Broccoli and Hormone Balance

Broccoli and Hormone Balance: The Connection to Estrogen

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

Did you wonder why, as menopause looms, health and wellness literature implores you to eat more broccoli? What does broccoli do? How much broccoli are we talking about? Do we have to eat it every day?

Broccoli seems to be the poster child for the entire brassica family, a type of plant in the mustard family. Brassica plants are also known as cruciferous vegetables because of their cross-shaped flowers. There are more than 375 types of these flowering plants, including many important food plants such as brown mustard, Brussels sprouts, cabbage, cauliflower, kale, kohlrabi, rape, rutabaga, and turnips.

Broccoli and Estrogen

Broccoli is connected to hormonal balance by its effect on how the body breaks down estrogen. Often we read that the body produces three estrogens: estrone, estradiol and estriol. While this is true, the dozens of estrogen metabolites the body creates as it breaks down these estrogens are often ignored. Let’s focus in on two of these: the metabolites of estrone called 2 hydroxyestrone (2-OHE1) and 16 alpha hydroxyestrone (16-αOHE1). The balance between these two metabolites is known as the 2:16 estrogen ratio.

The idea that adjusting estrogen metabolism to favor 2-OHE1 over 16-αOHE1 is beneficial has become popular, and many labs are able to test for these two hormones to compare them. While 2-OHE1 is thought to calm estradiol’s stimulatory effect on cells, 16-αOHE1 may provide the opposite effect, possibly stimulating estrogen-related cell growth. 16-αOHE1 also may be associated with genetic damage in cells, and some studies identified higher levels of 16-αOHE1 in breast cancer tissue and women with breast cancer when compared to healthy individuals. As part of his dissertation, “A Dietary Strategy to Reduce Breast Cancer Risk,” Dr. Jay Fowke was able to demonstrate that eating broccoli created a positive shift to 2-OHE1in healthy post-menopausal women. The daily intake was 500 grams or just over one pound of broccoli per day, with broccoli being eaten at two meals per day.

Broccoli Alternatives

You are not alone if you think a pound of broccoli per day is daunting, but there are a few possible alternatives:

  • Two important compounds are abundant in broccoli: diindolylmethane (DIM) and its precursor, indole-3-carbinol (I3C), both of which can have an impact on the metabolism of estrogens. These two compounds have been associated with a reduction in cancer and tumor cell growth. I3C and DIM appear to shift estrogen metabolism away from 16-αOHE1 and toward the more desirable 2-OHE1. Supplements containing these compounds may be an alternative to relying solely on broccoli to shift metabolism.
  • Another alternative to eating heaps of broccoli is supplementing with broccoli sprout extract. These supplements are readily available to purchase, or you can sprout your own seeds and eat them like alfalfa sprouts.

More about Broccoli

Another important component of broccoli is sulforaphane. Sulforaphane is being widely studied for its effectiveness in cancer, autism, schizophrenia, and more. An important detoxification molecule, sulforaphane may help with fatty liver disease and may enhance liver detoxification pathways, which are critical to metabolizing estrogens. Sulforaphane may also help with tissue damage known as oxidative stress, which is associated with aging and diabetes.

One caution about the use of broccoli comes from its effect on the thyroid. A steady diet of broccoli–or other members of the brassica vegetable group– eaten raw and in large amounts can have negative effects on thyroid function. Broccoli contains molecules called glucosinolates which may inhibit iodine uptake and thyroid hormone formation, particularly in the event of an existing iodine deficiency. Eating brassica vegetables in moderation, cooking them, and adequate iodine intake can reduce these effects.

Conclusion

Humans have evolved with our food sources for eons. Who first dared to eat broccoli? Who recognized that broccoli and the other brassica vegetables seemed to help with menopausal hormone changes? Who started recommending broccoli to family and friends? Thanks in part to these early innovators, today we have an abundance of studies relating to the specific molecules found in the brassica family of vegetables. We are starting to see the vast number of functions these foods have in the body. Food, it seems, really is our natural pharmacy. So eat up, and, as your mother always said, “Moderation in all things.”

Broccoli and Hormone Balance 2018-04-07T10:59:15+00:00

Hot Flashes and Heart Disease

Hot Flashes and Heart Disease

Written by Kathy Lynch, PharmD – Women’s International Pharmacy

Two recent studies have focused attention on cardiovascular disease (CVD) in menopausal women. The first study is a systematic review of 11 studies with a total of 
19,667 subjects. The researchers assessed the relationship between vasomotor symptoms (VMS), which included hot flashes and night sweats, and CVD risk factors, i.e., blood pressure, cholesterol, body mass index (BMI), and carotid artery measurements. They found that women with VMS had significantly higher blood pressure, BMI, and total cholesterol than women without VMS. The authors concluded that women with hot flashes and night sweats, as compared to women without these symptoms, may have unfavorable risks for heart and blood vessel disease.

