Why is my cholesterol level important?
Cardiac disease is the number one killer of women. Too much cholesterol leads to narrowing or “hardening” of the arteries and eventually cardiac disease. Cholesterol is a fatty substance that is generated from the liver, but also enters the body through dietary sources. All women should have their cholesterol levels checked at regular intervals throughout their lives, in addition to participating in a healthy lifestyle in order to minimize their risk of cardiac disease.
What is cholesterol?
Cholesterol is a fat like substance that is present in all cells of the body. Since it is a fat like substance, it does not mix with blood, which is water like substance. Cholesterol is therefore packaged by the body into lipoproteins. These packets allow cholesterol to be carried to the cells of the body where it is needed. There are two major types of lipoproteins: LDL (low density lipoproteins) also referred to the “bad cholesterol” due to the fact that elevated levels of LDL leads to plaque buildup in the arteries of the body and thus cardiac disease, and HDL (high density lipoproteins) also referred to as the “good cholesterol” since it carries cholesterol from other parts of the body to the liver, where it is removed from the body, and thus elevated levels lead to a lower risk of developing cardiac disease. Cholesterol is used to make hormones, vitamin D and substances that are involved with digestion. Additional important fat components in the blood are triglycerides, which are usually analyzed and evaluated with cholesterol.
What affects cholesterol levels?
Cholesterol levels are primarily affected by the food we eat, genes, age and gender. They are also affected by weight and activity. Fats in the diet can alter cholesterol levels, LDL cholesterol levels are raised most by saturated fats. Examples of foods containing a high proportion of saturated fats include: dairy products, animal fats, fatty meat, coconut oil, palm kernel oil, chocolate and some prepared foods. Trans fatty acids also raise cholesterol levels. Being overweight can also increase your LDL levels. High cholesterol levels can also run in families, and thus can be inherited. Individuals which have high cholesterol from birth may have a heart attack at an early age. As we age, our LDL cholesterol levels may also increase. Cholesterol levels in women may vary with their menstrual cycles, with as much variation as 19% in a month. As the level of estrogen rises during a woman’s cycle, her HDL level will also rise and peaks around the time of ovulation. In contrast, total cholesterol and LDL levels, as well as triglycerides, decline as estrogen levels rise. Estrogen containing compounds, such as oral contraceptives and hormone replacement therapies, can also influence cholesterol levels. Oral contraceptives have a modest positive effect on cholesterol levels, raising HDL-cholesterol and lowering LDL-cholesterol. This is a result of the estrogen component, as some progestins alone have a modest negative effective on cholesterol levels. Hormone replacement therapy has a broad scale impact on cholesterol metabolism. Estrogen therapy can increase HDL levels as well as decrease Lp(a), which is a cousin to LDL, and important mediator of cardiac disease.
Triglyceride levels are elevated by: being overweight, cigarette smoking, excessive alcohol use, very high carbohydrate diet, genetic disorders, certain drugs.
Why are elevated levels of cholesterol bad?
Elevated cholesterol levels can increase a woman’s risk to develop heart disease, and many women with elevated levels do not have symptoms. Elevated levels of cholesterol lead to buildup cholesterol containing plaques in the walls of the arteries. This eventually leads to narrowing of the arteries which can lead to decreased necessary blood flow to crucial organs of the body. Coronary arteries are the arteries which supply the heart with blood. When these are narrowed sufficiently, the heart does not receive the necessary oxygen and heart attacks can ensue. Some plaques can also rupture and lead to blood clots which block the flow of blood, leading also to a heart attack or stroke.
What do your cholesterol levels mean?
It is best to have your blood checked after not eating or drinking anything for 9 to 12 hours before the blood draw, so called “fasting” levels. Generally four levels are checked in a lipoprotein profile: total cholesterol, LDL, HDL and triglycerides. If it is not possible to fast before a blood draw, total cholesterol and HDL levels can be drawn in order to give you a general idea about your cholesterol levels. Additional testing should be done of your total cholesterol is greater than 200 mg/dL or your HDL is less than 40 mg/dL. Elevated levels of triglycerides can also increase a woman’s risk to develop heart disease.
Total Cholesterol
Less than 200 mg/dL – Desirable
200-239 mg/dL – Borderline high
240 mg/dL and above – High
LDL Cholesterol Level
Less than 100 mg/dL – Optimal
100-129 mg/dL – Near optimal/above optimal
130-159 mg/dL – Borderline high
160-189 mg/dL – High
190 mg/dL and greater – Very high
HDL Cholesterol Level
Less than 40mg/dL – A major risk factor for cardiac disease
60mg/dL and greater – Considered protective against heart disease
Interventions to lower your cholesterol
For all, lifestyle changes will be advised in order to lower cholesterol levels. This includes eating a low cholesterol diet and increasing exercise. For some women, medications may be prescribed in addition to lifestyle changes, based on other cardiac disease risk factors and level of LDL. Because the risk of heart disease is linked to the level of LDL cholesterol and other risk factors, the main goal of cholesterol treatment is to lower the levels of LDL cholesterol. This can be accomplished through diet, exercise, medications and some alternative therapies. Risk factors for cardiac disease in addition to elevated LDL cholesterol levels include: cigarette smoking, high blood pressure, diabetes, HDL levels less than 40 mg/dL, family history of heart disease (heart disease in father or brother before age 55; heart disease in mother or sister before age 65), age (women greater than 55 years and older). Interventions that a physician will employ based on LDL levels and risk factors include: lifestyle changes and drug treatment. Your LDL goal will be determined by your risk of developing heart disease.
In order to decrease LDL cholesterol through lifestyle changes it is recommended to: limit the amount of saturated fat, trans fat, and cholesterol that your eat, achieve a healthy weight, increase soluble fiber in the diet, and add cholesterol lowering foods, and participate in regular physical activity (30 minutes each day of the week). A diet high in fruits and vegetables, nuts, and seeds is recommended. Goals of a cholesterol lowering diet include: increase fiber (through consumption of fruits, vegetables, legumes and unrefined grains), increasing soy protein in the diet (tofu, soy milk, edamame and other soy products – if you have a history of breast cancer or are at elevated risk for breast cancer, review with your health care professional), and increase phytosterols (whole grains and vegetables).
Cholesterol lowering medications, in additional to change in diet and physical activity, may be prescribed for women who have cardiac risk factors in addition to elevated LDL cholesterol. There are five types of cholesterol lowering medications: statins, bile acid sequestrants, nicotinic acid, fibrates, and ezetimibe. Statins are the first line drug choice for many women; they block the production of cholesterol in the liver itself. They lower LDL, the “bad” cholesterol, and triglycerides, and have a mild effect in raising HDL. Side effects can include intestinal problems, liver damage, and in a few people, muscle tenderness. Examples of commonly prescribed statins include: atorvastatin (Lipitor), fluvastatin (Lescol), lovasatin (Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor), and simvastatin (Zocor). Nicotinic acid, a B-complex vitamin, is found in food, but is also available at high doses by prescription. It lowers LDL cholesterol and raises HDL cholesterol. Bile acid resins bind bile from the lever, made largely from cholesterol, and prevent it from being resorted into the circulatory system and thus deplete the body’s store of cholesterol. Examples of bile acid resins include: Questran and Welchol. Fibrates reduce the production of triglycerides and can increase HDL cholesterol. Examples include: Lopid and Tricor. Ezetimibe lowers bad LDL cholesterol by decreasing its absorption from the intestine. It can be used alone such as Zetia, or combined with statins, such as Vytorin when statins alone do not control cholesterol levels.
There are a number of alternative remedies for lowering LDL cholesterol, however these agents may interact with other medications and have serious and significant side effects. Therefore, you should always review with your health care professional whether these agents are safe and right for you. Supplements that may help to lower cholesterol levels include: garlic (may prolong bleeding and blood clotting time), guggulipid (gum resin of the mukul myrrh tree), red yeast rice, policosanol (from sugar cane). Most of these require additional, well controlled clinical trials to establish their effectiveness. As with any alternative therapy or supplement, the contents of these agents are not regulated by the major safety body for pharmaceutical agents in the United States, the FDA.
