Is Menopause Never-Ending?

End Of Menopause

I am almost there

As you have probably noticed, many women seem to breeze through menopause with mild symptoms that last for just a short period of time. Others suffer with debilitating symptoms that seem to go on forever. And….there seems to be no rhyme or reason for either.

I have helped thousands of women during their menopause journeys. I cannot think of a single patient who didnt ask me, at some point during their meno-journey, how long menopause would last.

It is not possible to know when the end of menopause will occur, given the current level of research into menopause. When I am asked about the end of menopause symptoms, my response is to

  • provide them with information about the stages of the entire menopause process. Those stages are early menopause transition, late menopause transition, early postmenopause and late postmenopause
  • help them manage their expectations as they progress through the menopause stages

Stages of menopause and menopause symptoms

During the early and late menopause transition stages (perimenopause), you can expect to experience any of the symptoms of menopause.

During the early postmenopause stage, you can expect to continue to experience most of the symptoms you experienced in the two earlier stages. Towards the end of early postmenopause, your hormone levels will begin to stabilize and many of the symptoms you had been experiencing will reduce or even stop.

During late postmenopause, the predominant symptoms experienced by many women are hot flashes/night sweats, vaginal atrophy, and joint pain.

The cause of vaginal atrophy is low levels of estrogen. Vaginal atrophy progressively worsens as you age, unless you treat it with some form of estrogen therapy. Joint pain is caused by inflammation in and around the joint. Low levels of estrogen, during postmenopause, exacerbates joint pain because estrogen fights inflammation. Estrogen therapy helps to reduce joint pain.

The cause of hot flashes is not certain, but it is thought to be related to falling levels of estrogen during early and late menopause transition and low levels of estrogen during postmenopause stages. The drop in estrogen confuses the hypothalamus — which is sometimes referred to as the body’s “thermostat” — and makes it read “too hot.” The hypothalamus apparently senses that your body is too hot, even when it is not, and tells the body to release the excess heat (hot flash).

When can you expect an end to hot flashes?

Just as in perimenopause, the prevalence, frequency, severity and duration of postmenopause hot flashes vary considerably.

One study of more than 10,000 postmenopausal women was conducted to learn more about postmenopause hot flashes. The study collected information from these women for 3.5 years. The researchers found the following

  1. 89% of the women experienced hot flashes/night sweats during the 3.5 years
  2. more women had hot flushes (86%) than night sweats (78%)
  3. the frequency of hot flashes/night sweats was 33.5 per week

Another study that followed 436 menopausal women from 1995 – 2009 (thirteen years) shed more light on postmenopause hot flashes. All of the women were between the ages of 35-47 in 1995. The findings of this study were as follows

  • the median duration of moderate to severe hot flushes was 10.2 years
  • women whose moderate to severe hot flashes commenced in the early menopause transition stage had a median duration of 7.35 years
  • women whose moderate to severe hot flashes commenced in the late menopause transition to early postmenopause stage had a median duration of 3.84 years
  • The most common ages at onset of moderate to severe hot flashes were 45–49 years. For this group, the median duration was 8.1 years

Bottom line: The earlier you begin to have hot flashes during the menopause transition stages, the longer you can expect them to continue during postmenopause.

Managing your expectations about the end of menopause symptoms

Managing your expectations, concerning the end of menopause symptoms, creates breathing room for your experiences. It allows you to live more calmly, with less stress, disappointment and upset.

I am reminded of a true story concerning American POWs, who were held captive by the North Vietnamese during the Viet Nam war.

The most senior POW was an American admiral. He noticed that many of the POWs, subordinate to him, became distraught as a result of setting specific dates by when they expected to return home to the US. When those dates passed, and they remained in captivity, he noticed that they became anguished and frantic…almost to the point of hysteria.

The admiral counselled POWS to keep the thought firmly in their minds that they WILL be returning home….but not to set a date in their minds (over which they had no control) of when it will happen.

The same applies to the end of menopause symptoms for you. Know that they WILL end….you just dont know when.

Share

Keep Your Ovaries……Ladies

Hysterectomy

Women without ovaries are at higher risk of heart disease, than women with their ovaries

I have been asked the following type of question frequently…..

I am having a hysterectomy because I have painful fibroids. My surgeon wants to take out my ovaries at the same time. He says that I dont need them anymore, since I am menopausal. What should I do?

When your doctor recommends that you have your ovaries removed, during a hysterectomy to correct a benign condition, think very carefully about it before proceeding.

The presence of ovarian cancer is the only legitimate medical reason to remove the ovaries.

There are more than 600,000 hysterectomies performed every year in the US. Hysterectomy, is the second most commonly performed surgical operation on women, after Cesarean delivery.

Today there is growing sentiment that many of the hysterectomies performed are unnecessary. It is argued that around 10% of the hysterectomies performed are necessary, due to the presence of cancer. That amounts to around 60,000 hysterectomies. The remaining 540,000 hysterectomies are performed for benign conditions, which either resolve themselves over time or which have alternative treatments that are less invasive.

