Menopause Blog

A procedure that has been proven very effective for management of pain is also showing promise for treating debilitating hot flashes. A stellate ganglion block (SGB) is a shot of anesthetic into nerve tissue in the neck, and one study showed some pretty remarkable results.

According to the lead researcher, Eugene Lipov, MD, “Nineteen out of twenty patients had at least an 80 percent decrease in hot flashes for a period of two weeks to a year, following SGB.” Dr. Lipov said that many of the women also saw marked improvement in insomnia and sexual function.

For women who suffer from debilitating hot flashes, this may be the answer. It is a non-hormonal treatment that lasts from two weeks to a year. That’s a pretty good payoff for one injection. The sleep factor alone is priceless if those middle-of-the-night sweats could be reduced or eliminated. Imagine eight straight hours of sleep with no nighttime flashes -- heaven.

This procedure is not yet widely available, but the pilot is promising. Although it was done on breast cancer survivors, the Dr. Lipov has used the procedure on menopausal women who did not have cancer and got the same dramatic results. He is currently continuing his research in this area.

This is one to watch. One injection, months of relief. Cool. Very cool.

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Nothing in these pamphlets will surprise you. They suggest that your “Daily Steps to Health” should include no smoking, more exercise, a healthy diet, moderate alcohol consumption and keeping your weight within reason. You knew that. But the value in this handy sheet is that they’ve boiled down lots of evidence-based research, reminding you of the few basic things you need to do to stay in touch with your health status. In addition to the daily steps, there is a quick list of preventive medications you might be wondering about (like aspirin, hormone replacement therapy and immunizations) as well as a list of screening tests and how often you need to have them done. Luckily, they include testing for HIV and sexually transmitted diseases, depending on your risk factors. (Yes, people over fifty are still having sex and still taking risks, so a little reminder about staying safe and getting tested is a nod to our continued sexual health.)

Lastly, there is a chart on which you can keep track of all your preventive screening tests – type, dates, results, etc. All in all, a compact, helpful reminder of what it takes to get and stay healthy after age fifty. Download your own copy of the checklist from the AHRQ website, and tuck it where it can gently remind you to head problems off at the pass.

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You answer questions about your medical history, menstrual history and current medications. (Have your prescriptions on hand when you fill out the questionnaire – it will ask for brand names and dosages.) There are some questions about menopause symptoms and risk factors, as well as a list of other questions you might like to ask your medical provider.

Once you finish the questionnaire, the information is compiled into a user friendly printout that you can take to your next visit. It summarizes your medical history and risk factors, and poses questions to your doctor at the end. All in all a very nice tool to get through your next doctor visit with all your questions answered and some help deciding whether to use hormone therapy to treat menopausal symptoms. Doctors seem to like it too, according to the website. Anything that makes it easier to get what you need from a medical visit is a plus. We menopausal women are notorious for the occasional memory lapse, so this is news we can use.

If you use the questionnaire, let us know in the forum whether you found it useful.

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The study followed the women from 1990 to 2000 and sent them a questionnaire every two years that asked for information on their dietary habits, smoking status, body measurements, medical history, use of hormone treatments and menopausal symptoms. What they discovered was that menopausal symptoms were associated with several factors, including some that were voluntary.

Women who smoked or drank alcohol were more likely to have symptoms, as were those who ate sugary snacks. They also found the risk of symptoms higher in women with benign thyroid disease, migraine and depression, but these are not modifiable factors. Since this was a large study done over a decade, it gave a lot of information about the cohort who participated. The more we know about risks, the more we can make choices that reduce them.

This research confirms what other studies have suggested – that women can, to some extent, lessen their risk of having menopause symptoms. At the very least we can quit (or cut down) smoking and drinking alcohol. We can find healthy substitutes for rapidly absorbed sugars in our diets, and thereby reduce symptoms or perhaps keep them at bay. While we wait for more good research to help us make right decisions, we can take matters into our own hands. Put down the drink, the cigarette and the doughnut – it may help you say "whoa" to menopause symptoms.

