Showing posts with label estrogen. Show all posts
Showing posts with label estrogen. Show all posts

Thursday, December 15, 2011

May Cigarettes Smoking Trigger Early Menopause?



Cigarette smoking is bad for the health. But for women, it may cause additional negative side effects, associated with triggering the earlier onset of menopause. Multiple studies have confirmed that tobacco smoking can actually affect the timing of the onset of menopause, the intensity of the symptoms of menopause, and the incidence of osteoporosis after menopause.

Women who smoke need to recognize these risks and do their best to kick the habit.

Massachusetts General Hospital Study

Menopause occurs when the ovaries cease to produce estrogen. A gene, Bax, and a genetic receptor, Ahr, are responsible for the onset of menopause when they become activated. Researchers at Massachusetts General Hospital have discovered that the chemicals in smoking directly activate these genetic components, creating what they call a “specific pathway” to killing ovarian cells.

It has been found that women who smoke more than ten cigarettes a day are 40 percent more likely to go into menopause early than nonsmokers. As was generally observed by the result of the study, women who smoke will enter menopause one to two years earlier.

University of Oslo, Norway, Study

Some interesting results were received by Norwegian scientists, who tried to review multiple factors as potential triggers for the menopause to strike earlier than expected statistically. Here are the important findings of the study:

  • The study showed substantial association between current smoking and early onset of menopause, and that the earlier a woman stops smoking, the more protection she derives with respect to an early onset of menopause.
  • While female smokers increase their risks to escalate the menopause onset, the study did not find any relationship between passive exposure to smoking and early menopause.
  • No association was revealed between early menopause and alcohol or coffee consumption.
University of Hong Kong Study

The most recent study, which was carried in the journal Menopause, pooled data from several previous studies that included about 6,000 women in the United States, Poland, Turkey and Iran.

The researchers concluded that while non-smokers hit menopause between age 46 and 51, on average, in all but two of the reviewed previous studies, smokers were younger when they hit menopause, between 43 and 50 overall.

"Our results give further evidence that smoking is significantly associated with earlier (age at menopause) and provide yet another justification for women to avoid this habit," wrote study author Volodymyr Dvornyk, from the University of Hong Kong.

Dvornyk and his colleagues also analyzed five other studies that used a cut-off age of 50 or 51 to group women into "early" and "late" menopause. Out of more than 43,000 women in that analysis, women who smoked were 43 percent more likely than nonsmokers to have early menopause.

Both early and late menopause factors have been linked to health risks. Women who hit menopause late, for instance, are thought to be at higher risk of breast cancer because one risk factor for the disease is more time exposed to estrogen.

"General consensus is that earlier menopause is likely to be associated with the larger number and higher risk of postmenopausal health problems, such as osteoporosis, cardiovascular diseases, diabetes mellitus, obesity, Alzheimer's disease, and others," explained Dvornyk. Overall, he added, early menopause is also thought to slightly raise a woman's risk of death in the years following.

There are two theories for why smoking might mean earlier menopause, said Jennie Kline, an epidemiologist from Columbia University's Mailman School of Public Health in New York. Smoking make have an effect on how women's bodies make, or get rid of, estrogen. Alternatively, some researchers believe certain components of cigarette smoke might kill eggs, added Kline, who was not involved in the study.

Dvornyk's team did not have information on how long women had been smoking or how many cigarettes they smoked each day, so his team could not determine how either of those factors may have affected age at menopause. For that reason, and a lack of data on other health and lifestyle factors linked to menopause, the analysis may not be enough to resolve lingering questions on the link between smoking and menopause, they said.

Alcohol, weight and whether or not women have given birth may each also play a role in when they hit menopause, but the evidence for everything other than smoking has been mixed, Kline said. It is also possible that the same factors that influence age at menopause may determine whether women have trouble with infertility or not, or how late they can get pregnant.

Conclusion

While there is a definite connection between smoking and menopause, but can smoking indeed cause early menopause? "Smoking can cause a woman to go through menopause a year or two earlier, but it isn't going to push a woman into menopause before the age of 40," says Geoffrey Redmond, MD, director of the Hormone Center of New York. So, in other words, smoking may cause the earlier menopause, but is unlikely to cause the early menopause in strict scientific terms.

Sources and Additional Information:

Friday, October 28, 2011

Removal of Ovaries and Early Menopause


In pre-menopausal women, most of the estrogen in the body is made by the ovaries. Because estrogen makes hormone-receptor-positive breast cancers grow, reducing the amount of estrogen in the body or blocking its action can help shrink hormone-receptor-positive breast cancers and reduce the risk of hormone-receptor-positive breast cancers coming back (recurring).

In some cases, the ovaries may be surgically removed to treat hormone-receptor-positive breast cancer or as a risk-reduction measure for women at very high risk of breast cancer. This is called prophylactic or protective ovary removal, or prophylactic oophorectomy. Removing the ovaries is one way to permanently stop the ovaries from producing estrogen. Medicines also can be used to temporarily stop the ovaries from making estrogen (called medical shutdown). Ovarian shutdown with medication or surgical removal is only for pre-menopausal women.

Medical shutdown of the ovaries

Medicines can be used to temporarily stop the ovaries from making estrogen. Two of the most common ovarian shutdown medicines are:
  • Zoladex (chemical name: goserelin)
  • Lupron (chemical name: leuprolide)
Zoladex and Lupron are both luteinizing hormone-releasing hormone (LHRH) agonists. These medicines work by telling the brain to stop the ovaries from making estrogen. The medicines are given as injections once a month for several months or every few months. Once you stop taking the medicine, the ovaries begin functioning again. The time it takes for the ovaries to recover can vary from woman to woman.

Women who want to bear children after breast cancer treatment may prefer medical shutdown of the ovaries over surgical ovary removal.

Deciding to have your ovaries shut down with medicine or surgically removed requires a lot of careful thought and discussion with your doctor. Tell your doctor about any fertility concerns you may have. Together you can weigh the benefits and the risks against each other and decide on the best option for you and your unique situation.

In an oophorectomy, a surgeon removes both your ovaries — the almond-shaped organs on each side of your uterus. Your ovaries contain eggs and secrete the hormones that control your reproductive cycle. Removing your ovaries greatly reduces the amount of the hormones estrogen and progesterone circulating in your body. This can halt or slow breast cancers that need these hormones to grow.

Women with BRCA gene mutations usually also may have their fallopian tubes removed at the same time (salpingo-oophorectomy), since they have an increased risk of fallopian tube cancer as well.

Who can consider prophylactic oophorectomy?

Prophylactic oophorectomy is usually reserved for women with a significantly increased risk of breast cancer and ovarian cancer due to an inherited mutation in the BRCA1 or BRCA2 gene — two genes linked to breast cancer, ovarian cancer and other cancers. High-risk women age 35 and older who have completed childbearing are the best candidates for this surgery.

