Category Archives: Hormone Replacement Therapy

This article was originally published here

Indian J Med Res. 2021 Apr;154(4):559-570. doi: 10.4103/ijmr.IJMR_313_19.

ABSTRACT

Immune checkpoint inhibitors (ICIs) are a relatively newer class of drugs approved for the treatment of malignancies such as melanoma, renal, bladder and lung cancer. Immune-related adverse events (IrAEs) involving the endocrine system are a common side effect of these drugs. The spectrum of endocrine adverse events varies by the drug class. Cytotoxic T-lymphocyte-associated antigen-4 inhibitors commonly cause hypophysitis/hypopituitarism, whereas the incidence of thyroid disease is higher with programmed cell death (PD)-1/ ligand (PD-L) protein 1 inhibitors. The focus of this review is to describe the individual endocrinopathies with their possible mechanisms, signs and symptoms, clinical assessment and disease management. Multiple mechanisms of IrAEs have been described in literature including type II/IV hypersensitivity reactions and development of autoantibodies. Patients with pre-existing autoimmune endocrine diseases can have disease exacerbation following ICI therapy rather than de novo IrAEs. Most of the endocrinopathies are relatively mild, and timely hormone replacement therapy allows continuation of ICIs. However, involvement of the pituitary-adrenal axis could be life-threatening if not recognized. Corticosteroids are helpful when the pituitary-adrenal axis is involved. In cases of severe endocrine toxicity (grade 3/4), ICIs should be temporarily discontinued and can be restarted after adequate hormonal therapy. Endocrinologists and general internists need to be vigilant and maintain a high degree of awareness for these adverse events.

PMID:35435341 | DOI:10.4103/ijmr.IJMR_313_19

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The side effects of immune checkpoint inhibitor therapy on the endocrine system - DocWire News

Id heard that your experience of menopause is often similar to your mothers, but my mum had already had a hysterectomy by my age. Shed been placed on the old form of Hormone Replacement Therapy (HRT) and then slipped quietly into post-menopause.

I didnt even notice, she said. Would that be my experience too?

I opened the book and couldnt put it down. I read it in three days, and the more I read, the more excited I got. I looked up every site the book recommended. I joined three perimenopause and menopause Facebook groups. I watched TED Talks. I was hooked.

Listen to The Quicky's episode on menopause. Post continues after podcast.

I talked with dozens of women and devoured their stories, the good ones and the awful ones. I wanted to hear about every symptom, every stage, every treatment. I learned about the new Menopausal Hormone Therapy (MHT) and looked up specialists to readtheir recommendations. I found podcasts and blogs and more books.

It felt like being let in on a secret - one I no longer found scary, but empowering. I brought up menopause with every single person I met: the hairdresser, friends at a barbecue, my sisters, my chiropractor, my doctor. Did other people know what I knew?I had to find out.

My husband listened attentively to way more than he probably cared to hear.

I wanted to make sure everyone had heard about perimenopause because to me, and many of the women I interviewed, it had been such a mystery.

The chiropractor and the doctor had only briefly heard about it in their training.

Ive always felt like I was missing something with my women patients. Like I was treating disconnected symptoms I knew were somehow connected, the chiropractor said.

The doctor, a young man who was trained within the last decade, said theyre taught almost nothing about menopause at medical school, unless theyre specifically interested in the topic. Nothing at all about perimenopause.

Its strange how little were told, considering its not rare, he said. Half the population will go through it.

I told my husband what hed said.

Well, its not a very sexy topic, he replied.

I stared at him. Seriously? Dont judge him too harshly here. I didnt. My husband is usually a smart manand this topic is new for him too. I decided to hold my tongue.

Bowel cancer isnt sexy and they learn about that.

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'I'm 43 and just married my much younger husband. It's made me worried about ageing.' - Mamamia

What is HRT?

HRT is a treatment that can reduce symptoms of the menopauseby changing hormone levels in the body. Hormones are chemical messengers. They can affect things like growth, fertility and our mood.

