Posts Tagged "estrogen"

Domino Effect

Posted by Liz on Aug 15, 2008 in sexual health | 1 comment

I’ve been writing about sex alot lately. Sexual dysfunction, sexual desire, sexsexsexsexsex. If you were Freud, you’d have a field day!

Seriously though, a new research study in an advanced publication of the journal Menopause suggests a strong link between symptoms of vaginal atrophy (thinning of the vaginal and vulvovaginal tissues due to declining estrogen levels) and sexual dysfunction. Sort of a domino effect, if you will.

Researchers from the University of North Carolina examined 1,480 sexually active postmenopausal women, 57% of whom had symptoms of vaginal atrophy. They then asked the women about their sexual experiences; more than half (55%) also had symptoms of sexual dysfunction. In fact, the study findings revealed that women with sexual complaints had almost 4 times the risk for vaginal atrophy.

These study findings suggest a strong overlap in these conditions. This implies that if you treat symptoms of one condition, you may be able to relieve symptoms of the other. The challenge will be to find a natural and effective treatment rather than rely on the old standby – estrogen or the novel standby – SERMS.

I am going to continue to explore this topic until I find a reasonable non-pharmaceutical or estrogen-based alternative for this problem. So far, I’ve not stumbled across anything that has some good research behind it. If you know of an alternative, do drop me a line.

Hung Out To Dry

Posted by Liz on Aug 10, 2008 in sexual health | 0 comments

[Credit: Raphel Bunuel]

Vaginal atrophy affects up to 40% of postmenopausal women in the United States. It refers to the thinning of vaginal tissues as a result of estrogen depletion. And it can lead to vaginal dryness, burning, itching and painful intercourse.

Physicians have traditionally prescribed estrogen replacement, along with over-the-counter lubricants and moisturizers to counteract the problem. Now researchers are touting the benefits of a new agent called Ophena.

Ophena is a type of drug known as a selective estrogen receptor modulator or SERM.  SERMS mimic the action of estrogen in the body without necessarily causing some of its harmful effects, such as increasing the risk of breast and uterine cancer. The only other SERM that is available is Evista, which is indicated to treat osteoporosis and has been shown to reduce breast cancer risk but does not improve vaginal atrophy.

In a recent 12-week study reported at the 12th World Congress on Menopause this past May, one or two Ophena tablets daily were shown to significantly improve vaginal dryness and painful intercourse symptoms. Reports claim that Ophena was well tolerated, although I’ve not seen the actual data.

Are SERMS really safer than estrogen?

The first SERM to be introduced to the market was Tamoxifen.  Tamoxifen is breast cancer treatment that has been associated with increased risk for uterine cancer and blood clots. Evista, the second SERM to be approved in the US, does not act on the uterus so it is not linked to an increased for uterine cancer. But it has been associated with an increased risk for stroke.

Newer SERMS, such as Ophena, are in various stages of clinical testing. However, based on prior experience with its predecessors, it appears that the jury is still out when it comes to using these agents for menopausal symptoms.

If you are looking for an alternative, there is some indication that regular sexual activity actually helps to increase circulation to the vaginal tissues and pelvic area. Avoiding products (e.g., soap, detergents, feminine hygiene spray) that increase dryness may also help. And of course, there are many types of OTC lubricants available at your local pharmacy.

What is your experience with SERMS? Good, bad? Let me know!

Burn Baby Burn

Posted by Liz on Jul 8, 2008 in women's health | 27 comments

[youtube=http://youtube.com/watch?v=NMSMViyCVNI]

In my last post, I mentioned that menopause has been linked to altered sensitivity in the roof of the mouth and a decreased ability to detect sweet taste. Interestingly, I heard from a friend that she recently started experiencing a burning sensation in her mouth and that her doctors have been attributing it to menopause. Say what?!

Seems that the Queen Bee of Menopause, the Sister of Love and Destruction, the Lady of Light and Dark, estrogen herself, is wreaking havoc on more than the tastebuds.

I was intrigued so I did a search. I found over 500 articles in the National Library of Medicine Database, PubMed, and also located this article in the journal American Family Physician.

Although burning mouth syndrome primarily appears to primarily affect women after menopause, some 10% to 40% of women in menopause can suffer from its effects. These may may include burning in the tongue or oral mucus membranes, dry mouth and taste alterations.

