I’ll take menopause for $100

Did you know that women can actually discern symptoms of menopause from the natural symptoms of aging?!

Evidently, study results released at the North American Menopause Society’s annual meeting this week suggest that 91% of women can correctly define menopause and that 99% and 96% of women, respectively, know that menopause causes night sweats and mood swings.

Any of you who’ve experienced one or both of these symptoms won’t find these results surprising. I certainly didn’t.

Sarcasm aside, there are some overlaps you should be aware of. In the survey, 84%, 72%, and 77% of respondents associated vaginal dryness, urinary stress incontinence and weight gain, respectively, strictly with menopause, even though they can also be caused by aging as well.

So, why should you care?

Knowing the reasons behind the symptoms can help drive informed health decisions about the best strategies and steps you can take to combat them. What’s more, because it can be difficult to tease apart the effects of aging and the effects of menopause, NAMS can use these survey results as a call to action for more funding and research.

All in all, a good thing, right?

Trifecta

 

Midsection weight gain is a hard pill to swallow, especially when you’re doing all the things that experts keep telling you to do, like watching your diet, exercising and limiting indulgences. In fact, it’s been reported that women in their midlife years gain as much as 1.1 pounds yearly over a five-year period, which places the odds of gaining weight about twice the average rate.  So what gives?

Last week, I wrote a post on the importance of moving your body. Several experts chimed in and added that regular weight training and a change in how and what you eat might help to stave off those pounds. In the particular report cited above, researchers wrote that the one pound a year weight gain equated with only an extra 10 calories a day and suggested that small, sustained changes in daily physical activity and diet can prevent further weight gain. Okay, that sounds reasonable, right?

Another study, published last year in the Journal of Clinical Endocrinology & Metabolism, showed that weight gain and changes in waist circumference in midlife are associated with both regular aging and  changes in ovarian function.  The good news in this study was that while waist circumference increased over a 6-year period, the rate of increase slowed one year after the final menstrual period.

BTW, the reason for the buildup of fatty of tissue has to do with balance. That is, as estrogen production declines, the body starts to rely on secondary production sites, such as body fat and skin. So, fatty tissue starts function like an endocrine organ instead of simply a passive vessel for energy storage. The body also struggles to hold onto bone mass and may compensate for its loss by holding on to extra body fat longer.

The news isn’t all bad however.

That ‘Old Black Magic’ has struck again!

Results of an animal study in the journal Maturitas show that black cohosh extract attenuates body weight gain and accumulation of intrabdominal fat and also lowers glucose levels to the same extent as estrogen. The effect on blood fats in this study was a bit more complex; black cohosh extract was associated with higher LDL-cholesterol levels and lower triglyceride levels and estrogen, the exact opposite. The researchers remain uncertain how these effects ultimately influence weight gain as well as associated health risks, such as the metabolic syndrome.

These study results undoubtedly need to be replicated in humans. But they do suggest a potentially viable strategy to battle weight gain: black cohosh.

So, perhaps the trifecta in overcoming menopausal weight gain is diet, exercise and black cohosh. Only time will tell.

Seeds of the Change

Flaxseed evidently has the potential to reduce the frequency and potential of hot flashes associated with menopause.

Last Summer, researchers from the Mayo Clinic in Rochester, MN reported results of a small trial enrolling 29 postmenopausal women who were experiencing at least 14 hot flashes weekly for a month. None of the study participants were taking estrogen or herbal preparations for their symptoms, but for six weeks, ingested 40 grams (~2.8 tbs) daily of crushed flaxseed.

Not only did the frequency of hot flashes decline by 50%, but overall severity of hot flashes decreased by 57%. Study participants also reported improvements in their mood, joint or muscle pain, chills and sweating, all of which significantly improved their quality of life.

The researchers concluded that flaxseed is potentially an effective treatment for hot flashes and imparts overall health and psychological benefits.

The downside? 50% of women experienced mild or moderate bloating and 29%, mild diarrhea.

Flaxseed is a plant-based estrogen source (photoestrogen)  that contains antioxidants with weak estrogen properties (lignans) and omega-3 fatty acids. It is also an excellent source of fiber. Various studies have not only touted its benefits for heart disease prevention but also suggest that it might boost the effects of conventional breast cancer therapies.

Most health experts recommend ground flaxseed over whole because it is more easily digestible in this form. It should be taken with ample amounts of water to avoid any gastrointestinal blockage. Flaxseed can also inhibit the ability of the blood to clot after injury so if you’re taking any heart medications or planning surgery, you might want to speak to your doctor before trying it. Additionally, it may exacerbate the effects of herbs that interfere with clotting such as:

• Danshen
• Devil’s Claw
• Eeuthero
• Garlic
• Ginger (in large amounts)
• Ginkgo
• Horse Chestnut
• Panax Ginseng
• Papain
• Red Clover
• Saw Palmetto

Personally, I don’t care for the taste of flaxseed.  However, it can be baked or added to other foods. In fact, some of these recipes look pretty tasty.