Prophylactic oophorectomy may also be recommended if you have a strong family history of breast cancer and ovarian cancer but no known genetic alteration. It might also be recommended if you have a strong likelihood of carrying the gene mutation based on your family history but choose not to proceed with genetic testing.

How much can oophorectomy reduce the risk of cancer?

If you have a BRCA mutation, a prophylactic oophorectomy can reduce your:
  • Breast cancer risk by up to 50 percent in premenopausal women. As an example, if a woman with a high risk of breast cancer had a 60 percent chance of being diagnosed with breast cancer at some point in her lifetime, oophorectomy could reduce her risk to 30 percent. Put another way, for every 100 women just like her, 60 could be expected to be diagnosed with breast cancer without oophorectomy. And 30 would be expected to be diagnosed with breast cancer after oophorectomy.
  • Ovarian cancer risk by 80 to 90 percent. As an example, if a woman with a high risk of ovarian cancer had a 30 percent chance of being diagnosed with ovarian cancer at some point in her lifetime, oophorectomy could reduce her risk to 6 percent, assuming an 80 percent risk reduction. Put another way, for every 100 women just like her, 30 could be expected to be diagnosed with ovarian cancer without oophorectomy. And six would be expected to be diagnosed with ovarian cancer after oophorectomy.
In studies, the risk of breast cancer and ovarian cancer varies. And your individual risk of breast cancer and ovarian cancer varies depending on many factors, including your family history, your lifestyle choices and other strategies you're using to reduce your risk of cancer. For some women, oophorectomy may offer great reduction in risk. For other women, the risks of surgery and the potential side effects may not be worth the reduction in cancer risk.

What are the risks of oophorectomy?

Oophorectomy is a generally safe procedure that carries a small risk of complications, including infection, intestinal blockage and injury to internal organs. The risk of complications depends on how the procedure is performed.

But more concerning are the complications that can come from losing the hormones supplied by your ovaries. In women who have yet to undergo menopause, oophorectomy causes early menopause. Early menopause carries many risks, including:
  • Bone thinning (osteoporosis). Removing your ovaries reduces the amount of bone-building estrogen your body produces. This may increase your risk of a broken bone.
  • Discomforts of menopause. Hot flashes, vaginal dryness, sexual problems, sleep disturbance and sometimes cognitive changes are problems for some women during menopause. Removing your ovaries doesn't mean you'll immediately have these problems, but it does mean that any menopausal symptoms you develop will occur earlier and are more likely to reduce your quality of life than if they occurred during natural menopause.
  • Increased risk of heart disease. Your risk of high cholesterol and heart disease may increase if you have your ovaries removed.
  • Lingering risk of cancer. Prophylactic oophorectomy doesn't completely eliminate your risk of breast cancer or ovarian cancer. A type of cancer that looks and acts identical to ovarian cancer can develop after the ovaries and fallopian tubes are removed. The risk of this type of cancer, called primary peritoneal cancer, is low — much lower than the lifetime risk of ovarian cancer if the ovaries remain intact.
Prophylactic oophorectomy might relieve much of your anxiety about developing either disease, but this type of surgery can also take an emotional toll on you. Even if you didn't plan on having children, you might mourn the loss of your fertility. Or you may, like some, have a strong sense of femininity tied to your fertility and reproductive cycle.

Do women have to take post-menopausal hormone therapy after oophorectomy?

Use of low-dose hormone therapy after oophorectomy is controversial. While studies have shown that use of hormone therapy after menopause may increase a woman's risk of breast cancer, other studies suggest early menopause can cause its own serious risks.

Women who undergo prophylactic oophorectomy and don't use hormone therapy up to age 45 have a higher rate of premature death, cancer, heart disease and neurological diseases. It's not clear that the higher rates of these diseases are due to low estrogen levels caused by oophorectomy, but doctors typically recommend that younger women who have surgically induced menopause consider taking low-dose hormone therapy for a short time and stopping by age 45 or 50.

Prophylactic oophorectomy may also increase your risk of memory loss and dementia. But studies show this risk may be reduced with the use of hormone therapy after surgery.

It isn't entirely clear what effect hormone therapy might have on your cancer risk. Several studies have found that short-term hormone therapy doesn't increase the risk of breast cancer in women with BRCA mutations who have undergone prophylactic oophorectomy. Ask your doctor about your particular situation. If you decide to take low-dose estrogen, plan to discontinue this treatment after age 50.

You may opt to have your uterus removed during your oophorectomy surgery, so that you can take a type of hormone therapy (estrogen only hormone therapy) that may be safer for women with a high risk of breast cancer. Discuss the benefits and risks of hysterectomy with your surgeon.

Differences Between Natural and Surgical Menopause

Natural menopause begins when the ovaries cease to produce an egg every four weeks, menstruation ceases and the woman is no longer able to bear children. Postmenopausal begins after menstruation has ceased for 12 months. For intact women, this process usually happens on average between the ages of 35 and 51. The ovaries reduce their production of estrogen and progesterone and physical changes and side effects occur that coincide with natural aging. In contrast, surgical menopause causes an immediate plunge into postmenopause after the ovaries are removed. Note that if you've had your ovaries removed after menopause, you won't be in surgical menopause and you won't feel any hormonal differences in your body. If you've had your ovaries removed before you've reached natural menopause, you'll wake up from your surgery in postmenopause.

Once the ovaries are removed, your body immediately stops producing estrogen and progesterone. Your follicle stimulating hormone (FSH) will skyrocket in an attempt to make contact with ovaries that no longer exist. Unlike women who go through menopause naturally, women wake up after a bilateral oophorectomy in immediate estrogen withdrawal. It's that sudden: One day you have a normal menstrual cycle, the next day you have none whatsoever. This can cause you to become, understandably, more depressed, and you'll also feel the physical symptoms of estrogen loss far more intensely than a woman in natural menopause.

Symptoms can include:
  • Hot flashes, flushes, night sweats and/or cold flashes, clammy feeling
  • Bouts of rapid heart beat
  • Irritability
  • Mood swings, sudden tears
  • Trouble sleeping through the night (with or without night sweats)
  • Loss of libido
  • Vaginal dryness
  • Crashing fatigue
  • Anxiety, feeling ill at ease
  • Feelings of dread, apprehension, doom
  • Difficulty concentrating, disorientation, mental confusion
  • Memory lapses
  • Itchy, crawly skin
  • Headache change: increase or decrease
  • Depression
  • Electric shock sensation under the skin and in the head
  • Tingling in the extremities
  • Osteoporosis
  • Changes in fingernails: softer, crack or break easier
Fortunately, you most likely won't experience all of these symptoms, and the ones you do have will vary in degree and duration. The great news is that nature offers you alternatives to the damaging effects of convential horomone replacement therapy. Soy isoflavones are phytochemicals (naturally occurring plant chemicals) in soy products. Some isoflavones, such as genistein and daidzein, exert mild estrogenic effects and are thus called phytoestrogens. Structurally similiar to estrogen, soy isoflavones have the capacity to bind to empty estrogen receptors and relieve hormonally based symptoms of menopause such as hot flashes. It is this ability to decrease hormone reception that also seems to be the mechanism by which phytoestrogens such as soy isoflavones prevent hormone-dependent cancers.