The second study evaluated the likelihood of cardiac or stroke death among 332,202 Finnish women who stopped hormone therapy (HT) between 1994 and 2009. Within the first year following HT discontinuation, the risk of death from any cause was significantly elevated. The risk of dying specifically from heart problems or stroke during this first year ranged from 26%-66%. This increased risk was decidedly higher in women who began and then discontinued HT before the age of 60. Contrary to current medical belief, women who started HT after the age of 60 did not seem to be at an increased risk for cardiac death within one year after stopping HT. Current medical guidelines recommend that practitioners encourage discontinuation of HT at annual office visits. The study authors believe the safety of this practice should be reevaluated in light of their results. Further studies are needed.

What conclusions might we draw from these 2 studies? Hot flashes and night sweats are the primary reason women seek menopause-related health care. If women with VMS tend to have more risk factors for CVD, and women who start and then stop HT before the age of 60 are at a significantly increased risk for cardiac and stroke death within the first year, continuing HT might be beneficial for a subset of women with hot flashes, night sweats and CVD risk factors. As always, a thorough medical examination and health history, along with an open-minded discussion with one’s trusted health care professional, can help women decide whether continuing the use of HT might be beneficial for them.

  • Franco OH, et al. Vasomotor symptoms in women and cardiovascular risk markers: Systematic review and meta-analysis. Maturitas. 2015; 81: 353-361.
  • Mikkola TS, et al. Increased cardiovascular mortality risk in women discontinuing postmenopausal hormone therapy. J Clin Endocrinol Metab; press.endocrine.org/journal/jcem.
Hot Flashes and Heart Disease 2017-12-12T17:05:57+00:00

Hormones for Hot Flashes

Hormones for Hot Flashes

Written by Kathy Lynch, PharmD – Women’s International Pharmacy

The FDA approved the first and only non-hormonal treatment for hot flashes in 2013. Brisdelle (paroxetine) belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRIs). These medications are used primarily to treat depression. Before Brisdelle was approved, estrogens were the only FDA-indicated treatment for hot flashes.

A new study highlights an increased risk for bone fractures in women taking SSRIs for non-psychiatric conditions like hot flashes. Statistics from an insurance claims database indicate that female patients, aged 40-64 without mental illness who started SSRIs from 1998-2010, had an increased risk of breaking a bone compared to a similar group that started using proton pump inhibitors for stomach disorders. It may be time to reevaluate the use of SSRIs for the treatment of hot flashes.

Estradiol is FDA-approved for the treatment of hot flashes as well as for the prevention of osteoporosis. Misinterpretation of the Women’s Health Initiative (WHI) Study has generated apprehension regarding the use of bioidentical hormone replacement therapy (BHRT) for hot flashes.

Dr Kent Holtorf has reviewed numerous published papers and concluded that BHRT is safer and more effective than conventional hormone replacement therapy. Individualizing therapy and balancing hormone benefits vs risks is the key to successful management of menopausal hot flashes. There is no need to substitute an SSRI for the real-deal.

Read more in the Women’s International Pharmacy Connections Newsletter on Menopause.

  • Sheu YH, et al. SSRI use and risk of fractures among perimenopausal women without mental disorders. Inj Prev. 2015 Jun 25. doi: 10.1136/injuryprev-2014-041483. (Epub ahead of print)
  • Holtorf K. The Bioidentical Hormone Debate:  Are Bioidentical Hormones (Estradiol, Estriol, and Progesterone) Safer or More Efficacious than Commonly Used Synthetic Versions in Hormone Replacement Therapy? Postgrad Med. 2009 Jan;121(1):1-13.
Hormones for Hot Flashes 2017-12-13T15:20:48+00:00

Book Review – An MD’s Life Saving Health Solutions by James A. Schaller

Book Review – An M.D.’s Life-Saving Health Solutions by James A. Schaller

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

Although not apparent from the title of this book, An M.D.’s Life-Saving Health Solutions: A Gynecologist’s Advice, Dr. James Schaller shares some very interesting thoughts about hormones from his long clinical practice in obstetrics and gynecology. He writes in an engaging fashion, almost like you were sitting in his office and having a conversation with him.

He is very clear that progestins (which he calls castrating drugs) are not progesterone. He calls the large Women’s Health Initiative (WHI) study ill-conceived and and says it fails to answer the question that that they sought. The question asked by the study was “Can hormones delay the onset of chronic disease in women?” Because the study used only Premarin and Premarin with medroxyprogesterone (progestin), we only learned that the synthetic or non-human identical hormones do not delay the onset of chronic disease in women.

