Women’s Health Update June 2019
Women’s Health Update June 2019
GENERAL
Effects of regulating intestinal microbiota on anxiety symptoms: A systematic review.Yang B, et al. BMJ Gen Psych, 32:2, 6/2019
Several studies have indicated that gut microbiota can regulate brain function through the gut-brain axis, and dysbiosis of intestinal microbiota has been related to anxiety. This review of probiotic intervention to decrease anxiety found that regulation of intestinal microbiota through supplementation of probiotics or by diet could treat anxiety symptoms, the rate of efficacy was 86%.
Analysis: Studies have been linking unhealthy microbiome to all varieties of health conditions in recent years, mental health among them. The present study contributes to this growing knowledge data that a healthful diet and probiotic supplementation can improve anxiety symptoms, presumably by improving balance in the microbiome.
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FERTILITY
“Age is Just a Number”: How Celebrity-Driven Magazines Misrepresent Fertility at Advanced Reproductive Ages. Willson SF, et al. J Womens Health (Larchmt). 2019 May 2.
This study looked at 416 magazine issues published between 2010 – 2014. 240 celebrities received at least one fertility-related depiction and 56% of those were of advanced maternal age (40+): only two mentions of related obstetrical risks and only 3 were reported to have use artificial reproductive technology. Donor eggs/sperm was not mentioned. The authors concluded that magazine content may be a contributing source to the public's misconceptions about age-related fertility decline.
Analysis: I think this goes without saying, but there is unfortunately a myth that pregnancies in advanced maternal age occur accidentally, without intervention, and free of complications. It just isn’t so for most women. It is a well-known fact that fertility decreases after age 30, further after 35, more still after 40 and rarely occurs without assistance after 44. There are several options to improve fertility as women age, contact me to find out more.
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The association between in utero exposure to stressful life events during pregnancy and male reproductive function in a cohort of 20-year-old offspring: The Raine Study. E.V. Bräuner et al. Human Reproduction, 2019
Stress early in pregnancy, particularly during the first trimester, is associated with reduced sperm counts and lower testosterone levels in adult sons. The stressors included death of a relative/friend, job loss, divorce, pregnancy concerns, marital problems, money issues, among other stresses.On average, compared with men unexposed to maternal stress, those who were exposed to >3 stresses had a 36 percent lower sperm count, 12 percent lower sperm motility, and 11 percent lower blood testosterone levels.
Analysis: We are learning more and more about in utero programming of offspring whether it is from stress, as is the case here, or from abnormal hormone levels, see below in the case of PCOS. We can’t stop stress from occurring, but we can mitigate its effects by seeking supportive counseling, social activity, and in some cases medications. The RESOURCES & REFERRALS tab on www.arcadiawomenswellness.comcan point you to therapists, meditation apps and groups and other local resources.
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Elevated prenatal anti-Müllerian hormone reprograms the fetus and induces polycystic ovary syndrome in adulthood. Tata B, et al. Nat Med. 2018 Jun;24(6):834-846.
The most common cause of female infertility – polycystic ovary syndrome (PCOS) – may be caused by a hormonal imbalance before birth. PCOS affects one in five women, 75% of whom experience fertility issues. The present study in rats suggests PCOS may be triggered before birth by excess exposure in utero anti-Müllerian hormone (AMH). Pregnant women with PCOS have 30% higher levels of AMH than normal and this excess seems to trigger PCOS in the fetus by overstimulating a set of brain cells that raise the level of testosterone. These findings may explain why women with PCOS seem to get pregnant more easily with age since AMH levels decline with age and, in women who start out with high levels, age-related declines may bring them into the normal fertility range.
Analysis: This is a great article that may explain why PCOS seems to be passed from mother to daughter without an apparent genetic link. There is evidence that treatments aimed at decreasing AMH, like metformin, cinnamon, and exercise, might be able to prevent fetal programming for PCOS. This supports the impact of preconception planning & care for women with PCOS.
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Acupuncture performed around the time of embryo transfer: a systematic review and meta-analysis. Smith CA, et al. ReproBiomed Online. 2019 Mar;38(3):364-379.
This systematic review and meta-analysis looked at 20 trials to determine the effect of acupuncture treatment at the time of embryo transfer in IVF compared with sham acupuncture and no treatment controls. The authors found increased pregnancies, live births and reduced miscarriage when acupuncture was compared with no adjunctive control, but not when compared to sham acupuncture.
