Search results for vaginal dryness

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.

Wednesday Bubble: Holy Hot Flash Menopause Woman!

Posted by Liz on Feb 2, 2011 in breast cancer | 5 comments

Bet you never thought you’d hear holy and hot flash in the same sentence! However, it appears that menopausal hot flashes, those bothersome, sweat inducing, embarassment producing, change of clothing inducing symptoms might actually deliver something better than a whole lotta dread. And so, dear readers, after the bad breast cancer news that I delivered on Monday, I’m happy to report some good!

You mean I WANT hot flashes? Well not exactly. But there sure is a interesting paradigm hidden somewhere in the diminishing returns of estrogen, that is, severe, wake you in the middle of the night or interrupt your meeting hot flashes might actually reduce risk for invasive breast cancer.

As we know all too well, menopausal symptoms often occur as estrogen and progesterone levels fluctuate and the ovaries cease to function reproductively.  However, utilizing data culled from a study whose original intent was to evaluate the link between hormone therapy and risks of different types of breast cancer, researchers have actually uncovered some positivity! In this study, women between the ages of 50 and 74 were randomly selected based on confirmed invasive breast cancer and then matched by age to healthy women. All were interviewed about their reproductive history, menstruation/menopause history, use of hormones, BMI, medical history, family history of cancer and use of alcohol.  They were also asked specifically about their experience with menopausal symptoms, including hot flashes, night sweats, vaginal dryness, bladder issues, irregular menstruation, depression, anxiety, emotional distress and insomnia and requested to rate them based on their frequency and severity.

Interesting enough, women who reported menopausal symptoms had a 40% to 60% lower risk of the type of invasive breast cancer that starts in the milk ducts (i.e., invasive ductal carcinoma or IDC) and invasive breast cancer that starts in the glands at the end of the milk ducts (i.e. invasive lobular carcinoma or ILC). Moreover, reduced risk for these cancers as well as the mixed ductal/lobular type was especially pronounced among women who experienced hot flashes with perspiration or whose hot flashes woke them up compared to women who had hot flashes without perspiration or others symptoms with awakening during the night.

The researchers say that they believe that menopausal symptoms may be markers for hormonal changes that precipitate breast cancer. In other words, pronounced the changes in reproductive hormones may actually be related to breast cancer risk. Less clear are the direct connections between individual symptoms and risk. However, they noted that the relationship between symptoms and risk did not change when hormone use, age when menopause began or BMI were factored into the equation.

Clearly, this is only one study so no firm conclusions can be drawn, at least not yet. But with all the bad news about hormone therapy and breast cancer risk, it’s heartening to learn that the hormones that are wreaking havoc on our lives may actually be protecting us from harm.

Holy hot flash indeed!

Musings: Menopause ain’t nothing but a…

Posted by Liz on Dec 10, 2010 in menopause, musings | 2 comments

Number?

Sometimes it is just that. And sometimes it’s not.

I’m reposting this piece, which first ran in June 2009, because a reader recently challenged me on my consistent opinion that menopause is not a disease.

“Menopause is truly a disease. There are many so called true diseases that cause far less damage to a womens body.”

Actually, the conditions that wreak the most havoc on a woman’s body as she grows older appear to more closely associated with aging than with menopause. Theoretically, this would mean that our best strategy to address prevention or risk reduction, right?

Here are the facts:

Australian researchers suggest that many of the more common complaints of menopause may be possibly related to aging in general and not specifically the transition. In fact, in a study presented during last month’s 8th European Congress on Menopause, they reported that menopause is strongly associated with some but not other common complaints.

So what about the other symptoms? After reviewing data from 58,724 women (ages 45 to 50) participating in the Australian Longitudinal Study on Women’s Health, the strongest associations were seen between menopause and hot flashes/night sweats. These findings remained after adjusting for age during the study, age at menopause, smoking history, body mass index, sociodemographics (i.e. education, income, marital status and geographic location) and other factors that might influence outcomes. Other symptoms, including difficulty sleeping, stiff/painful joints and poor or fair self-reported health were also associated with menopause but to a much lesser extent. Headaches, migraines and incontinence appeared to be more strongly related to the aging process.