During the menopause, the ovaries start to produce less of the hormone oestrogen. This means some people may experience menopausal symptoms, such as hot flushes and mood changes. For some, these symptoms are very uncomfortable, and HRT can help to reduce them.

Trans men and women may also use hormone therapy. But there isnt yet enough research about cancer risk associated with this. This webpage only covers menopausal HRT and cancer risk.

The main types of HRT are:

Some other forms of HRT are less commonly prescribed, such as tibolone (external link). Your GP can give you more information about the different types if you think HRT might help you.

Risk from HRT depends on many different things. This includes the type of HRT, when people start taking it, how long they take it for, age, and general health. And the benefits of taking HRT will vary from person to person too.

Everyones different, so talk to your GP about your options.

Its also important to remember that there are other things that affect cancer risk more than HRT. For example, you can reduce your cancer risk by stopping smoking, keeping a healthy weight, and drinking less alcohol.

Most types of HRT increase the risk of breast cancer. But the risk is higher for those using combined HRT, which uses bothoestrogen and progestogen.

Vaginal oestrogens are not linked to an increased risk of breast cancer, whereas tibolone is.

Taking HRT for 1 year or less only slightly increases breast cancer risk. However, the longer you take HRT the greater the risks are, and the longer they last.

The risk of breast cancer due to HRT can also vary from person to person. Things such as what age you are when you first start taking HRT, other medicines you may be taking, and your general health can impact the risk.

People who begin HRT before or soon after the menopause may have a bigger risk than those who start HRT later.

Yes, both oestrogen-only and combined HRT slightly increase the risk of ovarian cancer. But when HRT is stopped, the risk starts to go back to what it would have been if HRT wasnt taken.

Its not yet clear if theres any link between ovarian cancer and tibolone.

The risk of womb cancer depends on the type of HRT.

Oestrogen-only HRT increases the risk of womb cancer. The longer this type of HRT is used, the bigger the risk. Thats why oestrogen-only HRT is usually only offered to those who have had their womb removed (a hysterectomy) as they have no risk of womb cancer to begin with.

Combined HRT can reduce womb cancer risk. But combined treatment causes the biggest increase in breast cancer risk. So, its important to talk to your doctor about the balance of possible benefits and risks for you.

Similar to oestrogen-only HRT, tibolone also increases the risk of womb cancer.

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Does hormone replacement therapy (HRT) increase cancer ...

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Hormone Replacement Therapy Market Size estimated to exhibit at a 5.2% CAGR, Future Business Opportunities through 2028 | Abbott, Mylan N.V., Merck...

Students and staff have advocated for over a year for the Student Health and Counseling Center (SHCC) to offer gender-affirming care (GAC) for transgender and nonbinary students. In response to their efforts, the SHCC now plans to incorporate GAC by fall 2022.

Jordan Fitzpatrick, a first-year graduate student in the sasters in social work program, planned an informational meeting for students via Zoom on April 1 in response to students and staff being met with reluctance or refusal by the health center to incorporate GAC.

GAC includes counseling support as well as medical support, such as providing hormone replacement therapy (HRT) on campus, for transgender and nonbinary students.

Fitzpatrick was expecting to involve students in advocating for the inclusion of GAC. Instead, he was able to present attendees with the SHCCs plan for GAC, with both counseling and medical support, including having an experienced physician [to] provide HRT services on-site, according to the plan.

The plan states its primary goal is to provide a sustainable programmatic operational plan supporting our students with gender-affirming care.

The plan includes counseling and psychological services, medical services, an improved website with updated resources, a GAC care group, additional SHCC positions to hire for and a Cross-Cultural and Gender Center (CCGC) student liaison, all by the start of the fall 2022 term.

Fitzpatrick, who also uses the pronoun they, explained that offering HRT on campus rather than being referred out is particularly important due to the limited options for GAC within the Central Valley.

