Experiencing Hot Flashes?

hot-flashes

A common complaint of the majority of menopausal women is the hot flash. It is also called hot flushes or night sweats, and the medical term used would be vasomotor symptoms (VMS). Most women will relate a feeling of great heat that overtakes their entire body, and this can last up to 5 minutes. These flashes can begin a few years before menopause and can last for many years after. There is great variability as to the number and intensity of these flashes, but most women who experience these hot flashes all consider them a problem that is disruptive to their lives. The exact cause of these flashes is not completely known, but the decrease in estrogen in menopause plays the main role.

Read more about menopause hot flashes and menopause.

-Dr. P

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Decreasing Hormones. Decreasing Menstruation.

As a woman ages, her ovarian function begins to decrease, and as the follicular activity starts to wane, the production of estrogen and progesterone goes down.  The decrease in these hormones will eventually lead to no more menstrual cycles, and menopause is defined as 1 year of no menstrual bleeding.  This is a natural part of every woman’s life as the 50’s approach and the average age of menopause is 51 to 52.  With our ever increasing life spans, women may spend 30 to 40 years in this postmenopausal state.

menstrual

-Dr. P

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Is Bio-identical Hormone Replacement Therapy Right for You?

Are you approaching or in menopause and are concerned about its symptoms?  My office manager and I are here to help!  We discuss bio-identical hormone replacement therapy questions and answers.  You will hear an introduction about the therapy, and I will help you understand it with more depth.

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What Are the New Breast Cancer Screening Guidelines for Average-Risk Women?

Nurse Assisting Patient Undergoing MammogramThe American Cancer Society (ACS) recently updated their breast cancer screening guidelines for women who are at an average risk of developing the disease.  It was published in the October 20, 2015 issue of JAMA (Journal of the American Medical Society).

Here are the recommendations:

  • Women with an average risk of breast cancer should undergo regular screening mammograms starting at age 45
  • Starting at 40, have annual screenings if the woman desires
  • For women aged 45 to 54, the screenings must be annual
  • For women over 55, mammograms every 2 years or annually if the women desires
  • Screen as long as the overall health of the women is good or if her life expectancy is 10 years or greater
  • For average-risk women at any age, ACS does not recommend clinical breast exams for breast cancer screening

These recommendations have refueled the debate over what are the best guidelines, and these differ from the other major health organizations.  It can be confusing, but I think it opens more discussions between women and their health care providers concerning the best way to screen for breast cancer for each individual.  Please continue to speak to your health care provider about your breast health and come up with a plan best suited for you.

-Dr. P

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What Could Your Frequent Hot Flashes Indicate?

Mature Woman Experiencing Hot Flush From Menopause
Frequent hot flashes may indicate an increased risk of developing heart disease.

A recent small study of menopausal women with frequent hot flashes may show a relationship between these flashes and an increased chance of developing heart disease. Frequent hot flashes meant that the women experienced these flashes 5-6 times per day.

In the study, changes were seen in the vessels of the cardiovascular system.  This again points to the importance of menopausal women having regular visits with their health care professionals to assess their cardiovascular health!

-Dr. P

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These Missed Signs Could Be Why Women Are More Likely to Die of Heart Disease

Electrocardiogram - Concept of healthcare, heartbeat shown on monitor - pink

The risk of suffering from a heart attack increases for women after going through menopause.  It seems that estrogen is heart protective, and after the menses stops, estrogen production greatly decreases.  Therefore, heart problems become more of a concern.

It is important to remember that more women die of heart disease each year than men.  This may be attributed to the fact that women do not seek medical attention as quickly as men when possible heart concerns develop.  When suffering a heart attack, most men will describe crushing or squeezing chest pain while women will have no chest pain or simply a fullness feeling in the chest.  Many women during a heart attack may complain of dizziness, shortness of breath, nausea, and weakness.woman hugging her husband

Please be alert for a woman’s special signs of a heart attack, and do not delay a trip to the ER.  Your family and close ones need you!

-Dr. P

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Osteoporosis – Are You at Risk and How Do You Treat It?

…..Many menopausal women suffer from osteoporosis.  Osteoporosis is the thinning of bones which causes them to become weak, brittle, and more susceptible to fractures.  Women have an increased risk of osteoporosis throughout their lifetime.  Risk factors include:

  • Low body weight
  • Smoking history
  • Fair skin
  • Menopausal state

…..There are various methods of prevention and treatment for osteoporosis.  There are medications such as the bisphosphonates (Fosamax) and selective estrogen receptor modulators (Evista).  Supplements such as calcium and Vitamin D are important additives.  Helpful lifestyle Osteoporosis Treatment Preventionchanges include the cessation of smoking, decreased alcohol use, and weight-bearing exercises.