The researchers say that treatment (in this case, HRT) should be geared primarily towards alleviating vasomotor symptoms. Less clear, however, is how long therapy should be continued, since some symptoms can last for more than seven years. This study is scheduled to appear in Menopause.

Last September, I wrote a post about a survey being reported at the North American Menopause Society’s Annual meeting suggesting that women can actually discern the symptoms of menopause from those of aging.  Interestingly, many of the symptoms overlapped; in fact, 84%, 72%, and 77% of respondents associated vaginal dryness, urinary stress incontinence and weight gain, respectively, strictly with menopause, even though they can also be caused by aging as well.

So, what’s the primary point? It can be difficult to tease apart the effects of aging and the effects of menopause. Clearly, these new Australian data add a bit more to the confusion, and reinforce the point that more research and funding is needed in this particular area.

When I write that “menopause is not a disease and should not be treated like one,” what I am really saying is that disease, especially when it’s chronic can stigmatize, frighten and even create self-loathing. By offering up hormone replacement therapy as the only viable “solution” to preventing and ameliorating the symptoms of menopause and outrightly dismissing gentler alternative strategies, the medical community takes on the stance that Author Louise Foxcroft has written about:  “fear of the menopause is something we have learned, and it has grown out of a general, male and medical distaste for the idea of the menopause perceived as an end to viability, fertility, beauty, desirability and worth. Since the French physician de Gardanne coined the new term ‘ménépausie’ in the early nineteenth century, an onslaught of opinion, etiology, treatments, and not least and lest we forget, profit has followed. Women need to unlearn their dread and recognize that menopause is not, of itself, dread-full; that we are merely the victims of our biological process.”

So which comes first? Menopause and disease or aging and disease? Regardless, we can go out fighting or we can give in.

in all, a good thing, right?

Soy! Everything you wanted to know. Or should.

Posted by Liz on Sep 20, 2010 in hot flash, HRT | 6 comments

Confusion about soy abounds. Does it help hot flashes, improve bone health or prevent heart disease by lowering cholesterol? Or it is no more effective than placebo?  Does its effectiveness rely upon the ratio of certain isoflavones — the plant-based estrogen-like components, which in soy include  genistein (50-55% of total isoflavone content of soy), daidzein (40% to 45% of total isoflavone content) and glyceitein (5% to 10% of total isoflavone content) — or is the metabolite S-equol the only component that will yield estrogen-like benefits without negative health risks?

Are you perplexed? I sure am, which is why this particular post may be a bit to scientific for a few and too long for others. however, it’s important to understand some of the reasons why soy continues to intrigue, baffle and well, show differing results in terms of benefits for menopausal symptoms. So I encourage you to bear with me.

I’ve written previously that there are several key reasons why researchers have yet to make any any definitive conclusions about soy during menopause, such as poorly designed studies, small number of study participants, wide range of ages and years from menopause, and the fact that the pros and cons of an agent or strategy are not being studied for a long enough period of time. In other cases, there is an inconsistency in the soy preparation being studied and the ratio of isoflavones may differ; alternatively, researchers have not accounted for the presence of other isoflavones in the diet, which may influence results.

Does a new study that appears in the advanced online edition of Maturitas journal, comparing low-dose hormone therapy to soy powder in women with hot flashes, offer any anything more definitive or different than what’s gone before?

Briefly:

The 16-week study enrolled 60 women between the ages of 40 and 60, all of whom had had their last period at least 12 months, had the same frequency of hot flashes (more than 8 per 24 hours), had not used any hormonal treatment in the 6 months leading up to the study period, and were not currently using any drugs that lower blood fats, treat diabetes, taking other soy-based products or using herbal supplements.

Women participating in the study were randomly assigned:

1. low-dose hormone therapy (a Activelle ®tablet daily, better known as Activella® in the US) plus a placebo powder or
2. 2 portions daily of dietary soy supplementation powder (comprising 45 mg isoflavone per dose) plus a placebo tablet, or
3. 1 placebo tablet/2 portions placebo powder.

All women were first screened  for  current hormone levels, reproductive history, age at menopause, time since menopause, medication use and cigarette/alcohol consumption. During the study, they were asked to use a standardized scale to evaluate menopausal symptoms (hot flashes, heart discomfort, sleep, and muscle and joint problems) mood (depression, irritability, anxiety, physical/mental exhaustion) and sexual problems, bladder problems and vaginal dryness.

