Posts Tagged "estrogen"

Newsflash! U.S. Preventive Services Task Force Weighs in on HRT

Posted by Liz on Jun 4, 2012 in estrogen, HRT | 2 comments

Just like the Energizer bunny. HRT and bad news. When are women and practitioners going to believe the data and stop trying to find the silver lining?

This month’s news is from the U.S. Preventive Services Task Force, who issued a recent update of the evidence for or against the use of hormone replacement for menopausal symptoms; that update appears in the online edition of Annals of Internal Medicine.

Rather than bore you with the details, I’m going to cut to the chase and get to the heart of their findings:

• Estrogen plus progestin or estrogen alone provides significant protection against hip and vertebral fractures that result from osteoporosis and aging.
• Contrary to initial results from the Women’s Health Initiative study, use of estrogen plus progestin significantly increases the risk for invasive breast cancer.  Estrogen alone offers some protection against invasive breast cancer.
• Updated analyses also demonstrate that combination HRT also significantly increases risk for stroke, blood clot events, death from lung cancer, gallbladder disease and urinary incontinence.
• Estrogen alone increases the risk for stroke, blood clot events, gallbladder disease and urinary incontinence.

One of the primary arguments that proponents of hormone therapy have used consistently is that these data are restricted to women who are older and are not applicable to women who are perimenopausal or in the earliest stages of menopause. And yet, a variety of medical organizations caution against using HRT as a chronic disease prevention strategy, including the Canadian Task Force on Preventive Health Care, American Heart Association and American College of Obstetricians and Gynecologists.

Even the FDA posits that if you are going to use hormone replacement, you should use it in the short-term and only for ameliorating menopausal symptoms or preventing bone loss. And yet, if you read through four years of Flashfree or click on the tag cloud, you’ll find a number of alternative strategies to offer relief without the slippery risk slope.

What more can I say? Be informed so that you can make informed decisions. If a few less hot flashes or night sweats in the short term means a potential road of illness in the long-term, the benefit-risk ratio may not be worth it. Then again? Only you can decide.

Crow’s feet? What crow’s feet?!

Posted by Liz on Nov 14, 2011 in aging, appearance, menopause | 2 comments

Crow’s feet. Most of us start to develop them in our mid to-late 30s and by the time we reach the age of 50, they’re pretty pronounced. This is no surprise because aging skin is associated with a decline in elasticity and moisture. And, let’s face it, if you grew up with light-coloured eyes like I did, you have an even greater tendency to squint in bright light, another factor contributing to those tell tale lines around the eyes.  In women in particular, crow’s feet are a rule and not an exception, as aging is accompanied by a loss of estrogen, which has been linked with as great as a 30% loss of collagen in the dermis (the thick, sturdy layer of connective tissue that comprises about 90% of the skin’s thickness) within the first five years of menopause. Collagen, which is the most abundant protein in the body, is responsible for  skin’s durability and strength. As it declines, skin starts to sag and wrinkles form. Oh, happy day!

Unfortunately, researchers continue to debunk claims that replacing estrogen can improve the skin’s appearance. That’s the bad news. Likewise, don’t look for expensive moisturizers or facials to do the trick either. However, there are data that suggest that intake of soy isoflavones may improve aging skin. And once again, S-equol is the winner in the isoflavone antiaging department.

A bit of background…

If you are new to Flashfree, you may be unfamiliar with S-equol. Briefly, S-equol is a metabolite of a major soy isoflavone called daidzein. It has a particular affinity for estrogen receptors and possesses some estrogen-type activity of its own. S-equol is produced in the gastrointestinal tract however the ability to actually manufacture it depends on the presence of certain microflora there. Consequently, only 30% to 60% of individuals are actually able to produce S-equol on their own (although this figure is believed to be higher among Asians and vegetarians). (You can read a full range of posts on S-equol here)

Because skin cells responsible for producing collagen express estrogen, researchers believe that S-equol and its affinity for estrogen receptors may impact skin very similar to the way that estrogen does. In fact, when 101 Japanese menopausal women randomly took 10 mg or 30 mg standardized S-equol  (SE5-OH) or a sugar pill daily for 12 weeks, that is exactly what they found. Even more interesting was the fact that S-equol was studied in women who do not produce it naturally in their bodies (even though s-equol producers are believed to gain greater benefit from soy products).