Prevention
- Check your cholesterol levels
Healthy adults are recommended to have their levels checked every five years. Total cholesterol, HDL, LDL and triglyceride levels should be checked as part of a lipoprotein profile.
30 minutes of aerobic exercise on a dally basis is recommended
Guidelines from the National Cholesterol Education Program include:
- Saturated fat should account for less than 7% of calories consumed
- Less than 200 mg of cholesterol should be consumed daily
- Up to 30% of calories should be from total fat, but most should be unsaturated fat
- Consume soluble fiber and phytosterols
- Read food labels
Posted: October 10th, 2010 | Author: drpoynor | Filed under: general health, great health at every age, nutrition & diet, weight loss | Tags: reviews | No Comments »
Endometriosis is a condition which usually affects women in their childbearing years and can lead to pelvic pain and infertility. Endometriosis consists of clusters of endometrial cells (the cells which form the lining of the uterus and are shed each month with menstruation) growing outside the uterus. These clusters of endometrial cells, or implants, can be found most commonly in the pelvis including the ovaries, fallopian tubes, and the surface of the uterus. They can also be found on the intestine, upper abdomen or in other parts of the body such as the lung. Because endometriosis cells are subject to the same monthly hormonal changes that normal endometrial cells are, but cannot be shed, this can lead to scar tissue, cysts, and pain. Women who have endometriosis may have a higher risk of developing ovarian cancer. This risk has been difficult to quantify and the mechanism of this elevated risk is unknown.
It is estimated that endometriosis affects over one million women in the United States, and most cases are diagnosed in women between 25 and 35 years of age. However, because many women have no symptoms, the exact prevalence is unknown. The condition is uncommon in postmenopausal women. Other risk factors for endometriosis include being Caucasian (compared to African American and Asian), being tall and thin with a low body mass index, being infertile and delaying pregnancy until older ages.
We do not know the exact causes of endometriosis, but there are several theories. It is thought that estrogens contribute to the formation of endometriosis. Other possible causes of endometriosis include: retrograde menstruation – when endometrial tissue is deposited in strange locations because of menstrual flow that backs up into the fallopian tubes and abdominal cavity, immune system problems – causing the body to not recognize and destroy cells or tissue that is growing where it should not be, and cellular metaplasia – the cells of the areas lining the pelvic organs have certain cells that can grow into other forms of tissue such as endometrial cells.
Many women will have no symptoms of endometriosis, and the amount of the endometriosis does not correlate with the degree of symptoms. The predominant symptom of endometriosis is pain. Endometriosis associated pain may be located in the pelvis, lower abdomen, rectum, vagina, or lower back. It may vary with different points in the menstrual cycle. It may also occur during sex, bowel movements, ovulation, or all the time. Abnormal bleeding is also a symptom of endometriosis. Heavy periods, spotting or bleeding between periods, bleeding after sex, or blood in the urine or stool can occur as a result of the condition. Infertility can also be caused by endometriosis. Disrupted bowel habits such as constipation or diarrhea can also occur.
In order to diagnose endometriosis, a thorough medical history and physical examination will be taken in order to ascertain for the symptoms of the condition. Some health care practitioners will prescribe medical treatments for endometriosis; an improvement in symptoms after medication usually indicates that the problem was endometriosis. Imaging tests, such as ultrasounds, magnetic resonance image (MRI) tests, and CT scans also may be employed However, endometrial implants will many times not show up on even the most sensitive of imaging tests. The only way to truly diagnose endometriosis is through directly evaluating the abdominal and pelvic cavity. This most commonly accomplished through the use of laparoscopy, which is minimally invasive or “belly button” surgery. Biopsies are usually taken in order to rule out other conditions such as ovarian cancer.
Treatment options consist of medical treatments and surgical treatments. The route of treatment will depend on the goal of the woman and can differ if the woman wants to get pregnant or is focused on treating pain. Medical treatments include pain medicines such as NSAIDs (non steroidal anti inflammatory), birth control pills, hormone therapy such as GNRH (gonadotropin-releasing hormone analogs) such as Lupron, Danazol and progestins, and aromatase inhibitors. Many of the medical treatments provide only temporary relief while they are being utilized and can have side effects. Some, like Lupron, can only be used for a limited period of time due to their side effects of bone loss. Surgery may be an option chosen for some women who are attempting to get pregnant or in which medical management has failed. This may consist of ablation techniques or accomplished by excision techniques. This form of surgery, when conducted properly, is quite complex and a gynecologic surgical sub-specialist is encouraged to be consulted. The ovaries and uterus may also be recommended to be removed for some women. This type of surgery, while may be successful in the short run for relieving the symptoms of endometriosis, may not provide long-term pain control for all women,
Take home message:
Endometriosis may be a cause of unexplained pelvic pain, abnormal bleeding, or infertility.
Endometriosis is not an uncommon problem in women.
Diagnosis is usually made on the basis of symptoms and laparoscopy may be used.
Treatments may be either medical or surgical.
If surgery is being entertained as a treatment option, in order to assure that you have the best outcome, consult and expert gynecologic surgeon.
Posted: August 8th, 2010 | Author: drpoynor | Filed under: endometriosis, general health, gynecology | Tags: reviews | No Comments »
Pain Management Of Endometriosis: Conservative Approach Is First-Line Treatment
Source: Medical News Today June 23, 2010
Ob-gyns recommend conservative nonsurgical treatment approaches for treating women with endometriosis-associated pain followed by more invasive procedures if these fail to alleviate pain, according to a newly updated Practice Bulletin published in the July issue of The American College of Obstetricians and Gynecologists’ journal, Obstetrics & Gynecology. The Practice Bulletin “Management of Endometriosis” includes the latest recommendations on the incidence, diagnosis, and treatment of this common gynecologic health condition.
Endometriosis is a chronic condition in which endometrial tissue that lines the inside of the uterus migrates outside of the uterus and attaches to the lining of the abdominal cavity and to internal organs inside the pelvis, including the ovaries, fallopian tubes, bladder, and bowel. The condition occurs in 6-10% of reproductive-age women. Endometriosis is a leading cause of chronic pelvic pain and a common cause of infertility, the two main symptoms. Some women with endometriosis have no symptoms, but for those that do, pain can range from mild to severe.
“We recommend starting with conservative approaches to treating women with endometriosis-associated pain,” says Tommaso Falcone, MD, who led the document update. “For instance, continuous oral contraceptives and nonsteroidal anti-inflammatory drugs are effective. If these fail and further medical management is needed, then gonadotropin-releasing hormone agonists or progestins can help by suppressing the disease.” Medical therapy, however, will not improve fertility for women trying to get pregnant since most of these drugs suppress ovulation. Medical therapy is effective while using it, but recurrence of pain symptoms is common after discontinuing the drugs. Surgery to remove endometriosis tissue helps improve pregnancy rates among infertile women, but it is difficult to predict by how much, said Dr. Falcone.
According to the College vaginal ultrasound is the best way to investigate the presence of endometriosis. The only definitive way to diagnose endometriosis is with laparoscopic surgery. Laparoscopy also can remove visible endometriosis lesions, but it is not 100% effective in helping pain. As with medical therapy, there is a high recurrence of symptoms in patients after laparoscopic surgery. Both laparoscopic surgery and long-term hormone suppression-typically with an oral contraceptive-will likely be needed to control pain.
The treatment of last resort for women with severe endometriosis is hysterectomy. “If a woman has completed having children and all other conservative treatments haven’t worked to stop the pain, she may consider having her uterus removed,” said Dr. Falcone. “If both ovaries are normal and all of the visible endometriosis is removed, then consideration should be given to conserving them.” This way, Dr. Falcone noted, women won’t suffer the consequences of a surgical menopause.
Even when both ovaries are removed, endometriosis symptoms can recur in some women, likely due to lesions that remain attached to the bowel. The Practice Bulletin notes that estrogen therapy after ovary removal does not appear to affect the risk of recurrence of endometriosis and can be safely considered to avoid an immediate surgical menopause.