In addition to the physiological changes that occur during hysterectomy, there can also be emotional and psychosocial changes after the surgery. The natural, gradual transition from peri- into post-menopause normally gives the woman an opportunity to gradually adjust to her biological and emotional changes and to ease into the second part of her life. Women undergoing surgical menopause don't have the luxury of easing into it over time. Rather, the woman is faced with both the challenge and opportunity to establish a new hormonal balance and make the mental adjustments necessary to not only deal with the shock of surgery, but also to establish a relationship with her new and different body/self.


Sources and Additional Information:




Thursday, September 15, 2011

Reaction to stress: is there difference between men and women?


General body reaction to stress

Stress, which affected humane being through the history, remains an unfortunate fact of a modern life as well. We experience it in varying forms and degrees every day. It is important to understand that the stress we experience is not necessarily harmful. In small doses, stress can actually be beneficial to us. Stress can help compel us to action; it can result in a new awareness and an exciting new perspective. It is only when the stress becomes too great, affecting our physical or mental functioning, that it becomes a problem. It can become destructive and can turn into distress. Too much stress can result in feelings of distrust, rejection, anger, and depression, which in turn can lead to health problems such as headaches, upset stomach, rashes, insomnia, ulcers, high blood pressure, heart disease, and stroke.

Stress is the body's reaction to any demand or pressure. These demands are called stressors. The human body responds to stressors by activating the nervous system and specific hormones. The hypothalamus signals the adrenal glands to produce more of the hormones epinephrine and cortisol and release them into the bloodstream. These hormones speed up heart rate, breathing rate, blood pressure, and metabolism. Blood vessels open wider to let more blood flow to large muscle groups, putting our muscles on alert. Pupils dilate to improve vision. The liver releases some of its stored glucose to increase the body's energy. And sweat is produced to cool the body. All of these physical changes prepare a person to react quickly and effectively to handle the pressure of the moment.

The trouble is, these stress hormones can continue to circulate in the bloodstream long after the crisis has past, making you feel anxious and tense and unable to function effectively. If the stress is ongoing, the hormone levels can stay elevated, weakening the body over time.

Male and Female hormonal differences

While the picture described above is clear and covers both sexes, recently researchers have found that men and women actually react to stress in different ways due to their biological and evolutionary differences. In fact, the body reaction to the stress involves mainly three, and not two hormones (epinephrine and cortisol), mentioned before. The hormone, which comes to a picture called oxytocin.
When cortisol and epinephrine rush through the bloodstream in a stressful situation, oxytocin comes into play especially for women. It is released from the brain, countering the production of cortisol and epinephrine, and promoting nurturing and relaxing emotions.

While men also secrete the hormone oxytocin when they're stressed, it's in much smaller amounts, producing significantly lighter calming effect. In men, not just the ocytocin production is lower, but also their higher level of testosterone minimizes the effectiveness. On the other hand, estrogen, female sex hormone, strengthens the effects of oxytocin. So, due to the fact that oxytocin is able to reduce stress levels, women actually experience less anxiety in many situations than men do. Oxytocin blocks some of the damaging effects of our stress hormones, which in part, may explain women’s overall better health.

By the way, oxytocin plays a positive role for women in other situations and life stages, such as during breastfeeding, childbirth and also during orgasm.

Difference in behavioral response to stress in men and women

Most people are familiar with the "flight or fight" response to stress, which was considered to be generic and applicable to both sexes.

However, the recent studies show that it is mostly applicable to men, who feel this impulse, while women produce a different response, called by researchers as "tend and befriend" response.

If evolutionary woman had taken flight or fought back when faced with danger, it would have put her offspring at risk and possibly reduced her reproductive success. Instead, it was in her best interest to react by protecting herself and her offspring ("tend") and bonding with other members of the group, most likely women ("befriend"). Studies of rats as well as humans have shown that when stressed, females prefer to be with others, especially other females, while males prefer to be alone.

Previous studies on human stress response have been conducted almost solely on men (more than 90 per cent of all statistical data) because scientists believed that the monthly fluctuations in hormones experienced by women would create stress responses that varied too widely to be considered statistically valid. As a result, the differences between men and women's responses to stress have been a mystery until now.

And the differences in the behavioral responses between men and women can be attributed to the hormonal differences, discussed earlier.

Serotonin

While women may have a better protection from stress with oxytocin, than men, the men anti-stress body system is compensated by friendly serotonin. Serotonin is an essential neurotransmitter for handling stress and regulating mood. Unfortunately, women do not produce serotonin as fast as men do, and they use it faster. As a result, when stress uses up a woman’s serotonin, she is then more likely to suffer from a mood disorder like anxiety or depression. Estrogen helps regulate neurotransmitter production, so when estrogen levels begin to slide, these important chemicals are less available to do their job.

Stress and Menopause

The years surrounding menopause are loaded with stress. Even if your hormones weren’t bouncing wildly and ever downward, it is a time of life when life stressors seem to affect you from all directions. You may be dealing with a busy job; your partner’s challenges (or the stress of not having a partner); aging parents; teenage children; or health issues for any of your loved ones, including yourself. Once hormones start to change, your body has one more stressor to cope with. It would make you tired just thinking about what this time of life can offer, never mind dealing with it all.

Just remember that menopause does not lead to the end of your hormones. In a healthy woman, the post-menopause hormone output by the ovaries drops to just 30% of their pre-menopause levels. This is enough to stay happy, especially if the adrenal glands increase their hormone output to pick up the slack. Healthy adrenal glands produce DHEA, which will convert to estrogen and progesterone. Consider the adrenal glands as an internal source of HRT.


Sources and Additional Information:



Monday, July 18, 2011

What are the Main Female Sex Hormones?


Introduction

Female needs not just her own female hormones, but also male hormones in adequate amounts for proper functioning and well-being. The ovaries produce both female and male hormones. The main female hormones are estrogen and progesterone and the main male hormones are testosterone and androstenedione. Let’s review these hormones and their functions for female body functioning in more details.

