The Mysteries of Being Female – Your 5 Common Questions Answered

Sometimes being a woman can be challenging.  Hormones go up and down then come and go.  We have this amazing ability to become pregnant and deliver a baby out of an area that starts small and grows to 10 centimeters when fully dilated.  We crave, we cry, we cramp, we clean and we console often all in the same day (sometimes in the same hour). We can carry on four conversations at once while updating our Facebook status, cooking dinner and prepping tomorrow’s suit which makes us wonder why we are tired at the end of the day.  We do all this and yet there are times when our body just does not seem to want to cooperate or suddenly veers off course.  Here are some answers to 5 common medical mystery questions about the female body.

1.       Why do I have vaginal dryness (sometimes or all the time)? There are many reasons to consider but the big ones include: not fully aroused, stressed, other things on your mind, on the birth control pill, on clomid (or other fertility medications known to dry up mucus), history of a LEEP procedure on the cervix due to an abnormal pap smear, decongestants (they do not just dry up the nose), dehydration, and hormone changes.

2.       Why are some periods unlike other periods?  Some women have the “fluke” where their period comes early or late (not pregnant), is really heavy, really light, no cramps, severe cramps…etc and this is different from the normal.  Some women alternate months in that one month is an easier period then the next month is a more symptom heavy period. Remember (as I tell my patient’s), your ovaries are sisters not twins therefore “righty” and “lefty” may produce different hormone levels and create different symptoms. Some months may be a “righty” month and others a “lefty” month.  In addition, high stress, grief, flying, major transition, heavy exercise, weight loss, and hormone changes can all affect how your cycle rolls. 

3.       Am I too young for hormone changes?  Nope.  Hormone changes and imbalance can occur at any age from puberty all the way through menopause.  You may be too young for menopause but that does not mean there are not issues with hormone production.  Women who do not ovulate do not make progesterone and progesterone is typically known as the calming, soothing, anti-PMS, pro-pregnancy hormone.   High estrogen contributes to more PMS-type symptoms, heavier periods, weight gain and tender breasts.  Higher testosterone or testosterone sensitivity may create more acne and increased hair growth on the chin, neck, and around the nipples.

4.       Why are my periods irregular or why do I spot and bleed more than seems normal?  First of all, if you are fully menopausal and have not had a period in 12 months and suddenly you start bleeding, please contact your health care provider as you will need additional work up.  If you are peri-menopausal then expect your once regular periods to become very erratic and unpredictable due to the nature of the ovaries changing.  Other reasons for most all ages include hormone imbalances, fibroids, polyps, pregnancy, thyroid problems, being low in iron, having Polycystic Ovarian Syndrome (PCOS) and being on the wrong birth control pill dose.

5.       Where did my sex drive go?  This is tricky.  Some women do not start out with a thriving sex drive and as they go through hormone changes it begins to wane even more.  Those who are used to a higher drive find themselves perplexed when their mojo is gone.  Sex drive for women is rather complicated as it takes into account hormone balance, arousal, stressors, how many things are on their brain, attraction, confidence…and more.  Certain medications are known to lower drive such as the birth control pill and anti-depressants.  Men typically have an “on/off” switch while women have an entire control panel.  Talk with your health care provider about testing for hormones, thyroid, and energy zappers like iron, Vitamin B12 and Vitamin D.  Focus on your stress response, eliminating what is not a priority, communicating with your partner about what you need (A dinner out? The laundry done? Compliments? Forplay?) and do not be afraid to explore and change things up within your comfort zone.  Perhaps this means new lingerie, the addition of sex toys, erotic readings (grey ties anyone?), more date nights, or a mini-couples vacation.

While being a woman is wonderful and empowering (empowher!), please talk to your health care provider if you recognize some of the symptoms above and suspect your particular symptom is more than just a “fluke.”  There may be some true imbalances that require a little tweaking in order to help you feel your healthiest.

References:

1)      Bachmnan, G., and Santen, R. Treatment of Vaginal Atrophy.  Web.  8 June, 2013.

http://www.uptodate.com/contents/treatment-of-vaginal-atrophy

2)      Shifren, J.  Sexual dysfunction in women: Epidemiology, risk factors, and evaluation.  Web. 8 June, 2013.

http://www.uptodate.com/contents/sexual-dysfunction-in-women-epidemiology-risk-factors-and-evaluation?detectedLanguage=en&source=search_result&search=libido&selectedTitle=3%7E131&provider=noProvider

3)      Welt, C.  Physiology of the Normal Menstrual Cycle.  Web.  8 June, 2013.

http://www.uptodate.com/contents/physiology-of-the-normal-menstrual-cycle?detectedLanguage=en&source=search_result&search=irregular+menstrual+cycle&selectedTitle=12%7E150&provider=noProvider

Is Your Anxiety Worse With Menopause?