Most people have to travel outside the Central Valley in order to receive basic care. Often, when transgender and gender nonconforming people do seek medical care in the Central Valley, they face doctors who are not informed on how to care for [them], or refuse care, or are outright hostile to [them], they said.

Fitzpatrick noted that these students, who paid for services at the health center as part of their tuition just like other students, should be able to receive this care and not be denied hormones due to gender.

During the meeting, Fobear explained that the refusal to offer GAC, and in particular HRT, is an equity issue.

Fobear noted that currently two women can go to the SHCC, one cisgender and one transgender, and one can be given hormonal treatment in the form of birth control, and one can be denied hormonal treatment in the form of HRT, and called this an instance of discrimination.

Its really important that we make sure that this actually happens and we hold them accountable, and that we have a way to make sure that it stays in place, Fitzpatrick said.

Fobear and Fitzpatrick assured attendees that despite the promise to incorporate GAC, there was more to be done, and that the process to get there hadnt been simple, either.

The need to begin offering GAC care arose about a year and a half ago before the meeting, according to Fobear, when John Beynon from the English department spoke to the Fresno State LGBT+ Allies Network on the need for and the possibility of providing GAC at the SHCC, which he had seen being done at other CSU campuses, such as Chico State and Cal Poly.

Concerned campus members formed a GAC subcommittee focused on bringing GAC to campus, and have been in talks for the last year on how to begin offering this care to students as well as protecting transgender and nonbinary students seeking GAC from discrimination, Fobear said.

[The talks] intensified within the past four months, where the biggest sticking issue was about providing HRT on campus. There seem to have been a lot of maybe reticence, maybe roadblocks, but basically no sort of commitment into providing this, Fobear said.

Recent talks, which Fobear described as intense, showed no sign of improvement. Despite initially hesitating to involve students out of reluctance to stress out transgender and nonbinary students, Fobear said this is when she and Fitzpatrick decided to reach out.

Fitzpatrick sent out the invite to the first informational meeting for the student collective, but on March 31, the SHCC sent in its care model before the meeting even took place.

Still, due to the struggles to get to that point, attendees stressed the need to ensure accountability by the health center.

Fobear encouraged attendees to continue advocating for the need for GAC on campus and to stay involved in the process, attributing the current successes to student and facultys efforts and attention.

The logistics of ensuring accountability and making the GAC sustainable were discussed at the end of the meeting, and will continue to be specified in any upcoming meetings.

Other topics pertaining to LGBTQ+ students were discussed during the meeting, such as the possibility of turning the University Student Union into an LGBTQ+ center once the Resnick Student Union (RSU) opens. Concerns raised about gender neutral bathrooms in the RSU were settled by ASI President DAungullique Jackson, who also attendes and assured other attendess the gender neutral bathrooms would be available.

Students who are interested in attending future meetings and participating in these discussions can email Fitzpatrick at gac4fresnostate@gmail.com to be added to the mailing list and be alerted when future announcements are made.

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Health center to provide gender-affirming care on campus by fall 2022 - The Collegian - The Collegian

What causes menopause joint pain?

It may be a natural part of the female ageing process, but menopause can bring discomfort and pain in a number of ways. Learning how to manage your symptoms can make a big difference in your quality of life during this period.

From hot flushes and vaginal dryness to disturbed sleep and anxiety, there are lots of possible symptoms that may make daily activities more challenging. These noticeable changes reflect the significant change that's taking place in your body, as your sex hormone levels fluctuate and cause your ovaries to lose their reproductive function.

Ann Clare, a physiotherapist for MBST UK, explains how these changes can lead to menopause joint pain: "Oestrogen, the hormone that plays a key role in regulating your menstrual cycle, helps to decrease inflammation and keep the joints lubricated. During the menopause and perimenopause, oestrogen levels decrease and as a result, some women experience joint pain."

