You are Fifty: You May Need....A Hat

Not everyone who looses hair loses enough to need to only wear hats, or even to want to. But often the hair loss as we age is significant to produce thinning which is bothersome, and when it comes to treat or get a topper, the treatments aren’t uniformly effective, so you may find yourself using an occasional striking chapeau! Hair loss, beginning at the age of 50, occurs as we age. Your hair may thin everywhere, but it's most likely to thin on your head and less so in the other areas of your body. Hairs come and hairs go, normally at the same pace. Women will loose 75-100 hairs a day, and if you look at 75 long hairs in a bundle, it will seem fairly dramatic. But don't panic on a normal day, you'll replace all the one's you've lost with new hair growth to the tune of the same number...about 75 to 100 new hairs each day. If you are loosing over 100 hairs a day, you will get hair thinning. The most common form of hair thinning and hair loss is what is called non-scaring loss. It's temporary, the main losses begin to recover in 6-8 months and is likely due to elevated male hormones, chronic medical illness or stress. Various physical stresses can cause hair loss including fevers, very dramatic events in your life or long chronic illness.  Non-scarring hair loss is the situation in which hair follicles, the place that hair grows out of, may lose their hair shafts, but they are mostly not destroyed and they can once again grow a new hair. Mild follicle inflammation, like a localized infection or pimple can cause a temporary hair loss.So when you check in with your gyno you may indeed find treatable conditions. But if not, it's aging and there may not be a lot to do to turn around the hair loss an regain the hair of your 20s.

Estrogen Therapy for the Bladder

In the new position statement from NAMS on hormone therapy there is a differentiation between hormone therapy with estrogen and hormone therapy with progesterone and estrogen, and there has been some differentiation between hormone therapy over the skin verses systemic pill therapy. There has also now been a distinction between the various types of vaginal estrogen treatments. We have known that vaginal estrogen can normalize not only the lining tissue back to the condition prior to or during the menopausal transition, but it normalizes the vaginal environment and the types of bacteria. Through this effect it can result in fewer chronic bladder infections. Also in the position statement, they point out that the 2 mm vaginal ring, which leaks estrogen on a daily basis, can in fact reduce the symptoms of over-active bladder as well. So if you happen to have chronic bladder issues that are not resolving, see your gyno, perhaps she has suggestions for you that can help.

Hormone Havoc: Turning Male

We all have that ying and yang balance of male and female. Before menopause our ovaries make both estrogen and testosterone. And a bit of the boy gene along with a bit of the girl gene is just what our gyno recommended: for our personality. But when it comes to hormones: most women function best when their balance is keeping those male hormones  in check. If there you have too many male hormones relative to your female hormones the patient can show the physical effects such as unwanted hair, male baldness, acne or deepened voice, and it's more likely to be due to minor imbalances rather than massively high male hormone blood levels. Recently we talked about the unwanted hair growth that occurs if the male hormones are too intense, and condition is called hirsutism. If the imbalance becomes even more dramatic, then the skin can show other these other male hormone effects including acne that can be the cystic type that leads to scaring, and male-pattern balding (androgenic alopecia).

The Non-Hormone Hormone Therapy

Women will tell me that they are on "the estrogen therapy Premarin". In fact there are literally dozens of compounds in the medication called Premarin formulated to treat menopausal symptoms. Many of the compounds are indeed estrogens, some of which are similar to those humans have, and some only found in female hormes. But intrestingly, the alternative therapy wonmen may not know, that one of the mose successful nonhormone compounds used to treat menopause, is also found within this massive mix of actual hormones. The use of alternativto hormone therapy is more common than hormone therapy for the treatment of menopausal symptoms. Black cohoseh, red clover, St Johns's Wort are all hormone alternatives that have in some studies been shown to be better than placebo for the treatment of hot flashes, as are the SSRI Anti Deprssants. But one of the most talked about alternatives to traditional hormone therapy is the use of soy, or  soy by products. Soy products for the benefits of health became one of the main stories of the 1990s when it was discovered that soy protein could help one's cholesterol level, and in 1999 the FDA allowed soy products to be labeled as heart healthy. For hot flash therapy soy, more specifically it's plant estrogens (termed phytoestrogen) of the category isoflavones, is a non-estrogen way of stimulating estrogen action on cells. The way this works when we swallow soy to treat our hot flashes is really very complex. A bacterial energy metabolic byproduct of the soy isoflavone called daidzein is produced when some adults eat soy. This compound which some of us can make when we eat soy is called equol. We have to be able to metabolize soy in a specific way in order to get this compound and see benefit from soy! And it may be why some women reallyget well treated from soy and others seem to not notice that soy is helpful at all. Equol can also be injested in a supplement form for those of us who can't make it. Interestingly, the urine of pregnant mares has equol in it. This makes sense in that mares are often fed soy protein in their feed. So, although the fact that the horse estrogens are very potent and part of the success of this treatment, it also turns out that a very popular alternative therapy is one of the secrets as to why Premarin is a more effective hot flash treatment for many women!