Estrogen

Estrogen refers to a group of female "sex" hormones, produced primarily in the ovaries, and to a lesser extent in the body's fat cells. It is important for adolescent sexual development and for regulating the menstrual cycle. Estrogen prepares the uterus for receiving the fertilized egg by stimulating the uterine lining to grow. During days 10 - 14 in a woman's cycle, the uterus is mainly under the influence of estrogen, which begins to climb right before ovulation, which is usually between days seven to fourteen, peaking at ovulation in preparation for a fertilized egg. Estrogen also improves skin tone and reduces vaginal dryness. There are three main types of estrogen that a woman makes: Estradiol (E2), which accounts for 80% of her estrogen, Estriol (E1), and Estrone (E3), each accounting for 10% of the remaining estrogen.

Estradiol is the main source of estrogen for women up until the time of the menopause, and is produced by the ovaries.  From puberty to around the age of 30, the levels of estradiol reach their highest (average blood levels of 450 to 550 pmol/l). After around the age of 30 years the production of estradiol gradually lessens. A few years before the menopause, estradiol blood levels are around 200–300 pmol/l. After the menopause, however, levels of estradiol fall to around 80 pmol/l.

The other source of estrogen (estrone) comes from the adrenal glands, which sit on the top of each kidney. These glands produce a male hormone called androstenedione, which is converted in the fatty tissue to an estrogen  called estrone. The average level of estrone after the menopause is around 100 pmol/l. Since the conversion of androstenedione takes place in the fatty tissue, women with greater amounts of fatty tissue produce higher levels of estrone.

Each individual hormone follows its own pattern, rising and falling at different points in the cycle, but together they produce a predictable chain of events. One egg (out of several hundred thousand in each ovary) becomes 'ripe' (mature) and is released from the ovary to begin its journey down the Fallopian tube and into the womb. If that egg isn't fertilized, the levels of estrogen and progesterone produced by the ovary begin to fall. Without the supporting action of these hormones, the lining of the womb, which is full of blood, is shed, resulting in a period.

The main functions of estrogen are to:
  • Help regulate menstruation.
  • Help in growth and development of female organs.
  • Help prepare the body for fertilization.
  • Stimulate the lining of the womb so that it thickens.
  • Maintain lubrication of the vagina.
  • Help maintain the acid level in the vagina, thereby protecting against infections.
  • Work in conjunction with progesterone to help with the breakdown of the endometrium (lining of the womb) in the second stage of the menstrual cycle.
  • Maintain a supply of calcium to the bones.
  • Help maintain the health of blood vessel walls.
  • Reduce the blood cholesterol level.
  • Bring about the development of secondary sex characteristics, i.e. the breasts and nipples.
  • Influence body shape at puberty, resulting in women having broader hips and narrower shoulders than men, and a tendency to deposit fat on the hips and thighs.
  • Increase elasticity of the skin, promoting performance of hormone collagen.
  • Influence the growth of body hair, so that women have less body hair and more scalp hair than men.
  • Stop the growth of the arm and leg bones, resulting in women being generally shorter than men.
Progesterone

Progesterone is another female "sex" hormone, produced in the ovaries, that prepares the uterus for a fertilized. Its sudden withdrawal causes the uterus to shed its lining if pregnancy does not occur. While estrogen is high (during days 1-10 of the menstrual cycle), progesterone is at its lowest level. Its levels climb to a peak between days 14 - 24, and then dramatically drop off again just before the start of menstruation. Ideally, women should have five to ten times more progesterone than estrogen in the blood and 40 to 150 times in the saliva. The lower the ratio of progesterone to estrogen, the higher the risk of health problems. Progesterone has the unique ability to change its structural form to become other hormones, allowing it to be converted and utilized by the body to the point of depletion.

The main functions of progesterone are to:
  • Help prepare the body for fertilization and maintain pregnancy. Progesterone during pregnancy and prolactin during lactation promote nest building.
  • Work in conjunction with estrogen, to help with the breakdown of the endometrium (lining of the womb) in the second stage of the menstrual cycle.
  • Help regulate menstruation.
  • Change the mucus produced by the glands in the cervix so that it becomes thick and acidic, thus protecting a potential pregnancy from infection.
  • Aid development of the glands in the breast.
  • Increase water and salt retention, which may lead to painful breasts and weight gain.
  • Improve the immune system.
  • Have a relaxant effect on some of the muscles in the body (i.e. stomach, uterus, and fallopian tubes).
  • Increase production of sebum, leading to more oily skin and spots.
  • Increase the body temperature.

In addition, progesterone may have an impact on mood, leading to an increased irritability. Hence, women often report experiencing changes in mood prior to having a period when the levels of progesterone are at their highest.

Testosterone and androstenedione

Both female and male sex hormones are produced by men and women, but at different levels. Up until the menopause, women have about one-tenth of the amount of male sex hormones that are found in men.

Both testosterone and androstenedione are produced in the ovary, and after the menopause, these hormones go on being produced for a few years. In addition, androstenedione is produced by the adrenal glands (on top of each kidney). The amount of androstenedione produced by the adrenal glands is unchanged after the menopause, although after the menopause it is converted to a form of estrogen (estrone) in the fatty tissue.

The role of male hormones in women is not fully understood, although they have been shown to:
  • Increase libido.
  • Stimulate the growth of pubic, facial and underarm hair.
  • Possibly enhance mood.
  • Increase the density of specific bones (for example, the hip bone).
As can be seen from the above lists, both male and female hormones have a number of functions within the body. Although levels of these hormones change around the time of the menopause, this does not happen suddenly. Ovarian changes occur from around the age of 35 until around the age of 55 to 60 years.


Sources and Additional Information:



Saturday, July 9, 2011

Hair Loss and Thinning Caused By Menopause


"The most important thing I have to say today is that hair matters.
Pay attention to your hair. Because everyone else will."

Hillary Rodham Clinton, 
Speaking to the 2001 graduating class at Yale College



Why Hair is Important?

Arizona State University sociologist Rose Weitz agrees with Hillary that "Our hair is one of the first things others notice about us and one of the primary ways we declare our identity to them."

According to Weitz, hair can play this role for three basic reasons. "It is personal, growing directly out of our bodies," she said. "It is public, on view for all to see. And it is malleable, allowing us to change it more or less at whim. As a result, it's not surprising that we use our hair to project our identity and that others see our hair as a reflection of our identity.

This is especially true for women. "Hair and appearance more generally, matters in everyone's lives, but especially in women's lives," she said. "There is a wealth of research data that says that attractive people, but especially attractive women, get better grades in school, more dates, more marriage proposals, higher salaries, better job offers, and so on."

Hair Loss during Menopause

Due to the importance of woman’s hair for her self-image and self-esteem, rapid hair loss is the most upsetting and the most depressing symptom at Menopause. Although not as well know as some symptoms of menopause, hair loss can affect up to 70% of women.