"Recent studies have suggested that a decrease in oestrogen not only reduces natural bone density but also affects muscle strength and tendon health. In turn, this may result in longer injury recovery times," says Kirsty Lee, senior physiotherapist and pelvic health lead at Ascenti.

Menopause joint pain can affect joints all over your body and can also result in longstanding injuries becoming more painful.

According to Lee, menopause joint pain most commonly affects the following areas:

"As oestrogen continues to decrease, joints can become more inflamed and painful, resulting in an increased risk of osteoporosis (thinning of the bone) and osteoarthritis (inflammation of the joints) developing," she adds.

When it could be osteoarthritis

Osteoarthritis is more likely to occur in people over 50 years, around the same time that many women start menopause. While joint pain and stiffness around the time of menopause doesn't always indicate osteoarthritis, it can be a symptom. Osteoarthritis joint pain is more likely to occur in the knees, hips, lower spine, fingers, and thumbs.

When it could be osteoporosis

Being over 40 and going through menopause increases your chances of rapid bone loss, which may lead to osteoporosis. Unlike menopause joint pain and osteoarthritis, you usually won't feel pain unless you break a bone. Your doctor may wish to test you for osteoporosis if you are menopausal and have had a bone breakage from a minor injury.

Back pain, and particularly lower back pain, can become a problem for many women as they go through menopause. In fact, one survey of 5,325 women found that postmenopausal women were twice as likely to report lower back pain as premenopausal women.

Your spine is made up of multiple joints, including facet joints that allow movement in your back. Decreased oestrogen results in greater inflammation of these joints and also causes your spinal (intervertebral) discs to wear down.

Menopause joint pain of the knees is also very common. This may not be surprising, given that your knee is one of your largest joints, connecting and supporting your thighbone (femur), kneecap (patella), shinbone (tibia), and calf bone (fibula). Your knees are subject to a great deal of pressure and wear throughout your life as they support a large portion of your weight.

The good news is, there are both medical and non-medical forms of pain management that are proven to significantly reduce menopause joint pain. This can start with simple routines in the home.

Home treatments include:

Your diet is hugely important in both preventing and managing health issues, and menopause joint pain is no different. "Try to eat a healthy, balanced diet that is high in fibre with lots of fruit, vegetables and wholegrain foods," advises Clare.

Eating the right foods can improve a range of menopause symptoms. The key is to consume lots of nutrients from various food groups.

The foods that most directly impact joint and bone health include:

"You should also try to avoid large quantities of saturated fats. If you are suffering from hot flushes, try to make a note of what seems to bring them on - for some people it is alcohol and for others caffeine," adds Clare.

If you experience menopause joint pain, you may be tempted to limit your movements. It may feel counter-intuitive at first, but the experts recommend staying as physically active as possible.

Lee says: "Move! Motion is lotion, and if this is managed and progressed slowly it can be an effective tool for pain management."

Why: "Unfortunately, weight gain is also a common side effect of menopause, and increased weight can have a detrimental effect on joint and muscle pain due to increased load. Therefore, weight management is a key part of managing joint pain."

What: "There are lots of forms of exercise that can help with pain as well as other menopause symptoms. An effective 'menopause friendly' programme should consist of endurance, strength/resistance, and balance exercises."

Clare says: "It is best to be as active as possible and most of all enjoy your sports."

Why: "Weight-bearing exercises will strengthen your musculoskeletal system which will help to alleviate joint aches and pains, protect brittle bones, and may prevent osteoporosis."

What:

Ivana Daniell, movement and posture expert, says: "The right choice of exercise programme can be of great support during the time of menopause, both physically and mentally. Be aware of not pushing your body too hard, especially during this delicate hormonal transition."

Why: "When the female body is pushed too hard, it goes into adrenal stress and this creates havoc in the incredibly engineered yet delicate hormonal balance."

What: "Quality of movement versus quantity is paramount. Regular and consistent exercise is better than sporadic visits to the gym that make you exhausted. Choose activities that uplift your mood and practise 2-3 times per week in addition to your daily 30-40 minute walk."

