Musings for a Monday: Menopause. Be Very Afraid.
Don’t let the change of life torture you with fear!
I stumbled across this vintage ad for Mrs. Lydia E. Pinkham’s vegetable compound for menopausal symptoms. Evidently, Mrs. Pinkham had a history of brewing home remedies to combat menstrual and menopausal woes. Among its many ingredients (pleurisy root, life root, emmenagogue, fenugreek, unicorn root), it also contained black cohosh, which does raise the question of whether it was truly snake oil or a modern miracle?
Regardless, a simple musing for a Monday.
Read MoreWednesday Bubble: 10 is the loneliest number…
[youtube=http://www.youtube.com/watch?v=nTO4hvLEH4Q]
I’m using this Bubble to burst a few illusions, such as hot flashes during menopause don’t actually last very long.
How about 10 years?!
Right now, one year for hot flashes to come and then go sounds pretty tempting, doesn’t it?
A few years ago, I wrote about a study in the journal Menopause that alluded to the fact that hot flashes were likely to last for five years or more. Just this week, I ran across another study in Obstetrics & Gynecology that adds another 5 years to the evidence. Yikes!
How long is long enough?
Clinical Guidelines suggest that hot flashes peak one year into menopause and for most women, last anywhere from six months to two years. So, why is popular opinion, if you will, being challenged in research circles?
Using data from the Penn Ovarian Aging Study, which followed and monitored women over a 13-year period, researchers evaluated moderate-to-severe hot flashes on average, every 9 months. The women did not report having hot flashes at the study’s start, but developed them between the first year and near the study’s end. During each assessment, interviews were conducted on overall health, height, weight, hip and waist measures were taken and blood samples collected (to evaluate hormone levels). Menopausal status was also delineated by five stages:
- premenopausal (regular menstrual periods)
- late premenopausal (cycle change of 7 days or more in either direction observed one time)
- early transition (change of 7 days or more observed at least twice in a row)
- late transition (three to 11 months without a menstrual cycle)
- postmenopausal
More than 90% of women in the study were pre or late premenopausal at the study’s start.
Unfortunately, the results of the study are not very promising. On average, the median duration of moderate to severe hot flashes was 10.2 years, with only 37% of women reporting that their hot flashes stopped during the study. However, researchers found a relationship between length of time and when hot flashes began. For example. hot flashes tended to last longer (i.e. more than 11 years) in women who reported their hot flashes started in the premenopausal or late premenopausal stage compared to women whose hot flashes began in the early transition (average 7 years) and late transition (average 4 years).
Age was also a factor as the median duration of hot flashes tended to be longest in women who started flashing before the age of 40. Most commonly, however, more than a third of women tended to have the worst flashes when they were between the ages of 45 and 49. Other factors such as African American race and a body mass index less than 30 were also associated with having hot flashes for longer periods of time.
If you are wondering about the silver lining in this story, there actually is one. The researchers say that it may be a good idea to start addressing vasomotor symptoms like hot flashes in younger women who are starting to have irregular menstrual periods. Because “traditional hormonal therapy may not be the ideal choice for this population, given, for example, the problems with breakthrough bleeding and the need for contraception,” other treatments need to be evaluated.
I’ve long espoused the value of taking steps to shut symptoms down sooner rather than later, which is why alternative strategies may be so useful. If duration of hot flashes last longer when they start a younger age, and it is recommended that hormonal therapy be used for the shortest period of time possible, it’s not a bad idea to speak to a health practitioner about incorporating things like black cohosh into a daily routine. As always, there’s no time like the present to start taking charge of your health and get ahead of the change.
Read MoreWednesday Bubble: An ‘Evolutionary’ not ‘Revolutionary’ Rx for Hot Flashes?
This week’s bubble brought to you by the manufacturers of Amberen™, a new menopausal treatment that bills itself as revolutionary not evolutionary. What they mean by this is that Amberen, a novel, non-hormal treatment for menopausal symptoms, does not represent an evolution of the same herbs (e.g. black cohosh, chaste berry) used by other manufacturers but a revolutionary new approach and strategy to addressing troublesome symptoms during menopause. Personally, I believe that anything that isn’t HRT based is evolutionary, however that aside, this week’s bubble is pretty darn solid and early data, pretty encouraging!
What is Amberen?
Amberen is a food supplement mostly composed of an enzyme known as succinate that is involved in metabolism. Dramatic swings in estrogen that result during menopause significantly affect the sensitive functioning of the hypothalamic-pituitary-ovary (HPO) axis (part of the neuroendocrine system that regulates many processes in the body, including interactions between the glands and hormones). According to published research, very small doses of succinate help to restore the way that the aging HPO axis functions, thereby promoting hormonal balance. In turn, this appears to boost estradiol levels and alleviate menopausal symptoms.