Practice Bulletin #114, “Management of Endometriosis,” is published in the July 2010 issue of Obstetrics & Gynecology.
American College of Obstetricians and Gynecologists
Abbott And Neurocrine Announce Global Agreement To Develop And Commercialize Elagolix For The Treatment Of Endometriosis
Source: Medical News Today June 17, 2010
Abbott and Neurocrine Biosciences, Inc. announced they have entered into a collaboration agreement to develop and commercialize elagolix for the treatment of endometriosis-related pain. Elagolix is a novel, first-in-class oral gonadotropin-releasing hormone (GnRH) antagonist, which has recently completed a phase IIb study in endometriosis. In addition to endometriosis, elagolix will be evaluated for the treatment of uterine fibroids.
“Extensive preclinical and clinical experience with elagolix suggests this drug could be an important advance for women with endometriosis and uterine fibroids, highly prevalent conditions where there is a need for new treatments,” said John Leonard, M.D., senior vice president, pharmaceuticals, research and development, Abbott. “This agreement enhances Abbott’s late stage pipeline, with the potential for additional compounds in earlier stage development.”
Under the terms of the agreement, Abbott will receive worldwide exclusive rights to develop and commercialize elagolix and all next-generation GnRH antagonists for women’s and men’s health. Abbott will make an upfront payment of $75 million and will fund all ongoing development activities. Neurocrine is eligible to receive additional milestone payments of approximately $500 million from Abbott for the achievement of certain development, regulatory and commercial milestones; funding for certain internal collaboration expenses; plus royalty payments on any future product sales.
“We are pleased to have one of the world’s most admired companies as our partner in developing our entire GnRH portfolio for both women’s and men’s health indications,” said Kevin Gorman, president and chief executive officer, Neurocrine Biosciences. “Abbott shares our long-term vision for elagolix, and, together, we look forward to bringing this important new treatment option to endometriosis and uterine fibroid sufferers.”
About GnRH and Elagolix
Elagolix inhibits gonadatropin releasing hormone (GnRH) receptors in the pituitary gland and ultimately reduces circulating sex hormone levels. Elagolix has a unique profile that allows partial estrogen suppression. It maintains estradiol in the low-normal range, providing symptom reduction while avoiding significant bone loss or other adverse effects that can sometimes be associated with excessive suppression of estrogen. In Phase II studies, elagolix has been found to be effective in reducing the pain associated with endometriosis. To date, elagolix has been studied in 18 clinical trials totaling more than 1,000 subjects.
About Endometriosis and Uterine Fibroids
Endometriosis is associated with a multitude of symptoms, some of the most common of which include pain related both to menstruation (dysmenorrhea) as well as chronic pelvic pain throughout the menstrual cycle, and infertility. The World Endometriosis Research Foundation estimates that there are approximately 100 million women worldwide who suffer from endometriosis. With annual healthcare costs and endometriosis-related productivity losses of approximately $4,000 per patient, the annual direct and indirect costs of endometriosis are estimated to exceed $20 billion in the United States alone.
Uterine fibroids are benign tumors that form on the wall of the uterus. They are the most common type of growth found in a woman’s pelvis and are most common in women aged 30-40 years. While many women do not have symptoms, depending on the size, location and number, uterine fibroids can cause heavy menstrual bleeding, can put pressure on the bladder and rectum, and can cause pain and nausea. Symptoms can also include miscarriages and infertility. Depending on the symptoms, treatment sometimes requires surgery.
Source: Abbott LaboratoriesNeurocrine Biosciences
BioSante Pharmaceuticals Reports Positive LibiGel(R) Safety Data In Phase III Clinical Program
Source: Medical News Today June 23, 2010
BioSante Pharmaceuticals, Inc. (NASDAQ:BPAX), announced that the independent Data Monitoring Committee (DMC) of the ongoing LibiGel® Cardiovascular (CV) and Breast Cancer Safety Study unanimously recommended study continuation without modifications, after its third review of the study’s unblinded safety data. The review was based on data from almost 1,500 women-years of exposure. LibiGel is in development for the treatment of female sexual dysfunction (FSD), specifically, hypoactive sexual desire disorder (HSDD) in menopausal women, for which there is currently no FDA approved product. BioSante anticipates the submission of a new drug application (NDA) for LibiGel in 2011.
“To date, there have been only seven adjudicated CV events and only four diagnoses of breast cancer reported in the study population,” said Michael Snabes, M.D., Ph.D., BioSante’s vice president of clinical development. “If testosterone increased CV disease, the CV event rate would be expected to be higher in the women enrolled since as per the protocol, the study subjects are at the higher end of cardiovascular risk for the intended treatment population. With this favorable DMC recommendation, we believe that LibiGel will be the first product approved by the FDA to treat HSDD in menopausal women, also referred to as FSD.”
The LibiGel Phase III Cardiovascular and Breast Cancer Safety Study is a randomized, double-blind, placebo-controlled, multi-center, CV events and breast cancer study that will enroll between 2,500 and 4,000 women, exposed to LibiGel or placebo for 12 months. After NDA submission and potential approval of LibiGel, BioSante will continue to follow the women enrolled in the study for an additional four years. The first decision point as to whether enrollment is complete or needs to continue will occur early in the fourth quarter 2010.
The LibiGel safety study is tracking a predefined list of CV events, in agreement with the FDA, including CV death, myocardial infarction and stroke, in women 50 years of age or older and suffering from at least two CV risk factors including hypertension and diabetes. The objective of the safety study is to show the relative safety of testosterone compared to placebo in the number of CV events. The incidence of breast cancer also will be tracked over the course of the study.
About LibiGel
LibiGel® is a testosterone gel Phase III in clinical development for the treatment of women who suffer from female sexual dysfunction (FSD). The on-going Phase III efficacy trials are double-blind, placebo-controlled trials that will enroll up to approximately 500 surgically menopausal women each for a six-month clinical trial. The efficacy trials are being conducted under an FDA-approved special protocol assessment (SPA) agreement. LibiGel is absorbed quickly through the skin after a once-daily pea-sized application on the upper arm, delivering testosterone to the bloodstream evenly over time and in a non-invasive and painless manner.
In a Phase II trial, LibiGel significantly increased the number of satisfying sexual events in surgically menopausal women suffering from FSD by 238 percent versus baseline (p<0.0001); this increase also was significant versus placebo (p<0.05). In this study, the effective dose of LibiGel produced testosterone blood levels within the normal range for pre-menopausal women and had a safety profile similar to that observed in the placebo group. In addition, no serious adverse events and no discontinuations due to adverse events occurred in any subject receiving LibiGel. The Phase II clinical trial was a double-blind, placebo-controlled trial, conducted in the United States, in surgically menopausal women distressed by their low sexual desire and activity.
Source: BioSante Pharmaceuticals, Inc
Advisory Panel Says FDA Should Not Approve Drug To Address Female Sexual Dysfunction
Source: Medical News Today June 22, 2101
On Friday, an FDA advisory panel voted 11-0 against recommending FDA approval of a proposed treatment for hypoactive sexual-desire disorder, which decreases women’s sex drive, the Wall Street Journal reports.
The Reproductive Health Drugs Advisory Committee reviewed an application seeking FDA approval of the drug flibanserin, also known as the “pink pill” or “female Viagra.” Although the agency is not required to follow the panel’s recommendation, it typically does (Corbett Dooren, Wall Street Journal, 6/18).
The drug’s effects on women’s sexual drive was “not robust enough to justify the risks,” which included dizziness, fatigue and nausea, particularly with long-term daily use, according to Julia Johnson, chair of the advisory panel and head of the department of obstetrics and gynecology at the University of Massachusetts Medical School. She added that the drugmaker — Germany-based Boehringer Ingelheim — should continue to pursue research on the drug (Wilson, New York Times, 6/18).
According to the Journal, the panel’s recommendation “wasn’t surprising” because FDA released a background document last week with a “fairly negative review” of the drug. The company submitted data involving about 2,400 women for about six months treated with either flibanserin or a placebo months. FDA scientists said the drug did not show an increase in the women’s libido, although some women reported an increase in their number of sexually satisfying events. The document noted that it was “not clear whether the safety and efficacy data from these trials are generalizable to the target population for this drug.”