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A study from the Wake Forest School of Medicine in North Carolina has me wondering. A group of 56 women were selected for age (44-56), menstrual status (no period for at least 3 months), and menopausal symptoms (at least four hot flashes a day). The women were divided into three sub-groups, those who got:

• Regular menopause care,
• Traditional acupuncture, or
• Sham acupuncture

All the women experienced a reduction in their hot flash symptoms. The women receiving the usual medical care averaged a 10% reduction; those receiving traditional acupuncture had 40% fewer flashes; and those receiving sham acupuncture (shallow needles in non-therapeutic areas) also experienced 40% fewer flashes. Say what? It didn’t matter whether the acupuncture was the real deal or its imposter neighbor, women cooled down.

Was the success with faux acupuncture from the needles or was it placebo effect? And , more importantly, do we care? Instead of disdaining “placebo effect” as a therapeutic ugly step-sister, what if we embraced it as the best dang therapy since penicillin? It’s obvious that what we think has tremendous effect on how we feel. If our expectations can make us better or more comfortable, why not celebrate that and study it, as we would if it were a new drug or supplement?

Placebo effect is the Rodney Dangerfield of medical science. We give it no respect, and in fact point to it to justify that people are just silly little gooses for letting their brains do the work of the real heroes: medications.

What I don't get is why aren’t we studying the power of our expectations along with all the chemical boosters and concoctions? Let’s start by refering to it by a grownup name: “Expectation Physiology.” (That sounds pretty scientific, yes?) If I may borrow a phrase: A mind is a terrible thing to waste.

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Ghrelin is a hormone that regulates appetite and rises when we reduce our food intake. Ordinarily, this makes us hungry, so we eat. If we ignore our appetite signal, we produce even more ghrelin, which oddly enough, seems to reduce stress and anxiety. In research done at UT Southwestern Medical Center, ghrelin levels rose when mice were either denied their usual food, or when they were stressed by “bully mice.” As a result, normal mice experienced a decrease in anxiety as the ghrelin level climbed. Mice who were genetically altered not to be able to respond to ghrelin did not show lower stress or anxiety as their levels of the hormone rose. In evolutionary terms it makes some sense that if we are going without food, or if we are stressed by the local tyrannosaurus rex, those who produced a stress reducing hormone would be better able to hunt for dinner or deal with Rex.

So how could this translate into human terms? Well, it may explain why you get hungry when you are stressed, since stress triggers ghrelin production. And it may be a clue why people who are anorexic get hooked on food restriction, since it is possible the increased ghrelin is reducing their anxiety or depression, and reinforcing their low-cal behavior.

And for menopausal women who are struggling with keeping that tummy trim? It makes a case for using both exercise and calorie restriction when getting those pounds off. Not only is that combination the best route to healthy weight loss, but keeping yourself just a little bit hungry may trigger ghrelin production, and reduce your stress and anxiety while you try to fit into a certain dress for your 30th high school reunion. Then again, these studies were done on mice after all, and having written about this I now have an overwhelming urge to pull up a Mars Bar and wait for the human trials.

No, on second thought, I’m going to grab a slice of tomato and wait for the ghrelin to kick in. At the reunion I’ll be the one with the placid smile, looking longingly at the crème brulee.

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The North American Menopause Society (NAMS) has put out an updated position statement on estrogen and progestogen use in post menopausal women, based on a close look at existing research with particular attention to the Women’s Health Initiative data. They have included new categories such as vaginal symptoms, sexual function, endometrial cancer, changes in body weight, overall mortality rates, timing of beginning therapy, how to explain the risks, and the importance of individualizing therapy. The position paper underlines the need for ongoing research to confirm and clarify the risks and benefits for various populations of woman, and for various forms of hormone therapy.

