, as many as 70% reported that their dryness was intense and 60% said that their pain was intense. By the end of 12 weeks, improvements were seen in both vaginal dryness and vaginal pain; no women reported having intense symptoms and roughly half said that their symptoms were mild. Overall, roughly 97% of women using isoflavone gel saw improvements in both vaginal dryness and pain. Similar figures were observed in women using topical estrogen.

Now here’s the science geeky part. When the researchers took a closer look at the cells in the vaginal wall, they noted a shift towards values that one would see in a premenopausal woman. And, whereas topical vaginal hormone therapy sometimes results in vaginal bleeding and thickening of the lining of the uterus, these issues were not seen in women using the isoflavone gel (neither were they noted in women using topical estrogen, probably due to the extremely low dosage).

The researchers say that it appears that the isoflavone gel can be used safely without any risk of systemic absorption. Now? We need more studies so we can get this gel to market.

Reinventing Women: The Playing Field is Ripe for Change. Meet Karen Rogers-Robinson…

Posted by Liz on Jan 21, 2013 in aging, career | 0 comments

The National Women’s Law Center recently reported that women continue to lag behind men in terms of job recovery, regaining less than a quarter (24%) of jobs lost during the country’s recession compared to their male peers (who’ve regained 39%). A large part of the problem driving the slower recovery among women has been the loss of public sector jobs. The lesson? While this news may appear dismal at face value, it supports Social Media/Social Technology Consultant Karen Rogers-Robinson contention that today’s financial and work economy truly is “a perfect time to reinvent yourself,” pointing out that “the playing field has been wiped clean for most.

In 2009, Karen was forced out of 21 years of service at AT&T, losing an essential foothold of income and perhaps the dream that many like herself had bought into.  She says that during her tenure, she was “in touch with her inner Boomer” and hadn’t believed that they would force her out, particularly because she had been a top revenue producer and a top performer in her department. Yet, the job had its plusses and minuses; “While I loved the techie geek that I had evolved into over the previous 20 years,” she explains, “I HATED what I was doing! So, I decided that since my children were grown and I had only me to take care of, I should try something new.”

For Karen, this meant taking decades of basic customer service skills, dynamic telephone strategies and web page development she acquired at AT&T and diving into the social marketing and tech landscape. In fact, that transition (which took place immediately following her job loss) landed her initially as founder of  Onyx Mobile Marketing, a firm connecting small business owners to their clients via text message marketing and mobile apps and now, principal of a burgeoning and evolving social media marketing and branding consultancy, SMMMDiva..  Her reinvention? A self-described  “a new and improved version [of Karen] with more bells and whistles.”

Karen says that while she has felt good about the choices she’s made, the change has been drastic and has affected her lifestyle immensely. These choices have also affected her relationship with family members who long relied on her as a financial lifeline. Moreover, while she was undergoing her transition from AT&T employee to social media diva, her significant other also left.

Fortunately, despite the challenges, Karen has a good financial and emotional network in place to provide footing when the ground has been shaky. She says that this an essential in the reinvention process, as is having a strategic plan. However, she notes that she had only been three years away from having a fully vested retirement, adding “had I been smart when the first cuts [at AT&T] started, I would have started my reinvention plan [then].”

Hindsight may always be 20-20 but the time for reinvention might be now. “Why be unhappy and stressed trying to keep a high paying job when it could be taken away at the blink of any eye and not because of how you performed? Life is short; do what makes you happy.”

Why are you SPEAKING SO LOUDLY? Exhaustion, stress and hearing

Posted by Liz on Jan 18, 2013 in hearing | 4 comments

It’s fairly well known and accepted that many people in our generation have hearing issues like tinnitus or a slight loss, likely the result of late nights blasting the stereo, endless live concerts and the introduction of  mobile music players (anyone remember their first Walkman!). In fact, hearing problems on one of the top ten public health disorders and are believed to affect about a third of the general population. Coupled with aging, diseases such as diabetes, mental health issues or heart disease and the environment, and it’s possible that we don’t stand a chance against auditory dissonance. Or do we?

Researchers say that men are more prone to hearing issues than women. That is, until exhaustion sets in. Yup, exhaustion evidently makes women oversensitized to sound when they are exposed to stressful situations.

Say what?!

Stress plus exhaustion leads to hypersensitive hearing, that is, an acute reaction to sounds that would normally not bother us. In fact, when men and women were evaluated for their degree of emotional exhaustion and then exposed to an acute stress situation, the women became oversensitized, reacting to sounds at normal conversational levels (i.e. 60 decibles). In particular case, emotional exhausted was rated on a scale of one to five and entailed things like feeling drained by work or totally exhausted after the workday is completed or burned out . The acute stress situations only lasted five minutes. And, hearing was measured before and after the exercise.

So, what about the gender differences? Importantly, researchers say that women, namely postmenopausal women, have accelerated hearing loss (oh, joy!) that is related to sex hormones.  Add emotional exhaustion and stress to the mix, and we overreact to things that would normally not bother us. It’s not rocket science but it’s good to know that stress hormones and sex hormones together contribute to somewhat irrational behavior, you know, the type related to experiencing conversation, a rattling of cutlery or the sound of a car engine that causes a woman to go off her rocker a bit and even experience that sound as painful.  And while the mechanisms are not quite understood, the message is clear – if you are exhausted, you may be ripe for an overreaction of the audible type.