Issue Date: September 22, 2002
Ever-changing hormones and you
They steer our bodies, telling us when to grow, when to slow and every step to take in between. Hormone levels change over a lifetime, presenting special challenges at transitional periods. Here's a look at three situations many families face.
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Menopause
Nancy Pettit, like 35% to 40% of menopausal women, was on hormone replacement therapy (HRT) when that hot topic grabbed national attention this summer. A National Institutes of Health study was halted for safety, and just about every media outlet quickly began discussing the potential problems. Patients became alarmed, doctors sifted through the details, drug companies dropped information in the mail, and plaintiff's attorneys smelled blood in the water.
I think we all need to take a deep breath, relax and review a few things. First, the study showed that menopausal women who took 0.625 milligrams of estrogen plus 2.5mg of progestin in the drug Prempro daily for five years had slightly higher rates of breast cancer, heart attacks and strokes. The researchers didn't address the effect of estrogen alone, varying doses or other preparations (such as the patch). Also, it did not address symptomatic menopause, which is, I think, the most important reason to use HRT.
Let's talk about menopause. In midlife, a women's ovaries (the glands that produce the female hormones estrogen and progesterone) decline in function. As hormone production "sputters," women commonly develop symptoms including hot flashes, night sweats, weight gain, mood swings, and changes in skin texture and breast tissue. The worst of these symptoms tend to last three to four years.
Decades ago, the Food and Drug Administration approved using female hormones to combat these symptoms by helping women feel better. More recently, the FDA also approved HRT to prevent osteoporosis. But many patients and physicians have used HRT in the hope of reducing chronic illnesses, such as heart disease.
So, what should menopausal women do?
1. If I am not on HRT, should I start it? The recent study indicates that women who are contemplating Prempro for long-term cardiovascular risk reduction probably are doing so erroneously. But think about your particular situation. If you are like Nancy, the reason you're on HRT is to relieve symptoms of menopause. Quality of life for many women is vastly improved by HRT. It is extremely important that you have a detailed discussion with your physician regarding your symptoms, long-term goals, personal history and family history.
2. If I am on HRT, should I stop taking it? It depends. The study showed long-term use (more than five years) increased the risk of breast cancer, heart attacks, strokes and clots, but it lowered the risk of bone fractures and colon cancer. Depending on your personal situation, you may want to continue your HRT, change the preparation or gradually stop using it. The study's most important lessons are that HRT is not "one size fits all" and that an individual's profile is key.
3. Are there any alternatives to HRT? Some non-prescription remedies may reduce symptoms like hot flashes and night sweats. Soy protein in great amounts probably has a role, but it may harm women with a history of "estrogen-dependent" cancers. The herb black cohosh contains plant estrogens and is an old remedy. Prescription antidepressants can help mood swings; so can regular exercise and stress management (including things like tai chi and yoga). For night sweats and flushing, keep your environment cool, and limit caffeine and alcohol. To prevent osteoporosis, keep your bones strong with weight-bearing exercise, and try taking calcium supplements or prescription drugs, including newer "designer estrogens" not associated with increased cancer risks. For cardiovascular risk, get back to basics. The word "WATCHeS" (weight, activity, tobacco, cholesterol, high blood pressure and sugar) represents major modifiable risks for all of us.
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"Male menopause"
Menopause means very specific changes in how a woman feels and functions, but for men, midlife hormonal changes can be much more subtle. The dominant male hormone
is testosterone, and in some men the production drifts down past age 35. Symptoms include decreased energy, sex drive, muscle mass and muscle tone -- and even emotional changes such as depression or mood swings. This is called "male menopause," also known as viropause and andropause.
Of course, if you're not exercising, on a lousy diet, smoking or drinking too much, don't bet the farm that your decreased energy is due to low testosterone. Get your own habits in order first.
If you do go for treatment, beware: The medical community is not in agreement over the diagnosis of male menopause or its treatment. First, the tests are flawed. Only some men diagnosed with "male menopause" are found to have a low serum testosterone level. Newer tests are being developed, such as the "free" testosterone test. Also, the treatment itself is unrefined. The most effective delivery for testosterone still seems to be injection, which often is inconvenient and undesirable. Patches and other forms of therapy are available, but their utility seems more limited. Finally, some physicians don't buy the argument that reduced testosterone is a major player.
As in most challenges, there is no easy fix. Once again, my advice is to exercise good habits. As the old Texas saying goes: "If you could kick in the seat of his pants the man responsible for most of your troubles, chances are you wouldn't be able to sit down for six weeks!"
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Adolescent skin
Most kids have problems with acne as their hormones shift in a natural part of aging. The major goal in controlling acne is to minimize scarring. The earlier a kid starts, the better. So, what helps and what hurts?
Soap and water. A daily routine for anyone with blemishes; it remove oils and dirt and leads to improvement.
Coverups. Small amounts of over-the-counter acne cosmetics help kids socially. But heavy makeup and certain cosmetics aggravate the issue by making skin more oily. Girls should get advice on types of makeup and how to remove it.
Diet. There's no evidence that specific foods exacerbate acne, but if you find certain foods are associated with flare-ups, avoid those foods temporarily.
Drugs. Over-the-counter benzoyl peroxide products have antibacterial agents and can help strip excess oil from the face. Prescriptions, including topical antibiotics, are available from dermatologists.
And here's a word for all ages: Don't damage your skin by overexposing yourself to the sun.
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