Do you take flaxseed? How has it helped your menopausal symptoms? Any recipes you’d like to share?

And now for something completely different…

Cleaner water means longer life….and more hot flashes.

Seriously though, did you now that the World Health Organization estimates that unsafe water and inadequate sanitation kills some two million people annually, mostly children under the age of five? What’s more, over a billion people worldwide don’t have access to safe drinking water?

Chlorination of drinking water here in the U.S. is one of the most significant public health advances, says the Centers for Disease Control. Not only has it virtually wiped out waterborne diseases but it’s also extended Americans’ life expectancy from 47 years of age in 1900, to 78 years of age in 2006.

In honor of the American Chemistry Association’s 100th Anniversary celebration of chlorination, let’s raise a clean glass and say cheers! And then maybe give ‘em a few jeers; afterall, an increase in life expectancy means we’re all living longer (and longer through those menopausal years)!

Seriously though, we’re pretty lucky to have clean drinking water. Even when we’re sweating and swinging.

You’re getting veerry sleeepy…

Baylor University researchers report that hypnosis might represent an effective intervention for hot flashes in women with breast cancer.

Makes one wonder if mind-body treatments might represent a viable alternative for all menopausal women?

In the study, which appears in the online edition of the Journal of Clinical Oncology, 60 breast cancer survivors with hot flashes received 5 weekly hypnosis sessions or no treatment.

The women who received hypnosis reported a 68% decline in hot flash scores. Significant improvements were also observed in anxiety levels, depression, the degree to which hot flashes interrupted daily activities and sleep.

One topic which I’ve not yet addressed on Flashfree is the association between breast cancer treatments and menopause. Indeed, adjuvant therapy, which is a term used to characterize chemotherapy and/or hormonal treatments after breast cancer surgery, often launches as many as 10 to 50 percent of women younger than 40 and in 50 to 94 percent of women over 40 into early menopause. In fact, treatments for breast cancer can cause women to go into menopause in a matter of days.

The reason is that chemotherapy can damage the ovaries and affect their ability to produce normal levels of estrogen. Depending on the type of agent used and a woman’s age, it is possible for regular ovarian function to return. But for some women, early menopause may be permanent. Importantly, hormone replacement is not an option in breast cancer survivors due to an increased risk of recurrence. This makes alternatives even more important.

The results of this specific study resulted in a $2.6 million grant to Baylor from the National Institutes of Health to fund a broader study. According to Baylor, this is the largest grant ever awarded by NIH for this particular type of research.

The larger trial will enroll 180 women who entered menopause naturally and who are experiencing hot flashes. It will compare hypnotic relaxation therapy plus self-hypnosis techniques to another type of mind-body treatment.

Wednesday Bubble: No Pain, No!

Does menopause increase lower back pain?

Admittedly, I was a bit skeptical. when I read this So, I dug a little deeper to see if data support recent findings that suggest that lower back back is more common before than after menopause.

In the study, which was published in the September 4 advanced online edition of the journal Menopause. Australian researchers estimated the prevalence of back pain, as well as its intensity and related degree of disability in 506 local women via questionnaire. Demographic data  (i.e. menopause, relationship and employment status) were also collected.

The findings showed that more that 90% of participants had experienced low back pain, either during the previous 12 months (~75%) or at the time they filled out the questionnaire (~22%). Compared to pre- and perimenopausal women, 73% of postmenopausal women reported having high-intensity pain and 84%, a high level of disability.  A high body mass index and current pain were factors that were significant predictors of both.

In another study, published in the Clinical Journal of Pain, researchers examined the association between self-reported menopausal status and musculoskeletal pain in 2,218 women participating in the Study of Women’s Health Across the Nation. Not only did they find that 1 in 6 participants reported daily pain symptoms, but, postmenopausal women reported significantly more aches and pains that premenopausal women, even after adjusting for risk factors.

The reason? Estrogen, of course!

In a large study published in the journal Spine in 2006, researchers from the Netherlands evaluated information collected from 11,428 women, ages 20 to 59. Their goal was to examine how hormonal and reproductive factors might influence chronic lower back and upper extremity pain.

Results showed that factors relating to increased estrogen levels were especially likely to increase the risk of chronic lower back pain in particular. These factors included past pregnancy, young maternal age at first birth, duration of oral contraceptive use and use of estrogens during menopause. Importantly, these findings remained even after adjusting for age, education, working status, smoking, and overweight.

Steps you can take now

Exercise, stretching and core conditioning have all be shown to improve and keep back muscles strong. I plan on devoting another post to back strengthening exercises as I believe that it’s a topic worthy of full consideration. But in the interim, the North American Spine Society has an excellent overview of back strengthening strategies.

Of course, always check with a health professional before undertaking any major activity or change in regular routine, especially if you are already experiencing pain.

New Flash! In the Pipeline: Hot Flashes!

Listen up!

A consortium of five research centers in the Boston Area are dedicating their time to researching remedies for hot flashes and night sweats. The National Institutes of Health is sponsoring the five-year, $22 million initiative.

