Archive for estrogen
Everyone becomes forgetful at some point in their lives, but when it occurs to someone already dealing with the symptoms of aging; dementia becomes the feared ailment.
Forgetfulness is one thing, dementia is a whole other beast. While there are some things you can do to avoid dementia, some of it is predetermined by genetics. Preserving your memory is as much as preserving your health.
It is all about inflammation. What we do and don’t do to our bodies and to our health, causes inflammation. Inflammation causes harm to our cells; it is unavoidable but definitely can be minimized.
Memory loss in the form of mild forgetfulness is a normal consequence of aging, as we do lose brain cells and volume over time. It is also a function of too much brain multitasking, so a thought or intention is not properly imprinted. In other words, doing too much at one time can crowd the brain circuits and make it difficult to remember, usually the lesser important thoughts.
There are also some medical conditions that can make memory harder to preserve. Think of your brain as a computer. If it does not get proper energy, it cannot work. It also needs a break once in a while in the form of sleep and relaxation.
Your brain needs oxygen, blood flow and glucose to work. If you are not breathing well, or you have a heart condition; your brain may not get what it needs. Usually there is enough glucose, so this is rarely an issue. It also needs the nutrients that nourish the nerves such as the B vitamins, fatty acids, even cholesterol! Thyroid hormone also is the metabolic booster for the body. If this is not in adequate supply, the engine can’t work as effectively.
Finally, there are our sex hormones that help with brain function. Both estrogen and testosterone help with brain function and memory. As these hormones decrease with aging, you may notice a decline in your memory abilities.
Inflammation is also felt to be a culprit in decreasing memory. Inflammation can come from a wide variety of sources including infections, arthritis, smoking, diabetes, hypertension to name a few. Excessive alcohol use is also detrimental mostly through poor nutrition.
So it would stand to reason that improving your memory, or at least keeping it from worsening; would include proper healthy treatment of the medical conditions that cause inflammation. In addition, treating conditions that improve blood flow to the brain as well as oxygenation are key.
Exercise will improve your heart and your lungs, helping to deliver an abundant supply of oxygen and nutrients to your brain.
A healthy, well rounded diet with foods rich in Omega 3 fatty acids, and the B vitamins will support nerve health. Limiting alcohol which can damage the nerves is equally as important.
Avoiding poor sleep habits will help you to get a good nights sleep, allowing your brain to repair itself.
Managing your blood pressure and glucose metabolism with a healthy lifestyle and medication if needed, will help keep inflammation of your system down.
When do you worry? When your memory issues are impacting your life.
You don’t have to wait until you forget what city you are in to have your memory be a problem. Decreased work performance can be an indicator of a problem, or repeatedly forgetting names of people in social situations. Suddenly no being able to complete a set of chores that normally you complete in a day. These can all be indicators of a health problem.
See your medical provider to get some labs done. You will want to get your thyroid level checked, may be Vitamin B12 especially if you are a vegetarian. Vitamin D level may also be useful. You may need to review any medications you are on, statin therapy for cholesterol can be a big culprit in affecting memory.
Lastly, hormone therapy may be indicated. For women at low risk for heart problems and breast cancer, hormone replacement therapy is very useful at helping to restore memory. For men with a low testosterone, replacement with this hormone can also help to restore memory and erase the fogginess that low testosterone can cause.
While inflammation is an unavoidable consequence of aging, there is a lot we can do to minimize the inflammation in our body. Living as healthy as you can helps your brain as well as the rest of your system.
There are many injustices suffered by a woman in her lifetime. But none can quite match the fear and sometimes horror of hair loss during menopause. I suppose if we knew when it would stop, we could know whether to start searching for the wig stores! But like much in menopause, we feel and are to some degree, out of control of our bodies.
Our hair is one thing that defines us. It is the representation of the kind of care we take of ourselves. It can indicate our style, like the clothes we wear. Compared to most men, we have spent a small fortune at the hair dresser getting the perfect cut, coloring, and perming.
When we see our hair falling out in clumps, we feel we are watching our womanhood fall down the drain also.
Why does this happen and what can we do to stop it?
First and foremost, understand that some hair loss is expected. If female baldness does not run in your family, you are most likely not going lose a significantly noticeable amount of hair.
Secondly, get yourself to your medical provider and make sure you are not anemic, have a healthy thyroid and iron levels, don’t have a connective tissue disease. These can be the major medical causes for hair loss.
