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Smoke, Early Menopause And Fertility

Women who smoke and those who have been exposed to second hand smoke have more problems getting pregnant and are more likely to reach menopause at an earlier age than women who never smoked or those who were exposed to the least amount of second hand smoke. A new investigation from Roswell Park Cancer Institute reached these conclusions after researchers analyzed data on nearly 89,000 women in the U.S. Women who reported smoking were 14 percent more likely to have infertility (meaning that they were unable to get pregnant for a year) and 26 percent more likely to reach menopause earlier than women who didn’t smoke. Those exposed to the most second hand smoke had an 18 percent increased risk of infertility and reached menopause at an earlier age than women exposed to the least amount of second hand smoke. The analysis didn’t prove that exposure to smoke was responsible for infertility or earlier menopause, although the researchers adjusted the data to account for other factors that could lead to infertility or early menopause.

My take? As lead researcher Andrew Hyland, Ph.D. acknowledged, earlier investigations have linked smoking to reproductive problems in women, but few looked at associations between second hand smoke, infertility and early menopause. But these are not the only smoke-related risks women face. Some studies have suggested that teenage girls who smoke are at increased risk of developing breast cancer before menopause, and by age 50 women who began smoking as teens had a risk of breast cancer that was 80 percent higher than others who chose not to smoke so early in life. In addition, women with a family history of breast and ovarian cancer may increase their own risks of developing these cancers if they smoke. In addition, women smokers are 1.5 times more likely to develop lung cancer than men. If you’re a female smoker, these unique risks to women are all compelling reasons to make a New Year’s resolution to quit now.

Acupuncture For Hot Flashes

Some drug treatments for breast cancer are designed to keep estrogen levels low, causing a change in hormone balance that can trigger symptoms of menopause in women, including hot flashes. Because female hormones can foster the growth of cancer cells, these patients can’t take estrogen, even if symptoms become severe. Fortunately, new research from the University of Pennsylvania suggests that acupuncture may help relieve the hot flashes. The study, which included 120 breast cancer survivors who reported multiple hot flashes daily, examined the effects of four different treatments to assess the effectiveness of electroacupuncture, a therapy where the acupuncture needles deliver weak electrical currents. The women were divided into four groups. One group was treated with 900 mg of gabapentin daily, an epilepsy drug that has been shown to help reduce hot flashes. Another group received a gabapentin placebo. A third received two electroacupuncture treatments a week for two weeks, then one treatment weekly. The fourth group underwent sham electroacupuncture treatment. After eight weeks, the women who received electroacupuncture reported fewer and less severe hot flashes than women in any of the other groups. Those who received the sham acupuncture also had measurable relief followed by those who took gabapentin. The women who took the gabapentin placebo improved least. The investigators found that 16 weeks later, the women who underwent real or sham electroacupuncture were still experiencing fewer hot flashes – some were even more improved than at the end of the eight-week study. Compared to the sham group, the women who received the real electroacupuncture had a 25 percent reduction in hot flashes, but the researchers said the modest size of the study precluded a statistically definitive conclusion.

Carbs and Depression

We know that refined sugar and heavily refined carbohydrates like white bread, pasta, rice and sweetened soda affect insulin production and insulin-like growth factors, changes which promote inflammation and its negative effect on health. Here’s another good reason for women, in particular, to avoid refined carbs: researchers at Columbia University Medical Center in New York have reported that a diet high in these foods may increase the risk for depression in post-menopausal women. The team compared the dietary glycemic index (GI) and glycemic load (GL) of carbohydrates consumed and incidence of depression in data gathered from more than 70,000 women participants in the National Institutes of Health’s Women’s Health Initiative Observational Study. They reported that the higher GI scores and the more sugars and refined grains the women ate, the higher their risk of depression. The study found a lower risk of depression among women who reported eating more whole grains, vegetables and non-juice fruits, all good sources of fiber. The researchers wrote that their findings suggest that a glycemic-based dietary approach might help treat and prevent depression, but more study in the broader population is needed to gauge its effectiveness. 

Menopause and Caffeine

First the bad news: women who suffer from hot flashes may be making their symptoms worse if they drink coffee or other caffeinated beverages. The Mayo Clinic recently conducted the most comprehensive study ever to investigate the relationship between caffeine and menopausal symptoms. A total of 2,507 women seen at the Mayo Women’s Health Clinic in Rochester, Minn., participated. The women responded to a health questionnaire devised by the journal Menopause, which published the study online on July 21, 2014. Past studies have reached conflicting conclusions regarding a link between caffeine intake and hot flashes. The good news is that this same study showed that caffeine consumption by perimenopausal women was linked to fewer problems with mood, memory and concentration. While the study’s conclusions were described by its authors as “preliminary,” Stephanie Faubion, M.D., director of Mayo’s Women’s Health Clinic, noted that the results do suggest that limiting caffeine intake may be prudent for women suffering from hot flashes and night sweats.