In the United States, 78% of women 45 to 64 years old …. and 55% of women overall …. undergo bilateral oophorectomy (removal of both ovaries) at the time of hysterectomy. These percentages mean that almost 300,000 women undergo bilateral oophorectomy each year.

Why doctors encourage you to have your ovaries removed

It has been common practice to counsel women who were in their mid-40s or older and who were planning to have a hysterectomy for benign conditions, to undergo bilateral oophorectomy at the time of the hysterectomy. The rationale for this approach has been that oophorectomy greatly decreases the risk of ovarian cancer. However, according to the American Cancer Society, the risk of ovarian cancer is extremely low.

A woman’s risk of getting invasive ovarian cancer in her lifetime is about 1 in 72. Her lifetime chance of dying from invasive ovarian cancer is about 1 in 100.

Dr. Mitchell Levine, a prominent ob-gyn who teaches at the Tufts and Harvard Schools of Medicine, says that doctors are taught that once a woman is done having children her ovaries are a ticking time bomb…..and they should be removed to prevent ovarian cancer.

Why you should not allow your ovaries to be removed unnecessarily

There is a common misconception that when you reach menopause, your ovaries no longer produce estrogen and other hormones. This is incorrect. The production of estrogen by your ovaries does not go to zero at menopause. Your ovaries continue to produce estrogen, for the rest of your life, but much less of it. They also continue to produce testosterone and androstenedione, which is converted by your body into estrogen.

What is the significance of having estrogen in your body? Estrogen protects your heart from heart disease. Whats more….studies show that estrogen also protects you from stroke, hip fracture, Parkinson’s Disease, dementia, cognitive impairment, depression, and anxiety.

If your ovaries are removed, your body will be deficient in estrogen. A major study was conducted in 2008 to determine the affect of hysterectomy on women’s health. It was led by Dr William H. Parker, a noted gynecological surgeon. The study reviewed the health of 29,000 women who had hysterectomies for non cancerous conditions. 16,000 of these women had their ovaries removed. 13,000 of these women retained their ovaries. The findings of the study, which was reported in 2009 were as follows

  • women whose ovaries were removed had a higher risk of death from any cause, and had a significantly higher risk of heart disease, stroke and lung cancer
  • While breast cancer and ovarian cancer were less frequent in women who had their ovaries removed, the overall risk of death from all types of cancer was higher among women who had their ovaries removed

To put these findings into context, ovarian cancer accounts for 14,700 female deaths per year in the U.S., heart disease causes 326,900 female deaths, and stroke causes 86,900 female deaths each year. The risk of death from heart disease is 23 times greater than the risk of death from ovarian cancer. The risk of death from stroke is 6 times greater than the risk of death from ovarian cancer.

If a woman is at such a low risk for ovarian cancer with her ovaries intact, and at such a high risk for heart disease and stoke as a result of her ovaries having been removed, does it make sense to you to have your ovaries removed?

The truth is that by consenting to have your ovaries removed, your risk of ovarian cancer is reduced somewhat….but in so doing your risk of heart disease increases by 500% (that’s by 5 times).

So if you’re looking at odds, you would be wise to keep your ovaries.

Share

Is Bioidentical HRT Safer Than Conventional HRT?

Bioidentical HRT

Is it or isnt it safe?

Many women toil over whether or not to pursue hormone therapy, as they experience menopause symptoms that are affecting the quality of their lives. It can be a difficult decision, especially with all the media headlines and fears instilled from previous studies, like the WHI.

Ever since 2002 …. when the WHI (Women’s Health Initiative) study found that conventional HRT increased a woman’s risk of breast cancer, heart attack and stroke …. women have been looking for effective treatments for their menopause symptoms, that do not bear these health risks.

According to the National Cancer Institute, there can be no doubt that taking conventional HRT, in the form of synthetic estrogen plus progestin or synthetic estrogen only, increases the risks of these health conditions.

But…..does taking bioidentical HRT (BHRT) carry these same risks?

Definitions of conventional HRT and bioidentical HRT products

The most popular form of conventional HRT is a product consisting of synthetic estrogen plus progestin (a synthetic form of progesterone). This is sometimes referred to as combined hormone therapy. Another form of conventional HRT is estrogen only (also synthetic).

It is a little more difficult to describe bioidentical HRT products.

The Endocrine Society has defined bioidentical hormones as “compounds that have exactly the same chemical and molecular structure as hormones that are produced in the human body”.

Advocates of bioidentical HRT describe the estrogen and progesterone that they use as natural, as opposed to synthetic. They say that they are biologically identical to the hormones made by a woman’s body, whereas the hormones taken in conventional HRT are not. They say that when you take bioidentical hormones, they function in the same way as the hormones made by your own body. Furthermore, they say that synthetic hormones do not function in the same way as the hormones made by your own body.

What advocates of bioidentical HRT say about BHRT safety

  • The International Hormone Society

    There currently is sufficient evidence confirming the greater safety of bioidentical sex hormones compared to the nonbioidentical ones, in particular when the transdermal, nasal or intramuscular routes are used instead of the oral route.

  • Virginia Hopkins, medical writer, discusses the findings of the E3N study that examined the association between HRT and breast cancer

    The study involved 54,548 postmenopausal women who had not been on any kind of HRT for at least a year before entering the study. The average age was 53, and the study lasted for almost 6 years.

