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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

Vulvovaginal Health

Dear AFI: I recently read a valuable book that I would like to recommend to other AFI readers: The V Book: A Doctor's Guide to Complete Vulvovaginal Health by Elizabeth Gunther Stewart, MD and Paula Spencer (Bantam Books, 2003). It is a super book - comprehensive, with a great attitude - incredibly informative and you just can't put it down!

-Thanks, WV

Hypothyroidism and Addison's Disease

Dear AFI: I have hypothyroidism and Addison's disease, which I've handled pretty well for about 10 years. But when I turned 37 (three years ago), everything I thought I had figured out fell apart. My GP has no idea what to do with me; similarly any endocrinologist I've ever seen seems to dismiss female issues as whining. My OBGYN is trying, but I know he is feeling inadequate too. Any suggestions?

-S

AFI: Your thyroid is a small butterfly shaped gland that sits in the front of your throat. Its job is to regulate how much energy your body uses. Hypothyroidism is a condition that results when the thyroid is not producing enough of the hormones, T3 and T4. Women with hypothyroidism find that they gain weight, feel cold often, are very tired and lose hair; they may experience constipation, changes in their periods, dry skin, and possibly swelling in their feet and hands. Usually this condition is easily controlled with medication. However, women on medication to regulate their thyroid should have their blood checked at regular intervals to ensure that they are on the right dosage.

The adrenal glands are two small glands that sit just above the kidneys. Their function is to produce several different chemicals that have important roles to play in the body. Simply put, these chemicals affect the blood pressure, electrolytes, how the body responds to stress, and also the level of testosterone (or male hormone) in the body.

Addison's disease is a condition that results when the adrenal glands do not produce enough of these chemicals. When this happens, a person feels weak, loses weight, craves salt, experiences nausea and vomiting, abdominal pains, low blood pressure, and bowel upset; their skin may also turn brown. Those with Addison's disease are treated with steroid hormones, and as necessary, a hormone to supplement the low testosterone levels.

Women with Addison's disease may also have thyroid problems, and experience an early menopause as a result. Some people with Addison's and hypothyroidism may also go on to develop other conditions, such as diabetes, a specific type of severe anemia called pernicious anemia, and a rare disorder called myasthenis gravis.

From your letter, it is difficult to say what exactly is happening to you. It may be that you are experiencing an early menopause since your condition may affect many of the glands in your body, including your ovaries. Make sure that your doctors have explored other conditions associated with Addison's and hypothyroidism, by checking your blood sugar for diabetes, for instance.

It must be challenging to deal with several problems at once, but don't give up! If you feel your issues are not being dealt with adequately by your doctor(s), then maybe it is time to try a new doctor.

Estrogen and Breast Cancer

Dear AFI: Are there alternatives to estrogen for those people who have had breast cancer (estrogen receptive) and cannot take any kind of estrogen into their bodies, even phytoestrogens?

-Sincerely, OV

AFI: There is a lot of controversy over whether women with breast cancer or women with a high risk for breast cancer should use phytoestrogens. While there are various opinions on the subject at the moment, many health educators believe that phytoestrogens are fine if you consume them in moderation, and in a natural form - as it is found in foods, for instance, such as tofu. However, many caution against taking phytoestrogens in a concentrated form, such as a supplement or capsule.

My question back to you is: why do you think you need to use estrogens in the first place? If you are not experiencing any symptoms of menopause, then there is no need for you to use hormones. We now know that the risks of long-term hormone therapy use outweigh any possible benefits. If you feel you need estrogens because of problematic menopausal symptoms, there are many other possible ways to deal with these symptoms - depending on what they are.

For an excellent overview of your options, try Janine O'Leary Cobb's, Understanding Menopause (Key Porter, 2001); or visit www.womenshealthmatters.ca for several helpful FAQs (answers to Frequently Asked Questions) on menopause, hormone therapy, alternative therapies and healthy aging. Or feel free to write us again with your detailed symptoms, if you have them and they are causing you problems, and we'll do what we can to help!

Confused About Estrogen

Dear AFI: My situation is a little different than most, I think. I was 33 years old when my perimenopause started. I began getting hot flashes and night sweats and missed periods. Since then I've been debating over whether I should start HRT. I have been weight-lifting for 15 years, walking, biking, running most of my life, and I try to eat properly - a low fat, high fiber diet, etc. I stopped smoking two years ago.

I am now experiencing very dry cracked hands that never heal, and I have tried everything and nothing helps. Also, hair follicles on my hands become infected, I have decreased bladder control and some vaginal dryness. I have just received information on how to deal with these symptoms, and now am still wondering if I should be or even need to be on estrogen. It is so hard to decide.