You may also use over-the-counter medicines to help reduce inflammation and painful joints. These include common painkillers and anti-inflammatory gels and medication. Your pharmacist will be able to advise.

It should also be noted that hormone replacement therapy (HRT) is widely accepted as the most effective method for managing the symptoms of menopause. By restoring the oestrogen levels you lose during menopause, there is strong evidence that HRT can ease menopause joint pain alongside a whole host of other symptoms.

There are also several menopause herbal remedies and supplements on the market. Biomedical gerontologist Dr Marios Kyriazis says that supplementation should be used alongside - and not as a substitute for - healthy lifestyle changes:

"The most effective lifestyle changes include switching to an anti-inflammatory diet, incorporating light to moderate physical activity, practising breathing and relaxation exercises on a daily basis, and improving sleep patterns. Under these conditions, herbal blends and anti-inflammatory supplements work best."

Kyriazis recommends supplementing curcumin, the active ingredient in turmeric.

Curcumin may:

"By fermenting turmeric, its curcumin content becomes more bio-available at a smaller dose and is gentler on the stomach than the usual raw turmeric with black pepper that is generally recommended," he adds.

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How to ease joint pain during the menopause - Patient.info

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What do Michelle Pfeiffer, Tyra Banks, Jennifer Aniston, Jennifer Lopez and Helen Mirren have in common?

Social media platforms dont just harm teenagers, but can be harmful to women as they age, so these women are fighting back with make-up selfies to embrace their age, according to a recent Wall Street Journalreport.

"Were also bombarded by images on our phones all the timethis five years ago, this 10 years ago," New York psychiatrist Dr. Samantha Boardman, noting, " its a reminder of the passage of time and how we do look different."

She said we should be paying more attention how social media affects women as they get older, because it makes older women feel as bad as teenagers, especially when the way a woman looks doesnt match how she is feeling.

COVID-19 LOCKDOWNS: WHAT'S UP WITH NOSTALGIA FOR THE OUTBREAK ERA?"

"I have a craving to see real faces of my age, so I dont feel so alone in aging," said model Paulina Porizkova, who is56.

MIAMI, FL - MAY 11: Paulina Porizkova attends the Sports Illustrated Swimsuit Celebrates 2019 Issue Launch at Myn-Tu on May 11, 2019, in Miami, Florida. ((Photo by John Parra/Getty Images for Sports Illustrated))

Middle age is often a time of high stress for women, because many are trying to balance careers, raise children and also care for aging parents, according to theJournal.

As more older women begin to embrace their natural look, posting make-up selfies can be empowering.

"Its satisfying to feel connected and not so alone in how you look, so I think there is a generosity in that when its authentic," saidBoardman.

She cautioned the natural look might be staged at times with products, treatments and injectables that contribute to that look, so when sometimes celebrities post the "natural" hashtag, it might be supported by ring lights, secret makeup and even a filter, per the paper.

"Often were barraged with images that we dont even know are touched up," New Yorkbased psychiatrist and dermatologist Dr. Amy Wechsler told thepaper.

Some beauty brands, like Milk, Dove and Olay, are supporting this trend, using real photos that are not retouched across a wide spectrum of ages to showcase womens beauty at their stage inlife.

But make-up free selfies arent the only remedy middle-age women are using to take care of their mental health many are resorting to antidepressants, according to the Wall StreetJournal.

Tyra Banks recalled once holding her dress together while filming 'Dancing with the Stars.' (Getty Images)

But some doctors are concerned antidepressants are being overprescribed for symptoms that may actually be attributed to menopause, which the median age in the U.S. is 51, per the newsreport.

Approximately one in five women ages 40-59 and an estimated one in four women ages 60 and older used antidepressants in the last 30 days during 2015 to 2018, compared to one in 10 for women ages 18-39, according to the most recent data from the National Center for Health Statistics.