Boehringer said that women with HSDD have “extremely limited” treatment options and that flibanserin provided “clinically relevant” data for the drug’s efficacy (Wall Street Journal, 6/18). Christopher Corsico, the company’s U.S. medical director, said in a statement that the company is “disappointed with the advisory committee’s recommendation and will work with the FDA to address questions raised” (New York Times, 6/18).
Drug Marketing ‘Bigger Issue’ in Flibanserin Review, Los Angeles Times Editorial Say
Early Menopause Linked To Higher Risk Of Future Cardiovascular Disease
Source: Medical News Today June 22, 2010
Women who experience early menopause appear to have more than twice the risk of having a heart attack, stroke or other cardiovascular disease event later in life than do women who do not go through early menopause, a new study indicates. The results will be presented Saturday at The Endocrine Society’s 92nd Annual Meeting in San Diego.
Early menopause was defined as going through menopause before age 46, either naturally or surgically through removal of both ovaries.
“It is important for women to know that early menopause is a potential risk factor for cardiovascular disease the number one killer of American women. They can then work harder to improve their modifiable risk factors, such as high cholesterol and blood pressure, by exercising and following a healthy diet,” said the study’s principal author, Melissa Wellons, MD. She is a fellow at the University of Alabama, Birmingham.
Previous research found a link between early menopause and cardiovascular disease in mostly white and European populations, according to Wellons, but the new study had a multiethnic representation of women. Of the more than 2,500 participants, about 40 percent were white, 25 percent were black, 22 percent were Hispanic and 13 percent were Chinese-American.
At the beginning of the study in July 2000, women were ages 45 to 84. Nearly 28 percent of the women reported early menopause; 446 women had natural menopause and 247 had surgical menopause. Women not yet past menopause were included in the group that did not have early menopause. Follow-up tracked whether participants had a cardiovascular disease event, which included a heart attack, nonfatal cardiac arrest (a suddenly stopped heart), angina (chest pain due to narrowed or blocked arteries), probable angina followed by angioplasty or bypass surgery, a stroke or death due to stroke, heart attack or other cardiovascular disease.
No one had any such event before age 55. After that, women who had early menopause were more likely to have had a cardiovascular disease event than women who had not gone through menopause before age 46.
Even when the researchers’ statistical analysis controlled for current or previous use of hormone replacement therapy or for major cardiovascular risk factors, it did not change the results. Early menopause remained a risk factor on its own, although it is unclear why, Wellons reported.
“Our study is observational; therefore, we cannot conclude that early menopause somehow causes future cardiovascular disease,” Wellons said. “However, our findings do support the possible use of age at menopause as a marker of future heart and vascular disease risk.”
The women in this study were part of the Multi-Ethnic Study of Atherosclerosis (MESA), an observational research study funded by the National Institutes of Health and involving more than 6,000 men and women from six U.S. communities. Also contributing to the current study were researchers from Johns Hopkins Medicine, Baltimore; Wake Forest University, Winston-Salem, N.C.; and the University of Minnesota, Minneapolis.
Source: Endocrine Society
Progesterone Is Effective For Hot Flash Treatment And Provides An Alternative To Estrogen
Source: Medical News Today June 22, 2010
Postmenopausal women who experience bothersome hot flashes or night sweats may have an alternative treatment to estrogen. According to a new study, oral micronized progesterone relieves those symptoms. The results will be presented Saturday at The Endocrine Society’s 92nd Annual Meeting in San Diego.
“This is the first evidence that oral micronized progesterone, which is molecularly identical to the natural hormone, is effective for women with symptomatic hot flashes,” said the presenting author, Jerilynn Prior, MD, professor, University of British Columbia, Vancouver, Canada.
Available only by prescription and sold under the brand name Prometrium in the United States and Canada, this form of progesterone is manufactured from a steroid in yams.
“Vasomotor symptoms” hot flashes (sometimes called hot flushes) and night sweats are experienced by most women during the years around the final menstrual period. In the most symptomatic women (at least 5-10%) these symptoms disturb sleep, energy and quality of life, Prior said.
The researchers recruited 114 healthy postmenopausal women seeking hormonal therapy for hot flashes and night sweats and randomly assigned them to take either oral micronized progesterone or an inactive substance (placebo), both as three round capsules at bedtime. Neither the women nor the study team members were aware which treatment the study participants received during the three months of therapy. The time since their last menstrual flow was one to 10 years, with an average of four years. To be eligible to participate in the study, women could not have taken ovarian hormone therapy within the past six months.
Prior and Christine Hitchcock, PhD, of the University of British Columbia, calculated the average daily vasomotor symptom score, or VMSScore, from the data that subjects recorded in a daily diary. This score reflects both intensity and number for hot flashes and night sweats each day.
Progesterone, in a 300-milligram dose, was more effective than placebo at decreasing the intensity and number of symptoms, the authors reported, and the difference was both statistically significant and clinically important. The 68 women taking progesterone showed a 56% improvement from baseline in VMSScore, and a 48% reduction in the number of VMS; the 46 women taking placebo had 28% lower VMSScores and a 22% reduction in number.
“Women improve very quickly on oral micronized progesterone. The improvement is apparent within the first 4 weeks,” Prior said.
Micronized progesterone did not cause any serious side effects, she said. The drug may be an option for postmenopausal women who do not want to or should not take estrogen “currently the only effective therapy for decreasing severe vasomotor symptoms,” Prior said.
Besins Healthcare and Schering Canada donated the progesterone and placebo for this study.
Source: Endocrine Society
For Insulin-Resistant Women, Cutting Carbs Is More Effective Than Low-Fat Diet
Source: Medical News Today June 21, 2010
Obese women with insulin resistance lose more weight after three months on a lower-carbohydrate diet than on a traditional low-fat diet with the same number of calories, according to a new study. The results were presented at The Endocrine Society’s 92nd Annual Meeting in San Diego.
“The typical diet that physicians recommend for weight loss is a low-fat diet,” said the study’s lead author, Raymond Plodkowski, MD, chief of endocrinology, nutrition and metabolism at the University of Nevada School of Medicine, Reno. “However, as this study shows, not all people have the same response to diets.”
People with insulin resistance, a common precursor for Type 2 diabetes, metabolize carbohydrates, or “carbs,” abnormally, which may affect their rate of weight loss. For them, Plodkowski said, “the lower-carb diet is more effective, at least in the short term.”
At 12-weeks, the study funded by Jenny Craig and using prepared calorie-controlled meals as part of a behavioral weight loss program, found that the insulin resistant women on a lower-carb diet lost 3.4 pounds more than those on a low-fat diet.
Forty-five obese women between the ages of 18 and 65 years participated in the study, and all had insulin resistance, as found by fasting blood levels of insulin. The researchers randomly assigned the women to either a low-fat or lower-carb diet. The groups did not differ significantly in average body weight, the authors reported. On average, women in the low-fat diet group weighed 213 pounds, while women in the other group weighed 223 pounds.
The composition of the low-fat diet was 60 percent of calories from carbs, 20 percent from fat and 20 percent from protein. Although the lower-carb diet also had 20 percent of calories from protein, it had 45 percent from carbs and 35 percent from primarily unsaturated fats, such as nuts. Menus included a minimum of 2 fruits and 3 vegetable servings a day.
Use of prepared meals helped make the structured diets easier and more palatable for the dieters, according to Plodkowski. “We wanted to make this study real-world – anyone could follow this plan by making moderate changes as part of a healthy menu,” he said.
Both groups lost weight at each monthly weigh-in, but by 12 weeks, the insulin resistant group receiving the lower-carb diet lost significantly more weight, 19.6 pounds versus 16.2 pounds in the low-fat diet group – approximately 21 percent more on average.
“These data have potential widespread applications for clinicians when counseling people with insulin resistance to help improve weight loss as part of a calorie-restricted diet,” Plodkowski said. “They should at least initially lower their carbohydrate intake.”
