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Blog: MenoPause ~ take time to think about it

  • Compounding pharmacies come under scrutiny

    by Margery Gass | Oct 02, 2013

    An investigative reporter published disturbing findings about compounded hormones in the October issue of More Magazine. Cathryn Jakobson Ramin found that the pills in 12 prescriptions filled at different compounding pharmacies and tested by Flora Research Laboratories in Grants Pass, Oregon, did not contain what they were supposed to: all had less estriol than was prescribed, most had more estrone and estradiol than was prescribed, and nine out of twelve did not contain enough progesterone.

    “Had the compounded products we tested been commercially manufactured pharmaceuticals, none would have passed the FDA’s requirements for finished drugs, which mandate that the contents be no less than 90 percent or more than 110 percent of the prescription as the physician has written it,” writes Ramin.

    Compounding pharmacies made news after last fall’s tragic meningitis outbreak caused by contamination in a Massachusetts pharmacy. It spurred the US government to draft new legislation that begins to require greater regulation of pharmacy compounding.

    That said, compounding pharmacies do provide valuable services in select circumstances. For example, if you are allergic to an ingredient in your medication, a compounding pharmacist can mix a special batch for you that does not contain that ingredient. If you buy medications from a compounding pharmacy, you can check whether your compounder is accredited by the Pharmacy Compounding Accreditation Board at www.pcab.org. Or you can ask your compounder if they do skip lot testing, meaning that they select random products monthly to test for purity and safety. Also be aware that all hormones carry risks and none is approved for anti-aging purposes because there is no adequate evidence to support the claim.

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  • Health of vagina influenced by microbiome

    by Margery Gass | Sep 16, 2013
    The vagina is one of the body sites under study in the Human Microbiome Project examining the 100 trillion good bacteria that live in and on the human body—our inner ecosystem. These helpful bacteria are essential for digesting food, synthesizing vitamins, and protecting us from disease-causing bacteria.

    In a healthy woman, bacteria called Lactobacilli produce the lactic acid that makes the vagina acidic and relatively unfriendly to harmful microbes. But when vaginal bacteria are out of balance, harmful bacteria may invade. Research shows that this is associated with health problems, including vaginal dryness and bacterial vaginosis, an unpleasant condition that increases the risk of other infections. Nearly 30% of American women suffer from bacterial vaginosis.

    Douching can cause the microbial imbalance that leads to bacterial vaginosis, and one in three American women douche. Don’t do it. Women may believe that they are practicing good hygiene, but they are actually increasing their risk of infection.

    Much more microbiome research is on the horizon. We hope to know more soon about the microbial changes that occur with menopause and aging, as well as how women can maintain the best balance of good microorganisms in their bodies. Stay tuned!

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  • Just 21 minutes for better relationships

    by Margery Gass | Aug 20, 2013
    Is it inevitable that your marriage will take a downhill slide? What sociologists call “marital quality” often declines over time, but researchers found a way to stop the slipping and it takes only 21 minutes. The heterosexual couples in this study had been married for an average of 11 years. Each wife and husband was asked to write for 7 minutes about a recent conflict in the relationship, but they had to write about it from the perspective of a neutral observer. Then, the researchers used email reminders to have the couple do this two more times for other disagreements. That’s all it took to eliminate the decline in the quality of the couple’s relationship. A very handy, inexpensive technique.

    The takeaway? To best handle conflict, step outside yourself and look at your disagreement with another person as if you were an observer with no vested interest. This advice will likely improve any type of relationship, not just marriage. Here’s to happy relationships!
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  • You got your wish! Nonhormonal alternatives have arrived

    by Margery Gass | Aug 12, 2013
    Earlier this year, we asked women whether they thought there was a need for prescription nonhormonal treatments for menopausal symptoms. Overwhelmingly (89%), women said “yes!” We took that message to the FDA. The good news is that now there are two new approved treatment options for menopausal symptoms. Ospemiphene (Osphena) received FDA approval in February for painful sex that can be a consequence of the changes in and around the vagina that can come with low estrogen levels. Then in June, the FDA approved low-dose paroxetine (Brisdelle) for moderate to severe hot flashes. Ospemiphene acts like an estrogen in some tissues, but not others. The major advantage is its estrogen-like activity in the vagina and surrounding tissues, which keeps them supple and moist. It acts on the uterus as well, so you and your healthcare provider need to be alert to any unusual vaginal bleeding. Paroxetine is a name you might have heard before because in higher doses, it’s sold as the antidepressant Paxil. It doesn’t take much to reduce hot flashes, so the dose is lower than that used for antidepressant activity. It carries the same warnings as the antidepressant formula, so be sure to discuss all treatment options with your healthcare provider to determine if it is right for you.