Next, look at what sort of styling you are routinely doing to your hair. Persistent tugging and twisting of hair can strain follicles and cause them to shed their hair a little sooner. Believe it or not, most hair lasts 2-6 years, then falls out. That follicle then stays dormant for short time, then grows another hair. Harsh chemicals and dyes can dry the hair, causing early breaking off at any point on the length of the shaft.
Lastly, look at your diet and lifestyle. Do you get enough vital nutrients to feel the scalp and hair? Do you practice stress relieving activities to lower stress hormones. High levels of stress can cause the hair follicle to loosen the hair within the shaft and shed it; sometimes months after the stressful event.
Menopausal hair loss can last for up to 2 years, but usually your hair does recover most of its thickness within that time frame following the loss. You can accelerate this process by:
- Using gentle shampoos and eliminate any harsh chemicals and tight hair styling to lessen the stress on the follicle
- Consider taking hormones if you have other compelling reasons. The main reason you are losing this hair is a hormonal imbalance which makes the hair follicle less likely to grow new health thick shaft of hair. This is only a temporary solution, but it could give you time to work on healthy lifestyle changes including diet and stress reduction.
- Increase healthy nutrients in your diet by including foods high in iron, Vitamin E, vitamin D, calcium, as well as Omega-3 fish oil.
- Learn to meditate if you are stressed, or exercise to help reduce stress hormones.
- Drink plenty of water, eliminate cigarette smoking and drink alcohol only in moderation (7 drinks a week).
Hair loss occurs because of lower hormone levels, and as your hormones settle at a post menopausal level, the hair loss will stop. There are few medications for women other than topical rogaine, or the use of estrogen replacement.
The important thing is to take good care of yourself and your hair. Get plenty of rest and relaxation to keep stress low, consume a diet high in healthy nutrients. You may need to rethink your hairstyle or the chemicals you use. Don’t despair, your hair will most likely grow back.
Last week there was quite a bit of discussion in the various new media groups regarding osteoporosis and medications. The short version pushed by the news media was that medications for osteoporosis can cause fractures of the thigh bone.
While these sorts of fractures can occur and are no laughing matter, this simplification is not exactly accurate.
Our bones are made up of many living cells, some that make bone and some that break down old bone. This is meant to be a balance that maintains our bones as healthy with new, strong bone. Estrogen helps to stimulate the bone making cells; Vitamin D helps us to absorb the calcium we need for these bone making cells to make strong bone. As we move through menopause, the lower levels of estrogen cause these bone making cells to slow down. Meanwhile the bone destroying cells continue at their steady rate, breaking down the old bone. What you end up with is more in the loss column and less is the new column; like a business that pays out more in bills than it takes in as revenue.
Moving on to the medication for osteoporosis; drugs like Fosomax, Reclast, Actonel to name a few. This class of osteoporosis medications work by slowing down the destruction phase of bone remodeling, allowing a balance between destruction and formation to be achieved once again. When these medications were first released, they did represent a tremendous help to many women with osteoporosis. After all, there was not much treatment available other than supplements and vitamins. These medications were felt to be life changing for women at risk for a hip fracture. What has come to life, however, is the knowledge that these drugs can affect bone in different parts of our bodies, differently.
When taken for more than 5 years, some women are at risk for a fracture in the thigh bone. This is normally an area not affected by osteoporosis, unlike the wrist, spine and neck region of the upper thigh nearest the hip. For reasons yet unknown, the mid portion of the thigh is weakened by these medications in a very low percentage of women; thus resulting in painful fractures. Additionally, in rare instances, these medications have been shown to decrease blood flow to the jaw bone, resulting in osteonecrosis or bone deterioration.
When reading or listening to reports such as this, it is no wonder we are hesitant to start medication. After all, we can’t feel osteoporosis until it is too late and we sustain a fracture.
What do we do?
Don’t stop your medication until you talk with your medical provider. Discuss your risks of osteoporosis and make sure you understand all that you can do to improve your bone density. You are most likely safe to take these medications for 5 yrs, then stop to let the bone destroying cell have a chance to get rid of old bone.
Get your bone density study done at a reputable radiologic facility with an approved DEXA scanner.
Do weight bearing exercise daily, this stimulates bone making cells.
Get the proper amount of calcium and Vitamin D to make sure the bone you are making is strong bone.
When you listen to the lay press discuss these issues, make sure you understand that while they feel they are relaying important information to consumer; they are also selling stories. Talk with your medical provider before assuming the worst case scenario.