In small clinical studies, Amberen appeared to act as hormones in the body, resulting in self-reported reductions in the frequency of hot flashes, declines in insomnia and headache, and improvements in mood, anxiety and impaired sexual desire. Honestly, it sounds a bit too good to be true, so I am not entirely convinced. However, the researchers are quoted as saying that this approach to jump-starting HPO sensitivity could open the way for safer treatments for a variety of conditions, and not just menopause.
Amberen is not for everyone as it is not inexpensive, requiring at least a $90 commitment upfront (although there is an offer on the website for a 30 day free trial, a further dive shows that it takes at least 90 days to realize its full effects). However a three month on, three month off dosing schedule might be more convenient for women who have trouble remembering to take pills regularly.
Importantly, I did not see any reported details on side effects in the clinical studies I looked at, although the website cautions against women using Amberen if they have any thyroid or high blood pressure issues. I”d like to see more information on that as well.
Like any treatment for menopause, it’s essential to speak to your healthcare professional before diving in and trying Amberen. Personally, I’d like to see larger studies and specific information on side effects before making any real commitment to the product. However, I am intrigued by Amberen’s potential and certainly by this new approach to treatment, a seemingly viable and effective alternative to hormone replacement.
Have you tried Amberen? What do you think?
[Disclosure – I was approached by Amberen’s PR agency to see if I’d be interested in the product. After requesting and reviewing the clinical studies, I decided to write about it. I was not compensated for this piece nor was I sent or accepted any product.]
Read MoreIs your mattress the ‘key to cool’?
Hot flashes? Night sweats? I’ve written about various solutions, ranging from herbs to bed clothes and sheets. But I was intrigued when I ran across an article about a mattress manufacturer that claims that its mattress will keep you cooler without the all the trappings…as in, trapping the heat that is wafting off your body without circulating it properly.
According to Robin McRoskey Azevedo, the president of McRoskey mattresses, the ‘key to cool’ is in the way a mattress is constructed and the materials that are used. Consequently, theoretically, air circulates freely, cotton covers and materials breathe and vented sidewalls and flexible coils allow for better airflow.
Even the customer testimonials sound convincing.
There is a price to comfort, however, as McRoskey sets (mattress plus boxspring) can run upwards of $5,000. Lots of moula to insure better comfort during sleep.
There’s nothing better than a phenomenal mattress. I believe in making the investment because better mattresses do last. However, I’m not entirely convinced that the key to a cooler sleep is a better mattress. Rather, it seems that appropriate herbs (like black cohosh), great sheets, and proper bed clothes can make a huge difference without denting your wallet quite as deeply.
What do you think is the key to cool?
Read MoreWednesday Bubble: herbs and breast cancer
Can herbal medicines used for hot flashes, namely black cohosh and phytoestrogens, be safely used in women who’ve had breast cancer?
If you’ve had breast cancer, you’ve probably been told to stay away from herbal medications, right? Yet, women who’ve had breast cancer know that hot flashes are a common side effect of many cancer therapies. Research also suggests that the older a woman is at the time she receives chemotherapy, the more likely she is to develop menopause as soon as treatment stops. Moreover, roughly 80% of women taking Tamoxifen have hot flashes and about a third of those women rate them as severe. Hormones are not even an option due to the increased breast cancer risk.
The good news is that an extensive analysis of scientific studies shows that black cohosh might be safe for women who have had breast cancer. Although the researchers note that the evidence for the effectiveness of black cohosh for alleviating hot flashes is mixed, they cite research from the National Institutes of Health and other reviews that suggest that use of black cohosh in former breast cancer patients requires only standard screening. They also report that there is “little reason for excluding patients with estrogen-responsive tumors from using black cohosh.” In fact, recent laboratory studies, although not yet carried out in humans, suggest that black cohosh may actually protect the breast from developing tumors.
The case for or against the use of phytoestrogens (e.g. soy, red clover, chaste tree berry and flaxseed) in women with breast cancer is not quite as clear as it appears to be for black cohosh. In one of the largest reviews examining soy or red clover for menopausal symptoms, the outcomes were equivalent to placebo. Other studies have shown that they might be beneficial for women with mild to moderate symptoms who start menopause early. Moreover, while red clover in particular does not appear to affect certain breast cancer risk markers, reports about phytoestrogens in general, especially in estrogen positive cancers is conflicting. Still, the American Cancer Society does not advise against eating soy-rich foods by women who’ve had breast cancer. Some studies have also showed improved prognosis.
If you are wondering if there are any drawbacks, one of the largest challenges is that there are not that many studies looking at herbal medications in women with breast cancer and the ones that do exist are mostly short in duration. The researchers point out that because herbs can take awhile to work, a three month study might be too short to form a conclusion.
Clearly, more study is needed. In the interim, it appears both black cohosh and soy might be safe to try if you’ve had breast cancer. As always, the most important consideration is to speak to a certified practitioner who is well versed in herbal medicine and make sure that she or he works with your oncologist.
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