In general women are at higher risk for depression than men, but the risk of depression is highest leading up to menopause and immediately after it. Its sometimes difficult, however, to tease out the root cause of peri-menopausal symptoms, because the imbalance of hormones during this period that are responsible for typical symptoms, such as hot flashes and night sweats, can also affect a womans mood, per theJournal.

GOVERNMENT-MANDATED COVID LOCKDOWNS SPARKED SEVERE HEALTH CRISIS AMONG TEENS AS TEACHER'S UNIONS PUSHED POLICY

The most effective treatment for hot flashes and night sweats is hormone therapy with either estrogen or combined with progestogen, according to the North American Menopause Society and the American College of Obstetricians and Gynecologists.

But women are looking for alternative treatments since many are " so deathly afraid of prescribing hormones," said Dr. Stephanie Faubion, medical director of the North American Menopause Society and the director of Mayo Clinic WomensHealth.

Jennifer Aniston attends 26th Annual Screen Actors Guild Awards at The Shrine Auditorium on January 19, 2020, in Los Angeles, California. (Photo by Leon Bennett/Getty Images)

So now scientists are trying to develop anti-depressants that will target depression symptoms related to estrogen withdrawal without the side effects of hormone replacement therapy, according to Dr. Peter Schmidt, chief of the Behavioral Endocrinology branch in National Institute of Mental Health Intramural Research program.

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"While I look with wonder and awe at the women who age backwards, Id like a little more choice in representation of age. So I hope to provide a little of that for women who feel like I do, that age is coming into ones true beauty and character, and it should be celebrated, not erased," Porizkova said.

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What's behind the trend of women posting make-up free photos on social media? - Fox News

Im writing in response to Senate Bill 83, which was recently passed in the Kentucky legislature. Its referred to as the transgender sports ban. This bill is not necessary and a waste of time.

The bill, since it passed and is now waiting for Gov. Andy Beshears signature, effectively bans trans women from playing on the sports teams they want to play on. What Republicans fail to recognize is the fact that scientific studies have been done that show that transgender women hold zero physical advantage over cisgender women.

In fact, a year after being on hormone replacement therapy, trans women have the same strength as their cisgender female counterparts.

What the state legislature should focus on instead of passing LGBTQ discrimination laws is the child abuse rate. Currently, Kentucky ranks fifth in the country in reported child abuse.

The legislature needs to stop the hate of the LGBTQ community and start representing all Kentuckians equally.

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Legislature needs to stop its attacks on the LGBTQ community - messenger-inquirer

About one in five women ages 40 to 59 and nearly one in four women ages 60 and over used antidepressants in the last 30 days during 2015 to 2018, according to the latest data from the National Center for Health Statistics. Among women ages 18 to 39, the figure was about one in 10. Among men, 8.4% of those ages 40 to 59 and 12.8% of those 60 and older used antidepressants in the last 30 days, according to the NCHS data.

The figures are drawing increasing attention from scientists and doctors. Many are alarmed at how high depression rates were among midlife women even before the pandemic, now that the past two years have exacerbated mental-health issues for many Americans. And some doctors are also concerned that antidepressants are being overprescribed for menopausal symptoms.

In general, women have higher rates of depression than men throughout much of their lives according to scientific research. In midlife, the risk is greatest during the years leading up to menopause and right after it. The dramatic fluctuations in hormones that cause the most-commonly known symptoms of hot flashes and night sweats can wreak havoc on mood, too.

Estrogen and progesterone are fluctuating a great deal," says Lucy Hutner, a reproductive psychiatrist in New York City. Those shifts can be hard for our brain to take."

Scientists are working to understand just how hormones may drive depression, but receptors for estrogen and progesterone are found throughout the brain including in regions involving movement, cognition and mood regulation, says Hadine Joffe, a professor of psychiatry at Brigham and Womens Hospital and Harvard Medical School in Boston.