The causes of burning mouth syndrome range from depression and anxiety to underlying illness, high glucose levels and of course, hormones. Researchers have also identified alterations in the cranial sacral nerves that serve taste and pain sensations as possible culprits.

Currently, unproven treatments include benzodiazapines, antidepressants, anticonvulsants and capsaicin. However, I’m wondering whether or not craniosacral therapy might offer an alternative to women who don’t want to go the drug route. Mind you, there are lots of naysayers out there who claim that CST is quakery but having used it successfully for pain, I am a huge fan.

A fellow blogger also directed me to this extensive site on burning mouth syndrome. I can’t vouch for its content but it is definitely worth checking out for backgrounding purposes. Do you suffer from Burning Mouth Syndrome? What are you doing to treat your symptoms? Inquiring minds want to know!

Bioidenti what?

Posted by Liz on Jun 13, 2008 in women's health | 0 comments

Bioidentical hormones (also known in many circles as “compounded biodentical hormones”) are compounds that have exactly the same chemical and molecular structure as hormones produced in the human body. The term is most often used in the context of estrogen and progesterone (and androgens), although any hormone can be made this way. Notably, there are a few of these agents that are actually FDA-regulated and available from retail and not compounding pharmacies (meaning that dosage and purity are theoretically on par with synthetic types).

There’s been a lot of hullaballoo over these products from many of the major associations that are involved in women’s health (e.g. The Endocrine Society, North American Menopause Society) primarily because: 1) they are not regulated by the FDA or have any oversight whatsoever and 2) potency is inconsistent. In fact, the FDA sent warning letters to nine pharmacies in January due to what the agency felt were unsupported claims about safety and effectiveness.

FDA does not just randomly go after pharmacists who practice traditional compounding and who don’t make false claims about their products. Traditional compounding, in fact, involves the preparation of a drug for a specific patient based on a doctor’s request.

Consequently, FDA action might have been driven, in party, by Wyeth Pharmaceuticals, who filed a Citizens Petition that claimed: 1 that compounding pharmacies were not actually compounding but “manufacturing” mimics of approved agents; 2) that they used a form of estrogen known as “estradiol” not commonly found in “traditional” hormone therapies; 3) that they were engaging in illegal promotional practices. (BTW, Wyeth manufactures several estrogen products, including Premarin, Prempro, and Premphase.) You can read the rest of the petition here.

It’s important to recognize that not all compounded products are bad. In fact, compounding pharmacies continue to provide options to patients with contraindications to commercially-produced therapies. An article in a large monograph sponsored by the North American Menopause Society explains that pharmacies were compounding micronized progesterone years before an agent (Prometrium) was approved in the US. It also goes on to highlight several advantages that compounded hormones might offer over conventional products, including greater dosing flexibility, lower doses for women who are especially sensitive and the avoidance of potential allergens.

Organizations such as the International Academy of Compounding Pharmacists (IACP) have become quite outspoken about what they consider to be the FDA’s interference in physician decisions to prescribe estriol to their patients. Congress has even introduced a bipartisan-sponsored bill (Resolution 342) to reverse the FDA’s decision on estriol. There’s a website that further explains these efforts.

In the meantime, if you decide you want to try bioidentical hormones, speak to your health practitioner. S/he can devise a regimen that best meets your needs (and not the needs of the masses) and may be able to recommend a credible compounding pharmacy. The IACP might also be able to assist with your search.

Spray that flash away

Posted by Liz on Jun 9, 2008 in estrogen, hot flash | 0 comments

The FDA just approved a low-dose estradiol spray to treat moderate-to-severe hot flashes. Approval was largely based on a study, published in the journal Obstetrics & Gynecology, which showed significant declines in the frequency and severity of hot flushes after 4 to 12 weeks. Interestingly, women using the placebo spray also experienced declines in flush frequency although not to the extent as the prescription product, which is called Elestrin.

This form of estrogen carries the same risks as other forms, although delivery through the skin does bypass the liver and general metabolism to reduce some of the side effects of oral estrogen. Still, a key consideration remains the imbalance between estrogen and progesterone that I discussed in a previous post. This can become even worse with hormone replacement therapy (HRT) that focuses on the estrogen component at the expense of the progesterone component.

Clearly, I’m not huge advocate of HRT although I do believe that it is an individual decision that every woman must make for herself. I’ll be interested in monitoring responses to Elestrin. Has anybody tried it?