Source: The Endocrine Society
Posted: June 25th, 2010 | Author: drpoynor | Filed under: endometriosis, gynecology, menopause, nutrition & diet, sex, weight loss | Tags: cardiovascular, diet, endometriosis, home, hot flashes, libido, menopause, news, nutrition | 3 Comments »
First, take a deep breath and realize that if your Pap smear is abnormal it does not mean that you have cancer and that you are not alone. About 55 million Pap tests are performed each year in the United States. Of these, approximately 3.5 million (6 percent) are abnormal and require medical follow-up.. The Pap smear samples cells which are on the surface of the cervix and these cells are looked at underneath the microscope. The procedure is named after the doctor who first discovered that cervical cells changed before cancer of the cervix develops, Dr. George Papanicolaou. Cells on the surface of the cervix sometimes appear abnormal but are very rarely cancerous. The Pap smear was designed to pick up abnormal cells before they have a chance to become cancerous and having regular Pap smear tests and appropriate treatment and follow-up of abnormal results, significantly reduces the chance that cervical cancer will ever develop. Prior to the introduction of the Pap test, cervical cancer was a leading cause of cancer death in women, and still is in some parts of the world. Since the introduction of the Pap test, deaths caused by carcinoma of the cervix have been reduced by up to 99% in some populations where women are screened regularly. A healthcare provider may simply describe Pap test results to a patient as “abnormal.” It is important to remember that abnormal conditions do not always become cancerous, and some conditions are more likely to lead to cancer than others.
The cells of the cervix may be abnormal due to infection, lack of estrogen in older women, or precancerous changes. Although the Pap smear is not designed to reliably pick up abnormal cells from sources other than the cervix, some abnormal Pap smears may be due to vaginal, endometrial, fallopian tube, ovarian, or rectal abnormalities. Breast cancer cells have even been found in Pap smears, although quite rarely. The vast majority of precancerous changes in the cervix are due changes in the cells that cover the outer surface of the cervix, the squamous cells. Some precancerous changes will be due to the cells lining the inner portion of the cervix, called glandular cells. If any unusual cells are detected, further tests are done to determine if treatment is needed. This is the best way to find out if cancerous or precancerous cells are present.
Precancerous changes in the squamous cells of the cervix are referred to as cervical dysplasia or cervical intraepithelial neoplasia (CIN). If these type of changes are detected on your Pap test, they will be graded as mild (CIN 1), moderate (CIN 2), or severe (CIN 3). CIN 1 is also referred to as a low-grade squamous intraepithelial lesion (LGSIL) and CIN 2 and CIN 3 are referred to as a high-grade squamous intraepithelial lesions (HGSIL). Any of these changes require further discussion and evaluation with your health care professional.
We know understand that virtually all precancerous and cancerous changes in the cervix are due to the human papilloma virus (HPV), a very common, sexually transmitted virus. HPV infection is the primary risk factor for cervical cancer, however only a very small percentage of women with untreated HPV infections develop cervical cancer. Approximately 80% of women will become infected with the HPV virus in their lifetime and many times there are no associated signs or symptoms other than an abnormal Pap smear. About 6 million new genital HPV infections occur each year in the United States. HPV may also cause vulvar, vaginal and rectal cancers. In most cases of HPV infection, the immune system quickly attacks the virus, and it is cleared from a woman’s system. For other women, the immune system does not rid the body of the virus, and a small number of these women will develop CIN. The development of CIN is more likely to occur in older women who have had HPV for a long time. Women who smoke and have HPV face twice the risk of developing CIN than women who do not smoke. The good news is that if you have regular Pap smear tests and appropriate, regular follow-up, it’s unlikely that cervical cancer will develop.
The most common system for describing Pap smear test results is the Bethesda System. The Bethesda System uses a number of terms to relate the results. Squamous intraepithelial lesion (SIL) describes precancerous changes in cervical cells. Using this system, your Pap smear test results may be:
- Normal
- Atypical squamous cells of undetermined significance (ASCUS) This is the most common abnormal Pap smear test result indicating the presence of cervical cell changes. This term simply means that the squamous cells of the cervix appear unusual and cannot be further categorized. These changes may be due to infections, thinning of the cervix and vagina in women who have low estrogen levels, or precancerous or cancerous changes.
- Squamous intraepithelial lesion (SIL) This term describes abnormal cervical cell changes that may be a sign of precancer. SIL is either low grade (LGSIL) or high grade (HGSIL). LGSIL or HGSIL refers to the grade of dysplasia and CIN. LGSIL is indicative of either the presence of HPV or mild precancerous changes; this is a common type of abnormal Pap smear result. HGSIL, on the other hand, indicates more serious cervical cell changes.
- Atypical squamous cells, cannot exclude HGSIL (ASCH) This Pap smear test result means there is uncertainty about whether HSIL is present.
- Atypical glandular cells (AGC) This term implies precancerous changes to the upper cervix or uterus.
- Cancer Hopefully, you will never get this result from your Pap smear. Having regular Pap smear tests can almost guarantee that you will never get a result of cancer
- Endocervical and endometrial abnormalities can also be detected, as well as a number of infectious processes, including yeast, herpes simplex virus, and trichomonas.
What next?
Make sure that you review results with your health care professional. Many times, this will mean a trip to the office to review the meaning of an abnormal Pap smear and review recommendations for treatment.
Not all abnormal Pap smear test results require other tests and sometimes observation and closer surveillance will be recommended. The important thing is that you follow recommendations after having any type of abnormal Pap smear test result. In some instances, further investigation of the cervix with colposcopy will be recommended.
If the Pap test shows an ambiguous or minor abnormality, the healthcare provider may repeat the test to determine whether further follow-up is needed. Many times, cell changes in the cervix go away without treatment. In some cases, healthcare providers may prescribe estrogen cream for women who have ASC–US and are near or past menopause as these cell changes are often caused by low hormone levels. Applying an estrogen cream to the cervix for a few weeks can usually help to clarify the cause of the cell changes.
If the Pap test shows a finding of ASCUS, ASC–H, LGSIL, or HGSIL, the healthcare provider may perform a colpsocopy. A colposcope is a microscope that provides a closer view of the cervix. The colposcopic exam is similar to a regular pelvic exam and should only take a few minutes to perform. Anesthesia is not required.
Dilute acetic acid (vinegar solution) is placed in the vagina to help determine of there are any abnormal areas, they turn white and may be refereed to as aceto-white lesions. The colposcopy itself is painless, however if abnormal areas are seen, then very small (2-3mm) pieces of tissue may be removed in the form of a colposcopically directed biopsy. This may lead to a small about of pain, cramping and bleeding which usually rapidly resolves. This cervical tissue is then sent for laboratory evaluation. These biopsies cause no long-term damage to your cervix. Endocervical sampling may also be performed, which is a scraping from the inside of the cervix. This may also lead to cramping and spotting.
If the testing shows abnormal cells that have a high chance of becoming cancer, further treatment is needed. Treatment options include the following: LEEP (loop electrosurgical excision procedure) is surgery that uses an electrical current which is passed through a thin wire loop to act as a knife and is a larger cervical biopsy, CO2 laser which uses a narrow beam of intense light to destroy or remove abnormal cells, or conization which removes a cone-shaped piece of tissue using a knife, a laser, or the LEEP technique.
Summary:
Take a deep breath, the vast majority of abnormal Pap smears do not indicate the presence of cancer.
Follow your healthcare providers recommendations for treatment and follow-up.
Treatment of abnormal Pap smear test results depend on the type of cervical changes seen, the age of the women, and other individual circumstances.
With appropriate treatment, cervical cancer can be prevented in the vast majority of the time.