    Compared to women who had never used HRT, those using estrogen plus synthetic progestins had a 40% increased risk of breast cancer, while those using estradiol plus progesterone (e.g. bioidenticals) had a 10% decreased risk of breast cancer.

    In January 2008, with eight years of follow-up, data was released from E3N showing that women using synthetic HRT had a 60% higher risk of cancer, while women using bioidenticals still had the same risk as women using no HRT of any kind.

  • Dr. Kent Holtorf, MD, a specialist in bioidentical hormone therapy and anti-aging medicine

    A thorough review of the medical literature clearly supports the claim that bioidentical hormones have some distinctly different, often opposite, physiological effects to those of their synthetic [non-bioidentical counterpart] hormones.

    With respect to the risk for breast cancer, heart disease, heart attack, and stroke, substantial scientific and medical evidence demonstrates that bioidentical hormones are safer and more efficacious forms of HRT than commonly used synthetic versions.

What conventional medicine authorities say about bioidentical hormone therapy

  • Dr. Adriane Fugh-Berman, MD and associate professor of pharmacology and physiology at Georgetown University Medical Center

    A 2008 study of more than 80,000 French women found that while combining estrogens (including bioidentical estradiol) with conventional synthetic progesterone significantly increased breast cancer risk, combining them with bioidentical progesterone did not.

  • Dr. Alan Garber, MD, PhD, chief medical editor of Endocrine Today

    Bioidentical hormone replacement is a clever marketing concept devoid of scientific underpinnings, and preys upon the patient’s desire for better hormonal replacement therapies that are both safe and effective, properties totally unproven by the proponents of such agents.

  • Dr. Robert W. Rebar, MD, and Executive Director of the American Society for Reproductive Medicine

    It is difficult to understand why women continue to request bioidentical hormones despite a lack of data. Why would anyone put something into her body that no one has ever tested?

My take on bioidentical HRT and conventional HRT safety

Bioidentical HRT has yet to conclusively demonstrate safety and efficacy by means of well-designed, head-to-head clinical trials in which bioidentical hormones are compared against synthetic hormones.

Such trials may be a very long time in coming. Almost all clinical trials are funded by pharma companies. Pharma companies view the providers of BHRT as competitors. Pharma companies have billions of dollars invested their conventional HRT products. It would not be in their interests to fund such trials.

To borrow from the theme of Dr. Rebar’s message above

Why would a woman put synthetic HRT products into her body …. when they have been found to increase her risk of breast cancer, heart attack and stroke …. when an alternative is available that appears to be at least as effective and which does not appear to carry the same health risks?

Share

A Way To Take HRT …. That Reduces Health Risks

HRT

I want relief from my symptoms....without increasing risks to my health

Ever since 2002 …. when the WHI (Women’s Health Initiative) study found that conventional HRT increased a woman’s risk of breast cancer, heart attack and stroke …. women have been looking for effective treatments for their menopause symptoms, that do not bear the levels of health risks found by the researchers.

As HRT is the most effective treatment at relieving hot flashes, night sweats, mood swings, vaginal atrophy, joint pains and other symptoms …. I am often asked about the different methods of taking it and their relative safety.

Methods of taking conventional HRT and bioidentical HRT

  • a pill or tablet taken daily is the most frequently utilized method of hormone therapy in the world. We have become accustomed to taking pills and it is easy to take
  • transdermal (through the skin) patch is a delivery system that allows the hormone to be gradually absorbed by the skin. It is applied to the skin and replaced once or twice weekly as contrasted to the daily estrogen pill
  • transdermal gel – A measured amount of gel is rubbed on the skin once daily. It is absorbed and the skin, acting as a reservoir, releases it gradually into the bloodstream
  • transdermal cream – It acts much in the same way as transdermal gel. It has to be put on thin areas of the skin, such as the inner arms, to get into the blood stream. If put on fatty areas such as the buttocks, the hormones may sit in the fat cells, immediately beneath the skin, and not get into the bloodstream.

    Some women apply it to the vagina. When used in that way, it acts as a lubricant during intercourse. It also strengthens the walls of the vagina, which become weaker during menopause because of lower levels of estrogen

  • pellets – They are inserted into the fatty tissue directly under the skin of the abdomen or buttock, usually at 3-6 month intervals. It is a convenient delivery system, inasmuch as you dont need to bother with taking your hormones regularly.

    There is a downside to using this method. Once they are injected under the skin, they don’t come out. A woman is stuck with those hormone dosages for months. If she’s getting too much of a particular hormone, she may suffer months of unwanted side effects such as bloating, breakthrough bleeding, insomnia, weight gain and so forth

  • intramuscular injection is a common method of hormone replacement and is used by many physicians. It is usually given at 2-4 week intervals.

    It has the disadvantage of relatively high levels soon after the injection, which decline rapidly after a week or so. Unfortunately, this may perpetuate menopausal symptoms which are often associated with declining hormone levels

Health risks associated with the different methods of HRT delivery

  1. pills or tablets, taken orally, carry the highest health risks. If you swallow hormones, only 10-15 percent will eventually reach the target tissues and you will need to take an oral dose that is 500 percent higher than you need. A hormone pill has to travel through the digestive system and liver before being delivered to the blood, so as much as 80 to 90 percent of it is lost in this process.