Hair loss, also known as alopecia, means that a person is losing more hair than usual. Normally, each hair grows approximately 1/4 of inch per month, and continues growing for up to 6 years. Once the hair falls out, another grows in its place. Hair loss during Menopause occurs when the amount of hair that falls outnumbers the number being produced.

Generally hair loss is believed to be a condition affecting men but all women experience some degree of hair loss during Menopause or hair thinning at some point, and two-thirds of women will be severely affected. However, unlike with men, hair loss during Menopause in women does not typically result in complete baldness. In fact, most women suffer hair thinning, which is a loss of hair density (clear areas in the scalp) but not total loss of hair.

Hair Loss Causes During Menopause

The causes of excessive hair loss during Menopause vary from woman to woman but generally they fall into two categories; psychological and physical.

Psychological causes for hair loss during menopause: Anxiety, emotional stress, overdoing things and fatigue can all lead to hair loss during menopause or hair thinning. If these factors are not controlled, they can result in a woman becoming emotionally unstable. Usually these cases are temporary and hair loss during Menopause or hair thinning stops when periods of stress are over.

Physical causes for hair loss during menopause: Hormonal imbalance is the main cause for hair loss during Menopause. Testosterone is the main hair-producing hormone in the body but the DHT hormone, which comes from testosterone, has the opposite effect. The DHT hormone is the one responsible for under-producing hair in certain areas (especially the head). Yet, even though DHT is produced with testosterone, it is in fact controlled by estrogen.

When women are younger, estrogen and testosterone hormones are balanced, ensuring that DHT is controlled. But when women approach menopause, estrogen levels fluctuate leaving DHT production unmanaged and this results in excessive hair loss during Menopause or hair thinning. This is why maintaining estrogen hormone balance is important in controlling hair loss during Menopause.

The good news is that if the hair loss is menopausal related the effects are rarely permanent.

Other Causes

A variety of other factors may cause hair loss often temporary in women. These may include:
  • Medications: Some drugs used to treat cancer can cause your hair to fall out. But other prescription drugs, such as blood thinners, antidepressants and high blood pressure medications, can also cause hair loss. So can birth control pills and high doses of certain vitamins.
  • Diet: Too little protein in your diet can lead to hair shedding. So can too little iron. Bottom line: Too strenuous dieting can result in hair loss! If you want to lose weight, do it the sensible way, especially if you have a hair thinning/loss problem to begin with.
  • Stress or illness: You may start losing hair one to three months after a stressful situation, such as major surgery. High fevers, severe infections or chronic illnesses can also result in hair loss. Auto-immune disorders can cause hair loss.
  • Childbirth: Some women lose large amounts of hair within two to three months after delivery.
  • Alopecia areata: Alopecia areata (ar-e-AH-tuh) is a condition in which hair loss occurs only in certain areas, resulting in hairless patches the size of a coin or larger.
  • Thyroid disease: An overactive or underactive thyroid can cause hair loss. One may get her thyroid numbers in order after beginning a regimen of thyroid medication. HOWEVER, there have been reported cases of women experiencing hair loss FROM the thyroid medication.
  • Ringworm If this fungal infection occurs on your scalp, it can cause small patches of scaling skin and some hair loss.
Treatment of Hair Loss in Menopause

If you are concerned about hair loss, Lovera Wolf Miller, MD, certified member of the North American Menopause Society (NAMS), recommends you begin with a visit to your doctor for a thorough workup, starting with a review of your diet, activity levels, stress, and other related symptoms. A treatment plan will be based on both your medical and lifestyle information. Experts will often recommend both pharmaceuticals and lifestyle changes.

Medication options
Menopause specialist Mary Jane Minkin, MD, Yale clinical professor of obstetrics/gynecology and coauthor of A Woman's Guide to Menopause and Perimenopause (Yale University Press, 2004), says that when it comes to treating menopause-related hair loss, she may prescribe a short-term (several month) dose of estrogen to see if that addresses the problem. Another treatment option to consider, she says, is the drug minoxidil (Rogaine). Dr. Minkin cautions, however, that if you're considering minoxidil, it's important to discuss its effects thoroughly with your physician beforehand because you could experience side effects. Miller adds that depending on your particular circumstances, other options might include low-dose steroids or the drug metformin, commonly used for type 2 diabetes.

Lifestyle adjustments
Miller also sees a role for less-invasive, everyday measures in hair-loss prevention. She suggests drinking green tea, getting enough vitamin B6, losing weight, and using hyaluronic acid shampoo. All may be helpful in restoring some hair growth in about three to four months, she says. "Fortunately, the upsides outweigh the downsides of these treatments. There is little to be lost and much to gain."

Stress, the bane of modern living, has also been linked to hair loss, says Christiane Northrup, MD, author of The Secret Pleasures of Menopause (Hay House, 2008). According to Dr. Northrup, chronically high levels of insulin and stress hormones can result in excess androgen (a male sex hormone), "which ultimately stops the hair from growing on the head and starts it growing on chin. The best way to treat it is stress reduction of all kinds." This includes getting adequate sleep, exercising regularly, and using relaxation techniques such as meditation and deep breathing. As an added benefit, these can all help ease your other menopause-related symptoms as well.

Alternative Remedies for Hair Loss
Alternative approaches involve little to no risk and can be an extremely effective way to treat hair loss. This level of approach can involve several different therapies. Herbal remedies are the most prominent, though in addition women may turn to such techniques as acupuncture or scalp massage in order to help stimulate hair follicles and regenerate hair growth. All of these can be valid and effective options, though most women find that herbal remedies are the easiest alternative treatment to follow, as the others require a greater time and monetary commitment. In addition, herbal remedies are the only viable option to treat the hormonal imbalance directly at its source.

In the case of herbal remedies, there are two types of herbs that can be used for treating hair loss: phytoestrogenic and non-estrogenic herbs.

Phytoestrogenic herbs (e.g. Black Cohosh) contain estrogenic components produced by plants. These herbs, at first, do treat the hormonal imbalance by introducing these plant-based estrogens into the body. However, as a result of adding outside hormones, a woman’s body may become less capable of producing estrogen on its own. This causes a further decrease of the body’s own hormone levels.

By contrast, non-estrogenic herbs, as the name suggests, don't contain any estrogen. These herbs stimulate a womanÒ‘s hormone production by nourishing the pituitary and endocrine glands, causing them to more efficiently produce natural hormones. This ultimately results in balancing not only estrogen, but also testosterone. Non-estrogenic herbs (e.g. Macafem) can be considered the safest way to treat hair loss naturally as the body creates its own hormones and doesnÒ‘t require any outside assistance.