Over weeks, researchers measured numerous skin parameters, including crow’s feet, wrinkles, the degree that the skin was hydrated, skin elasticity and loss of water through the skin. To equalize the playing field, measurements were taken in a room that was the same temperature and humidity level each time, and women were instructed to remove any cosmetics using the same cleansing foam 20 minutes before each exam. They were also advised not to alter anything about their diet or sun exposure during the study period.

The findings?

Both 10 mg and 30 mg daily standardized S-equol significantly improved crow’s feet wrinkles/reduced the total wrinkle area compared to placebo tablet. And,  30 mg daily dose also significantly decreased wrinkle depth as well. What’s more, ingesting S-equol supplements did not appear to affect uterine or breast tissues or hormone status, indicating that unlike hormone replacement, using S-equol to combat declining estrogen levels is safe.

So, how does it work?

Although researchers say that the need a longer observation period to confirm S-equol action on skin, they believe that like hormone therapy, it gradually boosts the quantity and quality of skin collagen, and may even help preserve skin hydration from within. Additionally, because skin aging does not solely rely on estrogen levels, S-equol may also act as an antioxidant and help transport nutrients to the upper and middle skin layers.  And more importantly, other studies have shown that when Japanese,White, Hispanic and African-American women were compared, the Asian women had the least amount of wrinkling and sagging. If you translate the findings and consider the degree of differences in wrinkling among ethnic groups, it is very possible that S-equol may benefit women living in the U.S. even more than their Japanese peers.

Is it possible that S-equol is truly a Fountain of Youth is in pill form? Yikes! This is pretty darn exciting! Me? I’m off to the store in search of standardized S-equol. Crow’s feet? What crow’s feet?!

Estrogen and urinary incontinence: is there a link?

Posted by Liz on Nov 4, 2011 in aging, estrogen, HRT, incontinence/bladder control, menopause | 0 comments

One of the most common and (and yet unspoken about) conditions in women is urinary incontinence (UI) or problems with bladder control. Defined as the involuntary loss of urine – either due to a weakening of the pelvic floor muscles and in association with pressure on the bladder (stress urinary incontinence) or due to unknown causes and associated with an uncontrollable urge to pass urine, frequency and nighttime awakening (urge urinary incontinence or overactive bladder) – urinary incontinence is most definitely associated with aging. In fact, roughly 15 million women in the U.S. have stress urinary incontinence and about 20 million, overactive bladder.

There are a multitudes of risk factors for urinary incontinence and they range from weight, vaginal deliveries and pelvic surgery to alcohol use and of course, as mentioned, growing older. However, why is menopausal status also a risk factor?

One word: estrogen.

Indeed, results from the infamous Women’s Health Initiative study demonstrated that women who were randomized to combination hormone therapy or estrogen only were at increased risk for worsening urinary incontinence symptoms or for developing urinary incontinence after only one year of use. However, like other data from this study, questions have been raised with regard to the findings, namely that they are not applicable to the general population. And yet, it is critical to learn if using hormone therapy increases urinary incontinence risk; these conditions significantly affect quality of life and at their severest, limit physical and social activities, limit intimacy and other relationships, limit work productivity and affect overall wellbeing.

Rather than generalize, however, it’s important to take a close look at ethnically diverse populations of women in the community and tease out if there are any specific factors related to estrogen use that increase incontinence risk. That is exactly what a group of researchers did recently, when they examined a group of 167 women in menopause who had been surveyed in 1993, found to have no urinary incontinence and then reinterviewed eleven years later in 2004. In this study, which was published in Menopause journal,the researchers specifically evaluated if the women had used estrogen and if so, for how long (i.e. less than five years or more than five years). The findings? Although none of the women reported having urinary incontinence issues at the first interview, just over a decade later, 28% reported that they had developed urinary incontinence and almost 19%, that they developed urinary incontinence that resulted impacted their ability to function (e.g. avoiding social gatherings, not visiting friends or going to church, or avoiding traveling, shopping or physical activities). What’s more, of the women surveyed who reported that they had used estrogen for more than five years, 15% developed new cases of  urinary incontinence with an associated loss of function.

According a related piece in Reuters, the study’s lead investigator says that they didn’t take into account how much estrogen the women were using or if they used it in conjunction with progesterone, so there are weaknesses in the study. Still, it does appear that taking estrogen for more than five years may significantly increase the risk for bladder control issues. The next piece of the puzzle is discovering why it affects bladder function in the first place.

Bladder control issues are serious business. Yet another reason to speak to your doctor before moving forward on hormone therapy. Your move – worth the risk?