…..Evista is a medication used to treat osteoporosis in the selective estrogen receptor modulator class.  It mimics the beneficial effects of estrogen by increasing bone density.  Many studies have also shown that Evista decreases the risk of certain types of breast cancer.  The side effects of Evista are hot flushes, leg cramps, and infrequent blood clots or strokes.

…..Speak to your health care provider to see if Evista can be of benefit for you to treat osteoporosis and prevent breast cancer.

-Dr. P

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A New Way to Treat Your Hot Flushes

…..FlamesA new medication, called Brisdelle (paroxetine), has been approved by the FDA as the first non-hormonal treatment for moderate to severe hot flushes (vasomotor symptoms).  This is a common problem in perimenopausal and menopausal women.

…..Brisdelle contains the same ingredient as Paxil, but at a much lower dosage.  At this dosage, this medication is not indicated to treat any psychiatric condition but solely is for the hot flushes.

…..Many perimenopausal women suffer from severe hot flushes daily.  Brisdelle has been proven to decrease these attacks significantly.  It is reported to be a safe, non-hormonal option, and one capsule at bedtime is the advised treatment.

…..Pregnancy and some medications may prevent you from trying this medication.  As always, before starting a new medication, review your current medications with your medical provider.  So speak to your health care professional about the various treatments for menopausal symptoms and perhaps this new medication may be right for you.

-Dr. P

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A New Medication to Help a Painful Menopausal Symptom

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MH900370730In February 2013, the FDA (Food and Drug Administration) of the US approved a new drug for the treatment of dyspareunia (painful sexual relations), caused by the thinning of the vulva and vaginal tissues in the menopausal time of life.

The drug is called Osphena (ospemifene), and it acts as a tissue selective estrogen protagonist and antagonist.  This means that in some tissues, like the uterine lining and the vulva/vagina tissues, the ospemifene stimulates the tissue like estrogen, and in other tissues it acts like an anti-estrogen.

  • This is a medication in the same family as tamoxifen, which is used in breast cancer treatment and prevention protocols.
  • Dyspareunia is decreased because ospemifene has been shown to stimulate the vaginal mucosal tissue.
  • Osphena is an oral tablet which is taken daily.
  • It is contraindicated in patients with estrogen dependent cancers, a history of stroke or blood clots, or a cardiac history.
  • With this medication, there has been a reported increase in hot flushes.
  • This new medication may appeal to women who are not interested in using estrogen vaginal treatments or systemic hormone replacement therapy.

If you are suffering with this menopausal problem, speak to your health care professional because help is available, and this new medication may be an answer for you.

-Dr. P

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Postmenopausal Women – Preventing Your Urinary Tract Infections


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Postmenopausal women are at an increased risk for urinary tract infections (UTIs) because of a decrease in their estrogen levels.  This lower hormone state is associated with specific physical and physiologic changes that increase this risk:Postmenopausal Women – Preventing Your Urinary Tract Infections

  • Thinning of the mucosa of the vulva (vaginal tissue)
  • Changing of the normal bacteria that usually inhabit the vagina, especially a decrease in lactobacillus colonization
  • An increase in the pH of the vagina
  • Vaginal colonization of E. coli.

…..There have been multiple studies which have found a decrease in these UTIs with the use of estrogen intravaginal creams.  There are many variations on the types of estrogen used and many commercial products available.

…..If you are in the menopausal time of your life and suffer from recurrent UTIs, ask your medical professional about the possible use of a vaginal estrogen preparation.

-Dr. P

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Another Way to Reduce Your Risk of Developing Breast Cancer

Pink Breast Cancer RibbonSome women at a high risk for breast cancer may reduce their chance of developing invasive breast cancer with the use of the medication called tamoxifen.  Chemoprevention is the use of a medication to reduce cancer, and it may be considered in a patient who is at high risk of developing breast cancer.

In a high risk population, the risk reduction with the use of tamoxifen has been reported to be 49%, and this has resulted in the FDA approving tamoxifen as the first drug for breast cancer prevention.  In addition, studies have also found that another medication, called raloxifene, to be of benefit in menopausal women.  Of course there can be serious side effects with these medications, so their use may be limited.

If you are at a high risk of developing breast cancer, start a discussion with your medical team about the possible use of chemoprophylaxis!

-Dr. P

Read more about tamoxifen in my post: How Does Tamoxifen Treat Breast Cancer?

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How Does Tamoxifen Treat Breast Cancer?

…..Science HealthTamoxifen is a common endocrine treatment for both early and advanced breast cancer in pre- and post-menopausal women.  Some breast cancer cells are stimulated to grow in the presence of the estrogen hormone.  The estrogens bind to special areas in the cancer cells called estrogen receptors, and once the estrogens are attached, the cancer cells’ growth is enhanced.  These breast cancers are called estrogen receptor positive.

 …..Tamoxifen breaks down in the body into a compound that also binds to the estrogen receptor in the cancer cell, but it does not stimulate the cancer cell to grow.  Since the binding site is filled, any available estrogen cannot attach to the cancer cell and stimulate its growth.

