![“Pearls” for the [Peri-]Menopausally Inclined](https://www.drmichaelgoodman.com/wp-content/uploads/2016/08/Pearls-for-the-Peri-Menopausally-Inclined-760x360.jpg)
- More on Vitamin D
- Less wrinkles, better skin as we age
- Effect of the stress of the menopausal transition on clinical depression
- Armodafinil, a new use for an old medication: Treatment of fatigue associated with menopause
More on Vitamin D
The effect of isolated vitamin D supplementation on the rate of falls and postural balance in postmenopausal women fallers was studied, a randomized, double-blind, placebo-controlled trial study, by L.M. Cangusso, et al. from Sao Paulo, Brazil and published in the March 2016 issue of the journal Menopause. They studied the balance and rate of falls in 180 postmenopausal women aged 50-65 years, evenly divided into 2 groups that received either Vitamin D3 1000 IU supplementation or placebo. The women were studied after 9 months and found that in the treated group, Vitamin D levels rose from a baseline of about 15 to about 27/28 (control group stayed about 14-17.) The occurrence of falls was over 46% higher in the control group. The women who did not receive vitamin D supplementation were 2 times more likely to fall, and experienced greater “sway” and “lateral oscillation.”
This study is yet another in a long list of research showing that a minimum of 1000 IUs of Vitamin D delivers enormous benefits, not only in helping to build new bone, but also in the cardiovascular system (see my blog earlier this year) and now in postural balance and fall prevention. It’s even better to take 2000 IU, and possibly 5000 IU, of this easy-to-obtain and inexpensive supplement.
What’s the take-home message?
Backed by reliable evidence-based research, I recommend Vitamin D supplementation at a dose of 1000-2000 IU minimum daily.
Less wrinkles, better skin as we age
Sanam Hafeez, PsyD, of New York City, writes in BottomLine Personal magazine about the field of psychodermatology and How to Erase Years from Your Face. Psychodermatology is a new, research-based field that shows that chronic stress and other psychological issues, especially when combined with lowered estrogen, can trigger or exacerbate skin changes. These skin changes may be reversible through the use of emotional and other lifestyle changes.
Dr. Hafeez goes on to explain that stress can cause blotches, itching, redness and acne, all of which are inflammatory changes driven by increases in the adrenal hormone cortisol that stress induces. This inflammatory rise causes damage to tissues and capillaries that is readily apparent. Stress also increases blood flow, causing the tiny capillaries under the skin to become engorged. The dark circles that some women notice under their eyes are actually blood vessels that are visible through the skin. Additionally, lack of sleep causes fluids to accumulate under the eyes, making your face appear puffy and tired. Repeated facial expressions such as frowning and worry produce lines that can etch themselves permanently into your face.
Estrogen is largely responsible for the differences in appearance between young women and older ones. Women who are frequently stressed tend to develop dryness and a loss of skin elasticity.
What to Do?
- De-stress as best you can. Take mini-vacations such as a lunchtime walk, listening to a favorite song, or a short meditation to provide a break from stress.
- Avoid sugar in all its forms, including simple carbs, alcohol, highly-processed foods, cake, and cookies.
- Take estrogen supplementation/replacement therapy.
- Drink more water. People who stay hydrated tend to have plumper, younger-looking skin.
Effect of the stress of the menopausal transition on clinical depression
Dr. Jennifer Gordon, PhD. and her colleagues from the Department of Psychiatry at the University of North Carolina, Chapel Hill published an article in the March, 2016 edition of the journal Menopause. It suggests that estradiol (the major estrogen produced by the ovary, and the estrogen found in many of post-menopausal hormone replacement medications) variability may enhance emotional sensitivity to psychosocial stress, and particularly sensitivity to social rejection. Combined with very stressful life events proximate to the menopausal transition, this increased sensitivity may contribute to the development of depressed mood.
The researchers conducted a study of 52 women aged 45-60, and found that greater estradiol variability (as found in the menopausal transition) predicted greater depressive symptoms during the study period — though only in women reporting very stressful life events. They also found that the greater estradiol variability found in women whose estradiol levels were not regulated by replacement therapy had less resilience to the laboratory stressors provided during the 14-month study, and experienced greater feelings of rejection secondary to these stressors.
The evidence continues to accumulate. First it was discovered that the WHI (Women’s Health Initiative) study published in 2002 — which purported to show that estrogen causes breast cancer — was false, as it was the addition of medroxyprogesterone acetate (Provera™) added to the estrogen that slightly increased the rate of breast cancer but that giving women estrogen alone actually slightly decreased breast cancer risk! Then, three separate individual studies showed that if estrogens (especially transdermal- through the skin) were started within the first 7 years — perhaps even in the first decade following cessation of periods — the risk of cardiovascular disease (heart attacks, stroke, etc.) decreased by about 30%. The same was true of risks of cognitive decline and Alzheimer’s disease. Of course it has been well reported that estradiol prevents bone loss and osteoporosis, improves memory, and minimizes the bothersome symptoms of the menopausal transition.
Armodafinil, a new use for an old medication: Treatment of fatigue associated with menopause
A study by Dr. Fremonta Meyer, MD and her colleagues in the Department of Psychiatry at Brigham and Women’s Hospital, the Dana Farber Cancer Institute, and Massachusetts General Hospital in Boston was published in the journal Menopause in February, 2016. It studied the efficacy of the drug armodafinil for improving menopause-related fatigue and quality of life.
Armodafinil (available in this country as Nuvigil™, but available abroad as a generic) is a wakefulness-promoting agent that acts as a central nervous system stimulant. It has previously been FDA-approved for improving wakefulness in narcolepsy and obstructive sleep apnea, with additional efficacy for fatigue associated with HIV/AIDS.
This study investigated the effects of armodafinil on fatigue and quality of life in a population of pre- and post-menopausal women experiencing menopause-linked fatigue. At a dose of 150 mg/day, the investigators found a therapeutic effect of armodafinil on fatigue affecting quality of life, and a potential benefit for other menopause-related symptoms. In the study group of 20 women, fatigue decreased by 58% and physical stress symptoms diminished by 51%. Hot flashes went down 48%, cognitive function improved 59%, depressive symptoms diminished 65%, insomnia diminished 73%, and there was a 57% improvement in excessive sleepiness. Armodafinil appeared to be generally well tolerated; 3 women withdrew from the study for side-effects of jitteriness, headache, and/or hypertension.
I am beginning to use armodafinil in my practice for women who do not wish to take estrogen or who still have fatigue and excessive sleepiness symptoms after starting hormonal therapy.
