Questions & Answers

The pros and cons of black cohosh

Editor — Fri, 11 May 2007 18:01:00 GMT

Is black cohosh a safe menopausal treatment option?

Black cohosh is an herbal supplement prepared from the roots of a perennial plant native to North America. It is made available in capsule form, liquid extracts, or solid extracts such as pills. Black cohosh has a history of being used by the Native Americans to treat muscle pain, arthritis and colds, but its main use is now among women as it’s been gaining in popularity for its positive effects on menopausal symptoms.

It’s primarily taken to help women cope with hot flashes, vaginal dryness, night sweats and other menopausal symptoms. Black cohosh is believed to ease the symptoms of menopause because it contains phyto-oestrogens. Phyto-oestrogens are chemicals found in the black cohosh plant that bare a similarity to the female sex hormone oestrogen. Black cohosh helps by replacing oestrogens that are no longer being produced by the ovaries in the body during menopause. This can help to regulate the hormones thereby reducing the symptoms of menopause.

Research studies have produced mixed results concerning the benefits of Black Cohosh. While not much is known about the herb, it has been said to help reduce the symptoms of menopause. Some of the benefits of taking Black Cohosh include:

· Less frequent hot flashes

· Reduction in the intensity of hot flashes

· Helps with sleep disturbances

· Reduces perspiration

· Reduces pains associated with headaches

· Helps with mood swings

Of course like any medicines, there are risks associated with taking herbal supplements such as black cohosh and you should familiarize yourself with such risks. The following are some of the cautions that you should consider before taking black cohosh:

· There is no proven scientific research that shows that black cohosh will help reduce menopausal symptoms

· Can cause side effects such as stomach discomfort or headaches

· May not be safe for pregnant women or women who have had breast cancer

· Long term effects of the herb are unknown

· May interfere with blood pressure medications

Most physicians support the use of black cohosh up to a period of six months. However, it’s important to talk to your doctor before starting any herbal remedies to ensure they are being used safely and that they are right for you.

Cyst on labia

Editor — Mon, 23 Apr 2007 14:47:00 GMT

Question:

I have searched the web but the only explanation I can come up with is that I have a sebaceous cyst – I don't think this is the case. I have a cyst on my labia area which is very itchy, sometimes almost unbearable. The doctor didn't seem concerned and gave me a cream that did absolutely nothing. The itching was worse at night but now itches during the day as well (I think because it is a little raw). I am afraid I might scratch too hard, break the skin and get an infection.

Name withheld

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Answer:

Your concerns are valid, and you need a doctor who takes you seriously. Have you stated your concerns strongly? Too often, we allow embarrassment to silence us. This condition will require a medical solution, so tell your doctor what you need, and don’t take cajoling and pleasantries as a substitute for an answer. Can you think of any other industry where NOT solving a problem suffices? It’s time to demand results.

The North American Menopause Society’s Menopause Guidebook, 6th Edition, was a great resource in answering reader questions. We highly recommend downloading this document from their website, menopause.org.

Breast cancer and menopause relief

Editor — Mon, 23 Apr 2007 14:46:00 GMT

Question:

I had breast cancer 10 years ago. It was low grade, but I was told by my doctor that I was not able to take anything for my menopause. I have hot flashes bad. What can I do to help me with this?

Name withheld

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Answer:

Lifestyle changes may help. Make yourself aware of physical triggers, such as spicy foods. Make sure your bedroom is cool, and that you have layers during the day you can quickly remove. Regular exercise can help. And when a hot flash starts, practice keeping your breathing, slow, deep and controlled.

Question about Premarin in low doses

Editor — Mon, 23 Apr 2007 14:44:00 GMT

Question:

I am 67 and had been on premarin for at least 14 years when advised to go off by my doctor. I tried for six months, but had severe flushes, trouble sleeping and concentrating, and was tired most the time. Went back on premarin at a low dose which did the trick. I tried to go off again a year ago, and went back to feeling terrible again. My question is, have any studies been done on taking premarin in low doses for long periods of time and the dangers of it? I would like to go back on it; my doctor says he isn't concerned because of it being a low dosage. (I have tried herbal substitutes and creams but they didn’t help.

Name withheld

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Answer:

All HRTs have their risks and benefits. It sounds like you should follow your doctor’s advice. That said, no physician should ask you to be a blind follower. There are health risks associated with premarin and your doctor should explain what factors s/he’s weighing in determining that taking it is worth the risk. To do some research on your own, Google “women’s health initiative.”

Vaginal cream recommendation

Editor — Mon, 23 Apr 2007 14:43:00 GMT

Question:

My name is Dawn. I am 57, and I’m post-menopausal. I have vaginal atrophy and have been inserting vagifem tablets. To start with, they seemed to be working, but I now find that my vagina is burning and uncomfortable most of the time. I had a posterior repair done four months ago, and have had constant problems with vaginal atrophy ever since. Can you recommend some type of vaginal cream and could I have got this problem due to the operation? I hope some other woman with the same problem can give me some advice, as I don’t seem to get much satisfaction from doctors.

Name withheld

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Answer:

One of the things patients rarely do is say to their doctors: “I’m not happy with the treatment I am receiving.” People are intimidated by physicians and they shouldn’t be. Tell your doctor that the treatment s/he’s recommending isn’t working, that you’re sick of leaving the doctor’s office feeling like nothing’s been accomplished, and that you want a solution to your problem, not more months of uncertainty punctuated by periodic, useless checkups. This kind of confrontational approach can sometimes be easier with a new physician. You can set the stage in the very first appointment: “The reason I am here is because I was completely unhappy with the treatment I received from my last physician. I felt like s/he wasn’t solution-oriented. These are my problems and I want them solved now, not 12 months from now.”