…..After the diagnosis and treatment of a breast cancer that was estrogen receptor positive, many patients would be placed on 5 years of tamoxifen treatment, and this would reduce the recurrence of the disease.  New studies may cause oncologists to change the protocol to 10 years of tamoxifen treatment due to the findings of better long-term outcomes.  There are currently ongoing studies which should shed more light on the possibility of modifying the protocols.

…..I would like to touch upon two other points.  As with all medications, tamoxifen can have side effects.  Endometrial cancer is increased with the use of tamoxifen, and so oncologists follow patients closely for this potential problem.  Lastly, another group of medications, called aromatase inhibitors, is now being used more frequently with these patients, but worldwide tamoxifen remains widely used.

-Dr. P

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A Way to Help Determine the Status of Your Weight

Weight control is a major concern for most of us.  As menopause approaches, many women experience an increase in their weight, with about 70% being overweight.  Body mass index (BMI) is a commonly used calculation that quantifies where our weight is, and when using this classification, about 50% of perimenopausal and menopausal women are considered obese.

Using a person’s height and weight, body mass index can be calculated, giving us a guide to where we stand with regards to our weight.  A BMI of 24 to 29 is considered overweight, and over 30 is obese.  Let us look at where some weights fall:

  • At 5 ft. 1 in. a BMI of 24 to 29 corresponds to a weight of 130 to 150 lbs.
  • At 5 ft. 1 in. a BMI of 30 corresponds to a weight of 160 lbs.
  • At 5 ft. 6 in. a BMI of 24 to 29 corresponds to 155 to 180 lbs.
  • At 5 ft. 6 in. a BMI of 30 corresponds to a weight of 185 lbs.

Remember that this BMI number is not an exact measurement of body fat but it alerts us to where our weight status lies and gives us an indication of our risks for developing the complications of obesity.  These include diabetes, hypertension, heart disease, and many other medical conditions.

BMI Chart Larger

-Dr. P

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Could You Have Lichen Sclerosus?

Business DiscussionAt the recent Female Sexuality conference I attended, much attention was spent discussing vaginal pain.  Lichen sclerosus, a long-term skin condition which mainly affects the vulva, was a condition thoroughly discussed.  I knew it was a common problem, affecting 1 in 70 women, and over my career there have been many patients who I cared for with this condition.

In women, the genital and anal areas are mostly affected but it can appear on the upper body and breasts.  Females of any age can develop lichen sclerosus, but it is most common in post-menopausal women with the median age of onset at 51.

Early in the condition, it presents as small shiny smooth white spots or depigmented areas, which can be tender and very itchy.  It is often misdiagnosed as a yeast infection, herpes, or vitiligo.  With time, the spots can progress to bigger patches, and the skin can become thick and crinkled.  The skin can tear easily as the disease progresses.  When severe scarring has developed, the lips of the vagina can shrink, the vaginal opening can become narrowed, and the clitoris may be covered with scar tissue.

Continued in: Treatment for Lichen Sclerosus

-Dr. P

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Women: Your Most Common Cause of Hair Loss

…..More about hair loss in women…Women Your Most Common Cause of Hair Loss

…..The most common cause of hair loss in women is androgenetic alopecia (AGA), which is also known as female pattern hair loss.  This is a genetic disease that can be inherited on many genes, but it does not affect everyone who carries the genes.  By menopause, 40% of all women will be affected in some way.  It is identified as a gradual onset of diffuse hair loss.

…..The problem’s basis is the male hormone found in all women.  It attaches to sites on the hair follicles and affects the follicles that are genetically susceptible.  These follicles have a shortening of the growth phase, and the hair from these follicles are short and thinner than normal ones.

…..Again, hair loss in women is generally diffuse, and there is usually a preservation of the frontal hairline.  This is distinct from male pattern hair loss, with frontal peak and top loss.  AGA’s onset is usually gradual with no specific bare areas.  There does not appear to be an increase in shedding because the hair growth does not become less but is only affected.

…..At the medical exam, the scalp should be examined for redness, signs of infection, and scarring.  A family history should be taken to look for a similar condition in other family members.  Usually, there is not an endocrine cause for this problem, but if general hirsutism accompanies the finding, then a full hormonal investigation should be started.

…..The only FDA-approved treatment is the topically applied vasodilator called Minoxidil (Rogaine).  It comes in an over-the-counter preparation of 2% and 5% foam or liquid, which are all effective.  There seems to be better results with the 5%, but there may be an increased chance of local irritation.  How it specifically works is uncertain but there seems to be an increased growth phase, and the hairs grow longer and stronger.  Remember, the treatment is 2x per day and forever.  When you stop, the hair you gained will be lost.  Lastly, you may not see any results for 3-4 months, so patience is needed.

-Dr. P

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