The North American Menopause Society, NAMS, has recently released a new position paper on the use of hormone therapy during and following menopause. An analysis of several studies and data has shown that hormone therapy is not as dangerous or onerous as believed 10 years ago after the initial release of the Women’s Health Initiate study results.
The Women’s Health Initiative was designed to determine if HRT was cardioprotective; as well as to help determine if HRT caused an increase in breast cancer. This study was stopped prematurely due to an increase in cardiovascular events including stroke, heart attack and blood clots. Hormone therapy was quickly blamed for this increase in cardiovascular events, and consequently usage has plummeted.
You may be asking what is new about all this information?
Researchers have been continuing to analyze the data from this study, and have come to some conclusions which have helped guide NAM’s new position paper. This is what they have determined:
- Most cardiac events occurred in women over 60 who were placed on hormone therapy 10 or more years after menopause.
- Women who underwent hysterectomy and were placed on estrogen without progesterone had a lower rate of breast cancer, therefore taking estrogen for up to 7-8 yrs was not associated with increase risk of breast cancer.
- However, HRT started at time of menopause was associated with slightly higher risk of breast cancer than when started a few years post menopause.
- Women on estrogen therapy (ET) and estrogen/progesterone therapy(EPT) had lower rate of cardiovascular events when HRT was started at time of menopause, as opposed to several years post menopause.
- The types of estrogen and types of progesterone may influence risk of breast cancer and cardiac events.
What does this mean for you?
The recommendations suggest that you can expect the have your hormone therapy customized to your particular medical situation, including consideration for your risk for breast disease and heart disease.
For those of you who have had a hysterectomy, you could reasonably take your estrogen therapy for up to 7 years without significantly increasing your risk of breast cancer.
For those of you who still have a uterus, you would want to limit your use of HT for 3-5 years. After this, your risk of breast cancer increases.
The type of progesterone therapy may affect the risk of cardiovascular events. A natural progesterone, such as Prometrium, may have significantly less risk than synthetic progesterone, for both cardiovascular events and possibly breast cancer.
The route of delivery of estrogen may lessen the risk of HT. Topical estrogen, or estrogen patches may have less risk of thrombotic events; than oral estrogen.
Estrogen is the most effective therapy for vulva and vaginal atrophy, with topical vaginal cream, ring and suppositories being superior to oral estrogen.
Compounded Bio-identical hormones should only be used if an allergy to a component of federally approved estrogen or progestin hormone therapy exists. These compounded hormones have not been tested and may contain levels of hormones or ingredients that are harmful. For this reason, safety cannot be established as clinical trials proving safety have not been performed.
Hormone therapy can be very helpful when you are first experiencing menopausal symptoms. Now, with this statement paper, there is more guidance on safety of HRT use. Compounded Bio-identical Hormones are very popular, but their safety has not been establishes in the types of studies that this position paper discusses. There are many safe options for women that include patches, creams as well as pills; and this allows flexibility in dosing. This is is a form of customization.
This is information that you can use when you see your medical provider. Write in and share your own experience with HRT and whether or not it has helped, and even which preparation you used (your information is anonymous to our readers). It is through sharing information that we can enlighten one another about menopause and strategies to ease the common problems.
How many of us have gotten into the store and completely forgotten what we went there for? Or we run into an acquaintance or worse, a friend, and we completely blank on their name. These things are troubling to us and at times embarrassing. When they occur as we are aging, however, situations like this can be frightening. We all are concerned about becoming that person we hear of or know of whose body is present, but their mind in gone. So why do these changes seem to happen so suddenly to women during menopause? And what does this mean and what can we do lessen these effects?
A full 40% of women 48-55 complain of forgetfulness and most are associated with the time of menopause. In past years, it was always felt that the forgetfulness that is associated with menopause is a function of hot flashes and sleep deprivation. While this can certainly impact mental acuity, researches now feel there is a physiologic cause for this effect on memory, mood, and attention.
The brain has estrogen receptors (places that estrogen can physically attach) through out. Important areas , like the hippocampus and frontal lobes contain these receptors, which affect working memory, verbal memory, and retrieval of memories. Estrogen is believed to modulate( have a speed of action and a different effect when estrogen is present than when it is not) genetic expression, the action of neuropeptides and neurosteroids, as well as electrical pathways and synapses. Following menopause, these compounds change due to the lack of estrogen hormones in the brain. All of this suggests that estrogen has a very important role in brain functioning and its absence or declining amounts of estrogen can impact certain areas of the brain to the extent that neurotransmitters, neuropeptides and neurosteroids (chemicals in the brain that are part of memory storage and brain cell interactions) actually change to compensate. What do the studies suggest we can do to help lessen the impact of menopause on cognitive (thinking)function?
