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letters from AFI readers

Send us your letters: A FRIEND INDEED, Main Floor - 419 Graham Ave, Winnipeg, MB R3C 0M3 Or A FRIEND INDEED, P.O. Box 260, Pembina, ND, 58271-0260 - Or e-mail us at: afi@afriendindeed.ca

TIPS FROM AFI READERS

Vaginal Dryness

Dear AFI: In the November-December 2002 issue of AFI, my letter on vaginal dryness and flax oil was published. I have since come across another reference which would be good to let other AFI readers know about: Flax Oil as a True Aid by Dr. Johanna Budwig, PhD, Biochemistry (Apple Publishing, BC, 1994).

-Sincerely, SR

A Smooth Change

Dear AFI: I was fortunate not to have suffered any problems during the change. When the odd hot flash occurred, I felt normal, as I am usually quite cold. I'm fortunate to have inherited healthy genes. Exercise, a good diet, and a little meditation helped me as well. I'm also lucky to have a balanced (happy) disposition and good friends for support.

-Good luck to others through the change!

-GJ

Knee Aches and Menopause

Dear AFI: Is there any correlation between menopause and knee/leg aches and pains? I'm 52 and this past January went off of birth control pills for the first time in 30 years. I had no problems other than warm flashes occasionally, until February, when I began experiencing pain in the knees and aching and tightness in my calves and thighs. Before I went off the pill, I would get occasional feelings of pain in my knees and occasional aching after a day's work (where I do a lot of standing).

Is my pain linked to peri- or full-blown menopause? To age? To stopping the pill? When I was on the pill, I had very light periods. Since I've been off the pill, I've had no periods.

-AK

AFI: 30 years is a long time to be on birth control pills. When you are on the pill there is no way for a health practitioner to know if you are near, or even through, your menopause, since you will continue to have regular periods as the birth control pill dictates. But now that you are off of the pill, you should know over the next few months where you are at as far as menopause goes. If you do not have a period for one year after stopping the birth control pill, you can say that you have officially passed through your menopause.

As to what is causing your knee and leg pains, it is difficult to say whether this has anything at all to do with menopause or to stopping your birth control pills. There is clear evidence of a link between chronic pain and hormone levels (see AFI, March-April 2003). And many women have reported aching joints around the time of their menopause. Fortunately, they also report that this symptom improves over time.

At the 10th World Congress on Menopause in 2002, there was a special section dedicated to joint aches and pains during menopause. Researchers from the Melbourne Women's Midlife Health Project reported that joint aches and pains are one of the most prevalent and bothersome symptoms of menopause, occurring more frequently than hot flashes. Further research is currently underway to examine if there is any link between osteoarthritis and the menopausal transition.

You also mention that you do a lot of standing at work; occupationally-related health conditions can be cumulative, so what you used to be able to do without problem in the past, may be more difficult as you age. Consult a physiotherapist to see about important stretches and exercises that may help alleviate joint pain associated with your working conditions. Also, consider consulting Canada's National Occupational Health and Safety website: www.ccohs.ca or call: 905-572-2981. In the US, visit the National Institute for Occupational Safety and Health: www.cdc.gov/niosh/homepage.html or call: 513-533-8328.

However, anyone with joint or leg pain should visit their primary health care provider to ensure that there is not some other medical problem that requires treatment. Aching joints that are merely bothersome will often pass in time, but more severe pain requires immediate treatment since it may be linked to arthritis, and may lead to joint deterioration.

HRT and Arthritis

Dear AFI: When I started menopause over 10 years ago, my daughter gave me a subscription to AFI. I took hormones for most of the last nine years, but finally gave them up because of ongoing side-effects. I still get mild hot flashes, but no more mood swings. My mother who is almost 83 years old still takes hormones. She suffers from extreme arthritis, both osteo- and rheumatoid. I often wonder whether the hormones have made the arthritis better or worse. She seems to feel that the hormones have made her look younger. I am rather skeptical about this premise. Your views on this subject would be appreciated.

-Yours sincerely, HM

AFI: Unfortunately, there is no solid research to suggest that hormone therapy will either help or hurt arthritis, but as we mention in the response to the previous letter, there is some current research underway to look at the relationship of menopause and osteoarthritis. We'll keep you posted on those results. Perhaps other AFI readers have experience with arthritis and hormone therapy?

Your mother may believe that hormones make her look younger but there is also no solid research to support the belief that hormones decrease or prevent wrinkles.

Leaky Gut Syndrome

Dear AFI: I have "Leaky Gut Syndrome," and would love to learn anything you have to say about it. It is not a diagnosis that general practitioners recognize.

-Sincerely, MC

AFI: Leaky Gut Syndrome is not a medical term. Some people refer to a condition called "Protein Losing Enteropathy" as having a "leaky" gut. The symptoms for this condition include abnormal swelling (which can occur throughout your body, in your legs, arms, ankles and elsewhere), sometimes diarrhea, and by low protein levels in the blood stream. These symptoms are a result of an abnormal loss of protein from the digestive tract. This condition is not known to be associated with menopause, and requires specific medical attention by a qualified health practitioner.