Protect Against Ovarian Cancer: Tempering Dr. Oz's Advice

One of the most intersting of the contraceptive benefits of the birth control pill that was listed in the Gyno Gab Top Ten Things Your Birth Control Pills Can Do For You is the fact that birth control pills protect against ovarian cancer. And as soon as Dr. Oz talked about the fact that taking the pill after age 40 could cut your risk of ovarian cancer by half we got an immediate phone call from  a woman over the age of 65 wondering if she could get going on this terrific treatment. But alas it has only been shown as a protective factor over the age of 40 in women who are still ovulatory. t is the quiet of the ovary that is why it works, less ovulations lead to more protection, which is why longer use is associated with more ovarian cancer protection. At age 65 your cannot decrease your risk of ovarian cancer with birth control pills or with hormone therapy. In fact, some studies (although not all) of who have taken estrogen hormone therapy for over ten years have actually an increased risk of ovarian cancer, it's difficult to study this because of the risk of lining cancer of the uterus complicating the reported cases of cancers present in the ovary as well. Other factors which decrease the risk of having ovarin cancer are: having a baby, breastfeeding, having your tubes tied, having a hysterctomy, and having used the pain medication non-steroidal medications (NSAIDS like ibuprofen). Factors that increase your risk for ovarian cancer: infertility, caffeine intake , two or more eggs per week, increasing BMI (obesity) , and of course family or genetic risks. Gyno experts  haven't really figured out if alcohol or smoking are risk factors for or protection against ovarian cancer. Protection against cancer is possible and it's important to discuss with your gyno all the ways you may get this accomplished.

Think of Zinc

  Zinc is potent micronutrient that we need for general as well as gyno health. Health effects on the fetus of being deficient in zinc has been known for over 50 years and some famous studies of dwarfism in Iran had been traced to zinc deficiencies. It is a trace mineral, also called trace elements, widely available in meat and plant sources. Because the zinc is harder for us to chemically extract from vegetarian food sources so there is lower bioavailability in plant sources. Vegetarians and vegans are urged to get approximately 50% more zinc than those who do eat meat. Fish sources have zinc too, and oysters are among the best way to get zinc into your diet. Zinc is necessary for the function of dozens of our body's metabolic enzyme systems; it is important for our immune system, the repair of DNA and for wound healing. For those getting cosmetic treatments getting the right amount of zinc in your diet will help you heal more quickly and help enhance the way your products are working for your skin’s protection. If you have had diarrhea your skin can be listless for a variety of reasons: low fluid levels, too little magnesium and potassium in your system due to the loss during diarrhea, but low zinc can be responsible for the symptoms of being pale as well. Remember there are hidden ways doing things you think of as beneficial for your health, that actually can be detrimental. For instance too much zinc can be both toxic and compromise the amount of copper, another trace mineral, in your body. Too much iron can also affect how we absorb zinc from our intestinal track.  Discussing these issues with your gyno, boils down to a basic diet analysis. There is no approved blood level tests for zinc, and hair analysis is inconsistent, so you just have to rely on the content of our diet to get enough zinc in!