The results?

Both hormone therapy and soy supplementation were associated with significant improvements in hot flashes and joint/muscle pain (which declined by about 45.6% in the hormone group and 49.8% in the soy group) and in vaginal dryness (which decline d by 38.6% in the hormone group and 31.2% in the soy group) compared to women who took placebo. Improvements in mood scores were consistent between the three groups, indicating that other factors, such as caring and attention by medical practitioners throughout the study, may have played some role in wellbeing. Moreover, both treatments were considered safe with few side effects.

These results are quite promising, as they indicate that soy may indeed, offer an alternative to hormone therapy in menopausal women seeking relief. However, it’s important to consider the following:

• Like many of its predecessors, the study is a small one.
• The study length was short, lasting only 16 weeks, which some critics might say is too short a time period to elicit a satisfactory clinical response.
• The researchers did not analyze whether or not the women actually took the drugs or soy consistently, and relied on their self-reports.

On the other hand:

• The study followed strict Western scientific guidelines and the women and the researchers did not know who was taking what.
• Symptoms were measured using a common quality of life scale whose goal it is to diminish errors by healthcare practitioners when analyzing results of questionnaires. This particular scale, better known as the MRS, is widely used and allows researchers to evaluate symptoms and treatment over time.

There has been a lot of criticism geared towards alternative treatments, such as acupuncture, herbs and Chinese medicine, as being shams, especially because there is no evidence supporting their use for addressing troublesome menopausal symptoms. Others will claim that the placebo effect is at play, i.e. a situation in which symptoms are relieved by an otherwise ineffective treatment due to expectations or beliefs. However, the researchers of this particular study point to the placebo effect in studies comparing estrogen to placebo, demonstrating for example, a 75% reduction in hot flashes among hormone users compared to a 57% reduction in hot flashes among women taking placebo.

The most important conclusion to be drawn is that there is early evidence that soy supplementation may be as effective as low-dose hormonal therapy in relieving certain vasomotor symptoms and possibly, vaginal dryness. We need more studies like this one, enrolling larger numbers of women, in order to definitively demonstrate benefit. Dollar for dollar, the monthly difference between the two treatments may only be about $30.  Yet, this is one of the first studies I’ve seen that followed enough rules to quiet the rioters. And that alone, is worth the price of admission.

Stay tuned. The fat lady hasn’t sung her soy aria as of yet.

[Special thanks to Reuters Health Executive Editor Ivan Oransky, for your continued support of my mission to provide timely, evidence-based information on menopause and midlife to my readers.]

Wednesday Bubble: rhubarb rules the day

Posted by Liz on May 26, 2010 in herbal medicine | 10 comments

Today’s Bubble is straight from the research files and it’s not burstable. In fact, I’m pretty excited about this.

Researchers say that a phytoestrogen extract from Siberian rhubarb (rhapontic rhubarb), better known in studies as “ERr 731,’ is an effective alternative to HRT for alleviating menopausal symptoms.

Evidently Siberian rhubarb has been used for decades to treat menopausal symptoms, both in Germany, where it is readily and commercially available, and in Chinese medicine. Clinical studies suggest that ERr works very similar to estrogen in the body and in fact, has been shown to have properties that are equivalent to SERMS – selective estrogen receptor modulators – which are synthetic compounds that mimic the action of estrogen in the body without necessarily causing some of its harmful effects.

When I delved further into ERr 731, I found numerous, well-designed studies that demonstrate its benefits in perimenopausal women including:

• A significant decline in the number and severity of hot flashes over the short-term (i.e. 3 months) by as much as 50%, with further improvements through the long-term (i.e. 6 months).
• Improvements in other menopausal symptoms such as sleep disruption, mood and vaginal dryness.
• Improvements in self-reported quality of life.
• Minimal if any side effects and no changes in uterine or vaginal tissues among women taking the extract, suggesting that it may be safe in terms of breast or uterine cancer.

In the U.S., ERr 731 is marketed as a supplement called Estrovera. Although it appears to be safe, like any drug, you should speak to your practitioner before trying it.

I’m heartened to see that an herb that been in use for decades in both Western and Eastern cultures in finally available to US women. I’ll continue to monitor for additional studies but in the interim, I’d love to hear from you if you are taking Estrovera.