Resources:
http://www.cancer.gov/cancertopics/factsheet/Detection/Pap-tes
http://www.cancer.gov/cancertopics/factsheet/Risk/HPV
http://www.cancer.gov/cancertopics/understandingcervicalchanges
Posted: June 19th, 2010 | Author: drpoynor | Filed under: cancer diagnosis & treatment, cancer prevention, general health, gynecology | Tags: abnormal Pap smear, cancer prevention, cervical cancer, Pap smear | 3 Comments »
I was scrubbed in the operating room one day and all of a sudden announced to my operating team in a frantic voice that I was extremely and uncomfortably hot, and immediately wanted to rip my gown and gloves off. This was clearly not possible, so I asked in a very forceful fashion to please immediately lower the temperature in the operating room. In unison, all of the nurses in the room with me started to uncontrollably laugh. Confused, frustrated and downright angry, I asked again to reduce the temperature. And then I realized, I had just had my first hot flash. I have helped to manage hot flashes in women for about twenty years now, but until I had my first encounter with one I did not understand the impact that they can have. For some women hot flashes are nonexistent, for some they are mild, and for others they may be debilitating. Most of us cannot rip our clothes off and sit in a bucket of ice.
Eight five percent of women will experience some form of hot flashes as they approach menopause and for the first few years after their periods stop. Up to 50% women will experience hot flashes will have hot flashes that continue for a number of years more. For some, these will be unrelenting while for others they will decrease in intensity.
Hot flashes usually begin as a feeling of pressure in the head, neck, chest and back, and spread to the entire body. The number of hot flashes and the length of time of a hot flash are different for each woman: a woman may experience as few as one a day or as many as three an hour, when others may not experience any hot flashes. Hot flashes my interrupt sleep, which may result in feeling more irritable and having a condition, called insomnia. The good news is that hot flashes usually decrease, as you get further on in your menopause. Medication and lifestyle can affect hot flash intensity and frequency.
Hot flashes are caused by the decline of estrogen that women experience through either natural aging and peri menopause and menopause, through medications that turn off ovarian function, chemotherapy, or through surgical removal of the ovaries. The exact reason for hot flashes is not known. However, some scientists think that there is a release of a hormone called luteinizing hormone (LH) that happens at the same time as the levels of estrogen decrease. This release of LH may cause a change in certain nerve pathways and cause veins to get larger for no reason. This causes skin flushing (change of skin color to red), increase in perspiration and changes in blood flow, temperature and heart rate.
Estrogen replacement therapy is very effective for treatment of hot flashes, but many women will desire to avoid estrogen replacement therapy either due to personal preference or medical contraindications such as breast cancer. As estrogen therapy has its own set of side effects and complications, it is always reasonable to move from the least aggressive to more aggressive in the approach to hot flashes.
Practical Suggestions for Managing Hot Flashes
Personal Habits
- Wear absorbent, cotton clothing
- Dress in layers with lightweight clothing
- Lower the thermostat
- Use a room or personal hand held fan
- Sleep near an open window
- Change sleeping attire and bed linen to lighter fabrics
- Avoid hot baths or showers in the 2 hours prior to going to bed, try a cool shower
- Chillow- a personal cooling pillow that can help with sleep. Visit the web site.
- Record the number of hot flashes each day and identify triggers for your hot flashes. Record when they occur, what you were eating or doing, and how you were feeling at the time, and avoid triggers
- Get regular exercise, take the stairs instead of the elevator
- Avoid cigarette smoking
- Practice the paced respiration (slow breathing) techniques listed below
- Keep ice water nearby to help cool you down
- Where natural fabrics and avoid synthetics
Diet Modification
- Avoid caffeine
- Avoid alcoho
- Avoid spicy food
- Low fat die
Relaxation and Stress Reduction Techniques
Choose from any of these and begin to determine which work best for you. Success rates are variable for the use of these techniques to control or prevent hot flashes and most techniques are not studies in randomized controlled studies.
- Biofeedback techniques
- Breathing exercises
- Meditation and visualization
- Massage
- Reflexology
- Hypnosis
- Yoga
Instructions for Paced Respiration
- Take slow deep breaths totaling 6 to 8 breaths in one minute
- During each breath, allow the air to fill your abdomen and your lungs. You should feel your abdomen getting bigger in addition to your lungs expanding during each breath.
- Do these paced respirations for 15 minutes 2 to 3 times every day.
- You may do these paced respirations any time during the day or night in addition to the 2 times recommended. You may find them helpful to do in a situation that you have experienced a hot flash in the past (like being in a room that is too warm.) Do them also when you feel that you are about to have a hot flash.
Studies show that this technique decreases hot flashes by at least 50%.
Consider adding some Vitamins Supplements
- Vitamin B6, 200 or 250 mg daily
- Peridin C, two tablets three times a day
- Vitamin E 800 IU day
Herbs
Some herbs that some have tried include:
- Isoflavones
- Black Cohosh
- Chaste Tree Berry
- Ginseng
- Dong Quai
- Evening of primrose oil
- Wild yam
- St. John’s wort
- Red clover
- Linden flower
- Yarrow
- Green Tea Extract
There is limited scientific evidence that these herbs actually help menopausal symptoms, and many may have potentially harmful side effects and interactions with chemotherapy and other medications. Caution should be used when using these agents. Some phytoestrogen components may not be suitable for patients with estrogen dependent tumors.
Prescription Medications for Hot Flashes
There are other medicines that are available by prescription if you need additional assistance to help with your hot flashes please talk with your doctor to see if you should try another type of medicine that needs a prescription and to discuss possible side effects from these medications.
Some prescription medications include
- Antihypertensive: clonidine/Catapress, Aldomet
- Antidepressants/ Selective Serotonin Reuptake Inhibitors: venlafaxine/Effexor, paroxetine/Paxil
- Antiepileptic: Gabapententin/neurontin
- Sedatives: Bellergal
- Progesterone: Megace (a hormone, but not estrogen)
Guidelines
- Start with the above “over-the-counter” medicines.
- Allow at least 4 to 6 weeks for the medicines to work
- When possible, add one medicine at a time so that you can see if it is working for you.
- A doctor’s order is needed for some of the other medicines. Some of these may not be good for you if you have other medical conditions.
- Always review the use of any vitamin or herb with your physician to assure that these are not harmful for you based on your personal health history
Posted: March 10th, 2010 | Author: drpoynor | Filed under: menopause | Tags: home, hot flashes, menopause | 2 Comments »
The technical term for painful periods is dysmenorrhea, a condition that affects between 45 and 90 percent of women of childbearing age in the United States. Many women have periods that are only mildly painful for the first day or two and easily controlled with the use of an over the counter remedies such as non steroidal medications. However, a large number of women suffer significantly each month with severe pelvic pain limiting their ability to work and function. This may lead to lost work days, lost time out of life, significant pain and suffering. This topic caught my interest to write about because it was announced last week that a new study is being undertaken in order to evaluate a novel drug to treat dysmenorrhea. Currently, we can use non-steroidal anti inflammatory (NSAIDs), oral contraceptives and some vitamins to treat painful periods, but for many women these measures are not effective so that a new approach is needed and welcome.
Dysmenorrhea is reported greatest among young women, with the ages between the late teens and early 20’s being the time that a woman is most likely to experience dysmenorrhea. Painful periods may be relieved in some by child-bearing and can decrease significantly after the age of 40 years. The main symptom of dysmenorrhea is pelvic pain accompanied by abdominal pain, which may radiate to the back or to the thighs. Other symptoms may include nausea and vomitting, diarrhea or constipation, headache, dizziness, disorientation, hypersensitivity to sound, light, smell and touch, fainting, and fatigue. Symptoms of dysmenorrhea often begin immediately following ovulation and can last until the end of menstruation.
When painful periods occur as the result of a structural cause or underlying disorder, the condition is termed secondary dysmenorrhea. An example of secondary dysmenorrhea is a woman that has endometriosis and the painful periods that can result. Primary dysmenorrhea refers to painful periods that occur in the absence of a detectable underlying disease condition or structural abnormality of the uterus or pelvis. Prostaglandins are released during menstruation which causes the uterus to contract. It is these contractions of the uterus which are thought to lead to the pain with menstruation and women with primary dysmenorrhea may demonstrate increased contractility of the uterus. Prostaglandin release is also responsible for the other associated symptoms such as nausea and diarrhea that some women experience.
