Posts Tagged "aging"

Giving voice

Posted by Liz on Aug 14, 2009 in HRT, voice | 0 comments

Did you know that the female larynx is sensitive to sex hormone changes? Evidently, along with some of the better known symptoms — sleep disturbances, mood swings, hot flashes, night sweats, weight gain, etc — vocal quality may also change in some women.

Experts say that fluctuating sex hormones, i.e. estrogen, progesterone and androgen, can result in a thinning and dryness in the vocal folds (or vocal cords). Because it takes greater effort to make sounds, voice changes can occur. Notably, studies have shown that not all women are affected by these changes nor are they affected in the same ways. However, when women are affected, their voices may get rougher/huskier, lose stability, lose their top notes and vocal range, and change their timbre. Professional singers or actors, or even consultants on the lecture circuit, all of whom rely on their voices to earn a living, are especially affected.

Researchers acknowledge that further study is needed to distinguish between vocal changes that occur as a result of menopause versus those that occur as a direct result of aging. Yet, regardless of the cause and degree that each factor contributes, voice changes can affect almost half of postmenopausal women.

Treatment options include:

• Hormone replacement therapy. Study results have been mixed, with some findings showing improvements in voice complaints and voice function/vocal quality and others, demonstrating none. Further research is needed that evaluates the effect of HRT on the larynx as well as its ability to prevent voice changes if instituted early. Of course, HRT is wrought with other dangers that might make its use, prohibitive or not worth the risk/benefit ratio.
• Voice therapy. Although many questions remain unanswered, vocal coaches  and speech pathologists say that voice therapy can help relieve vocal fatigue. There are exercises that work well to address aging vocal cords, rebuild muscle tone and help women learn how to use their voice more efficiently.The American Speech-Language Hearing Association has a great resource for finding a local professional in your area that specializes in vocal deficiencies.
• Vitamin therapy. Research has shown that multivitamin therapy that includes magnesium, mineral salts, vitamins B5, B6 and E may improve vocal quality and help keep the vocal folds moist. Although experts say that there is not enough evidence for the role of vitamins in voice, vitamins, minerals and anxioxidants play an important role in health regardless of whether voice changes occur.

A quick search on PubMed turned up numerous articles on voice changes during the menopause and the article I sourced for this post (cited below), specifically references nine of these.

I am wondering how many women who are in the menopausal transition are experiencing these problems and are seeing clinicians who might not be aware of the potential link.

What about you? How is your voice quality? Have you noticed any changes?

[Source: D’haseleer E et al. The menopause and the female larynx, clinical aspects and therapeutic options: a literature review. Maturitas (2009) In press.)

Wednesday Bubble: Better living through chemistry? Your aging skin

Posted by Liz on Aug 5, 2009 in appearance, HRT | 2 comments

Still thinking that hormone replacement therapy (HRT) can improve the appearance of aging skin? You may want to think again.

This past March, dermatologists at the American Academy of Dermatologists’ annual meeting once again debunked claims that HRT can improve the appearance of aging, photo-damaged skin. Although I’ve written on this topic previously, the subject is interesting (and relevant) enough to revisit.

Undoubtedly, certain areas of the body are more receptive to estrogen than others, e.g., cells comprising the skin on the face. And while estrogen can increase collagen, help the skin retain water and promote elasticity, its ability to reverse the effects of aging remain questionable.

Dr. Margaret Parsons, assistance clinical professor of dermatology at the University of California-Davis, says that she does not prescribe estrogen to improve skin’s appearance because data have not consistently shown any benefit. Not only doesn’t she believe that topical or oral estrogens offer any sort of long-term solution, but she also points to the risks involved in their use, such as breast cancer.

Consider the evidence (or lack, thereof):

• In a study published last year in the Journal of the American Academy of Dermatology, researchers evaluated whether or not low-dose HRT could improve the appearance of fine lines and wrinkles, skin dryness/texture and sagging. Study participants were 485 women who had been menopausal for about five years.  No significant improvements were seen after 48 weeks of treatment, although researchers suggested that longer use of hormones or different doses might lead to better results.
• In another study, which I wrote about last year, applying topical estrogen to sun-damaged skin, likewise, did not improve the skin’s appearance, although it did appear to promote collagen production in areas that had not seen the light of day, i.e. the hip.
• A third study, published in the early 90s, suggests that use of a topical cream early in menopause and for a longer period of time, may improve the appearance of aging skin. However, this study was only conducted in 18 women over a period of six months, making it difficult to reach any definitive conclusions.

It appears that the jury is still out but deliberations don’t look too promising.