My take? Hot flashes can make a woman’s life miserable as she enters menopause, but luckily in most cases, the symptoms resolve on their own, usually within six months to a year. For those considering alternative approaches, black cohosh is an effective option and has been well studied, but unfortunately doesn’t work for all women. Dietary measures I recommend include two helpings daily of whole soy foods such as tofu, tempeh, edamame (green soy beans in the pod) and miso, which may help because these foods contain plant-based estrogens. Women can also try the supplements dong quai, vitamin E and evening primrose oil but, like black cohosh, they don't work for everyone. The most reliable treatment is estrogen replacement, which may be worth considering on a short-term basis, at the lowest effective dose, if nothing else helps.

Menopause Can Give You a Headache

Here’s some news that will vindicate every woman who blames menopause for migraine headaches. A new investigation suggests that the headaches can begin or worsen in the years just before menopause and, according to the researchers, can now be considered a symptom of menopause, right up there with hot flashes. The monthly decline of estrogen before menstruation has long been blamed for menstrual migraines. Now, the low estrogen typical of menopause, as well as other hormonal fluctuations as menopause approaches, may be the trigger for migraines that occur at this time of life in some women. The migraine and menopause investigation was part of the larger American Migraine Prevalence and Prevention Study, a survey of 120,000 U.S. households. The researchers gathered data on 3,603 women ages 35 to 65 who have migraines, and classified them based on headache frequency and on whether the women were premenopausal, peri-menopausal or postmenopausal. The question now, the researchers said, is how to best treat these menopause migraines. The findings were presented at the annual meeting of the American Headache Society annual meeting in Los Angeles.

Sources:
Mary Mcvean, “Women: You are having more headaches around menopause, researchers say.” Los Angeles Times, June 17, 2014, http://www.latimes.com/science/sciencenow/la-sci-sn-women-headaches-around-menopause-20140627-story.html, accessed July 5, 2014

Counter the Effects of Menopause

Danish researchers have come up with a unique way to help women address some of the increased risks to health brought on by menopause. Noting that declining levels of estrogen can elevate blood pressure and contribute to the development of cardiovascular disease, the research team at the University of Copenhagen Centre for Team Sport and Health examined the effects of playing floorball, a indoor team sport similar to hockey that requires intense physical effort including many short sprints and directional changes. The investigators recruited 23 pre- and post-menopausal women for 12 weeks of twice weekly floorball practice. Initial exams of the participants established that blood pressure among the post-menopausal women was 10 percent higher compared to women of the same age who hadn’t yet reached menopause. The researchers also saw higher levels of an early marker for arteriosclerosis in the post-menopausal group. Results of the 12-week study showed a reduction in blood pressure of four mmHg, which the researchers said correlates to a 40 percent lower risk of stroke. There was also this unexpected benefit: the women had so much fun playing floorball that they insisted on continuing after the study ended.

My take? This is good news for women. Based on what I’ve read, playing floorball requires intense interval aerobic exercise. While I’m not sure how adaptable the lessons of this study are to women in the U.S., the findings do testify to the benefits of working out with a group of friends to stay motivated. If you do exercise with others, however, I urge you not to do so competitively. If allowed to dominate the activity, competitive thoughts can negate some of the benefits of exercise, especially on your cardiovascular and immune systems and emotions.

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Sources:
Michael Nyberg et al, “Biomarkers of vascular function in pre- and recent post-menopausal women of similar age: effect of exercise training”, AJP: Regulatory, Integrative and Comparative Physiology, 2014; DOI: 10.1152/ajpregu.00539.2013

Restoring Women’s Sex Drive

After menopause the female sex drive often isn’t what it used to be as a result of hormonal changes. But the findings from two new studies may help change that. One looked at whether testosterone – the hormone that fuels both male and female sex drive – can help. Results show that just replacing testosterone to pre-menopausal levels didn’t appear to have a benefit, but a dosage that was five to six times higher did. Researchers didn’t report any adverse effects, except for a statistically insignificant drop in HDL (“good”) cholesterol. Nevertheless, they called for additional, well-designed studies to assess any potential long-term cardiovascular and metabolic dangers. The other investigation looked at the effects of the drug flibanserin on women who were distressed about their very low levels of sexual desire. Researchers found that women who took 100 mg of the drug at bedtime reported increases in the number of satisfying sexual encounters. However, 30 percent of the women reported side effects, including dizziness, sleepiness, nausea, and headache, but only eight percent stopped taking the drug as a result.

Sources:
J.A. Simon et al, “ Efficacy and safety of flibanserin in postmenopausal women with hypoactive sexual desire disorder: results of the SNOWDROP trial”, Menopause, December 2013

G.  Huang et al, “Testosterone dose-response relationships in hysterectomized women with or without oophorectomy: effects on sexual function, body composition, muscle performance and physical function in a randomized trial.” Menopause, November 2013