    This is a milestone year. For decades, hormone therapy has been the only medication approved for menopausal symptoms. Now there are choices. We hope this encourages others to conduct research in the field of menopause.
    4 Comments
  • 7 tips for better sex after 50

    by Margery Gass | Aug 01, 2013
    I recently compiled some tips for better sex after age 50 for the Cleveland Clinic—here’s the quickie version of the list:

    1. Practice, practice, practice. Remaining sexually active preserves the physical functioning of your vagina.
    2. Lubricate and moisturize if you’re experiencing dryness.
    3. Don’t be shy—talk to your healthcare provider about any sexual problems you are experiencing.
    4. No libido? Therapy may help. Relationship issues may be related to a lack of desire.
    5. Think your sex life could be better? Talk it through and share your feelings with your partner.
    6. Talk a walk—and do it regularly. Exercise will make you feel and look better.
    7. Try something different. Different sexual positions can make intercourse more comfortable and more interesting.
                    
    For more detailed sexual problems and solutions, read the full article and visit our Sexual Health & Menopause module.

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  • Calcium and vitamin D help hormones help bones

    by Margery Gass | Jul 15, 2013
    Really? The answer keeps changing, but a new analysis from the major Women’s Health Initiative (WHI) trial supports the use of supplements—at least for women taking hormones after menopause.

    The supplements and hormones in the WHI study had a synergistic effect. Women using both therapies had much greater protection against hip fractures than with either therapy alone. These results suggest that women taking postmenopausal hormone therapy should also take supplemental calcium and vitamin D. Although they couldn’t specify how much, authors noted that the benefits seem to increase with increasing total intake of calcium and vitamin D. The dose will depend on keeping side effects, such as constipation from too much calcium, to a minimum.

    That differs from the recommendation of the US Preventive Services Task Force (USPSTF), made earlier this year. USPSTF stated there was no basis for recommending calcium and vitamin D supplements to prevent fractures. But now, with a study this large, there may well be.

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  • FDA approves first nonhormonal hot flash treatment

    by Margery Gass | Jul 03, 2013
    Good news for women who have been waiting for an effective nonhormonal treatment for hot flashes: the FDA has just approved the very first nonhormonal therapy in the history of menopause. We have known for awhile that some antidepressants provide relief from hot flashes, but not one was officially approved for that purpose. The newly approved product will be a lower dose of an antidepressant first approved 20 years ago (paroxetine, brand name Paxil). The lower dose approved for hot flashes is called Brisdelle and will probably be available in November. Women who have not found sufficient relief for their moderate or severe hot flashes from lifestyle measures will now have one more option to discuss with their healthcare provider.

    Until now, hormone therapy was the only FDA-approved treatment for moderate to severe hot flashes. Some women cannot use hormone therapy for medical reasons or simply prefer not to use it. Brisdelle provides another choice. Although it may not reduce hot flashes as effectively as hormone therapy, it will decrease flashes for most women. Like other drugs, it will not meet the needs of every woman.

    Every drug comes with risks and side effects: In clinical trials studying how the drug affected menopausal women, side effects included headache, fatigue, and nausea/vomiting, most commonly occurring in the first week. The label also carries the warning of all antidepressants in this class, that of potentially increasing suicidal thoughts or behavior in the first few months. There is also a possible reduction in the effectiveness of the breast cancer drug tamoxifen if the drugs are used together.

    3 Comments
  • In younger women, HT does not harm cognitive function

    by Margery Gass | Jul 03, 2013
    The WHIMSY trial released somewhat reassuring data last week:  for women ages 50 to 55, using hormone therapy (HT) will neither harm nor benefit their cognitive function.  WHIMSY examined 1,272 Women’s Health Initiative (WHI) participants who were ages 50 to 55 when they began taking HT or placebo and reported on their cognitive health about 7.2 years after they stopped the medication.

    In some ways, this data was disappointing, as it did not support the “window of opportunity” theory that taking HT close to menopause maintains and benefits health. However, this theory does have evidence of benefit regarding women’s risk of cardiovascular disease, coronary heart disease, heart attack, and atherosclerosis.

    Here at NAMS, we counsel that the decision of whether to take HT must be individualized for each woman, considering her overall health, severity of symptoms, quality-of-life priorities, and personal risk factors. We know that the risks of HT use in healthy women ages 50 to 59 are low. In older women, however, HT is associated with greater risks: A related WHI trial (WHIMS) found that HT use in women ages 65 to 79 caused a near doubling of rates of dementia, higher rates of cognitive decline over time, and decreased brain volume.

    The bottom line of the new WHIMSY results is that younger women can be reassured that, if they choose to take HT for their symptoms, it will not harm their cognitive function or cause dementia.

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MenoPause: the blog!

Posts to our Blog are written by NAMS staff members and Dr. Margery Gass. All posts are reviewed and edited by Dr. Gass. We strive to bring you the most recent and interesting information about various aspect of menopause and midlife health. We accept no advertising for our website. We want you to have accurate, unbiased, evidence-based information. 

Margery L.S. Gass, MD, NCMP
NAMS Executive Director

An internationally recognized leader in the field of menopause, Dr. Gass became Executive Director of The North American Menopause Society in 2010. Dr. Gass has been an investigator on numerous research projects, including serving as a principal investigator for the Women’s Health Initiative, and has published and presented on a wide range of topics related to menopause, including osteoporosis, sexual dysfunction, and hormone therapy.

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