Think about it: are you willing to risk the adverse effects of HRT – cancer, death from lung disease, heart disease – for your appearance?

If you are deadset on erasing a few lines and a few years, there are effective therapies that dermatologist regularly suggest to improve skin’s appearance, for example retinoids, glycolic acid or procedures such as chemical peels, lasers, botox and skin fillers. While they might hit your pocketbook harder than HRT, most do not come with the same degree of health risks. You can learn more about taking care of mature skin in this issue of the American Academy of Dermatology’s SKIN e-newsletter.

Obviously, the best advice is to wear sunscreen regularly, avoid smoking and use a topical retinoid. We may not be able to turn back the clock but we can preserve what we have more responsibly. Estrogen might not be the ounce of prevention that works best.

Menopausal…pregnancy?

Posted by Liz on Jul 27, 2009 in fertility | 4 comments

I ran across a piece on MSNBC.com over the weekend,  in which a U.S. fertility doctor defends his decision to treat older recipients of fertility treatments. The result? Pregnancies well into a time in life when a woman is typically experiencing the cessation of reproduction and moving into menopause.

Unfortunately, the mother featured in the story died at age 69, leaving behind two-year old twins.

While the doctor states that he would prefer to treat women who are likely to live long enough to parent their children, he also asks the following:  “How old is too old to become a mom?”

Ironically, a little over a month ago, researchers presented data at meeting of the European Society of Human Reproduction and Embryology outlining successes in ovarian transplants. These procedures involve removing the ovaries and then freezing and preserving them for implantation at a later date.

Although this technique has traditionally been used to preserve ovarian function among women undergoing chemotherapy, the option is now being extended to women with other illnesses. However, before ovarian transplant becomes more widely available, for example, to women in their 20s or 30s who might want to delay childbirth until later in life, researchers say that they need to determine how the ovary will function, e.g. as a 30 year- old ovary in a 45 year- old woman or as a 45-year old ovary?

Both of these reports strike me as Frankensteinian, playing  with nature in the most unnatural way to delay an event, reproductive decline,  that has long defined human evolution.

Are fertility and ovarian treatments for the menopausal set poised to replace HRT as the panacea for aging? How old is too old? Like Dr. Frankenstein, have we gone too far?

Wednesday bubble: a panacea for aging skin?

Posted by Liz on Jun 17, 2009 in appearance | 0 comments

I was originally planning to devote this Wednesday to a discussion of the risks of early menopause. However, an article crossed my desk that was simply screaming for attention:

BBC News Headline: Anti-cancer cream fights wrinkles.

The cream in question is a topical chemotherapy treatment, fluroroucil, that is commonly used to manage skin cancer. Apparently, a study appearing this week in the Archives of Dermatology has shown an unexpected but welcome benefit of using flurorouciil: an improvement in the appearance of damaged skin.

So what’s the lowdown on the study? 21 study volunteers suffering from photodamage and dry, scaly rough patches of skin (actinic keratoses) that result from years of sun exposure were treated with fluroroucil cream,  twice daily for two weeks. They also had skin biopsies and other evaluations at the start of the study and periodically thereafter through week 24. The results showed significant changes in both the signs of actinic keratoses and photoaging/skin appearance — so much so that most of the patients said that they would be willing to undergo therapy again.

Fluroroucil evidently works by causing injury to the skin, leading to wound healing and regeneration and consequently, an improved appearance. This pattern of healing mimics that seen with other cosmetic procedures used to treat photoaged skin, such as laser therapy. But here’s the rub (no pun intended): fluroroucil is associated with significant side effects that include skin irritation, dryness, peeling, scabbing, weeping and even eye irritation. It also carries a FDA pregnancy category rating of ‘X’ meaning that it can harm an unborn child, and cause miscarriages and birth defects.

It’s essential to know the facts about fluroroucil, including its risk/benefits ratio. Undoubtedly the bonus of younger looking skin is enticing. And experts are already suggesting that its lower cost relative to other cosmetic treatments may promote its use beyond cancer treatment.

In the coming months, it will be interesting to see how many predators adopt fluroroucil as the latest and greatest thing since the Fountain of Youth. The new million dollar promise? Apparently you can iron out those wrinkles? But not without risk.

Buyer, beware!

Wednesday bubble: age ain’t nothing but a…

Posted by Liz on Jun 10, 2009 in hot flash, menopause, nightsweats | 2 comments

Number?

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

Confused yet? I certainly am.

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.

In the interim, I am just as happy to blame the ‘pause for my symptoms as I am to blame age. And equally as happy to take positive steps to overcome some of the more troublesome effects of the transition, regardless of whether it is a direct effect of menopause or not.

All in all, a good thing, right?