Analysis: This study points to a common problem in acupuncture research: comparing active needle insertion to “sham” acupuncture often does not show a difference, but when compared to no treatment controls, shows benefit. The possible explanations are multiple: a therapeutic relationship between acupuncturist and patient, “sham” acupuncture being able to activate acupuncture points through pressure, or needling points “unrelated to therapeutic points” can have beneficial effects. Fortunately, this study does support the use of acupuncture, sham or traditional, at the time of embryo transfer when compared to doing nothing and results in more live births and that is likely the most important take-home message.
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The effect of yoga on stress level in infertile women. Kirca N, et al. Perspect Psychiatr Care. 2019 Apr;55(2):319-327.
This study looked at twice weekly yoga intervention x 6 weeks for infertile women receiving fertility clinic at an IVF clinic. The women demonstrated significantly decreased stress associated with fertility treatments.
Analysis: This study supports the use of yoga to decrease stress for women undergoing fertility treatments. Other studies have suggested similarly and correlated these results to dropping cortisol levels and improved fertility outcomes. Since we know that infertility can cause stress and vice versa, yoga appears to be a safe and effective therapy to add. The CLASSES tab on www.arcadiawomenswellness.com will show you the current schedule for yoga classes.
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PERINATAL
Exposure to Maternal Depressive Symptoms in Fetal Life or Childhood and Offspring Brain Development: A Population-Based Imaging Study.Zou R, et al. Am J Psychiatry. 2019 May 6.
Exposure to maternal depressive symptoms in children at 2 months of age was associated with smaller total brain volume whereas maternal depressive symptoms assessed prenatally or in childhood were not.
Analysis: This study indicates that mother’s post-partum mood issues can have a significant impact on baby’s brain development. Several effective treatment strategies are available for women in the postpartum period, from cognitive behavioral therapy to group exercise to meditation to medication. The RESOURCES & REFERRALS tab on www.arcadiawomenswellness.comcan point you to therapists and support groups have an interest in maternal health.
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Role of sleep deprivation in the causation of postpartum obsessive-compulsive disorder.Sharma V. Med Hypotheses. 2019 Jan;122:58-61.
Link between insomnia and perinatal depressive symptoms: A meta-analysis.Emamian F, et al. J Sleep Res. 2019 Apr 14:e12858.
These studies suggest that sleep deprivation may play a critical role in the cause of perinatal depression and postpartum OCD.
Analysis: Adequate sleep continues to be a significant, modifiable factor in perinatal mood and anxiety disorders. Ever effort should be made to improve sleep in pregnant and post-partum women, including sleeping training classes for babies, assistance of family, friends, or paid care givers, cognitive behavioral therapy, meditation, acupuncture and, when needed, medications. The RESOURCES & REFERRALS tab on www.arcadiawomenswellness.comcan point you to local resources like Modern Milk & Matrescence that can help you with sleep support for you and your baby.
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Exercise prevents the adverse effects of maternal obesity on placentalvascularization and fetal growth. Jun SS, et al. The Journal of Physiology, 2019;
This animal study puts forth a possible explanation for the benefits of maternal exercise on fetal development, especially in obese mothers: exercise improves mother’s metabolism & placental function, which prevents the fetus from growing too big. Placental function is impaired due to maternal obesity, which likely alters nutrient and oxygen delivery to the fetus.
Analysis: This study provides a mechanistic explanation for how exercise can directly improve fetal health outcomes. This improvement in fetal development helps to prevent obesity and metabolic diseases later in life in offspring born to obese women. The RESOURCES & REFERRALS tab on www.arcadiawomenswellness.comcan point you to exercise & nutrition resources specifically focused on women’s health.
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PERIMENOPAUSE
Resistance training for hot flushes in perimenopausal women: a randomized controlled trial. Berin E, et al. Maturitas, 5/2019.
15 weeks of resistance training (3 x 45-minute sessions) with six exercises on resistance machines and two using body weight vs control group whose members did not change their physical activity. In the end, the group who did the weight training intervention cut the severity and frequency of hot flashes by nearly half whereas the control group was unchanged.
Analysis: Exercise has many benefits for for all, but postmenopausal women enjoy improved sleep and mood, and decreased heart disease, diabetes, weight, bone loss and cancer, and now reduced hot flashes. . The RESOURCES & REFERRALS tab on www.arcadiawomenswellness.comcan point you to exercise resources specifically focused on women’s health
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Cognitive behavior therapy for menopausal symptoms (CBT-Meno): a randomized controlled trial. Green SM, et al. Menopause, June 2019.