Dr. Schaller discusses the relationship between hormone balance and body fat at great length. He states ideally, a woman should have about 22% body fat. Less than 13% body fat and low estrogen at menopause is a real concern because there is not enough fat to allow for adequate estrogen storage. Consequently, very thin women have more sensitivity to swings in estrogen which occur throughout the cycle or in perimenopause. “Fat cells store, produce and release estrogen. The number of fat cells affects all hormonally-related effects,” Dr. Schaller claims.

Very thin women can experience stopped monthly periods because there is not enough estrogen available to build up the endometrium. Recall that cycling begins in a young woman who has at least 13% body fat. These women are also at higher risk for osteoporosis.

On the other hand, women who are overweight with more than 30% body fat, store plenty of estrogen in their fat cells. They have a life-long imbalance in progesterone needed to balance the estrogen they accumulate and store. Periods may also stop for obese women but they will likely experience abnormal bleeding.

It is important women understand normal ovarian function. Young girls usually experience pain during the first one to two days of their periods indicating that an ovulation has occurred. After a vaginal delivery this pain may stop. Pain can also occur at mid cycle or two weeks before bleeding begins. This pain can be stabbing or a dull ache and represents the pain of the follicle bursting through the ovary wall. He recommends avoiding strenuous activity when this happens. The ovaries can actually sway with rigorous exercise and prevent healing of the rupture in the ovarian wall.

Dr. Schaller’s book contains many more practical hints. He warns against using psychoactive drugs, medications that have an effect on mood, behavior, or thinking processes, for PMS when progesterone addresses the underlying issue and is less expensive too. He says statins are very dangerous. He notes that cholesterol-lowering drugs do not save lives but actually increase mortality and produce depression and memory problems.

Dr. Schaller is accepting of some doses of NSAIDS (non-steroidal anti-inflammatory drugs) for ovulation pain; however, he says using NSAIDs in excess can cause serious problems because of their potential for gastric ulceration. Drugs which are used for excess stomach acid actually prevent absorption of critical nutrients and bisphosphonate drugs used for osteoporosis interfere with normal bone metabolism.

It was a privilege to read this book and reap the benefits of the observations of a physician in practice for over 40 years. I am sad to see our medicine system turning into one which allows patients only a few minutes with a practitioner and uses treatment plans based on algorithms instead of treating people like individuals and tapping into the vast stores of knowledge and experience from physicians such as Dr. Schaller.

Book Review – An MD’s Life Saving Health Solutions by James A. Schaller 2018-01-22T10:56:17+00:00

Are More Women Choosing Personalized Medicine?

Are More Women Choosing Personalized Medicine?

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

Dr. JoAnn Pinkerton was the lead author for a paper entitled, Compounded Bioidentical Hormone Therapy: Identifying Use Trends and Knowledge Gaps among US Women, recently published in Menopause: The Journal of The North American Menopause Society.

The paper evaluated two studies that involved answering questionnaires via internet invitations. The first study analyzed data for 801 women reporting at least one menopausal symptom and the second study looked at data for women who were ever users of hormone therapies. The paper raised great concern because a low number of respondents using compounded bioidentical hormone therapies answered correctly when asked if they knew that their therapies were not FDA approved. Interestingly, the women who took manufactured hormone therapies were not asked about their knowledge of whether their therapies were FDA approved. Therefore, one cannot determine if the women using manufactured hormone therapies would have answered the same question correctly.

Bias is of significant concern in this paper considering the source of the funding is a pharmaceutical company focused on the development and commercialization of FDA approved hormone replacement products.

Compounded medications are not required to be approved by the FDA, nor should they be. The individualized nature of compounded medications makes it impossible to submit each customized combination to the FDA for approval. Compounding is regulated at the state level by State Boards of Pharmacy. The FDA oversees the quality of the ingredients used in compounding, and the manufacturers of these ingredients must be registered with the FDA. Prescribers are authorized to choose the therapy that best suits their patients’ needs and pharmacists, in turn, are authorized to provide these therapies.

The paper uses the data from the studies to estimate the number of women who use compounded bioidentical hormone therapies. Although many approximations were made to calculate the final estimate, one thing is clear: the number of women making the choice to use compounded bioidentical hormone therapies is considerable. Science is moving in a direction that makes more information about human individuality available for use in caring for patients. Soon we may be able to individualize most medical treatment options. Practitioners and their patients who choose customized bioidentical hormone therapies are working at the cutting edge of a healthcare revolution.