There are many common symptoms associated with both peri-menopause (the start of the hormonal changes) and actual menopause including hot flashes, night sweats, vaginal dryness, weight gain, increased joint pain, irregular cycles, heavier periods, hair loss, and insomnia.  In discussions with their friends, female family members and health care provider, most women have a general understanding of ‘what’s to come’ when it relates to the big hormonal transition however symptoms such as increased, worsening or new anxiety might be a surprise.  Many women have experienced at least some form of anxiety in their lifetime and find it concerning when those nervous, overwhelm, worry or fretting feelings really ramp up in their forties and fifties. 

Research (and anecdotally in my practice) shows that women who are prone to anxiety before menopause are much more likely to have higher levels as they go through it.  In fact, it is reported that 51% of women between 40-55 years old experience mood swings or anxious type feelings more regularly than when they were in their twenties and thirties.  While there is little research on the subject of “why,” and the reasons are conflicting, there are a few consistent theories that may apply.

As women approach menopause, the need to become pregnant becomes less therefore ovulation becomes less frequent.  Without ovulation a woman does not make (much) progesterone and progesterone is the more calming, soothing, anti-PMS hormone for women.  This leaves estrogen to become more dominant which can cause increased symptoms of PMS, irritation, anger and overwhelm.

This hormonal transition of menopause is often occurring at the same time that life is stressful – Murphy’s law?  Women are juggling family, work, financial, relationship, and world responsibilities while trying to eat healthy, exercise, stay sane and navigate menopause.  This causes a lot of internal stress on the body, particularly the adrenal glands, which leads to feelings of anxiety, irritability, overwhelm and panic. 

Women going through peri-menopause and menopause often experience long periods of insomnia or waking up regularly between 2am-5am.  This leads to more fatigue and less patience causing those low-level feelings of anxiety to worsen.  Everybody feels better after a good night’s sleep as it is restorative to the body.

So, what can be done?  First, recognize that it is a normal (but not fun or fair) part of going through menopause.  Talk to your female family members about their experience and then consult with your health care provider about options (even if temporary) to help you get on the other side of all the transition.  Find coping skills to first recognize what is going on and then how to act/react with yourself and those around you.  Put yourself in time out and take 5-10 minutes for yourself (or more) and just breathe deeply, go for a walk, sit in the sun, read, exercise or close your eyes.  Focus on setting boundaries and saying “no” to things that create more stress and chaos in your life and remember that it is okay to do so.  Lastly, hope that your menopause is short and sweet!

 

References:

1.       Bromberger, J., Kravitz, H., Chang, Y., Randolph, J., Avis, N., Gold, E., and Matthews, K.  Does Risk for Anxiety Increase During the Menopausal Transition?  Study of Women’s Health Across the Nation.  Web.  2 June, 2013.

http://www.medscape.com/viewarticle/803506

2.       The Merck Manual.  Menopause.  Web.  2 June, 2013.

http://www.merckmanuals.com/home/womens_health_issues/menopause/menopause.html?qt=progesterone&alt=sh

3.       Kumari, v., Konstantinou, J., Papadopolous, A., Aasen, I., Poon, L., Halari, R., and Cleare, A.  Evidence for a Role of Progesterone in Menstrual Cycle-Related Variability in Prepulse Inhibition in Healthy Young Women.  Web.  2 June, 2013.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3055354/

What Causes Osteoarthritis?

Many women experience joint pain whether it’s in their knees, hips, fingers or shoulders.  The pain might come and go, be worse in the morning, or feel aching and stiff most of the day.  The diagnosis is typically done with symptoms and possibly an x-ray that shows joint changes.  Arthritis can start as early as the late teenage years/early twenties however more than 50% of people over 65 years old exhibit symptoms of arthritis.  What causes the joints to begin to deteriorate and create arthritis?

1.       Joint injury – Research shows that those who sustained a joint early at a young age are more apt to develop arthritis in that joint at a later age.  As an example, 51% of women developed knee arthritis 12 years after tearing their anterior cruciate ligament (ACL) in soccer.  Many can point back to a car accident, sports injury, broken bone or other trauma when discussing their problem area(s). 

2.       Obesity – Extra weight on the body coupled with daily activities and gravity means more load on the hips, knees, ankles and feet causing those joints to become more strained and inflamed over time plus it increases the wear and tear on the cartilage that leads to osteoarthritis. 

3.       Age – Sorry ladies, aging does take its toll on the joints considering more than 50% of people over 65 have arthritis symptoms (as stated above).  Many women will say “I didn’t have these problems in my 20’s or 30’s!” but over time joint injuries happen, diet/lifestyle choices take effect, genetics kick in, hormones change, weight fluctuates…and suddenly one day women find themselves waking up more stiff and aching.  Those of you who can still go from sitting cross-legged on the floor to a standing position without (much) assistance count yourselves lucky. It will probably change.

