Search for tag: "estrogen"

Interviewer: Is hormonal therapy a good treatment option for menopause symptoms? Dr. Kirtly Jones, what's your advice?

Dr. Jones: For the two main symptoms of menopause, hot flashes and dryness, estrogen is the best therapy. The new North American Menopause Society guidelines outline the importance of individualizing therapy for each woman, looking at the options, discussing the symptoms, and the patient's own biology.

There are few, if any, absolute contraindications to hormonal therapy. It's all a risk/benefit discussion. Be prepared for your visit with your doctor. What are your symptoms? How much do they bother you? What is your medical history, and what are your fears and concerns and hopes? Coming prepared will help you and your clinician focus on your needs.

updated: June 11, 2021
originally published: June 19, 2019

Interviewer: Puberty's over, but you still have acne. Is this normal? We'll find out next on The Scope.

Announcer: Questions every woman wonders about her health, body, and mind. This is, Am I Normal? On, The Scope.

Interviewer: I'm here today with Dr. Kirtly Parker Jones, she's the expert on all things woman. Dr. Jones, I have one question that's on my mind. I feel like it's on the mind of a lot of other women. My teenage years are over, I'm supposed to be done with acne, but I still have them. First of all, why is acne happening, and is it a normal thing?

Dr. Jones: It's important for the listener to understand, I'm not a dermatologist. I am a reproductive endocrinologist, so I am a ladies hormone doctor. Acne is related to hormones. So what happens is that your skin makes oils, and the little hair follicles that you have on your face make oils. But when you go through puberty, both men and women start making more male hormones which actually start to make more oils in the skin. Female hormones are also made at the same time, but the oils of the skin then can get infected a little or build up, and that's how you get acne.

So when you're young, and a young male or a young female, your hormones are high, right? Every mother knows that, every teen knows that. And not everyone gets acne, but people who are predisposed to this who have certain kinds of genes, or who have certain kinds of bacteria in their skin, can get acne. Acne's very common in adolescence. So you say, okay fine, your hormones are kind of wacky the first couple years of your periods, but then they settle down and you think "Why do I still have acne?"

Well certainly there are some people who have acne all their life, and those people should see a dermatologist if it's severe acne with big bumps that are very painful and get infected, because there's medication that can calm down your skin. Many young women know, that when they go on the pill for contraception and actually can go on the pill just for their skin, that many of the new pills can calm down the male hormones, and it can significantly improve their skin.

However for women to continue to have significant acne after the first rocking and rolling years of adolescence, they may actually have a hormone problem. Particularly women who also have irregular periods. So there is a condition called polycystic ovary syndrome, about 1 in 20 women have this. It's associated with irregular periods. Eggs that kind of get stuck in development in the ovaries and so they don't grow and ovulate, so their periods are irregular, and these little eggs, these little follicles that make the eggs make male hormones. So women with this condition often have irregular periods and persistent acne. So this may carry on, and it's worthwhile talking to your clinician about it, because in fact, there are things that can make your face better. So that's the good news.

Interviewer: If it's related to hormones, do I have to see a dermatologist then?

Dr. Jones: I think if it's something which isn't the most severe kind of what we call cystic acne, that's going to take a medication that only dermatologists prescribe. It's not uncommon, particularly during the early teenage years, when women have acne and they have irregular periods. For their moms to bring them in maybe for their very first visit to the gynecologist and say, "You know gosh she's got acne, and she has irregular periods and I had that when I was a teen and I went on pills and my face just cleared up beautifully." I say "Great. If it's the right thing for your daughter, we can do that now." So that's an appropriate choice.

Interviewer: So what I'm hearing is, your hormones are kind of out of whack during your teenage years and that's the main reason why young girls and guys get acne. But then what happens when you grow older say in your 20s or 30s, even into your 40s and 50s and you still have acne, is it still because of your hormones?

Dr. Jones: Well it's still hormones in the sense that it's still hormones that are active in your face. However, everybody makes hormones during the reproductive years and men continue to make hormones all their life. So the question is, if you have continued to may have acne after adolescence, then it's worth seeing a dermatologist or and a gynecologist, who can sometimes work together to come up with the right hormone package for you, and the right anti-acne package for you. So here's, here's the other thing. So just as hormones are a little bit wacky at the beginning of reproductive life, they get that way at the end too. And about 10% of women going through menopause get acne again.

Interviewer: Wait you get acne during menopause, is this a Dr. Kirtly Jones problem, or is this still a dermatologist problem?

Dr. Jones: So if you get acne after, when you're going through menopause, it's probably both, in a sense that for certainly menopause women are at the age when they want the dermatologist to look at their skin so they can get a skin check. But a skin check by dermatologists is often just an excuse for someone to say, "Oh I have acne, my skin's not great, but can you look at these wrinkles right here, what can I do about that?" '

In fact, the transition into the perimenopause can cause acne again, because women's hormones are a little disrupted. Again, women may actually stop making as many ovulations, they may make a little bit more male hormones. The other important thing is the dermatologist can separate what is acne from what's rosacea.