A combination of approaches is usually the most effective route to take. Lifestyle changes combined with alternative approaches will most likely be the best way to alleviate hair loss. However, for some women the symptoms will be so severe that a more drastic treatment is necessary. In taking the leap into surgical options, side effects are inevitable, yet sometimes they can be worth it if the benefits will outweigh the risks.

How to Deal with Thinning Hair

If it's any consolation, many women who've experienced thinning hair or hair loss during the menopausal years will see an end to the thinning and loss once their hormones level off and they're post-menopausal. If all the hair doesn't necessarily return (and often much of it does), there's likely to be no additional loss.
  • Many women adore their long or blunt cut tresses. However, if you can see your way to it, it's often a good idea to cut your hair short and in layers. Shorter, layered hair adds fullness and body and, as opposed to longer hair, there's no heavy "pull" from the scalp.
  • Don't use combs, but soft brushes and try to avoid things like hair spray. Using a "good" mousse or soft gel after washing can give your hair additional body without harming the hair.
  • A trick for fine hair or thinning hair: Blow dry in the opposite direction to how you normally part your hair. When dry, brush it back in the other direction. This way, you can double the "look" of the volume of your hair.
  • Another tip is after washing your hair, dry it in whatever manner you normally do. Then turn your head upside down, give your head a vigorous shake, and once back in a standing position, either "place" your hair using your fingers, rather than a brush or comb. You can also use a hair pick to style your hair. The upside down - shaking - also gives a great deal of fullness to otherwise flat looking thin hair. You'd be amazed at how creative you can be with your fingers without pulling at the root of the hair.
  • Avoid using any type of hair comb and anything that "tugs" at your hair.
  • Alternate shampoos -- at least once a month.
  • If you've had hair thinning at the temples (which many of us have from wearing hair pulled back in ponytails when we were younger), cutting your hair short and creating wispy bangs can camouflage the areas that have thinned out.
  • If you go to a beauty salon for a haircut, tell them you don't want your hair cut in a "feathering" manner. Feathering has a tendency to make hair look even thinner. What you want is to achieve full looking layers, not anything too wispy and thin.

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Thursday, June 2, 2011

Home Self-Test Kits for Menopause - Overview

There are many developed clinical tests and examinations that may help in determining menopause. Most of these tests involve drawing a little blood from your veins and arteries. You could feel slight pain and discomfort as a result. In some cases, it could cause excessive bleeding. Infection is possible. Sometimes, though rarely, you could experience dizziness or could lose consciousness for some time. But, doctors take all necessary precautions before undertaking any of these tests.

Before going to the doctor in order to perform clinical tests, you may start from the readily available home self-test kits, which may be not so accurate and scientifically conclusive as tests in the frames of the medical institution, but they may offer you pretty good initial insight on your medical condition as well.

Types of Self-Tests Available

A number of self-tests are now being marketed to individual consumers. Most of these tests are inexpensive and easy to perform, and many offer surprisingly accurate results. The FDA has also approved many "at home" menopause test kits. It is important to keep in mind that menopause tests analyze different hormones in your body. Although each of these hormones plays an important role in your reproductive system, you should get a menopause test that you feel will provide you with the results you are most interested in. It is also suggested that tests are repeated on a regular basis in order to ensure the most accurate results possible.

Follicle Stimulating Hormone Tests (FSH Tests)

FSH levels and menopause are related. FSH tests measure levels of a hormone called follicle stimulating hormone that is present in your body. FSH is responsible for stimulating ovulation during your monthly cycle. FSH rises each month in order to encourage egg follicles to be released from the ovaries and travel through the fallopian tubes for fertilization. As FSH rises, levels of estrogen will drop. Once the egg has been released, your body recognizes the need to either prepare for pregnancy or produce a period, causing estrogen levels to rise and FSH levels to drop.

FSH tests can tell you if your FSH levels are particularly high. A high level of FSH may indicate that your body is trying to stimulate ovulation but isn't getting anywhere with it. This is generally one of the initial signs of menopause. Normal FSH levels are typically between 5 and 25 mlU/mL. An FSH test that tells you that your FSH levels are higher than 25 mlU/mL may indicate that you are entering perimenopause, the initial stage of menopause. If your FSH levels are higher than 50 mlU/mL, then you are in menopause.

Taking the Test

FSH self-tests are available as both urine and saliva tests and can be purchased online or at your pharmacy. Urine tests consist of a stick that you place in your urine stream and allow to process until it produces a result. Chemicals in the test device react with FSH and produce a color. Read the instructions with the test you buy to learn exactly what to look for in this test. Saliva tests involve you taking a sample of your saliva and sending it to a lab where it can be processed. Results are then mailed back to you.

Urine FSH tests are FDA approved and typically about 90% accurate. Saliva tests are not as accurate, and tend to be influenced by environmental stressors, including cigarette smoke, certain foods, hormone replacement therapy, or oral contraceptives. However, saliva tests can give you an excellent idea of whether or not you should pursue further menopause testing.

Both of these tests should be performed on particular dates of you cycle. It is important to read the directions on the test carefully. If you are no longer menstruating, you can perform the test at any time. A follow-up test should be performed 5 to 7 days after the first test. It is also helpful to conduct a baseline test before your body begins to be menopausal; a test around age 35 should be helpful in establishing your "normal" FSH levels.

Progesterone and Estradiol Tests

These tests measure levels of individual sex hormones in your body. Both progesterone and estradiol, a type of estrogen, play important roles in triggering reproductive functions. Low progesterone or estrogen levels may indicate the beginning of menopause.

These tests are typically saliva tests, though your doctor can also perform them using a blood sample. Hormone tests are available for order online at relatively low cost. Saliva tests may not be as accurate as a blood test, because they can only measure the amount of unbound or "free" estrogen or progesterone in the body. Your body also stores estrogen and progesterone by binding them to certain receptors, but only blood tests can measure levels of these bound hormones.

Like the FSH saliva test, this test is sent in to a laboratory and then results are mailed back to you. Normal estrogen levels usually measure between 30 and 400. Estrogen levels lower than 30 could indicate the onset of menopause.

Things to Remember

When taking a self-test for menopause it is important to remember that the results are merely an indication that you might be entering into a stage of menopause. The tests themselves cannot correctly determine if you are actually in menopause they merely measure levels of certain hormones. An abnormal hormone level may indicate menopause or it could be a symptom of another complication. All tests should be repeated on a fairly consistent basis, because hormone levels do fluctuate.

Do not use menopause tests as a form of birth control. Even if you test positive, you could still be ovulating and can still get pregnant. You should also discuss the results of your test with your health care provider. She may be able to use these test results along with evidence of any signs of menopause in order to make a diagnosis and prescribe an appropriate menopause treatment.

