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.

Like a Heatwave, Burning in My Heart

It appears that hot flashes affect more than quality of life.

Researchers from the University of Pittsburgh report that hot flashes might actually damage the blood vessesls and increase the risk for atherosclerosis, a form of heart disease characterized by hardening of the arteries.

Study partciipants included 492 women, ages 45 to 58 years, who were participating in the community-based Study of Women’s Health Across the Nation.

The findings, which were published in the eary online edition of the journal Circulation, show a significant increase in calcium deposits and buildup  (i.e. calcification) in the greater coronary artery and aorta in women with hot flashes. In fact, these women were 1.5 times likely to develop calcification than women not experiencing hot flashes.

The researchers report that hot flashes may indicate underlying adverse vascular changes in women.

So what can you do? Because hot flashes may be signs of subclinical or underlying changes in blood vessels that can lead to heart disease, shutting them down is not enough.

Rather, lifestyle changes that promote heart health, such as a healthy diet, regular exercise, weight maintenance or reduction, quitting smoking and moderate alcohol use, seem like smart choices.

In fact, research confirms that lifestyle interventions that include healthy eating and regular exercise can confer protection against and slow different forms of heart disease, including atherosclerosis, if started during perimenipause.

“Nature’s Great Emmenagogue”

E-men-a-gogue. n. A drug that induces menstrual flow.

I discovered this advertisement for McELREE’S Wine of Cardui in a publication called “Patent Medicine. The Golden Days of Quackery.” This particular ad reportedly ran in a newspaper in Virginia in 1900.

The Wine of Cardui was a leading medicine in the South at the turn of the century. If you click on the ad, you’ll see that the “change” that afflicts “elderly women” often leads to “dreadful diseases such as cancer and consumption.”

Fortunately, the Wine of Cardui (which btw, is based on a traditional Native American recipe), will “strengthen and purify the entire system and bring the sufferer safety over these pitfalls.” The sales pitch that accompanied this product was based on the the contention that because “the great spirit planted it, one could take it and be healed.”

All these benefits for only $1.

Say no more.

Burn Baby Burn Part 2

Regular acid, Heartburn? Have you taken hormones lately? Used OTC products like soy, wild yam or progesterone cream?

If you’re in that postmenopausal state of mind and continue to take prescription or OTC hormones for lingering symptoms, you may be placing yourself at risk for developing gastroesophageal reflux disease, better known as GERD.

A recent study in the Archives of Internal Medicine shows that use of estrogens,  SERMS, or OTC hormone preparations in the years following menopause (i.e. “postmenopause”)  is associated with a greater likelihood of GERD symptoms.

Researchers studied data from 51,637 postmenopausal women enrolled in the ongoing Nurses Health Study. 12,018 of women reported having GERD symptoms. What’s more, compared to women who had never used postmenopausal hormones, women who did had a 1.4 times greater odds of developing symptoms.

Here’s some other findings:

• Current users of estrogen had a 1.6 times greater odds of developing GERD symptoms
• Current SERM users had a 1.4 times greater odds of developing GERD symptoms
• Current OTC hormone estrogen users had 1.37 times greater odds of developing GERD symptoms.

The findings also suggested that risk increased with increasing estrogen dosage and increasing duration of use.

The researchers offered no suggestions for dealing with this problem.

I don’t know which is worse as symptoms are waning: continued flashing, sweating,  or a new one - burping?

National Menopause Awareness Month

[image source: 123NewYear]

I received an email from menopauseexpert.com the other day touting National Menopause Awareness Month. I have a lot of respect for Rebecca Hulem and the programs she has in place to educate women about menopause. However, I think that there are a few problems with this initiative.

National Menopause Awareness Month was started by the FDA in 2004 primarily to raise awareness and provide education about hormone replacement therapy. Since its inception, there have been efforts to broaden the topics to include some alternative treatments but a quick glance at available materials says “outdated information” and “not broad enough”  to me. So, do we really want to tout a dated and data-limited campaign that is probably driven by lots of manufacturers of hormone replacement? I say a resounding “NO!”

Mind you, there are a lot of organizations and independents who are using the month as a springboard for promoting solid health information and advice on how to deal with symptoms and diseases related to menopause. I applaud those groups.

I believe that the effort to educate women about menopause needs to be ongoing and more importantly, all-inclusive and not relegated to a single month in the year.

The original intent of the month was to raise awareness about HRT. To promote the medicalization of menopause.  As I wrote last week, menopause is not a disease.

Let’s get out of the disease mindset. And start looking at ways to raise awareness in a consistent and meaningful fashion that that doesn’t pigeonhole, exclude or minimize.

What do you think?

Hair Today. Gone…

Have you been seeing a few extra hairs in your comb or brush? Thinning hair and bald spots (also known as alopecia) occurs in roughly 37% of postmenopausal women. Although declining levels of estrogen play an important role, researchers now say that low iron levels before menopause fully sets in is an important risk factor.

In a recent study published in the European Journal of Dermatology, investigators evaluated hair loss in 5,110 women between the ages of 35 and 60 years. They also collected blood samples and measured the level of a protein called serum ferritin, which is a determinant of overall iron levels stored by the body. In this study, “excessive” hair loss was described as losing lots of hair during washing, brushing or towel drying, and/or finding lots of hair on the pillow or on clothing).

The findings showed that a majority of the women (57%) who were affected by excessive hair loss also had low iron stores (serum ferritin <40 micrograms/liter).  Conversely, low iron stores affected only 23% of postmenopausal women. These findings remained after adjustments for factors such as age, use of oral contraceptives or IUDs, and levels of red blood cells.

Iron is important for maintaining growth of hair follicles. Consequently, it appears that maintaining adequate iron stores may be critical to prevent hair loss after menopause.

However, too much iron can increase risk of developing certain diseases such as diabetes or cancer. So, in the interest of maintaining a beautiful head of hair, it’s important not to overdo it. Recommended daily allowance is 8 mg daily for perimenopausal women, and 14 mg if you’re also a vegan.

Two types of iron can be found in food: heme iron, which is easily absorbable and present in red meat, seafood and poultry, and non-heme iron, which is less absorption. and found in fruits, vegetables, grain and nuts. However, adding vitamin C to non-heme sources and increase absorption up to six-fold. Fortunately, if you prefer the vegetable route, those rich in both nutrients (e.g. broccoli and bok choy) can help to insure better absorption. You can find a complete listing of iron in a variety of foods here.