Interviewer: Okay.

Dr. Jones: So there's another condition of the skin common in women of menopausal years that can look like acne in that it's red and it's bumpy.

Interviewer: It's not.

Dr. Jones: But it's not. You don't treat it the same way. Now, for women who are going through menopause who get acne, the good news is, as they get older, the ovaries stop working entirely and in general it gets better. The other news is that some women who go on hormone replacement therapy, estrogen and progesterone or estrogen alone if they don't have a uterus, they often notice that their skin gets a little bit better because they're balancing things out a little bit.

So, A, your dermatologist can help differentiate what's acne from what's rosacea, a bumpy condition where your skin gets quite red, and it gets a lot redder when you have hot flashes. That's no fun. And they can make that difference and they can help guide you in terms of what might be the best therapy. And ladies, I've never seen a 70-year-old with acne so good news from that.

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Dr. Jones: Listen up, this is for ladies only. Gentlemen, kids, adolescents, go listen to stuff that is just for you. We're going to talk to ladies about vaginal dryness and pain after menopause. This is Dr. Kirtly Jones from Obstetrics and Gynecology at University Utah Healthcare and this is The Scope. Guys, change the channel. Ladies, plug in your earphones.

Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: There are many reasons why women are less interested in an intimate sexual relationship with intercourse after menopause, but one of the most common is that sex hurts. Menopause marks the end of significant production of estrogen by the ovaries. Estrogen production is linked to egg production, so it's a pretty good thing that we stop being fertile when we get to our 50s.

One of the prime targets of estrogen is the uterus, and after menopause the uterus gets smaller and the lining gets thinner and that's a good thing. That means there's less bleeding and cramping, in fact, if it goes as it should, no bleeding and cramping. However, the uterus is just part of the reproductive tract. Reproductive tract starts at the beginning of the vagina and those tissues get thin as well and sometimes they become very thin. They stop making as much fluids and the lining of the vagina can be painful and even bleed with intercourse. It only has to hurt a couple times and then women aren't so interested anymore. So what can be done about this?

First, how common is this? In a study reported in a menopause journal, 4,200 post menopausal women from Sweden, Finland, the U.K., Canada and the U.S. were surveyed about their symptoms and their knowledge. Thirty-four percent of Canadian women experienced symptoms with vaginal thinning and 43% of women in the U.S. noted symptoms, and two-thirds of them noted that the symptoms were severe and had a significant affect on their quality of life. That's a lot of ladies.

Fifty-one percent of American women didn't know that there was a local treatment for this problem, and 63% of women with symptoms had never been treated, but 67 of those who were treated had an improvement in their symptoms.

So what treatments are out there? Well, first, there's ordinary over the counter lubricants, slippery stuff. For some women, that's enough and it is safe and inexpensive. It's made by the same material that doctors use to make an internal exam more comfortable for women.

Second and most importantly, probably, is estrogen. Estrogen can be applied locally to the vagina twice a week in the form of pills or creams and this is very effective for the majority of women. There are many different ways to apply this local estrogen to the vagina. The dose is tiny and a recent study of half a million women in the Kaiser Healthcare system were studied to see if vaginal estrogens increased the risk of uterine cancer. They compared women who filled prescriptions for vaginal estrogens with women who didn't and the rates of uterine cancer were no different.

Women with a history of breast cancer are never supposed to use estrogens and they suffer, but there's no evidence that low dose estrogens increased the risk of breast cancer. Vaginal estrogen for women who've had breast cancer is controversial, but vaginal estrogen therapy's been used for decades for post menopausal vaginal thinning and pain with a terrific safety profile.

Third, DHEA, this is a weak adrenal male hormone that can be placed in the vagina and that can increase vaginal thickness and decrease pain. The trade name is Prasterone.

Fourth, Ospemifene, the brand name is Osphena. This is a pill that can be taken orally that isn't exactly an estrogen, but it does increase the thickness of the vagina and decrease pain.

So, why don't women get treated? I think we're in sort of a "don't ask, don't tell" situation here. Post menopausal women may not bring up the subject of pain within sex and doctors don't ask, but if there's evidence that sex is part of healthy aging, then doctors should ask and they should know the safety and effectiveness of treatments and, ladies, you should speak up. Sex doesn't have to be painful.

Now you can unplug your earphones and thanks for joining us on The Scope.

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Interviewer: Can men get breast cancer? Turns out the answer is yes. Find out more about that next on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Ginger Johnson is the president of GetScreenedUtah.com. Mainly, you're an advocate for women getting screened for breast cancer, but I was surprised when you said that I actually could be at risk for breast cancer. How common is that?