I just recently had a mammogram and bone density test. The mammogram came back negative, but I am still waiting for the bone density. Also my cholesterol is going up, and I am very careful of what I eat and how I cook.

-Confused and wondering about estrogen, SP

AFI: Hormone therapy has not been shown to help with skin healing, dryness or recurrent infection of hair follicles. A trip to a dermatologist would be helpful for looking into those symptoms.

Recent studies have shown that women on hormone therapy actually have more problems with bladder control than women who have not taken hormone supplementation. This is new information and contradicts previous medical beliefs that hormones were good for the bladder. Women with bladder control problems have several options to improve control. For example, Kegel exercises (if done properly) can be very helpful in improving bladder symptoms. For more information about how to perform Kegel exercises, consult Our Bodies, Ourselves for the New Century (Simon & Schuster, 1998).

Vaginal dryness can usually be managed with vaginal moisturizers. Vaginal moisturizers are different than vaginal lubricants in that they are used on a regular basis and are longer acting than a lubricant which usually lasts only a few hours. Some women have found that Vitamin E oil is also helpful for vaginal dryness. Regular sexual activity (by yourself or with a partner) is also helpful for maintaining vaginal moisture.

Hormone therapy is not going to solve any problems that you are having with your cholesterol. While hormones may reduce cholesterol levels very slightly, they may also raise your triglyceride levels, which may have a negative impact on your heart.

Unfortunately based on your list of concerns, it is unlikely that hormones would be the answer to your problems. Nevertheless it is good that you are questioning what is best for you. It might be useful to discuss these issues with your health practitioner in-depth to hear all of your options in each case.

Actonel and Osteoporosis

Dear AFI: I enjoy your magazine and appreciate the information on women's health. I would like to enquire if you have any information about the drug Actonel. My doctor has prescribed it to me for osteoporosis. Thanks for any information you can send me.

-FM

AFI: Actonel is also known as risedronate sodium. It is a member of the class of drugs called biphosphonates. It is used to treat osteoporosis, and to reduce the risk of osteoporosis for those who are believed to be at high risk for this condition. It works by halting the breakdown of bone. It does not build bone, but slows the thinning of the bones.

Actonel is given as a once-a-day dose, or more recently, as a once-a-week dose. Both seem to work equally well. The biggest concern at this point with Actonel is how you take the medication; it is important that you stay upright (either sitting up or standing) for 30 minutes after you ingest it because the medication is irritating to the skin of the esophagus (swallowing tube), and has been reported to cause serious trouble if it does not go immediately down into the stomach.

Actonel appears to be a fairly safe medication, but as with all biphosphonates, there are questions concerning its long term use - particularly the long-term effects it may have on the bone. We will keep AFI readers posted of new studies as they come to light.

SSRIs and Depression

Dear AFI: I read in one of the articles on your website that SSRIs should be used for depression rather than HRT. However, it should be noted that SSRIs are well-documented to reduce libido and cause sexual problems. I experienced this myself for two years, during which time my GP insisted that my libido problem was NOT caused by the SSRIs. After visiting a gynecologist, she told me that the problem is well documented. I went off the SSRIs and the problem cleared up after about six weeks.

-DC

AFI: SSRI stands for selective serotonin reuptake inhibitors. These chemicals enable an improvement in the amount of serotonin available to the brain. This change in serotonin levels improves a person's moods.

You are absolutely correct; a loss of libido or an inability to achieve orgasm are well described side-effects of SSRIs. However, this does not happen to all people who take these medications, and some SSRIs seem to cause this problem less often than others.

It is really important that if you are experiencing a change in your sexual function when you are on any medication that you bring this to the attention of your physician. Many medications, including the very commonly used blood pressure medications, can have a disastrous impact on your sex life! Unfortunately people all too often do not make the connection and therefore do not mention it to their physicians. More unfortunate, not all physicians are aware of the connection themselves.

Menopause and Mental Illness

Dear AFI: Any information on menopause and mental illness (mood disorders or thought disorders worsening during this time) would be very appreciated.

-CD

AFI: There are conflicting beliefs about whether women experience more mood problems at menopause. The current state of research implies that there is no increased risk for developing mood disorders at menopause. As well, there is no good evidence to suggest that hormone therapy will improve or affect a woman's moods. (That said, as we all know, if we are not sleeping well then we are not very happy. If treatment such as hormone therapy takes care of a woman's hot flashes and she is able to sleep better as a result, then her mood may improve.)

More serious thought disorders such as schizophrenia seem to generally run a less severe course in women than they do in men. There is very little research on the effects of the menopausal transition on women with schizophrenia. Anecdotally some women report that their medication needs may change during this time.

AFI readers - have you any thoughts on this important subject?

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. Jul/Aug 2003
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