Posted on May 08, 2009 under Hormonal |
For women several years past the menopause, one of the most troublesome symptoms of low oestrogen is ‘atrophy of the vaginal and urogenital tract’. To put it another way, the vagina becomes so dry that sex becomes difficult, continence problems develop, and infections occur in the vagina and urethra. One medical dictionary defines atrophy as ‘wasting away, from disuse or lack of nutrition’. In the case of the vagina and urethra, the atrophy is caused by a lack of the ‘nutrition’ of oestrogen.
It is a problem that tends to get more noticeable as the years go by, affecting mainly women from their fifties onwards, and for many of them it will be the first time they have needed to see the doctor about menopausal symptoms. Perhaps our typical woman ‘sailed through the menopause’, or lived with it without too many problems, but now she finds that a dry vagina means that sex is becoming painful, and she is starting to notice embarrassing ‘dribbles’ of urine.
This is the point at which she should not think, ‘Oh, I’m just getting older, there’s nothing that can be done about it.’ There is, and it’s called HRT.
‘Sex started to be uncomfortable, and I thought it was just my age, even though I was only 49. It never occurred to me that this might be a symptom of the menopause, or that anything could be done about it. In any case, I wouldn’t have wanted to talk to my doctor about something so personal. Eventually I plucked up courage to see the Practice Nurse at the surgery, and she was very helpful. I didn’t want to take HRT as it seems unnatural, but I now use just a vaginal oestrogen cream, and it has made all the difference.’
As well as being available as tablets, patches and implants, oestrogen can also be applied as a cream. Used in the vagina, it makes the lining thicker, moist and healthy, less vulnerable to infection and more open to stimulation during sexual intercourse. The cream is especially suitable for vaginal dryness, soreness, discharge, pain during sexual intercourse, and vaginitis, and it can be very helpful for some bladder and continence problems. When you first start using oestrogen cream, you may need a fairly high dose, as absorption through the walls of the vagina is usually poor, especially in cases of vaginitis. Once the walls revert to their previous healthy state, however, absorption of the cream will be higher, so a low regular dose should be sufficient, minimising side-effects.
The cream is absorbed through the walls of the vagina into the bloodstream, so it would not be suitable for women who should not take any form of HRT. Also, because it contains only a low level of oestrogen, it is not particularly effective for treating hot flushes, nor does it give protection against osteoporosis. It is also important to be aware that it is a treatment for vaginal dryness, not a lubrication, so it shouldn’t be used just before sexual intercourse. If you do use it then, your partner could absorb undesirably high levels of oestrogen, and may even, in extreme cases, experience some breast enlargement!
If you have not had a hysterectomy, you may be advised to use the cream for a few months only, then your doctor will review it and see whether you need to be taking progestogen. In many cases, use of the cream form of HRT does not give a high enough level of oestrogen to thicken the lining of the womb or necessitate taking progestogen, so it is a particularly suitable form of replacement therapy for older women who do not want the return of periods or need treatment for hot flushes, and whose only menopausal problems are vaginal and some loss of continence.
Vaginal oestrogen is also available as a pessary, called Vagifem (manufactured by Novo Nordisk Pharmaceuticals), that is inserted high up into the vagina with a special applicator. It works in the same way, and for the same conditions, as a vaginal cream.
In some countries (such as France), oestrogen is available as a gel as an alternative to the tablet, patch or implant Unlike the vaginal creams available in the UK, the gel contains enough oestrogen to eliminate menopausal symptoms such as hot flushes. It is rubbed into the skin of the abdomen or thighs, and French women find it more acceptable than HRT in tablet or patch form. Perhaps it may become available in the UK if enough women press hard enough for the range of HRTs to be extended.
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Posted on Apr 21, 2009 under Hormonal |
ANDROSTENEDIONE This is the most constant androgen before and after menopause and is the main source of postmenopausal oestrogen. The level of androstenedione after menopause is about half that present during the early part of the menstrual cycle. It is a little lower in women who have had a surgical menopause. The ovaries produce androstenedione after menopause in response to high levels of LH. The adrenal glands also produce it both before and after menopause.
TESTOSTERONE The most powerful of the androgen hormones, testosterone influences hair growth, voice and libido in women. The level of testosterone after menopause tends to be a little less than it was during the early part of the menstrual cycle. The level after surgical menopause is about half that after natural menopause. The testosterone of postmenopausal women is produced by both the ovaries and the adrenal glands.
DEHYDRO EPIANDROSTERONE (DHA) This is produced by the adrenal glands before and after menopause, and its output falls to about a third through the menopause transition.