Ginger: It's not very common, but it is possible. Men are a little bit different. Their lifetime risk of getting breast cancer is about 1 in 1,000. But the interesting thing is that a lot of guys aren't even aware that if they have a family member, a blood relative that has breast cancer that their chances of getting that actually increase. And so it's very important for guys to be aware that they have pecs. Those pec muscles can also have fatty tissue over them, that is breast tissue. And that tissue can be susceptible to disease, just like a woman's breast can be susceptible to disease.

Interviewer: So, as a man, if I tend to be a little bit heavier and have more fatty tissue, does that increase my risk?

Ginger: Fat is an interesting thing because fat tends to hold onto hormones. And so those hormones can actually trigger different kinds of cancer in your lifetime. That's why women are tested if they're estrogen or progesterone positive or negative when they get a diagnosis of breast cancer. But what we're finding is that guys aren't aware that if they have a lump on their chest, they just kind of blow it off. They won't go and say, "Hey, is this something that I need to look at?" Because they don't have the knowledge to even think, "Oh, this might be breast cancer," because it's such a foreign idea to them.

Interviewer: Yeah. It's fairly rare. Not a lot of guys are diagnosed with it, right?

Ginger: Not a lot of guys are. It's 100 times less common among men than among women. But, what we're seeing is that there are still about 2,000 new cases of invasive breast cancer that are going to be diagnosed this year.

Interviewer: So I'm sure you noticed that I started checking myself . . .

Ginger: You did.

Interviewer: Right?

Ginger: That's okay.

Interviewer: So is that what a guy should do? Is it, you're looking for a lump?

Ginger: Breast cancer can show up in a lot of different ways. There are actually 12 different ways that it can show up beside a lump. A lump, of course, is something that is very easy to see. You can feel it. But, it doesn't have to be a big lump. It can just be something small, like a pinhead, even, that's hard and immovable. If you think about breast tissue as, maybe, like a lemon. There's a great campaign on WorldWideBreastCancer.com that actually shows lemons. And, this is a great way for guys to really . . . that this can be, too. But, in their analogy of a lemon, you're looking for a bad seed. So it's going to be hard. It's going to be immovable.

It's going to be something that you go, "Oh, this, this isn't soft," like a bean, or something squishy, which could be fat tissue, or even a lymph node. This is actually hard and immovable.

Other symptoms, though, could be redness on the skin, itchiness that does not go away, hotness. If you feel like you're seeing erosion on the skin, or if your skin is starting to invert or look like an orange peel. There are a lot of different changes that can happen on skin. This is for men and women.

Interviewer: Okay.

Ginger: But, a lot of times guys don't get this education.

Interviewer: Yeah. Sure. I never would have thought that a rash could be something like male breast cancer.

Ginger: If it doesn't go away, it's always best, if it doesn't go away, if it stays consistent over the course of a couple of weeks, go in and get it checked. Just go so you can know and figure out what it is. Because, you definitely want to find it before you feel it.

Interviewer: So, are you recommending guys do self-exams? Are you recommending that they just be aware?

Ginger: I would say I would be aware. Because you are less at risk, I would just say, "Be aware of your tissue."

Interviewer: Okay.

Ginger: Be aware of your body. I would, honestly, talk to your doctor. I mean, guys don't often go into the doctor, we know how that is. But, if you're going to go in and talk to your doctor, and if you do have a family history of a mom, or a sister, an aunt, somebody in your family, just say, "Hey, Doc, what is this? Tell me what you know." Now, if the doctor you go to does not know, then you're going to want to do some research on your own because oftentimes doctors, themselves, we love them, they do as much as they can with the knowledge they have, but sometimes they might not have the knowledge for you. So you might need to get a second opinion.

Interviewer: Yeah. It might not necessarily even be on the radar . . .

Ginger: It's true.

Interviewer: Because it is, it does happen, but it is somewhat rare.

Ginger: It's true.

Interviewer: So, do guys then get mammograms, at that point? Just like a woman would?

Ginger: They would. They would have to go in . . .

Interviewer: Really?

Ginger: And have, have some kind of a mammogram, a ìMan-o-gramî if you will. But, they might do an ultrasound. There might be some other things that they're going to do for you. But there have been gentlemen that I know that have actually had mastectomies, where they've had to have that tissue removed. Now, it seems foreign to a guy to do that. But, they've actually had to go in and remove that breast tissue that is over the muscles so that they can remove any disease from that person.

Interviewer: All right. Any final . . . I don't know what else to ask at this point, other than, I'm going to start paying attention. And if I see something that's not going away, or feel any weird lumps, I'll talk to my doctor. And I'll know that if my doctor is, "What?" then I need to, perhaps educate myself. Anything beyond that?

Ginger: That's . . .

Interviewer: As a man?

Ginger: That's the best thing, and to realize, guys, how much influence you have in the women in your life. I don't think guys realize that the influence they have to say, "Hey, women, this is something that we all need to be concerned about. If I can get it, then obviously you can get it. Go in and get your mammogram." That's something they recommend for women, age 40 and over, to start with that baseline, and go regularly thereafter.

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