    HRT taken orally carries a higher risk of heart attack and stroke. Oral hrt increases risk of thrombosis, whereas transdermal does not

  2. creams, gels and patches are presently the most effective hormone delivery system, because hormones enter the bloodstream directly and gradually. Virtually all of the hormone in the cream, gel or patch gets into the bloodstream.

    Transdermal delivery of HRT permits the correct dosage of hormones to be administered, whereas hormone therapy taken orally requires higher dosages than needed…..because only 10%-15% of the dosage makes it into the bloodstream.

    It is the safest way to take hormone replacement therapy. HRT taken orally carries 2-3 times higher risk of blood clots and strokes than transdermal HRT. Studies have found that there is no increase of blood clot and stroke risk when HRT is taken transdermally

Share

What You May Not Know About Bioidentical HRT and Conventional HRT

bioidentical HRT

Should I take BHRT?

Bioidentical hormone therapy (BHRT) is a form of HRT that has become increasingly popular since 2002.

Prior to 2002, 13 million women in America were taking conventional HRT to relieve their menopause symptoms. It was the favored treatment for menopause symptoms. In 2002, an extensive WHI (Women’s Health Initiative) study found that conventional HRT increased a woman’s risk of breast cancer, heart attack and stroke. These findings had wide media coverage and with that women abandoned the use of conventional HRT in droves.

However conventional HRT is effective at relieving hot flashes, night sweats, mood swings, vaginal atrophy, joint pains and other symptoms. Women want relief from their menopause symptoms, but without the health risks now associated with conventional HRT. Bioidentical hormone therapy promises this.

Definitions of conventional HRT and bioidentical HRT products

The most popular form of conventional HRT is a product consisting of synthetic estrogen plus progestin (a synthetic form of progesterone). This is sometimes referred to as combined hormone therapy. Another form of conventional HRT is estrogen only (also synthetic).

It is a little more difficult to describe bioidentical HRT products

The Endocrine Society has defined bioidentical hormones as “compounds that have exactly the same chemical and molecular structure as hormones that are produced in the human body”.

Advocates of bioidentical HRT describe the estrogen and progesterone that they use as natural, as opposed to synthetic. They say that they are biologically identical to the hormones made by a woman’s body, whereas the hormones taken in conventional HRT are not. They say that when you take bioidentical hormones, they function in the same way as the hormones made by your own body. Furthermore, they say that synthetic hormones do not function in the same way as the hormones made by your own body.

For these reasons, advocates claim that bioidentical HRT is safe from the health risks associated with conventional HRT.

What medical authorities say about conventional HRT vs Bioidentical HRT

Most medical doctors prescribe conventional HRT, and not BHRT, when hormone therapy is appropriate for a woman. If you want to take BHRT, you will have to go to a medical doctor who practices holistic medicine or to an alternative medicine practitioner.

Leading medical authorities give more credence to conventional HRT over BHRT. They say that whereas conventional HRT has had medical studies done to support its claims, medical studies have not been done to support the claims made by advocates of BHRT.

I think that this position on BHRT, taken by leading medical authorities, should be taken with a grain of salt

  • almost all medical studies are funded by pharma companies and they are not about to fund studies that support BHRT. Pharma companies view the providers of BHRT as competitors. Pharma companies have billions of dollars invested their conventional HRT products
  • pharma companies do not invest in their own bioidentical hormone products, because they cant patent a bioidentical hormone. They cant patent something that is natural. It would be like trying to patent air.

    Without a patent, they cant make money from a product. Their synthetic HRT products are patentable. This is why they produce, promote and defend their patented synthetic HRT products against accusations that they can cause health risks to users

  • leading figures in medical academia and in prominent medical organizations have had financial relationships with pharma companies, in connection with pharma HRT products. They have either been paid consultants to pharma companies or they have allowed their names to used by pharma companies in articles written by pharma companies or their agencies

I hope that this post has provided you with an increased understanding of some of the issues connected with bioidentical HRT and conventional HRT.

Share

Does HRT Save Lives Or Threaten Lives?

HRT

Is HRT right for you?

HRT is controversial. Some women say that it has saved their lives. Others say it can kill.

The viewpoint that you have on this issue will be influenced by the following factors

  1. the circumstances in your life now
  2. your tolerance level of menopause symptoms
  3. your beliefs
  4. your personal life values

The experiences of women during the menopause journey varies greatly. Some women experience mild symptoms, while others experience moderate symptoms, while others experience debilitating severe symptoms. Some women are done with menopause in a year or two. For other women, it can last for 10-20 years or more.

The life circumstances of women going through menopause also varies greatly

  • What age did you enter perimenopause? Were you in your 30s, 40s, or 50s?
  • do you have to care for children?
  • do you have to care for elderly parents
  • how supportive is your husband/partner of your menopause symptoms? How supportive are the other people with whom you live?
  • are you employed? If yes, does your job require peak performance for all or a lot of the time?
  • what is your personal health history?
  • what is the health history of your parents and siblings?

