DHEA for Atrophic Vaginitis

Posted by on Dec 18, 2017

By Erin Conlon, ND, MS As we go through life we experience various and sundry joys of fluctuating hormones.  For many women, teen years bring forth a roller coaster of emotions and physical changes as we experience new and evolving levels of hormones.  The modification of hormones in pregnancy can further alter bodies and impact emotions.  Finally, the culminating change in hormones, known as menopause, influences the body in entirely new ways, as hormone production declines. The menopausal change in hormone levels may present with an assortment of symptoms that includes flushing with waves of internally generated heat, mood lability, vaginal dryness, and mental cloudiness.  Symptoms of hot flashes, mood swings, and brain fog often bring a woman into her doctor’s office, as these are commonly discussed topics.  But all too often, symptoms of vaginal dryness or pain with vaginal penetration are left untreated due to associated social stigmatization.  It should be noted that roughly 50% of postmenopausal women experience vaginal dryness between the ages of 50 and 70, a number that increases to over 70% after age of 70.  Unfortunately, only about 25% of affected women seek medical treatment for this condition. Vaginal dryness is often accompanied by sensations of itching and burning, increased incidence of urinary tract and vaginal infections, and urinary leakage.  Furthermore, vaginal dryness can contribute to pain with penetrative vaginal activity and an associated decreased libido.  This constellation of symptoms may all be attributed to a condition call atrophic vaginitis.  This atrophy/thinning, also affects a decline in pelvic floor/vaginal tone, urinary incontinence, and changes in the vaginal and bladder ecology such that vaginal and bladder infections can become more common. Atrophic vaginitis is the change in vaginal tissue and lower urinary tract following the loss of estrogen, which may occur with natural, surgical, or chemical menopause.  Current standard-of-care treatment for atrophic vaginitis is local vaginal estrogen.  The hormone can be delivered to the vagina through a variety of methods, including creams, suppositories, vaginal tablets or ring.  Creams, tablets and suppositories are generally used nightly for two weeks and then twice a week thereafter. Rings are used continuously.  The purpose of this long-term therapy is to help preserve the ecology, pH, and tissue of the vagina.  While the majority of the hormone is delivered directly to the vaginal tissue, some studies have shown that vaginal estrogen may contribute to elevations in systemic estrogen.  The potential for vaginal estrogen therapy to alter body-wide hormone levels, albeit very minimally, makes the treatment less than ideal for some women. Fortunately, there are other options to treat atrophic vaginitis!  DHEA, also known as dehydroepiandrosterone, is a precursor hormone that when in the presence of necessary enzymes, can be converted...

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Building Your Winter Blues Tool Box

Posted by on Nov 17, 2017

Building Your Winter Blues Toolbox Valeria Manning, ND   Seasonal Affective Disorder, better known as S.A.D., affects approximately 3-6% of the general population. The incidence is higher in northern latitudes and among women of reproductive age. Typical presentations of S.A.D. overlap significantly with major depressive disorder, however S.A.D. occurs in a more cyclical nature during the autumn and winter months. Naturopathic medicine boasts a variety of tools to help treat and even prevent Seasonal Affective Disorder. The following is a sampling of these treatments.   Please keep in mind that the best resource and safest option for someone experiencing S.A.D. is a thorough evaluation by a licensed physician.   Lab Testing- finding the cause Depressed mood, fatigue and weight gain could be symptoms of iron deficiency, hypothyroidism, hormone dysregulation and various other medical conditions. Ask your doctor to rule out metabolic and hormonal causes of your symptoms before you implement ideas in this article. Naturopathic physicians excel in evaluating a person’s whole-body health, taking into account nutrition, lifestyle, family history and environmental influences. You may also want to test your neurotransmitter levels (e.g. serotonin, norepinephrine, dopamine) to more accurately identify potential causes of your symptoms.   Light Therapy Full-spectrum light therapy is a promising treatment for S.A.D. The recommended administration of this therapy is 20-30 minutes of direct exposure to 10,000 LUX of full-spectrum light, ideally in the morning within an hour of waking. You may experience initial mild side effects of headache, eye strain or agitation. If this occurs, point the light slightly away from your face so your body can slowly adjust to the exposure. Full spectrum light bulbs can be purchased at your local hardware store or online. Full spectrum lamps or light boxes can be more expensive but can easily be found online. Remember that the necessary brightness is 10,000 LUX!   Exercise Exercise is an often-overlooked treatment for depression, which is unfortunate since it is a powerful tool for treating depression. The goal is 30 minutes of moderate intensity exercise, 5 days per week. Work your way up to this amount slowly and don’t feel guilty if you don’t make it to 150 minutes weekly. Start by committing 5 minutes per day, then increase to 10, 15, 20, etc. Online videos are a phenomenal and fun way to find virtually any kind of guided exercise- yoga, dancing, stretching, Pilates, weights or cardio. A gym membership is also a great option if financially possible.   Counseling or Talk Therapy Confiding in a close friend, family member or colleague can help us feel less lonely and isolated during the winter months. We may feel vulnerable talking about our feelings to others, however there is a high...

