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 to testosterone and eventually estrogen. In November 2016, the U.S. Food and Drug Administration approved DHEA to be used vaginally to treat atrophic vaginitis and associated symptoms. Research regarding DHEA has demonstrated the ability for the compound to improve symptoms of vaginal dryness and pain with sexual activity. In the future we may find that DHEA improves libido. Presently, however, data are limited and more research is needed to truly elucidate the impact of DHEA on libido. Additionally, daily use of DHEA appears to keep systemic hormones within the same ranges demonstrated in menopausal women not using hormone therapy. However, small increases in systemic estrogen have been noted with daily DHEA use, thereby potentially ruling it out as a treatment option in certain populations of women. Finally, it is of note that DHEA must be used daily in order to remain effective.
Discussed here are just two potential treatment options for atrophic vaginitis. Primary care doctors and women’s health providers have a variety of treatment options for this condition. Talk to your doctor about any menopause associated vaginal symptoms that you may be experiencing so you can get a tailored treatment that is best for you!
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.
Fatigue is the most common complaint doctors see in their office. The causes of low energy are numerous, and often there isn’t a single culprit. However, in women of reproductive age, low iron can be a common cause of or contributing factor to low energy. Many of my patients have been told to supplement iron in the past, but they haven’t been told why or for how long. Let’s explore the subject.
When considering any nutrient in the body, we have to think about 3 factors: how much of it are we taking in (diet or supplement), how much of it is getting absorbed in our digestive system, and how much are we losing.
One of the major challenges in my practice is relaying information about single nucleotide polymorphisms (SNPs) in a way that’s accessible and empowering for my patients. The acronyms alone make it daunting to approach: MTHFR, COMT, MAO, VDR, UGH (okay, that last one was mine). Genomic medicine can be a powerful tool for improving and optimizing health, so with that in mind, let’s try to decode the alphabet soup.
In Chinese medicine, spring is an excellent time to cleanse and renew. Much like the buds sprouting on plants outside, the body is energized and ready to emerge from its winter dormancy. The buzzword “detox” can evoke thoughts of deprivation with a dash of lemon-cayenne water, but there are many avenues for resetting your health. Below are some gentle ideas. (more…)
Sometimes I catch patients off guard by mentioning perimenopause as a potential underlying cause of their symptoms. In some cases, this is because the woman didn’t realize the menopause transition could cause more than hot flashes and night sweats. At other times, it’s because the person doesn’t realize that perimenopause can occur at their age. (more…)
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. (more…)
Varicose veins are a common concern for women as they age. They range from being an unsightly nuisance to being painful and debilitating. Surgical treatment is becoming increasingly sophisticated, but there are many lifestyle and nutritional steps that can be taken to help prevent them in the first place. (more…)
Did you know that anytime you have your lipid (i.e. cholesterol) levels tested, your results are compared to what would be considered the average range for male values? As is the case with many different lab types, women’s averages are generally lumped together with male averages. This happens because women are often underrepresented in research studies, and without enough women to represent a general population, “the normal range” is biased in the direction of “normal” for men. (more…)
Metabolic syndrome occurs when certain health metrics (waist circumference, blood pressure, blood sugar, cholesterol) trend away from the healthy normal. The condition is common; it affects a quarter of adults in the United States and climbs to nearly half of all adults over 50. While the parameters might seem trivially different from normal (fasting blood sugar more than 100, blood pressure 130/85 or greater), these slight elevations put together have significant impact on long term health and wellness. (more…)