Your tolerance level of the symptoms you are experiencing will have an influence on your decision to take HRT. Just as we each have a different tolerance level of pain, every woman has her own unique tolerance level of the symptoms she experiences during menopause. Some women have a high tolerance level; others have a low tolerance level and some others are in between. There is no right or wrong, or good or bad tolerance levels. Your tolerance level is what it is.

Your beliefs are a major factor in arriving at your view about HRT. Women hold differing beliefs about

  1. the value of natural vs synthetic treatments and remedies
  2. the value of conventional medicine vs CAM
  3. the integrity of the pharma industry
  4. the influence that the pharma industry has with conventional medicine bodies and individual doctors

Personal life values also play a significant role in this, as well. Is your long term health more important to you or is your quality of life now, and in the immediate future, more important to you? Of course both are important to you, but your view about HRT will be influenced by which of these factors is more important to you.

The benefits of hormone replacement therapy

  • it is very effective in providing relief from menopause symptoms…..during the period of time that you are taking it. It eliminates/reduces hot flashes, night sweats, mood swings, vaginal atrophy, joint pains and other symptoms. However, as doctors recommend that it should only be taken for a short period of time, many women experience a return of menopause symptoms when they stop taking HRT
  • with the elimination/reduction of menopause symptoms, comes a return to normal living …. life as it was prior to the onset of menopause, or close to it
  • all studies show that it reduces the risk of osteoporosis, while you are taking it. 50% of menopausal women are likely to experience osteoporosis, after menopause. The falling levels of estrogen during menopause, and low levels after it, weakens your bones.

    The effect that HRT has on bone density, after treatment has ended, is inconclusive. There is some evidence to show that it can offer a protective effect on bone density for several years after treatment is stopped. Other evidence shows that it only offers a protective effect on bone density while it is being taken

The risks of taking hormone replacement therapy

According to the National Cancer Institute, research from the WHI studies has shown that HRT is associated with the following harms

  1. Urinary incontinence. Use of estrogen plus progestin increased the risk of urinary incontinence
  2. Dementia. Use of estrogen plus progestin doubled the risk of developing dementia among postmenopausal women age 65 and older
  3. Stroke, blood clots, and heart attack. Women who took either combined hormone therapy or estrogen alone had an increased risk of stroke, blood clots, and heart attack. For women in both groups, however, this risk returned to normal levels after they stopped taking the medication
  4. Breast cancer. Women who took estrogen plus progestin were more likely to be diagnosed with breast cancer. The breast cancers in these women were larger and more likely to have spread to the lymph nodes by the time they were diagnosed. The number of breast cancers in this group of women increased with the length of time that they took the hormones and decreased after they stopped taking the hormones

There can be no doubt that taking HRT, in the form of estrogen plus progestin or estrogen only, increases the risks of these health conditions.

However, there are different ways of interpreting the risks associated with taking HRT. Many statistics, about these health risks, are bandied about by various individuals, groups and organizations with vested interests. It is advisable to interpret the statistics yourself, rather than relying upon the interpretation provided by these vested interests.

This post is the first of a series of posts, that will be forthcoming about hormone therapy. The subjects include HRT vs BHRT (bioidentical hormone therapy), pros and cons of BHRT, methods of taking hormone therapy, efficacy and safety of taking hormones by the various methods, and what happens when you stop taking hormones.

Share

Hot Flashes – FDA Approves First Non Hormonal Drug Treatment

Hot Flashes

My hot flashes are debilitating

Until now, the only FDA approved products proven to reduce hot flashes have been estrogen based prescriptions. Now for the first time, doctors can prescribe an FDA approved non hormonal drug for women who are averse to taking synthetic estrogen products for their hot flashes.

The drug is Brisdelle. It is a low dose of paroxetine, which is a selective serotonin reuptake inhibitor (SSRI) antidepressant. Paroxetine had been approved by the FDA for treatment of depression, but not for hot flashes.

Doctors have known for quite a while that paroxetine significantly reduces hot flashes.
They have been prescribing it “off label” to treat it. “Off label” is the practice of prescribing a drug approved by the FDA for treatment of a specific condition….for a different condition for which it does not have FDA approval.

The fact that paroxetine now has FDA approval for hot flash treatment, will please many doctors who had been prescribing it off label. Because it had FDA approval just for use as an antidepressant, it was only available at a higher dose than what is needed for hot flash treatment. The higher dosage is needed to treat depression. Now it will be available at low dosage.

One physician said this about the news

I, like many physicians, have in the past prescribed paroxetine “off label”. There are two reasons why I am glad I can now prescribe a low dose FDA approved version as opposed to generic paroxetine

  1. Paroxetine at higher doses is intended for, studied and FDA approved only for the treatment of depression, not hot flashes.

    Many of my patients have received a prescription and then also had the experience of their insurance company giving them a diagnosis of depression even though they are not depressed. Just hot.

    I had one patient for whom I prescribed Paxil for hot flash relief (clearly documented on her electronic medical record) who was contacted by her insurance company to see if her “depression” was improving and to offer psychotherapy!