The better to hear you…

Posted by Liz on Aug 29, 2011 in aging, hearing loss, menopause | 0 comments

What did you say?!

Did you know that menopause may be a trigger for age-related hearing loss?! Although men start losing the ability to hear high-frequency noise as early as age 30, a similar loss apparently does not become apparent in women until after age 50. This may be due to a protective effect played by female sex hormones, which would mean that as circulating estrogen starts to decline, it sets off a series of actions that trigger age-related hearing loss.

To test this theory, researchers conducted hearing tests (pure tone audiometry, which measures the ability to hear different thresholds) in 104 women who had been in menopause at least one year and were, on average, 51 years old. Hearing tests were repeated a second time roughly seven and a half years later. As a whole, the group of women was neither death or severely hearing impaired and the majority were not using hormones of any kind for their symptoms.

Interestingly, a vast majority of the women had accurate hearing when the study started. And yet, by the second hearing test, hearing decline relating to mid to high frequencies was very apparent, especially among women who were well into menopause (by about five to seven years). On average, these women were losing 1.1 to 1.5 decibals yearly. And even more interesting was the fact that depending on how long women had been in menopause, the hearing loss tending to favor one ear over another; women in menopause four years or less had greater decline in their left ear while their peers who had been in menopause five to seven years had greater decline in their right. This loss balanced out between ears by eight to 13 years into menopause and even appeared to slow.

The researchers say that estrogen appears to protect inner ear function and maintains what they refer to as ‘auditory integrity.’ However, once women enter menopause, there is a rapid, initial decrease in the ability to hear  mid to high frequencies, first in the left ear and then in the right.

There is not too much a person can do about age-related hearing loss except for limit exposure to loud  noise and keep your heart healthy so that blood flow to the ears is not constricted. However, unfortunately, most of us in our early 50s spent a lot of times in our formative years attending concerts, where noise level was the norm, not the exception. Consequently, we may already have a higher risk for hearing loss than our parents, but still a lower risk than our children, who by default, are constantly exposed to loud environments and noise from electronic devices. Add the estrogen factor and well, it’s sort of a losing proposition. Still, it’s helpful to know it’s not all in our heads or in our ears. Or better yet, entirely due to rock n roll.

Wednesday Bubble: is there a connection between dry mouth and osteoporosis?

Posted by Liz on Jun 1, 2011 in bone health, dry mouth, osteoporosis | 0 comments

This week’s bubble is neither burstable or good news. But it is important:

Dry mouth and bone mineral density appear to be related.

Say what?!!!

A bit of background is needed…

Osteoporosis is fast becoming a major health problem and as I’ve written time and again on this blog, is a significant characteristic of menopause, namely as the result of waning estrogen levels that lead to an imbalance between the build up and turnover of bone cells. Parathyroid hormone and cortisol have also been linked to bone turnover.

Dry mouth (i.e. a feeling of dryness in the mouth and need to use liquids while eating) and burning mouth syndrome (i.e. burning in the tongue or oral mucus membranes and taste alterations) are also common during menopause, affecting up to 40% of women. Until now, experts have not been able to adequately determine why these symptoms occur and more importantly, effective management strategies.

The link? Recent data have shown that estrogen levels may be significantly lower and both parathyroid and cortisol levels significantly higher in menopausal women who complain of dry mouth. Moreover, as the results of a new study in Menopause show, there may be a true relationship between these two conditions and that bone loss may be the actual cause of oral dryness and related symptoms. In this study, researchers evaluated 60 women in menopause (mean age 56) for the presence and severity of dry mouth and then based on their results, divided them into two groups. Dry mouth was confirmed by responses to a scientific questionnaire and collections of saliva. The researchers also measured bone mineral density at the spine.

Importantly, the participants were not particularly active and none engaged in any sports activity, except walking. The women were also matched by body mass index, age, or years of menopause. And yet, women with low bone mineral density, including relationship to other women in the same age group and 30 years younger, were significantly more likely to experience dry mouth and had significantly less saliva when their appetites were not stimulated.

Clearly, more research is needed. However, there are some things you can do now. The first strategy to combat osteoporosis and bone loss is to get measured for bone loss and disease markers. Steps like calcium supplementation, a healthy diet and regular exercise are critical. And if you suffer from dry mouth? You may want to speak to your dentist about a referral for a bone mineral density scan or better yet, have him or her contact your gynecologist or regular health practitioner for a pow wow. Not only may you help your bones, but you may actually change that dry feeling.