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Risk Factors & Signs of Melanoma

Posted by on Dec 29, 2016

Melanoma is the most common cancer in women ages 25 to 29 years and the second most common cancer in women ages 30-35 years. Due to ozone depletion, incidence has doubled every 10 years. Therefore, it is important that women be educated on the risk factors and signs of melanoma in order to identify a potential malignancy and monitor skin changes. Similar to self breast exams, women should become familiar with their skin and monitor for changes monthly. Moderate risk factors include fair skin and a history of UV exposure (sun and tanning beds), particularly a history of blistering sunburns. Additional factors of higher risk include eight or more moles that are greater than 6 mm in diameter and a history of a changing mole. Luckily, there is a mnemmonic that can help. The mnemonic is ABCDE. A, B, C, and D help to identify abnormal moles, while E helps to monitor for changes. A stands for asymmetry. An asymmetric mole is one that is not circular or eliptical. In other words, one half of the lesion differs from the other side. B stands for borders that are irregular or indistinct. A mole with indistinct borders may have blurred edges. C stands for color that is non-uniform (variable pigmentation involving at least two different colors). D stands for diameter over 5-6 mm – about the size of a pencil eraser. Lastly, E stands for evolution of a lesion – the evolution (or changes) in the size or features of a mole. Changes to note include any variation in size, shape, color, or surface. Moles are often flat, but an abnormal feature that should draw attention is a flat mole with a raised center. This is known as the “fried egg sign.” Additional features to pay attention to include: an associated itch or altered sensation as well as inflammation, oozing, crusting, or bleeding. A basic starting point is to look for “ugly ducklings” – any mole(s) that stand out as being distinctly different than others. Abnormal moles typically appear at puberty (as opposed to common moles that present in childhood) and continue to develop until age 40-50 years. More alarming is a new mole that appears after age 30. Abnormal moles most commonly appear on the back and particularly on the legs in women. Additionally, areas of the body that are typically covered from the sun have a higher incidence of abnormal moles, including the breasts, scalp, buttock, and groin. The incidence of malignant melanoma is increasing, and as the first and second most common cancer in women under 35 years, it is important to maintain a higher level of suspicion. In addition to monthly at-home monitoring, women should have...

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Natural Treatment Options in the Prevention of Osteoporosis