New treatments for depression in midlife women may be on the horizon. Scientists at the National Institute of Mental Health, for example, are studying a medication that acts on an estrogen receptor in the brain. The hope is that, unlike typical antidepressants, it will directly target depression symptoms related to estrogen withdrawal but without the side effects of traditional hormone therapy commonly used for menopausal symptoms, notes Peter Schmidt, chief of the Behavioral Endocrinology branch in NIMHs Intramural Research program.

Studies have found that womens risk of having an episode of major depression is two to four times higher around menopause than at other times during their lives; it is even greater for women who have a had a previous episode of depression. Menopause is defined to have occurred one year after a womans last menstrual period. The median age of menopause in the U.S. is 51.

Doctors also note that midlife is often a time of marked stress for womenand stress can increase the risk of depression. Many women are juggling careers, raising children and caring for elderly parents. You have a lot on your shoulders, and theres not a lot of room for taking time for yourself," says Dr. Hutner. Women also may be more likely to seek care for a mental-health problem than men, which may lead to higher rates of diagnosis and treatment.

Valerie DeMartin, 59 years old, says she fell into a depression in 2020. She was dealing with sleep problems, the stress of the pandemic and a move with two teenagers from the familys longtime home in California to Texas. An avid exerciser, she says she was also feeling sad to see her body changing in ways she felt she couldnt control.

I went through a life-altering move, my kids were angry with me, dealing with middle age and Covid and my body changing," says Ms. DeMartin, who works in home remodeling in Frisco, Texas.

Ms. DeMartin says she didnt seek therapy or take antidepressant medication. She says she has coped by reaching out to friends and staying busy with work. Shes also planning to try hormone-replacement therapy. Hopefully Ill have a little more energy and sleep better," she says.

Researchers at NIMH who have been following 90 women since 1988 have found that the incidence of womens midlife depression is concentrated in the two years before and after the last menstrual period, says Dr. Schmidt. The quality of womens midlife depression is distinct, too, Dr. Schmidt says, in that it often involves intense anxiety, irritability and sleep problems along with the more typical sadness and loss of pleasure in once-enjoyed activities.

Doctors speculate that antidepressant use among middle-aged women is being driven in part by the reluctance of womenand many of their physiciansin recent decades to use hormone-replacement therapy for menopausal symptoms. In 2002, a large study, the Womens Health Initiative, was stopped after women taking hormone therapy had an increased risk of breast cancer, heart attacks and strokes. Later analyses found that the risks were largely concentrated among women who were older when they started hormone therapy. For women in their 50s, hormone therapy actually reduced the risk of heart disease and death from any cause.

Hormone therapy, either estrogen alone or combined with a progestogen, is the most effective treatment for hot flashes and night sweats, according to the North American Menopause Society and the American College of Obstetricians and Gynecologists. Some research has found that it can also improve mood.

Still, many women and doctors are looking for alternatives. People are so deathly afraid of prescribing hormones," says Stephanie Faubion, medical director of the North American Menopause Society and the director of Mayo Clinic Womens Health. A lot of women, unfortunately, who are going to their doctors because of hot flashes and night sweats are getting slapped on antidepressants."

Research has shown that some antidepressants can ease hot flashes and night sweats. But Dr. Faubion says they are much less effective than hormones. The even higher rates of antidepressant use among women 60 and over may partly result from women being put on them when theyre younger, during this earlier period of mental-health vulnerability, and then being left on them by default, says Dr. Hutner.

This story has been published from a wire agency feed without modifications to the text

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Why so many women in middle age are on antidepressants - Mint

Among patients with diabetes, women are just as likely as men to suffer from sexual dysfunction, but their issues are overlooked, with the narrative focusing mainly on the impact of this issue on men, say experts.

Women with diabetes can experience reduced sexual desire, painful sex, reduced lubrication, and sexual distress, increasing the risk of depression, and such issues often go unnoticed despite treatments being available, said Kirsty Winkley, PhD, diabetes nurse and health psychologist, King's College London, UK.