  • Pinkerton J, Santoro N. Compounded bioidentical hormone therapy: Identifying use trends and knowledge gaps among US women. Menopause. 2015 Sep;22(9):926-36. doi: 10.1097/GME.0000000000000420.
Are More Women Choosing Personalized Medicine? 2018-04-02T16:36:44+00:00

A Tribute to Dr. Katharina Dalton

A Tribute to Dr. Katharina Dalton

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

 

Even though they’re not really funny, PMS jokes abound in today’s society. It’s very likely that most of us toss around the acronym of PMS (for premenstrual syndrome) without giving a thought as to where or how it originated.

In 1994, there was a movie titled Tom and Viv about the relationship of the American poet T.S. Eliot and his wife, Vivienne Haight-Wood Eliot, whom he married in 1915. Upon their marriage, he became the custodian not only of her money, but also of her physical being. Vivienne suffered terribly each month from what we now would recognize as PMS. After unsuccessfully trying to help her, T.S. Eliot had his wife committed to an asylum where she spent the remainder of her days. He never saw her again after she was committed. This movie reflected the thinking at that time. Women who suffered from hormone disturbances were thought to have mental rather than physical problems.

Dr. Katharina Dalton made a huge contribution to our understanding of hormone disturbances, and she is also the one who named the syndrome PMS. She identified and successfully treated many problems that were uniquely female. As we explore the mysteries and benefits of hormone therapies today, we are standing on the shoulders of her achievements, which include a tremendous amount of observation and study.

On her death at the age of 87 on September 17, 2004, Dr. Dalton’s life and work were reviewed by many major newspapers in Great Britain, where she practiced, and in the United States, where she also made a huge impact by identifying physical reasons for issues that had previously been dismissed as hysterical or only a figment of the mind. The concept of a women’s health movement may very well have started with her work.

At age 32, Dr. Dalton was still a medical student and pregnant when she wondered why she was suddenly free of the severe headaches she had experienced monthly. She took her observations to Dr. Raymond Greene, an endocrinologist, and speculated that progesterone, which is abundant during pregnancy and also should be abundant during the luteal phase (the second half of the menstrual cycle), might be the key. She and Dr. Greene first published their clinical experiences and theory in British medical journals in 1958, and proposed the term premenstrual syndrome. By then, Dr. Dalton had successfully treated premenstrual asthma, epilepsy, and migraine headaches with progesterone.

Progesterone, which has an effect throughout the body, is produced in the adrenal glands in addition to the progesterone produced by the ovaries. Dr. Dalton used progesterone that was equivalent in structure to the hormone found naturally in the human body. She was adamant that other synthetic derivatives of progesterone could not be used, contrary to what her medical colleagues believed.

Throughout her career, Dr. Dalton carefully examined her patients, collected data, posed theories, and tested her ideas. She developed a system of charting to help monitor the large number of symptoms that could present with PMS. An adaptation of the Symptoms Chart is available for download from our website.

One of Dr. Dalton’s observations was that some of the symptoms of PMS (including edema, hypertension, and albumin in the urine) seemed to also occur as early signs of toxemia in pregnancy. She began trials of intervention with progesterone, in collaboration with a maternity hospital. The hospital records showed an average incidence of toxemia to be 9%. After the first patients who were treated delivered babies in 1955, the incidence dropped to a low of 1.0%. Each patient was given a test dose of progesterone when early symptoms occurred, and then treated continually if symptoms resolved, while moderating the doses according to symptom relief.

Men, women, and children all have progesterone receptors in operation throughout their lifetime. Dr. Dalton focused her attention on progesterone receptors and, because only natural progesterone fits the receptors, she felt this was the only appropriate hormone to use. She also understood that, if there was too much adrenalin being produced, progesterone would not be able to be picked up by the receptors. Similarly, if women were experiencing swings of low blood sugar, progesterone would also not activate the receptor.

Dr. Dalton used very generous doses of progesterone to treat women; often a 400 mg suppository would be the minimum dose. Tests to measure levels of progesterone in the body using various means were immaterial, in her opinion, because the only meaningful test would be at the receptor sites. Successful treatment would be verified by a positive response to supplementation.

Dr. Dalton observed that progesterone has a very positive effect on hair growth in women. After delivery of a baby, many women experience significant hair loss because of the sudden drop in progesterone. When progesterone is supplemented for those women, the hair regrows luxuriantly.

Progesterone has also proven to be effective for brain trauma because of its protective effect on the myelin sheath, which covers nerve tissue. Additionally, progesterone can reduce swelling in the brain and has even been used by neurosurgeons prior to surgery.

Dr. Dalton also claimed that there was no unsafe dose of progesterone. In high enough doses, started before ovulation, progesterone could be used as a safe contraceptive. It was also safe to use with breast cancer, even concurrent with breast cancer treatments.