Posted by on Aug 29, 2015

Osteoporosis refers to a skeletal condition characterized by decreased bone mass. This contributes to fragile and porous bones leading to an increased risk of fracture. Osteoporosis is most common in postmenopausal women due to declining estrogen levels, which accelerate bone loss. Osteoporosis prevention is optimal if initiated within the first three decades of life when bone building is at its peak. Later in life, while many pharmaceutical interventions are available in the prevention and treatment of osteoporosis, there are many options available in natural medicine known to support bone health, although select patients will need to also use conventional medicines for this purpose, because they are at high risk of fractures or have already had osteoporosis related fractures. Lifestyle Interventions Exercise. Weight bearing exercise is a fundamental concept in the prevention of bone loss because it encourages the natural process of bone breakdown and rebuilding. Research shows that exercise early in life boosts bone mass while exercise later in life maintains it. Smoking cessation. Most studies suggest that smoking not only increases the risk of fracture but also extends healing times and leads to more complications if a fracture occurs. Women that smoke often produce less estrogen (leading to accelerate bone loss) and have been found to have almost twice the risk of hip fracture compared to female non-smokers. Reduce alcohol intake. Heavy alcohol consumption is specifically linked to the most serious type of fracture (the hip) and actually kills osteoblasts, the bone-making cells of the body. Regular consumption of more than two alcoholic drinks per day increases the risk of osteoporosis. Dietary & Nutritional Interventions Consume a diet rich in dark leafy greens. Dark leafy greens are rich in bone fortifying nutrients such as calcium, vitamin K, magnesium, potassium, and boron, all of which are associated with higher total bone density. Monitor dietary salt. High sodium intake can increase urinary excretion of calcium. The recommended daily intake of sodium should not exceed 2300 mg daily, equivalent to about 1 teaspoon of table salt. Avoid excess caffeine and colas. Caffeine has been shown to potentiate bone loss. Colas, but not other types of sodas, have been associated with low bone density due to high phosphoric acid content, as well as caffeine. I generally recommend no more than three cups of coffee daily if osteoporosis prevention is a goal. As for the cola, no consumption is best. Ensure adequate dietary calcium. While this is controversial advice in some circles, aim for at least three servings of high quality organic dairy products or calcium fortified foods daily (1 serving size = 1 cup of milk or yogurt, 1.5 oz. cheese). A serving size represents approximately 300 mg of dietary calcium. Consumption of...

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Hormone Use in Women Older than 60-65

Posted by on Jul 21, 2015

Several studies have shown that menopausal vasomotor symptoms (hot flashes and/or night sweats) and sexual symptoms are undertreated in all age groups of women. In fact, an article published in Menopause last February found a “high prevalence of untreated moderate to severe vasomotor symptoms and sexual symptoms even in women aged 60 to 65 years”. This large study evaluated 2,020 Australian women aged 40 – 65 years of age over a period of 18 months. As new research continues to verify the presence of bothersome hot flashes and sexual symptoms persisting later in life, the medical industry must consider rethinking its approach to menopause treatment in older women. In response to these findings, the North American Menopause Society issued a statement encouraging the consideration of hormone therapy after 65 years of age when appropriate and when benefits outweigh risks. The society’s medical director stated, “the use of hormone therapy should be individualized and not discontinued solely based on a woman’s age”. This is an important finding, as insurance companies often choose to deny coverage and physicians may also refuse to prescribe hormone therapy because of supposed safety concerns in older women. This has traditionally been justified on the basis of a standard list of medications that may harm older people, known as the Beers list, which includes hormones. Furthermore, many guidelines still recommend against systemic hormone use for women more than 10 years after menopause or after age 60 (and to use them for only a limited time, ideally for 3 – 5 years). Considering that the average length of menopause symptoms is now thought to last approximately 7.5 years, traditional recommendations leave both patients and physicians in a conundrum. It also means that women age 60 and older who have really bothersome menopause symptoms are often left without many options. I am really pleased to see the North American Menopause Society (NAMS) stepping up to the plate here with the reminder to healthcare professionals that many women in this age group are still experiencing symptoms and deserve appropriate care. According to NAMS, “the official position is that there should not be any hard and fast rules against hormones after age 65.” This goes without saying that a complete medical history that evaluates the pros and cons of hormone therapy in older women should absolutely be performed and is a vital part of appropriate prescribing. However, I think these recent findings and the response from NAMS not only encourages the medical profession to stay up-to-date on the current research and thinking but also provides relief from an antiquated belief that hormone therapy must be limited due to age. At A Woman’s Time, each of our physicians is well trained in hormone replacement therapy, including bio-identical hormone prescribing. In our practice, we always aim to start women on the lowest possible effective dose and customize our hormone...

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