4.       Congenital abnormalities – If someone were born with joint problems or cartilage issues, then over time the stress on the joints will cause arthritic changes.  For example, scoliosis in the spine, or one leg shorter than the other will shift the way the body carries itself causing joint problems. 

5.       Endocrine disorders – Diabetics and those with low thyroid hormone are at risk for more joint and cartilage problems that can lead to arthritis.  Women heading into menopause often complain of more joint pain because their estrogen levels are gradually (or suddenly) decreasing. 

What does all this mean?  It means, take good care of yourself!  This is your one body.  Eat healthy, stay hydrated, maintain a healthy body weight, limit sugars and processed foods, and stretch regularly.  Thankfully there are articles here for tips to reduce the symptoms of arthritis if your joints are causing you pain on a regular basis.  Lastly, talk with your health care provider about appropriate work-up and treatment suggestions. 

References:

1.       Sofat, N., Ejindu, V., Kiely, P.  What Makes Osteoarthritis Painful?  Rheumatology. 2011;50(12):2157-2165.

2.       Roos, E.  Joint Injury Causes Knee Osteoarthritis in Young Adults.  Curr Opin Rheumatol. 2005;17(2):195-200.

3.       Kramer, P.  Prevalence and Distribution of Spinal Osteoarthritis in Women.  Spine. 2006;31(24):2843-2848.

5 Health Questions To Ask Your Mom

Sunday was Mother’s Day and many were celebrating with cards, calls, flowers and brunch to honor the women in their lives.  Yet, how many know the full health history of their mom, grandmother and aunts?  This information could prove to be critical when it comes to your own health therefore these are 5 questions to ask the female family in your life.

1.       How was menopause?  This question is important as women tend to follow them other women in their family when it comes to peri-menopause and menopausal changes.  Do the hot flashes and night sweats start in the 40’s or 50’s?  How long did it take?  Was it rough?  Was it easy?  How did she treat it?  Any complications? 

2.       Who has had cancer in the family?  And at what age?  This applies to both the men and women however mom tends to know this information.  If grandma and the aunts had breast cancer at a younger age, this is more concerning than finding out grandma had it later in life.  Has anyone had thyroid cancer? Prostate cancer? Ovarian, cervical or uterine cancer? Skin cancer?  Know your family’s cancer history.

3.       What are the family trends?  If all the women eventually develop thyroid disease and go on thyroid medication, this helps both you and your health care provider to be extra diligent and pro-active.  Does heart disease run in the family?  What about obesity?  Fertility problems?  Endometriosis?  Osteoporosis?  Do the women tend to lose their hair as they age?  Everyone have their gallbladder?  What about digestive or food allergy problems?  All of this information is critical for future planning and may shed light into current symptoms.

4.       Any outliers in the family?  The 2^nd cousin with celiac’s disease may not strike you as important however as your gas and bloating worsens, it could be a direct link.  The weird uncle whose mood alternates from really happy and hyper to down and depressed may be suffering from undiagnosed bi-polar.  This can be genetically linked as can depression in the family.  If just grandma had aches and pains it could have been undiagnosed fibromyalgia or a certain type of arthritis – how is your pain?

5.       What about your siblings?  Not all brothers and sisters are close therefore they may not inform each other about different health issues, concerns, scares and symptoms but mom usually knows.  Ask her if your symptoms sound like anyone in the family or periodically check in on the health of the rest of the family.  You may find out that your older sister has been having problems getting pregnant too or that your brother experiences the same types of migraines that you do and the same medications are not working.

While some people may prefer to keep some of their health history private, the more you know the more you (and your family) can be pro-active and prevent when possible.  Let your health care provider know of any changes as well to routinely keep your chart up-to-date and help them provide the best care possible for you.

 

Learn more on the women's health website, Emowher!

References:

1.       Segurado, R., Deterawadleigh, S., Levinson, D., Lewis, C., Gill, M., Nurnbergerjr, J., Craddock, N. Depaulo, J.  (2003). "Genome Scan Meta-Analysis of Schizophrenia and Bipolar Disorder, Part III: Bipolar Disorder". Am J Human Genetics 73 (1): 49–62.

2.       Steiner, A., Baird, D., Kesner, J.  (2008). Mother’s Menopausal Age is Associated with her Daughter’s Early Follicular Phase Urinary, Follicle Stimulating Hormone Level.  Menopause. 15(5): 940–944.

How Much Alcohol do you Drink?

Alcohol consumption is a large part of the American culture in that it is used in celebration, toasts, as a form of bonding, at sporting events, after bad days and during the holidays.  It is advised that men not drink more than 2 drinks per day, and women keep it to 1 drink per day however recent research in the February 2013 Journal of the Academy of Nutrition and Dietetics found that 18 percent of men and 11 percent of women are drinking above and beyond this recommendation. 