Cognitive behavior therapy (CBT) has previously been proposed as a low-risk treatment for hot flashes, but a new study suggests it may also effectively manage other menopause symptoms, including depression, sleep disturbances, and sexual function and improved lasted for up to 3 months. CBT is a type of psychotherapy that teaches patients how to modify dysfunctional emotions, behaviors, and thoughts and to develop personal coping strategies.
Analysis: While the majority of evidence suggests that low dose hormone replacement therapy can be safely prescribed for symptomatic perimenopausal women, there are those women, notably those with a history of breast cancer, for whom avoidance is best. In these women or those that simply prefer to avoid HRT, CBT is a viable option. The RESOURCES & REFERRALS tab on www.arcadiawomenswellness.comcan point you to therapists that provide CBT and have an interest in women’s health.
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Acupuncture or phy(F)itoestrogens vs. (E)strogen plus progestin on menopausal symptoms. A randomized study. Palma F, et al. Gynecol Endocrinol. 2019 May 29:1-4.
The effect of acupuncture and phytoestrogens on climacteric symptoms was compared to the effect of hormone therapy (HT) with estrogen plus progestin. All 3 interventions had improvements, with all three being similar in quality of life improvements and acupuncture and HT outperforming phytoestrogens in hot flash frequency and intensity.
Analysis: This study is significant in providing evidence that improvement in menopausal symptoms were similar for acupuncture and HT. For women who are looking for alternatives to HT, acupuncture alone or in combination with phytoestrogen appears to be worth a try.
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The synergistic effects of vitamin D and estradiol deficiency on metabolic syndrome in Chinese postmenopausal womam. Jiang X, et al. Menopause. 2019 May
Several previous studies have suggested a possible synergistic effect of vitamin D and calcium (CaD) and estrogen on the cardiovascular disease (CVD) and osteoporosis risk factors. This new study suggests that this combination could help prevent metabolic syndrome, a constellation of conditions that increases the risk of heart disease, stroke, and diabetes in postmenopausal women.
The abdominal obesity and heart disease lead to metabolic syndrome increases as women age and appears to be directly associated with estrogen loss in postmenopausal women leading some researchers to recommend estradiol treatment as a means of preventing heart disease. Vitamin D has been associated with several markers of metabolic syndrome, including obesity, hyperglycemia, insulin resistance, and diabetes and supplementation has been shown to reduce the risk of metabolic syndrome over a 20-year follow-up. In addition, the combination of calcium and vitamin D had been shown to decrease the risk of stroke experienced by some women using synthetic forms of estrogen.
The present study found higher levels of vitamin D and estradiol were associated with improved cholesterol, blood pressure, and glucose levels.
Analysis: The study provides further evidence that calcium, vitamin D, and low-dose estradiol for perimenopausal women could in fact improve many of the health parameters, namely cardiovascular disease and diabetes, most likely to contribute to early morbidity & mortality in women. It should be noted that these therapies should be combined with exercise and proper nutrition to truly improve cardiovascular and metabolic risk factors. Be aware, new evidence has emerged that you can get too much vitamin D with resulting health consequences. Find out your levels before supplementation, or alternately, take 2000IU per day total across all supplements.
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The Burden of Vulvovaginal Atrophy on Women's Daily Living, Rossella E, et al. Menopause, May 2019.
Atrophic vaginitis can cause significant vaginal, vulvar, and urinary symptoms in perimenopausal women with the decrease in estrogen levels and in this study, was confirmed in over 90% of the subjects and symptoms were shown to have a direct association with worsening quality of life.
Analysis: Atrophic vaginal changes in perimenopausal women can start several years before the last menstrual period and can present as urinary symptoms, pain with intercourse, dryness, general discomfort, and infections. This study pointed out, unsurprisingly, that these symptoms can significantly impact a woman’s quality of life. The good new is that most women can benefit from and safely use local therapies like estradiol or DHEA to improve tissue integrity and decrease symptoms without any systemic side effects or risks.
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Relationship between vasomotor symptom improvements and quality of life and sleep outcomes in menopausal women treated with oral, combined 17b-estradiol/progesterone. Mirkin S, et al. Menopause June 2019 26(6)
This study used a combination estradiol/progesterone oral pill to show significant improvements in quality of life and sleep parameters through improvements in hot flash frequency and severity.
Analysis:This study provides further support to the use of bioidentical forms of estrogen & progesterone to eliminate hot flashes and sleep problems in perimenopausal women without significant risks or side effects.