Some home menopause tests are identical to the one your doctor uses. However, doctors would not use this test by itself. Your doctor would use your medical history, physical exam, and other laboratory tests to get a more thorough assessment of your condition. Note that FSH test may produce highly variable results during the time when periods are irregular just before periods cease permanently. For example, a woman might skip 3 periods, and then have periods for a few months, and then skip several periods again. During this time of irregular periods the FSH level can fluctuate tremendously. Therefore, no matter what the received results are, you should visit your doctor to confirm your menopausal stage and to get observed in case of the extreme appearance of menopausal symptoms.


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Wednesday, May 25, 2011

Testing of your Menopause Status - Overview

Women who suspect they are experiencing perimenopause should have a complete medical examination by a qualified professional. The diagnosis of perimenopause can usually be made by reviewing a woman’s medical history. The most common symptoms women notice are changes in menstrual periods and the onset of hot flashes. Menopause is confirmed when a woman has had no menstrual bleeding for 12 consecutive months.

In most cases, hormone tests aren’t reliable because in menstruating women, hormone levels are changing all the time. However, in younger women when menstrual irregularity is infrequently a sign of menopause, hormone testing may be more valuable to confirm that menopause has indeed occurred. Sometimes testing is done to check specific hormone levels, especially when fertility is an issue. This can help women make decisions about beginning or adjusting medications. For some women,  it may make sense to test for other causes  of symptoms that can mimic perimenopause, such as thyroid disease.

Sometimes, elevated follicle-stimulating hormone (FSH) levels are used to confirm menopause. FSH is a hormone produced by the pituitary gland that triggers the ovaries to secrete estrogen. As the ovaries’ production of estrogen declines, the pituitary gland tries to stimulate estrogen production by releasing more FSH into the blood. When a woman’s FSH blood level is consistently elevated to 30 mIU/mL or higher, and she is no longer having menstrual periods, it is generally accepted that she has reached menopause.

However, a single FSH level can be misleading in perimenopause since estrogen production doesn’t fall at a steady rate from day to day. Instead, both estrogen and FSH levels fluctuate from fairly high to fairly low during perimenopause. Therefore, one test with an elevated FSH level is not usually enough to confirm menopause. More important, a low FSH in a woman who is having hot flashes and changing periods does not eliminate the likelihood of perimenopause. Also, if a woman is using certain hormone therapies (such as birth control pills), an FSH test isn’t valid.  

Some healthcare practitioners recommend testing a woman’s saliva for estrogen levels. There is no conclusive evidence that this test provides accurate information around menopause.

Why Testing is Important?

Whether you visit with your doctor or self-test at home, it is always important to get an accurate picture of what is going on with your body. It can be frustrating to have to deal with symptoms like hot flashes and insomnia and not know why they are happening. Getting a test done to measure your hormone levels could provide you with an explanation for all those uncomfortable symptoms.

Getting tested will also help prepare you for changes that your body may be beginning to experience. Aging is associated with various health issues, including osteoporosis, heart disease, and infertility. By getting your hormones tested you may be able to get on top of these issues sooner, decreasing your chances of having to face a serious illness. Testing for menopause is also a way that you can take control of your body and your health.


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Wednesday, April 27, 2011

How to Deal with Vaginal Dryness during Menopause?

One of the most common menopause symptoms is vaginal dryness. It often occurs quickly and without warning in perimenopausal, menopausal, and postmenopausal women. It affects more than 80% of women just entering menopause and continues to affect up to 50% of those completing menopause. If you haven't experienced it, menopausal vaginal dryness may seem like a minor annoyance, but in reality it can be quite devastating. Vaginal dryness can ruin sexual intercourse for some menopausal women and leave behind feelings of inadequacy and guilt. Fortunately, effective treatments are now available for menopausal women who experience this symptom.

Vaginal Dryness in Menopausal Women

Also called vaginal atrophy, vaginal dryness is defined as a lack of adequate moisture in the vaginal area. It can affect women of all ages but it particularly affects women between the ages of 40 and 65.

The body naturally lubricates the vaginal walls with a thin layer of moisture. This moisture layer is made of a clear fluid excreted through the blood vessel walls around the vagina. When a woman is sexually aroused, these blood vessels receive more blood flow, stimulating the secretion of fluids, thus increasing vaginal lubrication.


However, hormonal changes that occur with menopause and other female life events can disrupt this process, both during sex and in daily life. Symptoms of vaginal dryness can range in severity from mild and slightly annoying to significantly life impeding.

The lubricant also has a slight acidity level, which helps to protect your vagina from foreign bacteria, keeping it free from infection.

Estrogen is the key to maintaining vaginal health and elasticity. As estrogen levels decrease during female menopause, the mucous membranes (vaginal epithelium) near your uterus produce less mucous. As a result, the vagina becomes very dry and thin. The walls of your vagina will become weaker and more sensitive. Acid levels also begin to decline, leaving you open to invading microorganisms, which can cause yeast infections and urinary tract infections. As your estrogen levels decline, less blood will circulate to the tissues in the pelvis, causing your vagina to thin and sag. Your vulva and vagina will probably begin to look different than it did before. Tissue and fat around the vagina will begin to disappear.

Symptoms of Vaginal Dryness


The most common symptoms of vaginal dryness are itching and painful sexual intercourse. Without its natural mucus, the vagina becomes very dry and fragile and cannot handle rough penetration. Forceful penetration may rip or tear the vaginal walls. You may have been wondering why you are experiencing vaginal bleeding after menopause. Spotting or bleeding can occur after sex if the vagina is too dry. A lot of women cannot stand to have sex at all, because the painful intercourse in menopause is simply not enjoyable.

Menopause itching due to dryness can also become painful and annoying. Incontinence also often occurs with vaginal dryness. As estrogen levels decrease, the walls of your vagina become increasingly weak, and are unable to prevent urine from escaping. Women with vaginal dryness are also at increased risk for developing vaginal infections like yeast infections, which are characterized by a thick, odorous discharge.

Treating Vaginal Dryness

Fortunately for menopausal women, vaginal dryness is not a condition that needs to be permanent. There are self management techniques to cope with this symptom, and varying degrees of treatment. It is recommended to begin with the least invasive method and progress up to more drastic treatments if symptoms are unaffected.

Lifestyle Changes

Your doctor will probably recommend that you try to have sex as much as possible. This may seem strange, but sexual intercourse will help stimulate the mucus glands at the base of the uterus, making your vagina moist. Women who refrain from sex often find that their dryness becomes even worse.

There are other lifestyle changes that can be implemented into a woman’s life as well, such as dietary adjustments or a different exercise program. Stress reduction techniques such as meditation or yoga can help women to relax if the vaginal dryness is stemming from emotional causes. Communication with one`s partner is recommended.