Top 5 NuvaRing Questions

I always figure that the questions in our gyno practice are the questions you have so here they are with the answers:
1. Can I wash my NuvaRing: yes, you can, this is covered in the package insert
2. Can I leave in my NuvaRing for 4 weeks instead of 3 so I skip this month's period: yes, you may get a bit of spotting instead of a normal period, but it likely will hold your period off until your next time you take the ring out for a few days (no more than 7! or you won't be protected!)
3. Can I take my NuvaRing out during sex: yes, but for no more than 3 hours
4. Can my partner feel my NuvaRing: about 35% of men say they can feel the ring during sex, and abot 1/5 women say they can feel it during sex as well, but rarely is this bothersome to women
5. I  know it has to be refrigerated, but how long can I keep it in the fridge: 4 months after you pick it up from the pharmacy, then it has expired according to the product information.

The Hormone of Thin

Leptin is the hormone produced by our body, pro  that causes weight loss. It itself does produce weight loss independently and through decreased food intake. Higher leptin levels cause (in animal studies) less food intake. But it also will increasty and it will decrease your heat production so that you will burn more calories. Exactly just how we can get this hormone to turn on is less well understood than how this hormone turns off. So, fasting will decrease leptin! Exercise will decrease leptin! Now exercise will produce it's own heat loss and energy expendititure, but fasting cannot do that. Although we are taking in less calories, so 'less to burn', ultimately, fasting has the counter-productive effect of making weight loss harder! This all has to do with this crazy hormone leptin...and the other hormones produced in our adipose (fat) tissue...but more on those later!

Pregnant, But are there Twins? What Are the Odds?

Women get that positive pregnancy test and they want to know so much more! What is my due date, am I having a boy or a girl, am I having twins! And when they have those questions we quote the following odds of twins We have between 100-120 chance of having twins, and naturally triplets occur about 1.7900. Quadruplets once in 370,000...approximately. The studies vary by your age and ethnic background. Of course these are the 'natural' rates with the rates after taking fertility medications much higher. Some fertility medications have rates as high as 50% of having a multiple pregnancy!

I Shall Please

I've seen more and more talk about the effectiveness of the administration of placebo. With the implication that placebo care is no care at all. And not so, because as patients and physicians we care very much which is at the root of the "pleasing principal." As a gyno I feel that just knowing the origin of this fascinating phenomenon's term explains the essence of placebo to me. The phrase I Shall Please is powerful, and it is the the meaning of the latin verb placere. Placere in the plural is the derivative of the word placebo. Most of us mentally think of the phrase, "placebo pill" when we think of the word placebo, but is is not just a pill it is an entire physiologic process that acts to produce the responses seen when a placebo is administered. More correctly, the "I Shall Please" process is a 'placebo effect." It is why administration of the placebo medication in research trials almost universally produces salutatory treatment results.And the key to the phrase is the interaction. It is that inexplicable bond between treater and patient, it is thus explained by Leon Eisenberg to be a "healing response" or a "response to care", in fact he emphasizes that it is an important response. We of course knew this in Avicenna's time, a 11th century Persian physician who wrote over 450 documents on medicine, including the fact that the treatment will not work unless the physician believes in it and conveys that to the patient. So the pleaser has to get that feedback from the pleased, so I prefer to call this a "healing dynamic" as well as a treatment response!

The 'Official' Line on Menopausal Hormone Treatment

If you like facts and figures when making your yearly 'to take or not to take' decision regarding hormone therapy, then the 2012 position statement on hormone therapy from the North American Menopause Association is what you want to review. To my reading there is ongoing support for the benefits of hormone therapy for many women with diverse treatment needs. There is also more support for the safety of the transdermal (over the skin) preparations. It is also true that in the new very low dose estrogen treatment programs the safety is very close to the transdermal products. Keep in tough for other posts as we delve into the details of the update., and be sure to write in with the questions you have!

Does Menopause Cause Heart Risk?

The simple answer to the question of whether menopause causes heart risk is yes. The loss of estrogen and the loss of testosterone make women rapidly transition from having less heart risks than men to having more heart risks.And this risk is not trivial and should be discussed with your gyno. If you have always been thin, if your cholesterol is low, if you have always exercised, and eaten a low fat diet, your heart risks are less than women who have not had those preventative measures, whether you transition through menopause or not. But the average American Woman, according to a study of atherosclerosis in perimenopausal women has about a 30% chance of already having plaque in their arteries.This means many of us are already at high risk without taking the proper measures to protect ourselves from potentially fatal consequences. So as your hormones change, don't just get a pap, get a heart check as well.