Most studies prior to The Women’s Health Initiative were observational(not an experiment) at best, and in retrospect not very accurate. The large scale study, The Women’s Health Initiative in which 161,808 women between age 50-79 were followed for 15 years, gave researchers a wealth of data regarding several issues in women and menopause. One of the primary goals was to determine if hormonal therapy helps with prevention of cognitive(thinking/memory) decline, as well as heart disease and a host of other health issues. A subset of the WHI is the WHIMS study where 7,480 women older than 65 who had no dementia at baseline(the start of observation).
These women were enrolled(permitted to participate in the study) and given one of the following: estrogen, estrogen and progesterone, or placebo. The working premise was that HRT(hormone replacement therapy) will protect against dementia or cognitive decline. Prior to WHIMS, it was felt that HRT did protect against Alzheimer’s Disease ( AD) and Mild Cognitive Impairment (MCI)up to 30%. As mentioned above, most studies were observational and as it turns out on closer analysis, biased due to sampling error. At the termination of the WHI and WHIMS trial, data indicated that women taking estrogen and progesterone had twice the risk of dementia over women on estrogen alone and placebo. Estrogen alone did not confer any benefit or harm over placebo in regards to dementia and cognitive decline.
Since WHIMS, there have been several smaller studies looking at use of HRT in the early post menopausal time. These studies have shown an improvement in cognitive testing but surprisingly, this was not consistent. Most improvement was seen in the subjects who were experiencing the most menopausal symptoms. With use of HRT, specifically estrogen alone, these women had improvement in cognitive testing involving verbal memory, attention, abstract reasoning and motor speed. Women not experiencing menopausal symptoms did not demonstrate improvement in cognitive functioning while on estrogen treatment.
The most robust response for cognition occurred in the group of women who had undergone surgical menopause(had their ovaries removed before natural menopause began) and were on estrogen alone. This study was only carried out for several months; most of the participants had intact uteri(ovaries gone, uterus intact) and therefore would not be able to remain on estrogen alone. In regards to the WHIMS study, the decline in cognition was felt to be consistent with use of progesterone and the deleterious effects on vasculature also seen in the heart disease prevention arm of the study.
What is a woman to do? The studies do suggest that use of HRT early in post menopause may be helpful for women experiencing memory issues significant enough to impact their lives and sense of productivity. This requires
- a review of risk factors in using hormone replacement
- a discussion with a regular medical provider regarding appropriateness of use of HRT.
It is always helpful to maintain balance with plenty of sleep, relaxation and exercise, as well as testing the brain in different ways. A new routine, using crossword puzzles and staying active socially all keep different areas of the brain active. The old saying “use it or loose it” applies to the brain and memory also.
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In the previous article on hot flashes I mentioned a some lifestyle changes which can help with hot flashes. In this article I will discuss medications and supplements which can help with hot flashes. It is still important to remember that the life style changes you make will improve your health in many ways, not just in reducing hot flashes. I admit it is easier to take a pill to help a symptom, but most pills come with side effects and they can only accomplish part of the job. All of the supplements and medications mentioned in this article work one of two ways. They either provide the body and brain with synthetically made estrogen, as in the case of pharmaceutical and/or bio-identical estrogen; or provide a plant based estrogen-like product called phytoestrogens. Or, they change the way the body responds to the signal to cause a hot flash.
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This is what happens with a hot flash, other than you get hot, sweat and feel miserable and embarrassed. Lower circulating levels of estrogen trick the hypothalamus portion of the brain(the area which regulates body temperature as one of its’ jobs) into believing that the body and itself(the brain) is too hot. So it sends out a signal by way of its’ messengers to lower the body temperature by dilating skin blood vessels, triggering sweat glands to sweat, and causes the heart to beat faster to help all this happens quicker. These messengers are epinephrine, norepinephrine, serotonin and prostaglandins (haven’t we heard of these guys before? Oh yeh-in the weight gain article) All of this is an attempt to cool the body off, but as all of us menopausal women know, this isn’t what actually happens!