Perimenopause side effects

Editor — Mon, 23 Apr 2007 14:42:00 GMT

Question:

I'm 51. I have always had regular periods – every 28 days. This year, I skipped a period in March. I then got my period [every month] from April to June. I have not received my period since. I know that I am going through my changes. I have been getting hot flashes.

Lately, I have been feeling breathless and my chest hurts. I had a physical and was told that my heart is fine. I would like to know if feeling breathless is another sign of menopause.

Bernice

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Answer:

The feelings you are describing sound like they are within the range of normal perimenopause side effects. That said, chest pains should never be casually dismissed. It would be a good idea for you to have another checkup and confirm that what you are experiencing is related to the approach of menopause.

Burning in groin

Editor — Mon, 23 Apr 2007 14:40:00 GMT

Question:

I had a hysterectomy at 29 years old, but was left with my ovaries. I do not know if I ever went through menopause, but I am now 51 years old. The past three weeks I have been experiencing a burning sensation in the left groin area. It is not painful, just constant, and annoying. Is this anything like having a hot flash?

Claudia

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Answer:

It may be. Having your uterus removed doesn’t immediately trigger menopause, although women who’ve had a partial hysterectomy sometimes start menopause a few years earlier than other women. What you are describing may be a symptom of menopause, but it could be something else. You should make an appointment with your doctor.

Menopause Clinic

Editor — Mon, 23 Apr 2007 14:39:00 GMT

Question:

Is there a clinic [specializing in menopause] in northern California?

Name withheld

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Answer:

Contact the Alexander Foundation for Women’s Health (contact@afwh.org), in Berkeley. There’s also the Menopause Clinic in Berkeley, at 510/848-6004, or you can reach the East Bay Menopause Clinic at 510/450-1148.

When will I be finished menopause?

Editor — Mon, 23 Apr 2007 14:37:00 GMT

Question:

When are you completely finished with menopause?

Name withheld

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Answer:

A good rule of thumb is 24 months after your last period, but it varies.

How long will this last?

Editor — Mon, 23 Apr 2007 14:36:00 GMT

Question:

How long does menopause last?

Lucy

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Answer:

Perimenopause can last six years or more. Actual menopause is simply the exact point at which the ovaries stop producing eggs, generally determined by going 12 months without experiencing a period, after which perimenopause may continue for another year, give or take.

Androgen treatments

Editor — Mon, 23 Apr 2007 14:33:00 GMT

Question:

I had a hysterectomy in 2000. I was 40 years old at the time. I have no sex drive at all, but I am also on opioids for back pain. Would that affect my sex drive? What kind of medication would you suggest to increase libido.

Jewels

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Answer:

There are androgen treatments that might help with your low libido, but they are not without side effects. You’ll need to talk to your doctor about these prescription medicines. Lifestyle changes may also help – getting more active (pursued cautiously, this avenue might help your back, too), improving eating or developing more intimacy with your partner.

Menopause and cognitive decline

Editor — Mon, 23 Apr 2007 14:32:00 GMT

Question:

I am 55 years old and feel that I am experiencing some degree of cognitive decline, loss of initiative, and some degree of apathy. Will this go away? What can I do?

Name withheld

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Answer:

You’ve asked a lot in three short sentences. Your feelings could be related to menopause, but they could also have other sources, including psychiatric, social and lifestyle. There are lots of things you can do: see a doctor and find out if there’s a medical answer; eat better, exercise, get to bed earlier, quit smoking and cut back on alcohol; join a club, start a new hobby, set goals for next week, next season and next year; challenge your brain by taking a university class, learning a new language, starting to play a musical instrument. And lastly, identify sources of dissatisfaction in your life, and work to resolve them. Don’t let apathy hold you back: apathy is a state of mind; you can be mentally apathetic but still physically active; by forcing yourself to take action, regardless of your mental state, you may find that your mind eventually takes pleasure in what you force yourself to do. One thing is clear: if you feel stalled, adding new input into the equation is a good way to prompt a positive change; so stop recycling the same negative thought patterns and, instead, see what happens when you go for a bike ride, head out to the movies, or read a book on a subject you’ve never thought about before. Don’t let inertia win. Do something even if you don’t want to do something.

Low sex drive and depression

Editor — Mon, 23 Apr 2007 14:31:00 GMT

Question:

My wife is almost 48. She is in great physical condition. We had a great relationship until a few months ago. She says she has not started menopause yet and won't for a few more years. However, she seems to be having multiple periods and also seems depressed. Her sex drive seems, at least to me, to be a lot lower. She seems more intolerant of me, et cetera. Could she be going into menopause?

Neil

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Answer:

Yes. The symptoms you are describing are common in women experiencing perimenopause, which is the period that precedes menopause by as much as five years, and can follow menopause for another year.

Do I need to practice safe sex?

Editor — Mon, 23 Apr 2007 14:29:00 GMT

Question:

I have not had a period for 22 months. Do I need to worry about contraception?

Name withheld

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Answer:

Probably not. Generally, you are said to have passed menopause when you haven’t had a period for 12 months. That said, unlikely incidents do occasionally occur. The only way to know absolutely is to have a checkup.

My tubes are tied - am I in menopause?

Editor — Mon, 23 Apr 2007 14:28:00 GMT

Question:

Do you go through menopause when you tie your tubes? I’ve heard yes and no on this question.

Rima

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Answer:

The only medical procedure that is guaranteed to instigate menopause is having your ovaries removed, or having medical treatments – radiation, for example – that cause your ovaries to stop functioning. Having your tubes tied will prevent eggs from entering the uterus, but won’t stop the ovaries from producing hormones.