In the initial evaluation of dysmenorrhea, pelvic ultrasonography should be performed in order to rule out causes for secondary dysmenorrhea. NSAIDs are usually the first choice for treatment of presumptive primary dysmenorrhea. These medications can help some women with dysmenorrhea but can cause nausea, ulcers and diarrhea and their long term use can have additional adverse effects. COX2 inhibitors (such as Celebrex) may be prescribed for some women; however their use can also be associated with adverse cardiac events. Some hormonal contraceptives may provide relief for some women, along with depo provera or the progestin releasing IUD. If the typical interventions for primary dysmenorrhea are ineffective, a laparoscopy may be considered in order to rule out underlying conditions which may cause secondary dysmenorrhea. Nutritional supplements which may help the treatment of dysmenorrhea include: omega-3 fatty acids (found in flax oil), magnesium, vitamin E, zinc and thiamine (vitamin B1). Alternative therapies include acupuncture, acupressure, TENs (trans cutaneous electrical nerve stimulation) units and behavior therapy. Other interventions include: the use of topical heat; the Japanese herbal remedy toki-shakuyaku-san and a low-fat vegetarian diet.
An international research program is now underway to study an investigational drug designed as a possible treatment of dysmenorrhea. It is hoped that the investigational drug, presently named VA111913, may prevent the cause of the cramps that can leave some women bedridden, rather than just treat the symptoms. Pivotal Research is recruiting women of childbearing age who suffer from dysmenorrhea and normally take medicine to treat their menstrual cramps to take part in a research study. The study will assess the effect that treatment with VA111913 has on pain experienced during menstruation, including the intensity and duration of the pain. In earlier studies, VA111913 has been shown to control abnormal contraction of smooth muscle tissue, such as that found in the uterus wall. By targeting receptors of a hormone called vasopressin, it is hoped that the investigational drug will prove effective in controlling the abnormal contractions that cause painful periods.The study, which involves centers in the US and the UK, is a Phase II study designed to show whether the drug is effective in treating menstrual cramps. Results from this study are expected in 2010 and if it, and further studies are successful, the drug could be available in four years.Dr. Louise Taber, the physician conducting the study at Pivotal Research, said: “Dysmenorrhea affects a large number of women and there is currently no targeted therapy to treat the cause of the condition. Earlier results with this investigational new drug showed effects on the contraction of smooth muscle, and it is hoped that VA111913 could potentially offer an effective treatment to the many women whose lives are affected by this painful and debilitating condition.” (Source: Medical News Today 2/10/10)
Posted: February 28th, 2010 | Author: drpoynor | Filed under: endometriosis | Tags: endometriosis, home, NSAIDS, paintful periods | 3 Comments »
Many women will experience distressing sexual dysfunction. This may be brought on by stressors in life, or by the declining estrogen and testosterone levels that occur with the aging process. As many as 43% of women between the ages of 18 and 59 years will report sexual problems within the previous year. It is becoming more common in my practice that women report to me sexual issues. I can attribute this to a few reasons: women tend to remain more youthful in their approach to aging and maintenance of sexual function is desired, aging men now have erectile dysfunction medications so that they can remain sexually active, I ask my patients more about these issues and women are more likely to report sexual problems as we have more of a dialogue about this in the popular press. The technical term for lack of libido which causes distress is hypoactive sexual desire disorder (HSDD).
HSDD is defined as the persistent or recurrent deficiency or absence of sexual thoughts, fantasies, and/or desire for, or receptivity to, sexual activity which causes marked personal distress or interpersonal difficulties. There are three components to sexual desire: drive, cognition, and motivation. Drive is the biologic component of desire which is based on neurologic mechanisms and manifested as spontaneous sexual interest. Drive naturally declines with age. Cognition consists of expectations, beliefs and values that influence desire. A woman that believes that sex is a healthy component of life will have a stronger desire than a woman who thinks that sex is inappropriate. Motivation consists of psychological and interpersonal factors that create a willingness to engage in sex. For example, motivation will be influenced by the interpersonal relationships with ones partner.
Common causes of loss of desire in women include declining estrogen and androgen levels, thinning of the genital tissues with age, and progestins. Loss of estrogen can lead to shortening and thinning of the vagina, loss of vaginal elasticity, diminished vaginal lubrication, diminished blood flow, reduced nerve transmission, sleep disruption and mood alterations. These changes lead to vaginal dryness, painful intercourse (dyspareunia), and painful or more frequent urination. Progestins may alter mood and may alter the metabolism of androgens.
One of the largest barriers to physician initiation of a discussion of sexual health with their patients is a lack of knowledge and training in sexual medicine. Indeed, I have had to learn on the job. It was not part of my medical education at any point in my training. Women may not bring up sexual dysfunction with their physicians due to embarrassment. Questions that your physician may ask you include: are you sexually active, are you having any problems with intercourse such as pain, are you having any problems with your libido or sexual desire, are you having any problems reaching orgasm?
Interventions for HSDD include: psychotherapy, sex therapy, and pharmacologic therapies. There are currently no approved FDA drugs for female HSDD. Topical estrogen therapy can increase vaginal lubrication, and vaginal blood flow, which can lead to increased arousal. Systemic estrogen therapy also has the potential also to increase desire. Testosterone therapy can lead to increased desire in a subset of women, but has not been FDA approved. Long-term safety data for androgen therapy is lacking and therefore its use must be very cautiously undertaken. Monitoring of hormone levels and lipid levels is necessary with testosterone use. Other medications which may help some women include DHEA, PD5E inhibitors, and some topical formulations such as Viacreme and Zestra.
In addition to HSDD, additional sexual disorders which may occur in women include sexual aversion disorder (extreme aversion to sexual contact), sexual arousal disorder, orgasmic disorder, dyspareunia (painful intercourse), and vaginismus (difficulty allowing entrance of any object into the vagina despite the desire to).
The bottom line:
If you are having problems with sexual desire, you are not alone.
There are medical interventions for women who are experiencing difficulties.
If you cannot review with your physician, find one that you feel comfortable discussing your problems with.
If your physician is not experienced in the management of sexual health issues, find one that is.
Posted: February 21st, 2010 | Author: drpoynor | Filed under: estrogen, sex | Tags: estrogen, home, libido, sex, testosterone, women | 3 Comments »
The use of estrogen in the treatment of women has radically changed over the past fifteen years. Fifteen years ago virtually all women were encouraged to take estrogen soon after menopause in order to prevent cardiac disease. At this point in time we knew that there may be an elevated risk to develop breast cancer with estrogen therapy, but we counseled our patients that estrogen helped to prevent the leading killer of women, cardiac disease. Then in 2002, the Women’s Health Initiative (WHI) Study changed the landscape of hormone therapy for women.
This very large scale study determined that the risks of hormone therapy outweighed any perceived benefits, and women throughout the country were told to stop taking their estrogen. Unfortunately, this study was flawed from the beginning and did not yield results that were generally applicable to the recently menopausal woman who was considering hormone therapy to control symptoms of this life transition. We have now realized the problems with the WHI study and have swung back to a more reasonable, individualized approach to hormone therapy in women, and have also realized that estrogen therapy may indeed prevent cardiac disease when initiated soon after menopause. Our larger questions which now need to be addressed include the safety and efficacy profiles of various preparations. While prolonged estrogen and progestin use may increase a woman’s risk to develop breast cancer or thromboembolic disease (problems from blood clots) the benefits for some women may outweigh this risk.
The North American Menopause Society (NAMS) has released today an updated position statement on the use of estrogen and progestogen in postmenopausal women. NAMS is a non-profit organization which has previously released position statements from advisory panels consisting of clinicians and researchers who are experts in the field of women’s health. This is an updated version from their 2008 release. Their goal is to clarify the risk benefit ratio of hormone therapy with estrogen and progestin in the treatment of menopause symptoms and disease prevention. They have concluded that the use of hormone therapy should be consistent with treatment goals, benefits and risk for the individual woman. They note that the benefit and risk ratio will change for each woman with her age and her menopausal symptoms as she ages.
The below summarizes and highlights their recent position statement.
Benefits of the use of hormone therapy include:
Relief of vasomotor symptoms (hot flashes and night sweats)Treatment of vaginal atrophy (dryness).