Prior to menopause, Dr. Dalton noticed that progesterone would typically start to become deficient for at least two years. During this time, women would develop symptoms that were similar to those she identified as PMS, which we now identify as symptoms of perimenopause.

She also identified the onslaught of symptoms some women experience after childbirth as having a pattern similar to PMS. She advocated for using large doses of progesterone immediately after childbirth, especially in those women with a history of PMS, to cushion them from the effects of the huge drop in progesterone that occurs at delivery.

Unlike current conventional thinking, Dr. Dalton claimed that women who have had a hysterectomy need more than the amount of progesterone needed by a woman who has undergone a natural menopause. The reasons behind most hysterectomies are consistent with a long-term progesterone deficiency; thus, so much more progesterone is needed to relieve symptoms afterwards. Ignoring the considerable research on progesterone receptors throughout the body, many practitioners today still believe that women with a hysterectomy do not need any progesterone because they maintain that it is only the uterus that benefits from progesterone and, because the uterus has been removed, progesterone no longer has any function.

As an active advocate in the justice system, Dr. Dalton also published a book titled Premenstrual Syndrome Goes to Court. She studied women serving time in prison and found that a large majority of the violent crimes committed (such as manslaughter, baby battering, and assault) occurred during the luteal phase in women who had a history of PMS symptoms. As part of her study, Dr. Dalton devised a menstrual chart indicating symptoms and their cyclical occurrence, helping the women establish the cyclical and hormone dependent nature of the symptoms. She appeared in court in about 50 trials in defense of women suffering from PMS and claiming a state of diminished responsibility if their criminal actions occurred during the luteal phase of their cycle.

She tried to find an independent marker for PMS and studied sex hormone binding globulin (SHBG). In the groups studied, she found that SHBG, which would bind estrogens and testosterone tightly, was low in the women suffering with PMS. She theorized that low SHBG translated into more free estrogens, which then created inadequate progesterone activity. This premise, unfortunately, was not verified by other scientists.

Dr. Dalton practiced the true scientific method. She made her observations based on the evidence she found, devised a theory that tested the observations she made, and tested her theory. She even applied her theory to situations beyond PMS, recognizing the implications of a host of different symptoms, to further an understanding of the importance of progesterone, as illustrated by her observations of patients with post-partum depression and toxemia during pregnancy.

Today, faced with the numerous symptoms that present with PMS, scientists only look at one issue at a time. Instead of turning to progesterone, which is indeed the golden key for progesterone receptors (as Dr. Dalton has shown), we treat PMS piecemeal with diuretics for edema, with narcotics and anti-inflammatories for pain, with anti-epileptics for seizures, and with antidepressants, anxiolytics, and antipsychotics for mood disorders.

Some say it takes 50 years for a new idea to take hold in our collective minds and, since we are now more than 50 years from her first publication, the time is now ripe for acceptance of Dr. Katharina Dalton’s work with progesterone. Pointing to the current widespread use of bioidentical hormone therapies in women’s health today as proof, perhaps her ideas have at last garnered a place in our consciousness.

  • Gilbert B. Tom & Viv. Oxford, Oxfordshire, England, UK; Miramax Films; 1994.
  • Oliver M. Katharina Dalton, 87; First Doctor to Define, Treat PMS [obituary]. Los Angeles Times. September 28, 2004.
  • Dalton K, Holton W. Depression after Childbirth: How to Recognise, Treat, and Prevent Postnatal Depression (4th Edition). Oxford, United Kingdom: Oxford University Press; 2001.
  • Allen LV Jr, et al. Interview: Katharina Dalton, MD: Progesterone and Related Topics. Int J Pharm Compd. 1999 Sep/Oct:332-9.
  • Dalton K, Holton W. Once a Month: Understanding and Treating PMS (6th Edition). Alameda, CA: Hunter House Publishers; 1999.
  • Dalton K. Premenstrual Syndrome Goes to Court. Droitwich, UK: Peter Andrew Publishing Co Ltd; 1990.
  • Dalton K. Should Premenstrual Syndrome be a Legal Defense? In: Ginsburg BE, Carter BF, eds. Premenstrual Syndrome: Ethical and Legal Implications in a Biomedical Perspective. Boston, MA: Springer-Verlag US; 1987:287-300.
  • Dalton ME. Sex hormone-binding globulin concentrations in women with severe premenstrual syndrome. Postgrad Med J. 1981 Sep;57(671):560-1.
  • Dalton K. Toxaemia of Pregnancy Treated with Progesterone during the Symptomatic Stage. Br Med J. 1957 Aug 17;2(5041):378-81.
A Tribute to Dr. Katharina Dalton 2018-04-03T11:13:16+00:00

Hormones and the Aging Voice

Hormones and the Aging Voice

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

We have all heard it. Your aging mother’s voice has changed. It cracks, it quivers, it wobbles, and the tone is lower. The voice you hear over the phone is breathy and lacks the robustness it once had. You suddenly realize, this is the voice of an old person.