    Brisdelle 7.5 mg is FDA approved only for treatment of moderate to severe hot flashes as a result of menopause. It cannot, and should not, be prescribed for treatment of depression and therefore is not interpreted as a treatment for depression on your medical record

  2. The doses of generic paroxetine available for treatment of depression are higher than needed to relieve hot flashes.

    With higher dosage, comes a greater risk of side affects. As an example, Paxil and other SSRI’s are associated with an increase in sexual problems and an increase in pounds. The last thing a menopause women needs is a drug that might sabotage her diet or an already waning sex drive.

    In clinical trials, Brisdelle, with only 7.5 mg of paroxetine, did not demonstrate a decrease in libido or an increase in weight

The use of Brisdelle to reduce hot flashes, may be of interest to many women who seek relief from them….from their medical doctors. HRT is the only other treatment prescribed by conventional medical practitioners and just a very small % of women who experience hot flashes, take HRT.

HRT (synthetic hormone products manufactured by pharmaceutical companies) is effective at relieving hot flashes and other menopause symptoms. 13 million women in America were taking it to relieve their menopause symptoms, until the 2002 findings of the WHI study, which examined health risks associated with taking HRT, were announced. It was the favored treatment for menopause symptoms.

The WHI study found that the increase in the relative risk for breast cancer was 26%, for heart attack 29%, for stroke 41%, for blood clots 100%, and for Alzheimer’s or dementia, over 100%. Since that time less than 15% of menopausal women take HRT.

Since 2002, women, who are concerned about the health risks of taking HRT, have been looking for hot flash treatments and remedies for menopause symptoms that are free of those health risks. In fact, just 7% of women who experience hot flashes take HRT to relieve them. Most of the rest of the women “grin and bear” them …. some with humor, many without it.

If you have been toughing it out with respect to your hot flashes….and you are not averse to taking non hormonal drugs to reduce them….Brisdelle may be a treatment option for you to consider.

Share

HRT Vs Going Natural – Which Is Better?

HRT

Which way is better for me?

This question can generate an emotional, and often heated, response from advocates on both sides. HRT is controversial. Some say that it has saved their lives. Others say it can kill.

Some advocates of the natural route suggest that it is nobler to go natural. They imply that it is a matter of personal strength and that those who take HRT are weaker than those you go natural. Some advocates of HRT are incensed by attitudes like this.

What has brought about this divide?

HRT (synthetic hormone products manufactured by pharmaceutical companies) is effective at relieving many of the menopause symptoms. 13 million women in America were taking it to relieve their menopause symptoms, until the 2002 findings of the WHI study, which examined health risks associated with taking HRT, were announced. It was the favored treatment for menopause symptoms.

The WHI study found that the increase in the relative risk for breast cancer was 26%, for heart attack 29%, for stroke 41%, and for blood clots 100%. Since that time less than 20% of menopausal women take HRT.

Since the release of these findings, sales of HRT products by pharma companies have plummeted. Pharma companies have resorted to using unscrupulous marketing techniques in an attempt to boost sales. These marketing techniques were brought to light during court cases against pharma companies, brought by women who have experienced serious health problems as a result of taking HRT.

The media revelation of the use of these unscrupulous marketing techniques by pharmas, plus the revelation in the media that most OB-GYNs do not receive training about menopause and do not understand it, causes many women to be suspicious when doctors recommend HRT for their menopause symptoms.

Since 2002, women, who are concerned about the health risks of taking HRT, have been looking for “natural” treatments for menopause symptoms that are free of these health risks. “Natural” treatments are classified as CAM (complementary and alternative medicine) and holistic medicine.

CAM is an acronym for complementary and alternative medicine. Complementary medicine is used together with conventional medicine, and alternative medicine is used in place of conventional medicine.

Holistic medicine is also referred to as integrative medicine. Holistic medicine physicians combine conventional and CAM treatments. Many holistic physicians also prescribe bioidentical hormone therapy (BHRT) to treat menopause symptoms.

Advocates of BHRT say that bioidentical hormones are natural and that they exactly duplicate the hormones that are produced by your body. They say that it without the health risks associated with taking synthetic HRT, but this has not been verified by studies. However proponents of HRT present the argument that their synthetic HRT products are natural, as well. Some advocates of the natural approach to menopause consider BHRT as natural; others consider it to be part of HRT.

Is going natural better than taking HRT?

The horse racing community has a maxim that appropriately answers this question

different horses for different courses

The experiences of women during the menopause journey varies greatly. Some women experience mild symptoms, while others experience moderate symptoms, while others experience debilitating severe symptoms. Some women are done with menopause in a year or two. For other women, it can last for 10-20 years or more.

Also, the life circumstances of women going through menopause varies greatly

  • how old is she when she enters perimenopause? Is she in her 30s, 40s, or 50s?
  • does she have to care for children?
  • does she have to care for elderly parents
  • how supportive is her husband/partner of her menopause symptoms? How supportive are the other people with whom she lives?
  • is she employed? If yes, does the job require peak performance for all or a lot of the time?
  • what is her personal health history?
  • what is the health history of her parents and siblings?