In a given week, how many alcoholic beverages do you drink?  Wine with dinner? Cocktails with the girls? A beer to relax?  While moderation is important and the occasional drink may be okay, remember that alcohol has other implications that may get in the way of your health.  First, alcohol increases the risk of certain cancers, particularly breast, liver, mouth, colorectal, and throat.   Second, alcohol requires a lot of processing by the liver which can interfere with the processing of other important substances such as medications, chemicals, and hormones.  Third, liver processing, especially at night, can lead to insomnia or 3am wake-ups.  Fourth, alcohol is not calorie free therefore it can cause weight gain and (depending what your drink of choice is) increases in blood sugar levels.  Fifth, ongoing alcohol consumption can further depress mood disorders, lead to a decreased memory and worsen psoriasis and other skin disorders.

Alcohol addiction is an important health concern to recognize in both yourself and the people you love.  Many choose alcohol as their coping mechanism when times are stressful or things are tough however other healthier options are available.  Even though the current recommendation for women is 7 drinks per week, remember that a drink is typically considered 5 ounces of wine, 1.5 ounces of hard liquor or 12 ounces of beer and 7 drinks may be too many for you and your health goals.  With that said, how many drinks do you really have? 

References:

1.       Grens, K.  Too Many Americans still Drink too Much: Study. Web.  25 February, 2013

http://www.nlm.nih.gov/medlineplus/news/fullstory_134308.html

2.       Bagnardi, V., Rota, M., Botteri, E., Tramacere, I., Islami, F., Fedirko, V.,   Scotti, L., M., Jenab, Turati, F., Pasquali, E.,  Pelucchi, C., Bellocco, R.,  Negri, E., Corrao, G., Rehm, J., Boffetta, P., and  La Vecchia, C. Light Alcohol Drinking and Cancer.  Web. 25 February, 2013.         http://www.medscape.com/viewarticle/778949

3.       Kazakevich, N., Moody, M., Landau, J., and Goldberg, L.  Alcohol and Skin Disorders.  Web.  25 February, 2013.

http://www.medscape.com/viewarticle/742538

5 Facts About the Hormone Testosterone for Women

When women think of the word testosterone they often think of MEN.  To sum it up, testosterone is what makes a man a man (so-to-speak) while estrogen and progesterone are often more associated with women.  However, testosterone is just as important to women but not in the same high level amounts.  These are five things about testosterone that may have you asking your health care provider for a test.

1)      Testosterone is made from cholesterol (its backbone) and another hormone known as DHEA.  DHEA is made in the adrenal glands and can help with stress, increased energy and low mood.  The more well known DHEA is DHEA-S, which is the one to test for.  Supplementing with DHEA should be done in the morning however; women should use lower doses than men.  The side effects can include increased anger, irritation, acne and inappropriate hair growth often on the face, nipples and chest.

2)      Testosterone helps significantly with energy, motivation, sense of well-being and sex drive in women.  When testing for this hormone, the total and free levels should be evaluated as the ‘free’ is active.  Testosterone has similar side effects to elevated DHEA and should be used with caution only under your health care provider’s direction.

3)      Keep in mind, testosterone is not a ‘magic pill’ for sex drive.  Many women have normal levels of testosterone and still find themselves lacking in desire.  A lot more goes into the libido for women than it does in men.  As women get older, their hormone levels overall change but so do their energy levels, sleep habits and stress which all interfere with their sex drive.

4)      Testosterone is made in both the ovaries and adrenal glands. Women who had their ovaries surgically removed may notice a significant decline in testosterone in the body.

5)      The birth control pill, if used correctly, protects against unwanted pregnancy but can also lower sex drive by lowering testosterone.  The pill increases a hormone known as sex hormone binding globulin that binds up excess free testosterone and gets rid of it from your body.  With less testosterone floating around, the desire for sex is less.

 

Just as a man might need testosterone replacement, so might a women but with significantly lower doses.  Consider asking your health care provider about testosterone and DHEA-S testing if hormone changes, fatigue, mood issues, and lower sex drive are occurring on a regular basis.  Your hormones may truly be out of balance.

References:

1.       Androgen Replacement Therapy in Women.  Web.  2 December, 2012.

http://www.medscape.com/viewarticle/773774_1

2.       Birth Control Pill Could Cause Long-Term Problems With Testosterone, New Research Indicates.  Web.  2 December, 2012.

http://www.medicalnewstoday.com/releases/35663.php

The Happy Healthy Vagina on Blogtalk Radio!

Check out this interview with Dr. Jones on Dr. Lauren Noel's blogtalkradio about maintaining vaginal health - from probiotics to infections, lubrication, menopause and kegel exercises!
Check it out here.