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.
This week’s bubble is neither burstable or good news. But it is important:
Dry mouth and bone mineral density appear to be related.
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.Read More
Any regular reader of this blog knows that I am not a fan of hormone replacement therapy (HRT) nor the health risks associated with it. Nevertheless, although I espouse alternative strategies for dealing with menopause, I do feel that sharing news about HRT is important; accurate information leads to informed and shared decisionmaking.
So, do they (i.e. hormones) or don’t they (cause harm)? Undoubtedly, important variables come into play, including current age, how close to menopause hormones are started, current health status, whether or not a woman has had a hysterectomy, smoking history, etc. Also important is whether estrogen is used alone or in combination with progesterone. And yet despite these factors, many medical organizations continue to recommend that HRT be used for the shortest time period possible if at all.
Still, researchers continue to delve into data from the now infamous Women’s Health Initiative Study to tease out the bad, ugly and even the good.
This week, they are reporting on over 7,600 women who had taken estrogen alone for approximately 6 years, had had prior hysterectomies and were followed for an average of 10 years after the trial ended. If you recall, there has been some controversy as to whether or not estrogen alone is safer than combined HRT and actually lowers the risk for breast cancer in particular, which is why these data are particularly intriguing.
The researchers report that age at the time that hormone therapy (in this case, estrogen alone) is started is important. In fact, women who started estrogen therapy in their 50s, an increased risk for stroke and embolism, which appeared while taking estrogen, actually disappeared in the years that followed. Unfortunately, so did protection against hip fracture. Moreover, earlier reports of a decline in breast cancer risk were upheld despite body mass indices. However, the researchers say that this finding in particular, runs contrary to the preponderance of evidence from the majority of observational studies which show that estrogen use increases the risk of breast cancer, especially in lean women and after a long time period of use.
In an accompanying editorial, also in JAMA, the authors point out that more than 80% of women who took estrogen as directed only used it for an average of 3.5 years. Their point is that the results don’t directly address the “balance of risk and benefits associated with longer term estrogen use.” They also point to a larger review of data that show duration is an important factor when it comes to breast cancer risk, especially among lean women. Additionally, they say that tamoxifen, which actually antagonizes estrogen, has been shown to reduce breast cancer by 50%, which has led the International Agency for Research on Cancer to “conclude that unopposed estrogen therapy and combination HRT are carcinogenic.”
Are you confused yet?
Both set of researchers say that the decision to use estrogen or not is one that should be made between a woman and her doctor. Don’t forget: study findings continue to contradict. They add that while “there may still be a role for short-term use of unopposed estrogen for treating some women with menopausal symptoms, this role may be vanishing as existing and emerging data continue to be better understood in terms” of patients.
My thoughts? Err on the side of caution. Always.Read More
There’s a new term that’s being kicked around in medical circles: ‘windows of vulnerability.’
It appears that a growing body of evidence supports the fact that during times of hormonal flux or reproductive cycle “events,” women become increasingly vulnerable to mood swings, anxiety and depression. And while this is certainly not news for many women, it still requires some attention because among the many windows that women may go through, the menopausal transition is evidently one of the most complex. The reason? This is a time when hormones interact with aging, sexuality, life stressors, self-esteem and general health issues.
The subject of depression and menopause is not new to this blog, nor are statistics suggesting that as many as 20% to 40% of women are believed to suffer major depression or at the very least, depressive symptoms during the peri/postmenopausal years. Moreover, women may have as much as a two- to four-times increased risk of developing depression as they transition from pre- to perimenopausal status. Among the multiple factors at play, estrogen is one of the most important; estrogen has been shown to promote the amount of the mood neurotransmitter serotonin available to the body, thereby providing an important antidepressant effect. However, a recent review suggests that the role that hormones like estrogen play in depression is directly related to their wide fluctuations rather than the fact that they are becoming deficient.
So, why is this important? For one, it highlights that hormone replacement is not the only answer for depression during menopause but rather, that it’s critical to pay attention to timing, i.e. when preventive strategies, including exercise, behavioral therapy and antidepressants might yield the greatest long-term benefits. Yet, it also suggests that estrogen-based therapies may indeed have a role in depression during menopause. And, since estrogen alone therapy has been shown to up the risk for ovarian cancer except for in women who’ve had hysterectomies, it also helps supports the need to explore the role plant-based estrogens in treating menopausal depression; fortunately, S-equol has already shown promise in this regard.
Feeling the window of vulnerability? There’s no time like the present to insure that you aren’t simply looking through the window but actually seeing that there’s hope and help on the other side. There are a lot of resources and strategies available to address depression during this time of life. While depression may be a “menopause-associated risk,” like others, it can be successfully ameliorated.
Thank you to Dr. Claudio Soares from McMaster University for an excellent review of depression in menopause and the inspiring, succinct “windows of vulnerability” terminology.Read More
A study presented at the esteemed San Antonio Breast Cancer Symposium last week has fanned the flames about the benefits versus risks of hormone replacement for menopausal symptoms. In this study, which ironically was pulled from the site press release highlights after experts questioned its merit, researchers did a reanalysis of data from the Women’s Health Initiative trial, the infamous 2002 study that was halted after Preempro was shown to increase breast cancer risk. Their findings? That women who had participated in the estrogen only arm of the study, had had benign breast disease, had had hysterectomies and had family histories of no breast cancer actually had significant reductions in breast cancer incidence. What’s more, 75% of women who did not have benign breast disease at the study’s start also had a reduced risk of developing breast cancer.
So, this is good news, right?
Well, estrogen alone can only be used by women who have had hysterectomies; estrogen plus progestin is used in women with intact uteri in order to avoid uterine cancer. This means that only a subset of women with menopausal symptoms are eligible to use estrogen alone. Moreover, as a physician blogger points out, the findings run counter to most data that show that estrogen use is actually associated with an increased risk of breast cancer. He also notes that abstracts that are accepted as posters at major medical meetings often have flawed or spotty data; in fact, in my years as a medical writer, I’ve often run across abstracts that ultimately disagree with published works.
The bottom line here is that despite the news, using estrogen alone to treat menopausal symptoms might only be an option for a very small percentage of women and may still place them at risk for cancer. At the end of the day, prescribing hormone replacement therapy continues to challenge the Hippocratic Oath: first do no harm.Read More