There is also the "embarrassment factor" on the side of both the healthcare professional and the patient, she said in a session she chaired at the Diabetes UK Professional Conference 2022 this week. Many women with diabetes "wouldn't necessarily know" that their sexual dysfunction "is related to their diabetes," she told Medscape Medical News.

For women, sexual health conversations are "often about contraception and pregnancy," as well as menstrual disorders, genital infections, and hormone replacement therapy. "As healthcare professionals, you're trained to focus on those things, and you're not really considering there might be sexual dysfunction. If women aren't aware that it's related to diabetes, you've got the perfect situation where it goes under the radar."

However, co-chair Debbie Cooke, PhD, health psychologist at the University of Surrey in Guildford, explained that having psychotherapy embedded within the diabetes team and "integrated throughout the whole service" means that the problem can be identifiedand treatment offered.

The issue is that such integration is "very uncommon" and access needs to be improved, Cooke told Medscape Medical News.

Jacqueline Fosbury, psychotherapy lead at Diabetes Care for You, Sussex Community NHS Foundation Trust, said that "intimate activity is clearly beneficial for emotional and physical health," as it is associated with increased oxytocin release, the burning of calories, better immunity, and improved sleep.

Sexual dysfunction is common in people with diabetes, she noted. Poor glycemic control can "damage" blood vessels and nerves, causing reduced blood flow and loss of sensation in sexual organs.

A recent study led by Belgian researchers found that among more than 750 adults with diabetes 36% of men and 33% of women reported sexual dysfunction.

Sexual dysfunction was more common in women with type 1 diabetes, at 36%, compared with 26% for those with type 2 diabetes. The most commonly reported issues were decreased sexual desire, lubrication problems, orgasmic dysfunction, and pain. Body image problems and fear of hypoglycemia also affectsexuality and intimacy, leading to "sexual distress."

Moreover, Fosbury said female sexual dysfunction has been identified as a "major predictor" of depression, she added, which in turn reduces libido.

Treatments for women can include lubricants, local estrogen, and medications that are prescribed off-label such as sildenafil. The same is true of testosterone therapy, which can be used to boost libido.

Next, Trudy Hannington, a psychosexual therapist with Leger Clinic, Doncaster, UK, talked about how to use an integrated approach to address sexuality overall in people with diabetes.

She said this should be seen in a biopsychosocial context, with emphasis on the couple, on sensation and communication, and sexual growth, as well as changes in daily routines.

There should be a move away from "penetrative sex," Hannington said, with the goal being "enjoyment, not orgasm." Pleasure should be facilitated and the opportunities for "performance pressure and/or anxiety" reduced.

She discussed the case of Marie, a 27-year-old woman with type 1 diabetes who had been referred with painful sex and vaginal dryness. Marie had "never experienced orgasm," despite being in a same-sex relationship with Emily.

Marie's treatment involved a sexual growth program, to which Emily was invited, as well as recommendations to use lubricants, vibrators, and to try sildenafil.

Fosbury reiterated that, in men, sexual dysfunction is "readily identified as a complication of diabetes" and is described as "traumatic" and "crucial to well-being." It is also seen as "easy to treat" with medication, such as that for erectile dysfunction.

It is therefore is crucial to talk to women with diabetes about possible sexual dysfunction, and the scene must be set before the appointment to explain that the subject will be broached. In addition, handouts and leaflets should be available for patients in the clinic so they can read about female sexual health and to lower the stigma around discussing it.

"Cultural stereotypes diminish the importance of female sexuality and prevent us from providing equal consideration to the sexual difficulties of our patients," she concluded.

No funding declared. No relevant financial relationships declared.

Diabetes UK Professional Conference 2022. Session: Sexual healing in the diabetes clinic. Presented March 28, 2022.

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Link:
Below the Belt: Sexual Dysfunction Overlooked in Women With Diabetes - Medscape