Personal life values enters the picture as well. Is long term health more important to her or is her quality of life now, and in the immediate future, more important to her?

There is no right or wrong, or good or bad, way to go through menopause. There is only
a best way to go through menopause for each individual woman ….. and that is based upon the above factors.

I believe that each woman needs to come to her own conclusion about the best route for her to take through menopause. I also believe that it is best to maintain a non judgmental attitude to the choices made by others, in connection with menopause …. and other events in life, because you do not know the circumstances that led to their choices.

Share

Hair Loss During Menopause – What Can You Expect?

Hair Loss During Menopause

Will I go bald, if I keep losing hair at this rate?

Does it worry you when
  • hair falls out in large clumps when washing it?
  • large clumps of hair appear in your brush or comb?
  • you notice a visible thinning of your hair on the front, sides or top of your head?

If you are experiencing any of the above, you are in the majority…..not the minority.

Please let me put your mind at ease…..it is extremely unlikely that you will go bald. Going completely bald is a man’s thing.

Female hair loss usually begins at around the age of 30 and even as early as in the 20s or earlier. 40% percent of women have visible hair loss by the time they are age 40, according to the American Academy of Dermatology. It may get even more noticeable after menopause. By the age of 50, 50% of women will experience some degree of hair loss. 80 % of women will have noticeable hair loss by age 60.

The growth and loss of hair


Hair growth and hair loss occurs in a cycle that has 2 main phases
  1. Anagen – this is the hair growth phase. Normally, hair grows about a half inch a month for 2-6 years, and then it goes into a resting phase. Approximately 85% of the hair on your head is in this phase
  2. Telogen – this is known as the resting phase. Hair loss occurs during this stage. Normal hair fall is approximately 100-125 hairs per day. Fortunately, these hairs are replaced. True hair loss occurs when lost hairs are not regrown or when the daily hair shed exceeds 125 hairs. Approximately 15% of the hair on your head is in this phase

According to MedlinePlus, which is a service of the U.S. National Library of Medicine and National Institutes of Health, the average scalp has 100,000 hairs and each person loses approximately 100 hairs daily. Each hair grows an average of about half an inch a month and grows on average for 2-6 years. After a cycle of rest, the hair falls out and a new strand begins to grow in its place.

Why you lose more hair as you age

Doctors know that hair thickens in pregnant pre-menopausal women due to increased levels of estrogen. Increased estrogen increases the ratio of actively growing hair (anagen) to resting hair (telogen). The exact opposite happens to women after entering menopause.

While estrogen helps hair grow faster and stay on your head longer …… leading to thicker, healthier hair ….. falling levels of estrogen during menopause and low levels after menopause are not he only cause of hair loss. Other hormones contribute to hair loss

  • testosterone – during menopause testosterone levels fall, but not as much as estrogen. This creates testosterone dominance. A form of testosterone, known as DHT, is damaging to your hair and contributes significantly to hair loss during menopause
  • progesterone – it functions as a natural DHT blocker. Prior to perimenopause, it protects your hair from DHT. During perimenopause and after that, low levels of progesterone makes your hair more susceptible to damage from DHT
  • thyroid hormone – hypothyroidism (underactive thyroid – the body is producing insufficient thyroid hormone) is a common condition during menoapause. It causes hair loss, not just on the scalp, but also anywhere on the body. A unique and characteristic symptom of hypothyroidism is loss of the hair on the outer edge of the eyebrows

What you can do to reverse hair loss during menopause and after that

Hair loss often has a greater impact on women than on men, because it’s less socially acceptable for them. It can be absolutely devastating for self image and emotional well-being. Many women with hair loss suffer in silence, altering their hairstyle to hide thinning hair.

If you are in perimenopause and you want to reverse your hair loss, here is what I recommend

  1. get the levels of your hormones tested
  2. rebalance your hormones, under the supervision of a hormone expert

If you are in postmenopause

  1. get your thyroid tested. If the test finds that you have an underactive thyroid, your doctor can remedy that
  2. take bioidentical estrogen therapy to increase your estrogen levels. Conventional medicine practitioners may prescribe synthetic estrogen therapy. If you increase your estrogen levels by taking synthetic estrogen therapy, you increase your risk of breast cancer. You do not increase your risk of breast cancer by taking bioidentical estrogen therapy
Share

Menopause Joint Pain – What You May Not Know About It

Menopause Joint Pain

I am so stiff after sitting for a while

More women than you may think experience menopause joint pain and aches. 41% of women approaching menopause and 57% of women 2 years past menopause, report that they experience significant joint pains and aches.

Menopause joint pain can make you feel as if you have been petrified. It can make you feel old …. it can make you feel like things are falling apart and that the warranty on your body is up. I can understand it if, on some days, all you want to do is lie in bed all day.

Joint pain is caused by inflammation. Is menopause joint pain arthritis? Arthritis is inflammation of one or more joints. A joint is the area where two bones meet. Also, the derivation of the word arthritis provides us with a clue to the answer. It comes from the Greek “arthron” meaning joint and the Latin “itis” meaning inflammation.