Unlike the dramatic changes a young man’s voice goes through at puberty, the changes that happen to a woman’s voice are gradual, often taking years to present.

A woman may use facelifts, tummy tucks and Botox to “stay young” but her voice will still betray her. She will still have an old person’s voice, and it seems there is nothing she can do about it. Or is there?

As it turns out, the voice is extremely sensitive to hormone changes. We know this from an extensive study done with women who depend on their voices for their livelihood: singers. Women at the top of their vocal careers in their 40s and 50s may find that menopause brings it to a dead stop. With menopause, the voice range often deteriorates and those lovely high notes are no longer attainable; or worse, during a performance, the voice cracks and no note comes out at all. Many professional singers have no option but to end their career at this point.

So, what is going on with hormones to affect the voice? The larynx and the vocal cords contained within are extremely sensitive to thyroid and the sex hormones. In fact, cyclical changes occur in women’s voices starting at menarche. In the first part of the cycle (follicular phase), estrogen dominates and progesterone is at lower levels. During this time, there is more fluid build up in the vocal chords and a relaxation of the nasal passages, changing the perception of the voice. During the second half of the cycle (luteal phase), progesterone dominates, causing the larynx epithelium to slough off, and opposing estrogen-induced proliferation. Singers often find that their ability to reach the high notes is compromised during this phase.

In other words, if progesterone is not abundant enough, the singer suffers from estrogen dominance in the luteal phase (or during PMS), and voice clarity or efficiency suffers. Vibratos wobble and it is difficult to sing softly. This condition is known as dysphonia premensturalis.

Researchers Jean Abitbol and his wife Beatrice performed a study that compared slides of swabs obtained from the vocal cords with slides containing cervical smears, both taken at various intervals of the menstrual cycle. The slides were indistinguishable from each other! Their astounding discovery is that vocal chords and vaginal tissue are the same kind of tissue. The vaginal dryness experienced at menopause is similar to the dryness experienced in the vocal chords.

Research has also demonstrated that progesterone, operating as a neurosteroid, protects the myelin sheath. Ian Duncan at the University of Wisconsin illustrated the effect of progesterone on the brain in 1995. With the significant drop in progesterone production that occurs at menopause, nervous tissue is less protected, which leads to a voice that is less controlled.

Testosterone deficits also have an effect on the voice in that the muscles and cartilage that make up the larynx become flaccid and weakened. Not only that, but low testosterone contributes to less muscular strength throughout the body. Singing is hard work and requires good structure and posture, strong abdomen muscles, great breath control, and plenty of endurance. Perversely enough, women who receive too much testosterone replenishment may find that their voices change to a lower timbre, which is thought to be permanent.

Both hypothyroidism and hyperthyroidism also cause voice disturbances. Low thyroid produces hoarseness and a lack of range. This may be from elevated polysaccharides (think mucin) in the vocal chord folds, leading to fluid retention and thickening of the vocal chords. Treating hypothyroidism generally relieves these symptoms. Too much thyroid hormone also causes hoarseness, which is usually relieved with treatment.

Other chronic diseases that accompany aging can also impair the voice. For example, diabetes sufferers often experience dry mouth, which can be a vocal hindrance. Hearing loss, another hallmark of aging that can also occur with diabetes, can cause difficulties in the quality of the vocal sounds produced.

Does hormone replenishment really make a difference? It seems to. This area certainly warrants further exploration. Keeping oneself in good physical condition with exercise, a healthy diet, and good hydration also goes a long way toward maintaining a youthful voice.

Not surprisingly, there are specific exercise programs that singers use to keep their voices working effectively. Just as they say with regard to sex, “if you don’t use it, you lose it;” yet another parallel between vaginal tissue and the vocal chords.

  • Kadakia S, et al. The Effect of Hormones on the Voice. J Sing. 2013 May/June;69(5):571-4.
  • Benninger MS, Abitbol J. Dysphonia and the Aging Voice. Voice. American Academy of Otolaryngology-Head and Neck Foundation; 2006:67-85.
Hormones and the Aging Voice 2017-12-11T16:24:52+00:00

What Does Tinnitus Have To Do With Hormones?

What Does Tinnitus Have To Do With Hormones?

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

 

Tinnitus, commonly known as “ringing in the ears,” is prevalent among the elderly and in women. The severity can vary from a mild annoyance to significantly disturbing.