Improvement of sexual function through relief of dryness and increase sexual satisfaction due to increased blood flow and sensation in the genital tissues.
Improvement in urge incontinence (a form of urinary incontinence).
Decreased risk of recurrent urinary tract infections.
Prevention of osteoporosis.
Early initiation of hormone replacement therapy does not increase cardiac disease and may reduce cardiac disease.
May lead to improved mood (data is mixed).
Risks:
Elevated risk of uterine cancer when estrogen is used without a progestin (five times elevated risk after three years of estrogen alone use).
Breast cancer is elevated in women treated with combined estrogen and progestin therapy after 3-5 years of use; however women treated with estrogen alone having a lower risk of developing breast cancer but may increase after 10-15 years of use.
May increase dementia when hormone therapy is initiated in older women (over 65 years).
There is currently no data to determine if one type of estrogen or progestin has a better safety profile, however there are likely to be differences of different regimens Transdermal estrogens (patches and gels or mists) do not increase triglycerides, lead to no change in C reactive protein and have little effect on blood pressure. They may also be associated with a lower incidence of deep venous thrombosis.
Usage recommendations:
A progestin is generally not recommended to be used in conjunction with ultra low dose vaginal and transdermal estrogens; however the addition of progestins may improve vasomotor symptoms.
The lowest effective dose of estrogen consistent with treatment goals, benefits and risks for the individual woman should be the therapeutic goal, with the addition of a progestin added if the woman has her uterus in place.
There is emerging data that the timing of initiation of hormone therapy is important, and that early initiation of therapy may reduce total mortality and heart disease risk. Therapy should not be initiated in women over the age of 60 years without a compelling indication.
The length of use is not well established and extending the use of hormone therapy for an extended period of time if the symptom benefit outweighs the risk and for the woman who is on estrogen replacement therapy for her bones when other treatments are not appropriate.
Bioidentical hormone therapy:
The term “bioidentical hormone therapy” generally refers to estrogens and progestin naturally produced in women. However the term is many times used to describe custom made preparations that are compounded for an individual according to a healthcare provider’s prescription. These are generally made in compounding pharmacies. These compounds have not been tested for safety or efficacy by the FDA and they are not FDA approved. NAMS recommends that filled prescriptions for bioidentical hormone therapy should include a package insert identical to those that have regulatory approval. The FDA has stated that there is no scientific basis for using saliva testing to adjust hormone levels.
Summary:
Therapy should be individualized.
There is a growing body of evidence that each type of estrogen and progestin, route of administration, and timing of therapy has distinct beneficial and adverse effects.
Further research remains essential.
Posted: February 16th, 2010 | Author: drpoynor | Filed under: estrogen, gynecology, menopause, science | Tags: estrogen, home, hormones, menopause, NAMS | 1 Comment »
Why should I care about this? The FDA does not currently require health studies or pre-market testing for cosmetic products before they are sold. We live in a world where most of us enhance beauty and daily living through the cosmetics and pharmaceutical industries, and many women use a lot of these products. The typical person uses up to an average of 9 personal care products with as many as 126 unique chemical ingredients, applied to the skin daily. I am a child of this more is more world. Until recently, I routinely used all the latest fragrances, hair dyes, skin care products and cosmetics. This began to change when I had a child. I necessarily made myself aware that environmental exposures early in life can have potential devastating consequences. One example is lead exposure in young children, which can lead to lifelong developmental and behavioral deficiencies. I was also made aware of the dangers of heating plastic bottles and containers. I immediately switched to glass for all of my storage needs for my son. I began to read the bottles of the cleansers and shampoos that I used for my young child. Until recently, however, I did not read the bottles and review the contents of the products that I use. Over the past few months, I simply have not had time to color my hair or get to the department store to buy the latest facial cleanser or moisturizer and I resigned myself to having a few gray hairs as natural highlights. I began to use the natural soap that my son uses, along with his natural and largely organic shampoo and body cleanser. Surprising to me I felt healthier, my hair looked much better and my skin did not have a chronic film of “gunk” on it.
All of this lead me to look more closely into the daily products that not only I am using, but my patients are using. I am a physician and surgeon that specializes in cancer. All of this will, I hope, ultimately lead to better care of my patients. The first group of products, being a gynecologist, that I began to look at more closely are the vaginal lubricants that women use.
Women begin to have a decline in estrogen sometime in their forties and the resulting vaginal dryness can casue discomfort on its own, or lead to painful intercourse. Younger women may also have this problem, especially if they are on a low dose birth control pill. Vaginal dryness can be treated with vaginal estrogen (not the topic of this post – check back in the future) or by non hormonal lubricants. Until recently, there were virtually no natural lubricants on the market and I would recommend Vitamin E oil or the generally available “drugstore” preparations.
It is important to look at the components of the topical agents that we apply to our skin and scalp, as well as those used vaginally. Some of the more popular vaginal lubricants which are mass marketed and generally available in a drugstore may contain gylcerins, propylene glycol and parabens. Glycerin may lead to increased problems with yeast infections. The safety of propylene glycol has been questioned by some groups. Propylene glycol is widely used in food and cosmetic manufacturing. It is a liquid substance that absorbs water and helps to maintain moisture in the product to which it has been added. Some have noted that this agent may be a possible carcinogen and skin irritant. The FDA lists propylene glycol as generally recognized as safe “GRAS”. Parabens are also widely used in the personal care industry as a preservative. Researchers from the Department of Biology and Biochemistry of Brunel University in the UK conducted a study that found that the alkyl hydroxy benzoate preservatives (that is, methyl-, ethyl-, propyl-, and butylparaben) are weakly estrogenic. Allergic reactions and dermatitis may also be caused by parabens. Preservatives are a key component to personal use products, otherwise they can become overgrown with bacteria which has its own set of risks. The following ingredients—can also be used as preservatives and seem to cause the least irritation and fewest allergic reactions: grapefruit seed extract, tocopherol (vitamin E) · vitamin A (retinyl) · vitamin C (ascorbic acid).
While we cannot over analyze each product and its content, there are practical maneuvers that a woman can use in order to cut down on risks from environmental exposures. The effect of any ingredient is dependent on the level of the exposure, including the amount that is contained in a particular product and the frequency of use of the product. Our modern society is moving in the less is more direction with more and more large commercial manufacturer’s marketing and promoting “green” and “organic” products. The trick is to make sure that their claims are true.
The take home message:
- Be aware of the products that you use on a daily basis and what they contain
- Try to avoid vaginal lubricants with parabens
- If possible try to use lubricants based on natural ingredients with organic certified production.
- For more information on your personal lubricant its contents and safety profile go to Skin Deep: Cosmetic Safety Reviews
Posted: February 13th, 2010 | Author: drpoynor | Filed under: general health, skincare & cosmetic surgery | Tags: cosmetics, home, lubricant, safety, vagina | 3 Comments »
This is very good news! Something that many of us crave, may actually be good for us. Flavonoids in chocolate may lower the risk of having or dying from stroke. 2 large studies will be presented which suggest that chocolate consumption may help to lower one’s risk for having a stroke and dying from a stroke. These results are to be presented at the annual meeting of the American Academy of Neurology in Toronto.
The first study found 44,489 people who ate one serving of chocolate per week were 22% less likely to have a stroke than people who didn’t eat chocolate. The second study showed that 1,169 people who ate 50 grams of chocolate once a week were 46% less likely to die after a stroke compared to people who didn’t. A third study included in the review found no association between chocolate consumption and risk of death from stroke.
Researchers say chocolate, especially dark chocolate, is rich in antioxidants called flavonoids, which have been shown to have a number of health benefits.
“More research is needed to determine whether chocolate truly lowers stroke risk, or whether healthier people are simply more likely to eat chocolate than others,” researcher Sarah Sahib, BScCA, of McMaster University in Hamilton, Ontario, says in a news release.
Source Web MD by Jennifer Warner
Posted: February 12th, 2010 | Author: drpoynor | Filed under: great health at every age, nutrition & diet, things we like | Tags: chocolate, diet, home, nutrition, stroke | 1 Comment »