However, it is not clear from your letter if this is the condition you are referring to; feel free to write us again and provide more detailed information and we'd be happy to respond.

Reducing HRT Dosage

Dear AFI: I am 62 years "old" now and started menopause around the age of 49. My position in middle management became very stressful at that time and my previously dependable coping mechanisms failed me. My female physician urged me to start HRT. I resisted for one year, and then in desperation, relented to using the patch, which relieved some of my symptoms. In retrospect, I feel that I suffered more from a later diagnosed depression than menopause. I am on antidepressant medication now.

For the past few years, against my physician's advice, I have halved my estrogen absorption and reduced the intake of Provera accordingly. When Estrogel became available, I switched to it on the recommendation of my physician - again using only half the recommended dose.

Since the release of the findings of the HRT study (WHI study, July 2002), my doctor changed her recommendations; she now advises that I replace the Provera with a daily dose of 100 mg of Prometrium. Can you provide more information on Prometrium?

Since I am feeling fine on my halved HRT, I am undecided about its discontinuation. But the daily dosage of Prometrium and its propensity to cause drowsiness leaves me suspicious and uneasy.

When I reduced the amount of estrogen absorption, my doctor warned of ill-effects of low hormone levels and related stories of patients who had stopped HRT altogether and ended up with severe osteoporosis within a year.

-Thanks, SE

AFI: Prometrium is the brand name of the medication that contains the hormone progesterone. Prometrium is called a "bioidentical" hormone. This means that the chemical structure of this medication is identical to the structure of human progesterone. Some women find that they have less side effects from this medication - perhaps due to the fact that their body recognizes it as "familiar." Progesterone does make some women tired, so it is better to take it at bedtime to minimize feeling sleepy during the daytime. Prometrium contains peanut oil so anyone with a peanut allergy should not use this medication.

In the wake of the Women's Health Initiative study, which showed that overall, the risks of HRT use long-term outweigh health benefits, many women are struggling with whether or not to continue with or begin hormone therapy. For a balanced online source of information on "The Pros and Cons of Hormone Therapy," visit: www.cwhn.ca/resources/hrt/index.html

The current recommendations for hormone therapy - endorsed by a variety of medical organizations, and the FDA, is that hormone therapy should not be used for disease prevention in healthy women, but only for the relief of menopausal symptoms, and that the lowest possible dose should be used for the shortest possible duration. There are non-hormonal therapies for the prevention of osteoporosis, as well as lifestyle changes, such as changes in diet and exercise, which most health experts agree should be explored first before hormone therapy is considered an option.

Black Cohosh

Dear AFI: I am anxious for suggestions. I had a complete hysterectomy and both ovaries removed at the same time (August, 1998). I was 59 years of age at the time. They also removed a large fibroid tumor.

The doctor put me on estrogen (0.625 mg, 1 tablet daily). I stayed on that dosage until November 2002 when I decided I should come off estrogen. Since then, I've had frequent hot and cold spells - worse at night when I'm trying to sleep. I'm not able to sleep that well and my skin seems dryer than usual.

I started taking 20 mg of black cohosh in January 2003. I've had some relief - the hot flashes don't seem as frequent, but I would like to know what other options there are out there.

-Sincerely, RJ

AFI: Recent studies indicate that black cohosh appears to be safe, and many women find that it helps to alleviate menopausal symptoms, such as hot flashes, perspiration, headaches, depression, nervousness and concentration problems, among other things. However, like many herbal remedies, it may take four to eight weeks before a benefit is experienced. See our special AFI issue on naturopathic medicine for midlife women, with guest author Tori Hudson, which also features detailed information on black cohosh and other botanicals (AFI January-February 2002).

Some women also find that taking Vitamin E alleviates hot flashes. However, there are some safety concerns if you have high blood pressure or heart disease, so as with any medication or botanical supplement, you should check with your health practitioner to discuss if this solution is best for you, and to see what dosage is best suited for your needs. Your dosage of black cohosh also appears to be lower than what some naturopathic experts suggest for the successful treatment of menopausal symptoms, so consult your health practitioner to see if your dosage is appropriate.

Identifying and avoiding triggers for your hot flashes may also be useful. Spicy food, alcohol, and caffeine in both foods and drinks may trigger hot flashes. Avoiding hot rooms and hot tubs may reduce your hot flashes as well. Regular exercise and dressing in natural fibers are also useful in helping to cope with the symptoms of menopause. You may find that if you follow some of these suggestions, your hot flashes will improve, and then your sleep will improve as well.

Finally, while many women experience hot flashes into their 60s, you should find that these symptoms ease as you get older.

Responses to questions are intended to offer helpful information and do not replace the advice of your personal health practitioner.

Copyright Initiatives for Women's Health, Inc. May/Jun 2003
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