Tinnitus may also be associated with deafness and dizziness. Most will experience a temporary tinnitus when exposed to loud sounds. Loud sounds can also induce a chronic tinnitus.

The “ringing in the ears” can actually be heard as a variety of sounds such as ringing (the word tinnitus comes from the Latin word for “ringing”), buzzing, whooshing, swishing or clicking. These sounds create a background of noise when there is no sound actually present. In his book Musicophilia, Oliver Sachs even reports cases of tinnitus of a musical nature. The American Tinnitus Association website has recordings of the various sounds of tinnitus.

The onset of tinnitus in women seems to be particularly related to periods of hormone variability. It can be triggered by PMS, perimenopause, menopause and pregnancy. Menopausal symptoms such as sweating, hot flashes and mood changes may correlate with tinnitus.

Tinnitus can also be caused by some prescription medications, including antidepressants, aspirin and quinine, some antibiotics, benzodiazepines, anticonvulsants, some chemotherapy and certain diuretics. Sometimes conventional hormone treatments have brought on tinnitus. A review posted at eHealthMe.com compiled the details on side effects from 69,299 Premarin users, of whom 0.5% have reported tinnitus as a side effect. The incidence increases dramatically with the number of years on Premarin, and no one reported a recovery. While the search for a pharmacologic solution for tinnitus has been on for decades, there have not been any successful candidates thus far.

However, while presenting at the Royal Society of Medicine on May 8, 1985, Dr. Albert Gray successfully treated 7 of 14 patients with an injection of thyroxine (T4) solution through the tympanic membrane of the ear. Tinnitus has been identified as a symptom of both hypo- and hyperthyroidism. This observation should trigger more investigation into the thyroid status of a sufferer.

Tinnitus treatments involving the injection of other drugs (particularly the synthetic analogs to hydrocortisone) through the tympanic membrane have been attempted, also without success. Otologists had reasoned that this procedure would allow a larger concentration of the drug to reach the inner ear, and that the localized treatment would be more likely to have an effect.

Research in the last decade has increased our awareness of hormones acting on the central and peripheral nerves. Low estradiol, for instance, may be responsible for confusion in the transmitting of sound signals from the ear to the brain, possibly resulting in tinnitus.

In 2012, researchers from Nigeria reported on the correlation of vitamins C and B12 and melatonin by examining those levels in a group of elderly people, some with and some without tinnitus. They found no significant correlation with vitamin C levels, but found significantly lower levels of B12 and melatonin in those people with tinnitus.

Treatment options now offered include counseling, cognitive behavioral therapy, auditory stimulation, and neuro feedback. Efforts to mask the noise, such as using white sound or hearing aids, are also sometimes used. Drug therapies are not effective at treating tinnitus but may be offered to treat anxiety, depression or sleep deprivation, which may accompany it.

An evaluation of nutrition (particularly with regard to the B complex vitamins), stress levels, exposure to loud noise and hormone balance may be avenues to explore for tinnitus relief.

What Does Tinnitus Have To Do With Hormones? 2018-04-05T11:22:18+00:00

Book Review – The Edge Effect by Eric R. Braverman, MD

Book Review – The Edge Effect: Achieve Total Health and Longevity with the Balanced Brain Advantage by Eric R. Braverman, MD

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

 

In The Edge Effect: Achieve Total Health and Longevity with the Balanced Brain Advantage, Dr. Eric Braverman introduces the notion of a series of “pauses” that occur as we age, such as menopause. Some women experience their first menopause symptoms as young as in their 30s, characterized by dramatic drops in testosterone and progesterone. Estradiol losses may also start in their early 30s. Diminished bone density, less abundant hair, and cognitive dysfunctions accompany the loss of these sex hormones. Andropause (the male equivalent of menopause) typically starts around the mid-40s and continues over the next 30 years with similar effects.

Dr. Braverman points out that our bodies go through many other “pauses” as we age:

  • Up until about the age of 30, bone mass increases or is near optimal. After that, osteopause begins. The availability of proper nutrients in the diet typically starts to be a concern, plus the ability to absorb and make use of those nutrients has also started to decline.
  • During the 30s and 40s, dermopause begins to show with diminished skin thickness, flexibility, or elasticity, all of which are related to the ability to make collagen. The skin also becomes increasingly dehydrated.
  • The maximum heart rate achieved during exercise typically peaks in the 40s, marking the beginning of cardiopause.
  • Along with cardiopause is vasculopause, which is characterized by high blood pressure and diminished blood flow.
  • Thyropause starts generally in the 50s, when the production of thyroid hormone and calcitonin is reduced.
  • Thymopause starts even earlier. The thymus gland aids our immune system by directing the function of T lymphocytes (or T cells). Although this continues life long, the thymus starts to shrink and accumulate fatty tissue at puberty.
  • From the 50s to the 70s there is a marked decline in lung function or pulmonopause. In fact, the effectiveness of breathing is a prime indicator of longevity. Stress, anxiety, and exposure to pollutants negatively affect pulmonary function.
  • Adrenopause, which is characterized by diminished DHEA, can begin as early as the 30s and up through the 60s. By the 70s, without adequate DHEA, cortisol levels also soar. This unhealthy state has earned cortisol the title of “death hormone” because there are so many issues associated with diminished adrenal function. Primary health concerns include changes in focus, memory and attention, depression, lack of energy, loss of libido (especially with women), anxiety, panic attacks, and increased appetite, all symptoms that we readily associate with advanced aging.
  • The loss of muscle mass is another hallmark of aging. By the 90s, 20-40% of muscle mass is lost. This is known as somatopause, and includes reduced muscle strength as well as reduced mental ability.

All of the above are physical “pauses” that typically occur; however, Dr. Braverman and most people believe that the “pauses” related to brain function are even more critical to measuring how well we age:

  • Sensory pause refers to the loss of sensory functions. Hearing starts to decline in the 20s to 40s. The sense of smell starts diminishing in the 40s and more rapidly declines after age 65. Nearsighted increases in the 40s but the ability to see fine details starts to decline in the 70s.
  • Pituitary pause refers to the decline in function of the pituitary and hypothalamus, which are the glands that are masters to the sex hormones, adrenal hormones, thyroid hormones, and more.
  • Electropause refers to the loss of voltage, speed, rhythm and synchrony. For instance, just a 10% drop in voltage can signal signs of depression. With a 90% drop, dementia is a reality.
  • Biopause relates to the brain mediated control of the cascade of all the other pauses.

Other neuropsychiatric disorders can occur at any age but they are especially prevalent in those over 85 years of age, affecting as many as 50% of that population. These types of disorders include cognitive dysfunction and dementia, substance abuse, and personality disorders.

The neurotransmitter hormones Dr. Braverman believes are at the center of delaying the “pauses” are GABA, dopamine, acetylcholine, and serotonin. He correlates the dominance of one or the other of these neurotransmitters to personality types, such as those used in the Myers-Briggs test. His book is brimming with questionnaires to help identify your personality type and neurotransmitter dominance. In addition, he provides guidance as to “bending one’s chemistry the right way” with diet and exercise, as well as supplementing nutrients and bioidentical hormones, and making changes to your lifestyle and/or environment. Further, he invites you to explore how technology can positively affect your brain chemistry.

This litany of “pauses” presents a grim picture of aging. However, Dr. Braverman suggests that there is no reason we can’t slow down their progression. He believes that the brain, and our ability to make and make use of the neurotransmitter hormones in a balanced fashion, is the key to doing so.

  • Braverman ER. The Edge Effect: Achieve Total Health and Longevity with the Balanced Brain Advantage. New York, NY: Sterling Publishing Company, Inc.; 2005.
Book Review – The Edge Effect by Eric R. Braverman, MD 2018-05-02T12:15:55+00:00

Foot Fat Pad Atrophy

Foot Fat Pad Atrophy

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

 

Here’s another one to add to the number of signs and symptoms of declining hormones: Is the heel or bottom of your foot causing you pain? Are you finding yourself seeking relief in the Dr. Scholl’s section of the pharmacy? It could be due to foot fat pad atrophy.

The foot fat pads are the tissue that protects your foot on the ball of the foot and at the bottom of the heel. Atrophy means shrinking or disappearing. The foot pad tissue under the foot does decline with age. Menopause and surgical menopause increase the rate of decline. Obvious mechanical issues, such as being overweight, can also have a negative impact and hasten the loss of the plumpness of this tissue.

If plantar fasciitis (painful inflammation of the bottom of the foot) has been an issue, your practitioner may have used one or more injections of “cortisone” to relieve pain. Unfortunately, this “cortisone” is not the same as the cortisone hormone the body produces; it is actually a synthetic analog that can lead to even more atrophy of the foot pads.

In addition, as Dr. Sergey Dzugan points out in The Magic of Cholesterol Numbers, cholesterol levels elevate when the body senses a deficiency of the sex and adrenal hormones, which are normally produced from cholesterol. So statin users beware! When taking statins, not only do cholesterol levels fall, but the ability to make hormones drops even further. Statin drug use may be a source of foot pain from accelerated foot fat pad atrophy.

If you are experiencing foot pain, have your practitioner check for hormone deficiencies, including vitamin D (which is also made from cholesterol). These deficiencies may be the underlying cause of your foot pain.

Foot Fat Pad Atrophy 2017-12-14T15:16:50+00:00