Inhibin
Inhibin is a recently discovered ovarian hormone with two major roles. It signals information to the brain about the state of egg production in the ovaries, and helps to regulate this process by controlling the level of FSH. After the menopause its level drops, which helps to explain why the level of FSH rises.
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Posted on Apr 21, 2009 under Hormonal |
Regular exercise that stimulates the lungs and blood flow (aerobic exercise) has a beneficial effect on blood clot formation and blood fat levels, lowers blood pressure and reduces the tendency to be overweight. Brisk walking, running, swimming and cycling are all excellent choices. Recent research indicates that muscle-strengthening resistance exercises like weight training also have a favourable effect on blood fat levels.
Reassuringly for those who do not have the urge to run or swim marathons, most of the benefits for heart health; occur with moderate exercise programs. You can walk for a total of six hours a week, play golf for five hours or swim for four hours to achieve about the level of activity necessary to provide significant protection against heart disease. Nearly 40 per cent of women around the menopause do not get this amount of exercise, however, if the Melbourne Women’s Midlife Health Study is any guide. A further 15 per cent have borderline energy expenditure levels, while just under half have good or very good weekly activity levels.
Smoking endangers heart health, as well as being bad news for bones. If you are a twenty-cigarette-a-day smoker, you will suffer more from atherosclerosis (narrowing and plugging of arteries) than comparable non-smokers. You have double or triple the risk of sustaining a crippling or fatal heart attack than someone of the same age, family history and activity level who does not smoke. Giving up smoking achieves a rapid improvement in heart health. Twelve months after quitting, your risk of sudden death from heart attack is almost half that of persistent smokers and, after five years, this risk is almost identical to that of non-smokers.
Apart from smoking^ what you eat and drink are the most important environmental influences on whether or not you will develop heart disease. Healthy eating should not be bland or restrictive, but enjoyable and satisfying. Important features of healthy eating include low levels of fat and sugar and plenty of fresh fruit and vegetables. To reduce the fat content of your meals you should
- remove visible fat from meat and poultry;
- grill, steam, microwave and boil foods rather than frying them;
- use minimal oil and margarine in cooking, sauces and spreads (one to two tablespoons a day);
- eat more fish (but don’t fry it!);
- choose low-fat dairy products; and
- limit your intake of ‘hidden’ fat foods such as processed meats and pastries.
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Posted on Apr 20, 2009 under Hormonal |
Women with a uterus who use oestrogen on its own for several years face a risk of endometrial cancer that is five to ten times greater than for women not using oestrogen at all. After more than ten years of use, the risk is more than ten times greater than might be expected. Even after oestrogen is no longer being taken, the risk persists for many years, if not decades. This is why many doctors are reluctant to prescribe oestrogen on its own (in pill, patch or implant form) to women with a uterus, preferring to add progestogen to protect the endometrium from possible cancer development. The most common exception is oestrogen in the form of vaginal creams, tablets and pessaries. These formulations can be used safely on their own provided that medical instructions are followed – daily for a week or so, but thereafter not more often than about two or three times a week.
Reassuringly, women who develop endometrial cancer while taking oestrogen typically have a good chance of survival. This is probably because doctors tend to keep a close watch on the health of such women and, at the first sign of unusual bleeding, the endometrium is examined and curative surgery performed.
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Posted on Apr 20, 2009 under Hormonal |
A second common oestrogen—progestogen combination involves taking both hormones every day. This is described as continuous combined HRT. Individual doses of progestogen are lower than when the progestogen is taken for ten to fourteen days a month, but the total monthly intake is similar. If progestogen gives you side effects like those of premenstrual syndrome (such as irritability and breast tenderness) you may find this hormone format helpful. About 80 to 90 per cent of users of this continuous combined HRT no longer experience withdrawal bleeds after an interval of six to twelve months. However, irregular bleeding may occur for the first few months, and women with fibroids may have irregular bleeding that is difficult to control without surgery. There is some research to suggest that continuous combined HRT may have a less stimulatory effect on breast cells and breast cancer than combined cyclical therapy or oestrogen alone.
Freda, whose principal reason for being on HRT was control of severe hot flushes, was pleased with the effect on her bleeding patterns of swapping from one HRT routine to another. Her experience of cyclical progestogen therapy was unacceptable. ‘I was still having moderate to heavy with-
drawal bleeds sixteen months after I started and I felt these were more of a nuisance than the hot flushes. My doctor then suggested I try continuous combined HRT and, after three months of intermittent spotting and seven months of withdrawal bleeds, I no longer had any bleeding and felt well.’
As with combined cyclical therapy, women on continuous combined HRT who do not have withdrawal bleeds are considered to be at no higher risk of endometrial cancer than women who bleed, and should continue with progestogen as recommended by their doctor.
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