One of the recommended yoga exercises to treat vaginal dryness is as follows. It sounds simple, but requires concentration. Squeeze the anal/pelvic floor muscles firmly while inhaling; hold. Breathe out, holding the root lock and add a chin lock. Hold for two seconds. Visualize the nectar of the universe flowing down your spine and between your legs. Relax as you inhale.

However, as the primary cause of vaginal dryness in menopausal women is the natural decline in estrogen that is typical of this age group, the most logical method of restoring vaginal lubrication is to address the fundamental hormonal imbalance. Natural supplements can be an easy, safe and effective treatment option.

Some natural supplements to consider:

  • Bryonia: root chakra overheated and dry, dry vagina, dry stools/constipation.
  • Lycopodium: lack of root stability, vagina very dry, self-confidence withered, skin dry.
  • Belladonna: vagina painfully dry and too sensitive to tolerate touch.
Recent studies have shown that a diet rich in soy flour and flaxseeds promotes vaginal health and prevents vaginal dryness. Drinking lots of water also can help your whole body, including your vagina, stay hydrated.

Sexual Activity

Sexual activity is a healthful prescription for postmenopausal women who have a substantially estrogenized vaginal epithelium. It has been shown to encourage vaginal elasticity and pliability, and the lubricative response to sexual stimulation. Women who participate in sexual activity report fewer symptoms of atrophic vaginitis and, on vaginal examination, have less evidence of stenosis and shrinkage in comparison with sexually inactive women. A negative relationship exists between coital activity, including masturbation, and symptoms of vaginal atrophy.

Because no positive relationship has been shown to exist between estrogen levels and sexual activity, coitus is not hypothesized to restore or maintain estrogen in postmenopausal women. The existence of a positive relationship between coital activities and both gonadotropins and androgens indicates the importance of these compounds to healthy vaginal epithelium when estrogen levels are decreased.

Lubricants

To ease physical symptoms, over-the-counter products such as vitamin E oil, vaginal moisturizers, or water-based vaginal lubricants may be a boon to sexual comfort. There are lubricants that you can use during sexual activity that will make you more slippery. These include K-Y Jelly and Astroglide.

There are also products you can use on a regular basis to eliminate vaginal dryness, such as Replens.

You can open vitamin E capsules and apply the oil inside your vagina daily for a week or two and then once or twice a week after that.

Drugs - Estrogen Replacement Therapy

Because the lack of circulating, natural estrogens is the primary cause of vaginal dryness, hormone replacement therapy is the most logical choice of treatment and has proved to be effective in the restoration of anatomy and the resolution of symptoms. Estrogen replacement restores normal pH levels and thickens and revascularizes the epithelium. Adequate estrogen replacement therapy increases the number of superficial cells. Estrogen therapy may alleviate existing symptoms or even prevent development of urogenital symptoms if initiated at the time of menopause. Contraindications to estrogen therapy include estrogen-sensitive tumors, end-stage liver failure and a past history of estrogen-related thromboembolization. Adverse effects of estrogen therapy include breast tenderness, vaginal bleeding and a slight increase in the risk of an estrogen-dependent neoplasm. An increased risk of developing endometrial carcinoma and hyperplasia is conclusively related to unopposed, exogenous estrogen intake. Factors that determine the degree of increased risk include duration, dosage and method of estrogen delivery. Routes of administration include oral, transdermal and intravaginal. Dose frequency may be continuous, cyclic or symptomatic. The amount of estrogen and the duration of time required to eliminate symptoms depend greatly on the degree of vaginal atrophy and vary among patients.

Systemic administration of estrogen has been shown to have a therapeutic effect on symptoms of atrophic vaginitis. Additional advantages of systemic administration include a decrease in postmenopausal bone loss and alleviation of vasomotor dysfunction (hot flushes). Standard dosages of systemic estrogen, however, may not eliminate the symptoms of atrophic vaginitis in 10 to 25 percent of patients. Systemic estrogen in higher dosages may be necessary to alleviate symptoms. Some women require coadministration of a vaginal estrogen product that is applied locally. Up to 24 months of therapy may be necessary to totally eradicate dryness; however, some patients do not fully respond even to this treatment regimen.

Other treatment options include transvaginal delivery of estrogen in the form of creams, pessaries or a hormone-releasing ring (Estring). Treatment with a low-dose transvaginal estrogen has proved effective in relieving symptoms without causing significant proliferation of the vaginal epithelium. The genitourinary pH level is also lowered, leading to a decreased incidence of urinary tract infections. Absorption rates increase with treatment duration because of the enhanced vascularity of the treated epithelium. The advantage of transvaginal treatment may be a decreased risk of endometrial carcinoma because a lower hormone amount is required to eliminate urogenital symptoms. Negative effects of transvaginal treatment include patient dislike of vaginal manipulation, less prevention of postmenopausal bone loss and vasomotor dysfunction, decreased control of absorption with vaginal creams compared to oral and transdermal delivery, and irregular treatment intervals that may cause patients to forget to administer the treatment.

Transvaginal rings offer convenience, constancy of hormonal concentration in the blood stream and a therapeutic value equivalent to creams without the need for frequent application. Control of hormone dosage is manipulated by changing the surface area of the ring. Atrophic vaginitis symptoms are relieved (with a dosage of 5 to 10 μg per 24 hours) without stimulation of endometrial proliferation, thereby eliminating the need to add opposing progestogen to the regimen. Rings may be removed and reinserted by most patients with little difficulty and can be worn during coitus.

In any case, consultation with a doctor is strongly advised with these options due to the possibility of complications.

Vaginal estrogen can be very effective in treating dryness. There are a number of methods currently available for taking estrogen vaginally. Two options are Premarin cream and Estrace. Both are very well absorbed. Some women think that because you apply the cream only inside your vagina, none of it will get into the rest of your body. This isn't the case. Some of the estrogen is absorbed into your blood. In fact, both Premarin and Estrace raise your blood levels of estrogen much the same as estrogen pills.


You only need a low dose of these products. One study found that a dose of 0.1mg provided effective relief from vaginal dryness. When you start using vaginal cream, you apply a small dab just inside your vagina daily for three or four weeks. Then you can reduce your use to once or twice a week. If you apply it daily for more than four to six weeks, it becomes less effective. It's important to remember that this is not a lubricant. You should use K-Y Jelly or Astroglide or another type of lubricant before having sex.

Easier and less messy are the new sustained release products, Estring and Vagifem. Estring is a low-dose estrogen ring that is placed in the vagina (much like a diaphragm) for three months at a time. It releases small amounts of estradiol over time. The estrogen dose is so low that it is not absorbed into the rest of the body. Newer products like Vagifem involve placing a tablet in the vagina rather than a ring.

Note to Women with Breast Cancer: Women who have had breast cancer can use Vagifem or Estring. Estrogen cream, such as Estrace is not recommended. Neither is Femring which is a form of hormone replacement therapy (HRT).


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