Harvard Medical School Researchers Dr. Lee Cohen and Dr. Hadine Joffe are leading the effort, which is focusing on both low-dose hormones and most importantly, alternative approaches.  Randomized studies will be exploring the following therapies:

• antidepressants
• yoga
• relaxation breathing
• exercise
• low-dose estradiol patches and gel

Other clinical trials are also underway. If you’re interested in learning more or volunteering for a study, here’s a complete listing of those that are actively recruiting volunteers.

The Great Pretender

Back in June, I wrote a post about the dangers of buying herbs for menopause right off the shelves.  Consumerlabs.com is now reporting that testing shows great variation in the amount and quality of herbal menopausal products., including supplements containing black cohosh, soy isoflavones, red clover isoflavones and also, progesterone creams.

For example:

• One supplement contained only 30% isoflavones despite a guarantee and another, only 65% of a specific type.
• Two products failed to comply with FDA labeling that require detailed information on plant parts used as ingredients.
• Lead contamination was found in one product.

On a more positive note, ConsumerLab found that seven soy isoflavone products met their quality standards and provided at least 50 mg to 70 mg total soy isoflavones, which is the amount research has associated with relieving hot flashes.  Additionally,

• Two red clover isoflavone products contained the correct amount (40 mg) associated with hot flash reduction.
• Six black cohosh products met quality standards.
• The progesterone creams tests provided the listed amount of progesterone, which ranged from 15 to 21 mg per gm.

You can read more about the tests at the company website.

So, what’s the take-away message from this research?

As Ellen Stern mentioned during our interview a few months ago, it’s critical to look for standardized herbs, meaning that they have undergone rigorous manufacturing practice and protocols to insure quality. She also recommended that search for “standardized x extract” on the American Botanical Council website. Finally a simple rule of thumb is that the least expensive product is not always going to be the best choice.

Move Your Body

30 minutes of exercise a day will keep the menopause weight away.

Evidently, this may be  a dream. In fact, it turns out that you may need a lot more than 30 minutes of physical activity to maintain your desired weight.

Current guidelines specify that most folks need about 30 minutes a day for at least 5 times a week. That averages out to 150 minutes of exercise a week. However, keeping the weight off may require at least 55 minutes of moderate intensity physical activity five days week on top of normal activities, or 275 minutes a week.

Yikes! Who has time?

A recent study, published in the Archives of Internal Medicine, suggests that this amount of exercise, in combination with daily intake of about 1,200 to 1,500 calories, is important for sustaining weight loss of more than 10%. Now granted, the women in this study were overweight and obese to begin with, which is why I’m encouraging you to check out the abstract for more study details.

However, this begs the question, is the 55 minutes daily activity requirement relevant for women of normal weight?

I did a deeper dive into this issue to see if I could uncover some answers.

According to the USDA’s Dietary Guidelines for Americans 2005 (this report is published once every 10 years), adults need at least 60 to 90 minutes of daily physical activity to maintain normal weight (while, at the same time, not increasing caloric intake).

More specifically, you may need at least 60 minutes of moderate to vigorous exercise daily to stave off gradual, unhealthy body weight. 30 minutes daily can help prevent chronic diseases.  To achieve optimal physical fitness, the recommendations suggest that you incorporate cardiovascular conditioning, weight training, and resistance exercise to improve strength and endurance.

Sounds daunting, doesn’t it?

I’ve asked a few physical fitness experts to weigh in on this post so be sure to check the comments section. And I’d love to hear your questions as well – this is an important dialogue.

In the meantime, guess it’s time to get moving.

Wednesday Bubble: Rub-a-dub-dub

Is a youthful appearance only a rub-a-dub-dub away?

I ran across an interesting article in the UK’s Daily Telegraph on topical estrogen. Evidently, applying estrogen to the skin can stimulate collagen production and provide a more youthful appearance.

Seems like a great post for a Wednesday Bubble, right?

A closer read of the study on which the article was based suggests that it’s not quite that easy….or accurate.

Here’s what you need to know:

A University of Michigan research team evaluated the effects of applying various strengths of topical estrogen (estradiol) to the hip, forearm and face. Study participants comprised 40 postmenopausal women and 30 men (average age ~75 years). The cream, which varied in strength between 0.01% and 2.5%, was applied three times daily for two weeks. In addition to comparisons between the cream strengths, comparisons were also made to a placebo cream.

The results showed that topical estrogen applied to areas protected from the sun (i.e. the hip) increased production of procollagen I and III, and collagen I protein levels. For your information, pro-collagen type 1 is the precursor of collagen type 1, the most abundant form of collagen found in the body. Pro-collagen type III the precursor to the main component of the fibers that are found alongside the collagen.

However, no significant changes were observed in the photoaged skin of the forearm or the face, even though estrogen receptors were stimulated.

So, what’s the bottom line?

The study results suggest that while topical estrogen can stimulate collagen production in sun-protected areas, it does not affect the appearance of photo-aged skin, (i.e. skin that has been exposed to the sun or other elements).

In other words, topical estrogen is not yet a panacea for aging skin.