Enter in hot flash relief. Lets start with herbal products. All herbal products are available without a prescription, some are advertised as mail order. Most of these products contain a combination of soy isoflavones, black cohoosh and evening of primrose. Each of these different components have been looked at and studied, there is a wide variety of results. For as many women you find who have been helped by herbal products, just as many have noticed no benefit from them. Soy is probably the best known and perhaps the most effective herbal product. It contains isoflavones which have estrogen-like properties although it is plant based. Women taking between 50-100mg daily have had reduction in hot flashes. This is best taken in the diet in the form of soy, tempeh, soy mild and miso. Isoflavones are present to a much lesser degree in peanuts,peas, beans and flax seed. Soy is also available in pill form but it is not as effective in this form.
Also used and touted to reduce hot flashes is black cohoosh which is also plant based. There have been trials in the US as well as in Europe using black cohoosh root stock (Remifemin) which is showing very effective reduction of hot flash frequency and intensity, the product is felt to be more standardized as it comes from root stock. It has been unclear how black cohosh relieves hot flashes but is has been suggested it works through the thermoregulory center in the brain. Lastly, Evening of Primrose Oil has also been pro ported to help with hot flash relief. This claim appears to be more tenuous then black cohosh and soy. Close study has not shown any great reduction of hot flashes, although it does appear to help eczema. There are also claims it helps breast pain, premenopausal symptoms and arthritis. EPO(evening of primrose oil) is an essential fatty acid and also contains gamma-linolenic acid.It has been theorized to have anti-inflammatory effects as its mode of action in reducing hot flashes. EPO has some serious side effects and interactions with certain medications, and should only be used after discussing with you medical provider. These items come in pills, and can be effective in relieving hot flashes, although have not been found to be as effective as soy.
None of these preparations are regulated by the FDA, so active ingredients can vary. It is important to buy a brand which states on the label that there is quality control performed on each batch manufactured. With soy products, there is some controversy as to the potential risk of breast cancer and because soy is estrogenic in nature, there is the possibility that soy supplements have the same risk factors as estrogen products, but to a lesser extent. There are no studies to substantiate this, however it is now felt within the medical community that a women who has had a female cancer or cardiovascular event (stroke, blood clot, heart attack) should avoid soy supplements.
All of the above herbal products are not as effective as estrogen products. The decision to use estrogen products is often a difficult decision due to potential risks such as possibility of breast cancer, and cardiovascular events such as blood clots, stroke or heart attack. Estrogen products replace the estrogen that the body is not producing as much of anymore. It can quickly eradicate the symptoms of menopause, and is usually safe for a few years which is often enough to get through the worst of symptoms. It is usually taken in pill form and must be taken with progesterone if you have an intact uterus. Estrogen can be taken alone if a women has had a hysterectomy. By taking estrogen, the uterine lining will become thicker, just as when a woman is having regular menses. If this lining is not shed, an endometrial, or uterine, cancer can develop. If you don’t have a uterus, then you don’t need to shed anything and don’t need progesterone. Estrogen is prescribed by a medical provider and attempts at using the lowest possible dose should be made. Estrogen products were widely used until the publication of the long term study “The Women’s Health Initiative” which revealed an increase in breast cancer, stroke and heart attacks in women using estrogen and progesterone. This study continues to be re-evaluated but did cause a significant decrease in estrogen and estrogen/progesterone usage. This hormonal product comes in several forms and should be discussed at length with your provider before deciding or not deciding to take.
More recently there has been usage of certain blood pressure medications and certain antidepressants to lessen or relieve hot flashes. Clonidine, a blood pressure medication, works to reduce hot flashes by altering the degree of blood vessel dilation in the skin in response to the brains’ command to give off heat. Effexor, an antidepressant, works by altering how epinephrine and serotonin respond to the brain’s heat alarm. This medication showed significant relief of hot flashes in breast cancer patients, and is now being used in non breast cancer patients with menopause symptoms.
While there are many options now for hot flash relief, it is important to remember that it is difficult to completely eliminate hot flashes and as with everything in life, there is a balance between symptoms and relief of symptoms. When you try to tweek mother nature, there can be consequences. It is always important to consider how much you feel you need relief, and the potential risks therapy may bring. Menopause is a time of life that women must pass through, and it is inevitable that some changes occur that are unwelcome. The key is finding a balance that works for you and paying attention to what is happening to your body, and continuing to try to change your lifestyle to adjust to those changes so you remain healthy as you move through this change of life.
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