The bottom line, after a careful look at what we know now, is that hormone therapy is still a great idea for some women, and a not so great idea for others. Some of the highlights include:

• Starting hormone therapy early seems to offer more benefit than waiting years to start it. For women 50 to 59, it has a better benefit/risk picture than for women who start taking hormones after the age of 60.
• It is still the most effective treatment for vasomotor symptoms like hot flashes
• Using it locally – in the vagina – works best for vaginal symptoms like dryness or pain with intercourse
• It is very effective in preventing osteoporosis if other therapies are not possible
• It should not be used to treat or prevent strokes, memory loss, depression or weight gain
• The lowest dose that works is the safest choice when using hormone therapy to treat menopausal symptoms
• Every woman should be evaluated individually to decide whether hormone therapy is a good option for her

We will learn more and more as research is done to refine our understanding of the benefits and risks of hormone therapy. It is still a good choice for some women, so if your menopausal symptoms are disrupting your life discuss your options with a doctor who understands hormone therapy. Weigh the pros and cons, and find an approach that keeps you safe, sane and healthy.

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Have you noticed that those times in your life when the hormones are stormiest are also life-changing events that move you from one phase to the next? First, there is puberty, where you go from being a carefree child to being an angst-filled adolescent. This is when you get a new body, and learn to manage your new adult sexuality. For the first time you are expected to make decisions about your adult life. Big decisions -- like sexual partners, jobs, education and life roles. No pressure there.

Sometime after puberty there may be pregnancy. Once again you are thrown into a world that no one can really prepare you for. Once again you have a new body to get used to, important decisions to make, and once again you enter into a different life as a result of those decisions. Your body changes, your hormones take you on a roller coaster ride and after it's over, there is a new person in your world to deal with. Even if your pregnancy decisions are different than the married-with-children variety, it's still a crossroads that you will remember and that will change your way of viewing life.

Then, the childbearing wanes and you get close to menopause. Without much warning you discover yourself in another developmental phase that opens up your life into a series of new hormone swings and life decisions. Your health decisions are suddenly really important, lifestyle habits are beginning to show (good and bad), and you are reassessing your choices.

Stormiest of all is when one type of hormone chaos meets another – say when you are in the perimenopause and your daughter is entering puberty. To give your adolescent some clues about how to handle your menopausal years, here is a little tutorial from E-How. Both of you are getting used to body changes, new sexual priorities, crazy mood changes and expectations that being older makes you a different person. Talk about a recipe for turmoil. Watch Lauren Mayer sum it up in her own playful way, singing “Hormone Hell.”

The way to handle these hormone squalls is to remember three other important P-words: Patience, perspective and playfulness. Have the patience to cut each other slack, keep your perspective because this will not last forever. When in doubt, find a reason to laugh. It just might get you through.

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Did your mom smoke when she was pregnant for you? If she did, it's possible that you will have an earlier menopause than someone whose mother didn't smoke. Researchers in Boston followed over 4000 women through menopause and obtained detailed histories, including whether they were exposed to prenatal cigarette smoke. Women whose mother smoked were 21% more likely to be postmenopause at any given age than unexposed women.

It's hard to say exactly what the link is, but one theory is that prenatal exposure to smoking has an effect on follicle production and thereby plays a role in your age at menopause. One interesting note was that this affect on menopause timing held for women who were not smokers themselves, but not for women who smoked. It's long been known that smokers tend to go through menopause up to two years earlier than non-smokers. But smoking seems to have an effect on menopause age even if your "smoking" happened in utero. So talk to your mom, and ask whether she smoked while she was pregant. And if you were a smoker during your own pregnancy, give your daughter a heads up.

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One surprising finding was that this reduction of risk was true even in women who smoked. Women who smoked and who were currently on hormone therapy had a lower risk for lung cancer compared to other smoking women who were not on estrogen. The researchers did not identify exactly why this connection exists, but this study opens the door to explore what it is about estrogen that gives women an advantage in lung cancer prevention.

When considering whether to use hormone therapy during and after menopause, this is one more piece of information to put into the decision. More research will refine what we know about why estrogen may lower the risk of lung cancer, and which women benefit the most. In the meantime, quitting smoking is still the best way to lower your lung cancer risk.