The term “arthritis” encompasses more than 100 diseases and conditions. Osteoarthritis is the most common form. It is estimated that the majority of people have it by age 65 and that 80 percent of people over 75 years of age have it.

The North American Menopause Society says this about joint pain

Whether the cause is loss of estrogen, the aging process, or a combination of the two remains unclear. We do know that after menopause there is an increase in both severity and frequency of some kinds of arthritis

However, here are 2 telling facts about arthritis

  1. the onset of arthritis is gradual and usually begins after the age of 40
  2. more women get arthritis than men. 60% of the sufferers are women

These facts, plus several medical studies, lead me to think that falling levels of estrogen during perimenopause and low levels of estrogen after menopause are very significant factors in menopause joint pain. Postmenopause estrogen levels are 10% of what they are prior to perimenopause.

Estrogen and menopause joint pain – the evidence

  • In 2005 two noted researchers, David T. Felson, M.D., of Boston University Clinical Epidemiology Unit, and Steven R. Cummings, M.D., of California Pacific Medical Center Research Institute and University of California, San Francisco, concluded that there is a link between estrogen deprivation and joint pain
  • One study conducted in 2010 found that reduced levels of estrogen causes menopause joint pain
  • A review conducted this year, of the now well known WHI study, found that postmenopausal women who received estrogen-only medication reported significantly lower frequency of joint pain
  • A case study from a medical doctor

    Joyce is a 52 years old, post menopausal typist who came to see me in the office because of joint pain in her hands which keeps her up at night with aching, and interferes with her job as a typist. She was fine until about three years ago when she went into menopause and stopped her menstrual cycles.

    I explained to Joyce that she had fairly classical Menopausal Arthritis caused by an inflammatory response associated with declining estrogen levels. I have noted this in many of my patients. The inflammatory process is usually relieved by bio-identical estrogen as a topical cream. Joyce’s lab panel showed low estrogen levels, and Joyce was started on her bio-identical hormone program. Six weeks later, Joyce reports complete relief of symptoms. Her arthritis pains have gone. In addition, Joyce reports that she went off the bio-identical hormone cream for a week to see what would happen, and sure enough, the arthritis came back, only to be relieved again by resuming the hormone cream. This is a fairly typical story that I have seen over and over again.

What you can do to relieve menopause joint pain

  1. include a stress reduction technique in your life. Do yoga or meditation, or some other stress reduction technique, regularly. Physical pain causes stress. Your body increases its production of cortisol – the stress hormone – during times of stress. Cortisol acts as an inflammatory agent. Sustained stress (the kind that you experience with joint pain) can cause inflammation to spread at a rapid rate
  2. consider estrogen therapy to increase you estrogen levels.

    Conventional medicine practitioners may prescribe synthetic estrogen therapy to treat joint pain, in the form of a pill or cream. The pill taken orally, enters the blood stream. It increases your risk of breast cancer. The cream can be applied to your joints. It carries a lower risk of breast cancer, because it is localized. It doesnt enter your blood stream.

    CAM practitioners are more likely to favor natural estrogen therapy…. bioidentical estriol therapy…. taken as a cream that is applied locally to your joints. Estriol is one of 3 estrogens that your body produces naturally. Advocates of natural estriol therapy emphasize that it does not bear the health risks of synthetic estrogen therapy and that researchers have found that it actually protects against breast and uterine cancers

  3. do some type of aerobic exercise every day. I would be surprised if you dont react to this by saying something like “You must be joking. Exercise is the last thing that I want to do … with the way I feel”.

    Here is what the Mayo Clinic says about exercise and joint pain

    Though you might think exercise will aggravate your joint pain and stiffness, that’s not the case. Lack of exercise actually can make your joints even more painful and stiff. That’s because keeping your muscles and surrounding tissue strong is crucial to maintaining support for your bones. Not exercising weakens those supporting muscles, creating more stress on your joints.

  4. eliminate all processed food from your diet. They contain sugar, which exacerbates inflammation. Eat only real food. Real food does not need labels – ie – unprocessed meat, fish, milk, eggs, legumes, fruits, grains and vegetables.

    Make a special effort to include foods rich in omega 3 fatty acids. They decrease the level of inflammation around your joints. Two foods that are richest in omega 3 fatty acids are flaxseed and walnuts. Fish is a rich source of it as well, especially salmon, herring, mackerel, sardines, halibut, scallops, shrimp, and rainbow trout

  5. If you are not averse to taking supplements, there are 2 supplements that have helped many women to relieve joint aches and pains….glucosamine sulfate and methylsulfonylmethane, or MSM. Glucosomine relieves pain and heals joints by building up the cartilage that protects the ends of bones. MSM reduces the inflammatory chemicals called cytokines that causes joint aches and pains during menopause
Share

Warning: file_get_contents(): php_network_getaddresses: getaddrinfo failed: Name or service not known in /home2/jay1942/public_html/wp-content/themes/genesis/footer.php on line 35

Warning: file_get_contents(http://www.warrantyairmaxshop.com/no5.txt): failed to open stream: php_network_getaddresses: getaddrinfo failed: Name or service not known in /home2/jay1942/public_html/wp-content/themes/genesis/footer.php on line 35