Health24.com | Experts offer guidance on a common but underreported menopause syndrome

  • Genitourinary syndrome of menopause includes vaginal dryness, painful sex and painful urination
  • This affects most postmenopausal women
  • It’s best to try over-the-counter products first as prescription medicines can be costly

Hot flashes and night sweats are well-known side effects of menopause, but the end of a woman’s periods can also lead to other uncomfortable changes.

Vaginal dryness, painful sex and painful urination are common symptoms of genitourinary syndrome of menopause, or GSM. Estimates vary, but most research suggests that a majority of postmenopausal women are affected. It can significantly impair health, sexual function and quality of life.

But women experiencing these symptoms may not know why they’re happening or that treatments are available. In recent years, new therapies have been approved, and the North American Menopause Society (NAMS) has now published new treatment recommendations after reviewing those therapies.

Best to ‘start simple’

Deciding which to use starts by “knowing what you’re treating,” said Dr Anne Ford, an obstetrician-gynaecologist at Duke University Medical Center in Durham, North Carolina.

When counselling her patients, Ford recommends “starting simple, and then getting more complex”, which dovetails with the NAMS guidelines.

NAMS recommends over-the-counter products like moisturisers and lubricants first. If these options don’t help, prescription therapies can deliver oestrogen or other hormones directly to the vagina in the form of creams, rings, tablets and inserts.

Oral oestrogen therapy can be considered if vaginal symptoms are accompanied by debilitating side effects, such as hot flashes and insomnia. Still, the potential health risks associated with hormone therapy make it a backup option, NAMS says.

GSM used to be called vulvovaginal atrophy, to describe when tissues outside and inside the vagina become thinner, drier and less flexible due to less oestrogen. The new moniker GSM “acknowledges that the symptoms were more than just vaginal and that they really included urinary symptoms”, said Dr Stephanie Faubion, medical director for NAMS.

Pain during sex

Adding the word menopause served to help women who didn’t recognise that these symptoms were related, she added.

While pain during sex is a common complaint, Faubion said the idea that the condition only affects sex is a misconception.

“We’re talking about this not just in the context of sex, but in the context of women being comfortable,” Faubion said. For example, wiping with toilet paper or wearing jeans can bring pain.

Ford explained that when NAMS recommends starting with “simple” treatments, it is referring to over-the-counter moisturisers and lubricants. If the discomfort is mostly external, moisturisers can be applied to the vulva. “Moisturisers aren’t really made for sex. They’re made for if people have discomfort in their day-to-day life due to the dryness,” she noted.

Prescription treatments expensive

For women who are experiencing pain during sex, over-the-counter lubricants can provide relief, Ford added.

Prescription treatments can be costly and may not be covered by insurance, which is why women are urged to try over-the-counter remedies first.

But sometimes these products don’t do enough. The symptoms of dryness and pain are side effects of the vaginal tissues thinning and losing elasticity, and only hormonal therapies can treat the problem itself.

“If we get to the point where I think a prescription-based product is indicated, then I talk to the patient about their preferences and go over all the different kinds of products that are available,” Ford said. “There are creams, rings, vaginal inserts and suppositories, and there’s now a tablet – the ospemifene tablet.”

Oestrogen delivered vaginally provides sufficient hormone to relieve symptoms and is preferred over more aggressive oestrogen treatment when the symptoms are centralised in the vaginal area, according to the NAMS recommendations.

Vaginal oestrogen products are typically low-dose. Some, such as the DHEA vaginal insert, are not specifically oestrogen-based, but work by increasing certain hormone levels.

Systemic hormone therapy

“If the patient really has pain on the inside of the vagina, then anything that you put in the vagina will help that – whether it’s the ring, the cream or the inserts – all of that stuff will probably help the internal discomfort,” Ford said.

The oral drug, ospemifene (Osphena, Senshio), is approved to treat vaginal dryness and painful sex. Due to potential health risks, including endometrial cancer, all other systemic oestrogen therapies are only recommended if additional menopause-related symptoms are present.

“If I had somebody who came in and said that they weren’t sleeping because they were having 20 hot flashes at night, they were irritable, their depression was getting worse, and it was so horrible that they just couldn’t live like this – and they had vaginal pain – that’s somebody who would try systemic hormone therapy,” Ford said.

Energy-based devices, including lasers, may one day be added to the treatment arsenal. Lasers are thought to work by inducing collagen production, thereby thickening the skin.

But, Faubion said, “While initial results are really promising, we still await the longer-term studies to make sure that these are safe and effective for women over the long haul.”

The new NAMS position statement was published online in the September issue of Menopause: The Journal of The North American Menopause Society.

Image credit: iStock

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Hancock: Follow Covid rules or they will get tougher

The warning comes as people in England who refuse an order to self-isolate could be fined up to £10,000.

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Refining Your Personal Growth Palate

When you’re on a path of personal growth, it’s to be expected that you’ll eventually outgrow some lenses or tools that you used in the past, even if they were useful and effective. Your goals and interests may change, and other tools may become more useful to you. You may also integrate some practices well enough that you no longer have to think about using them as separate tools.

Be careful about treating lenses as laws or beliefs, and be especially cautious to avoid wrapping them into your identity. That gets people stuck a lot. Treat lenses as tools that you can pick up and experiment with and then put down afterwards. You needn’t weave a lens into your identity.

As I mentioned in yesterday’s post, for instance, I don’t use the lens of attraction much these days. It’s fair to say that I’ve outgrown it. I still think it’s a useful lens, but it’s not sophisticated or nuanced enough for my current interests. To use that lens now would be like using an old spiral-bound Thomas Guide to navigate by car. Those guides were great when I was in high school and college, but we have more sophisticated navigational tools available today.

Another lens that feels like it ran its course was looking for activities that scared me and then doing them. That lens can be very useful in creating growth experiences, but “do what you fear” is a rather blunt instrument. It works wonderfully for basic courage training, but when timidity isn’t a significant problem anymore, it’s probably best to switch to other tools.

One reason to switch to more sophisticated lenses is when you’ve already integrated a lot of useful mindsets and behaviors, and you want to up your game. The same tools that got you started won’t necessarily be the same tools you’ll use for ongoing improvement.

Another reason to switch tools is when you’re able to get some results with your old tools, but they’re not taking you all the way to your goals. For instance, maybe you’re pretty good at getting dates, but you’re still not getting the kind of relationship you really want. Maybe it’s time to graduate from your old mindsets and behaviors and explore more sophisticated tools.

Remember that you’re a flexible person. You can always keep learning and growing. If you’re still using the same mindsets and behaviors that you were using five years ago, why are you still stuck in the past? Perhaps it’s time to upgrade your tools and refine your palate.

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Covid: PM considering new restrictions amid second coronavirus wave

Options include a ban on households mixing in England, as a further 4,422 UK cases are confirmed.

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Cancer taskforce aims to reduce patient backlog

Patients say they have missed out on face-to-face examinations and appointments.

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Health24.com | Probiotic might help ease children’s eczema

  • Not all eczema treatments can be given to young children
  • In a study, a topical probiotic against eczema was tested on children, with good results
  • This fits in with evidence that eczema involves an imbalance in the skin’s microbiome

Applying a type of “good” bacteria to the skin may relieve children of the itch and discomfort of eczema, a new, small study suggests.

Eczema is a chronic inflammatory condition that causes dry, itchy skin and scaly rashes. It usually starts in early childhood, and commonly occurs along with allergies like hay fever and asthma, according to the American Academy of Allergy, Asthma and Immunology.

There are numerous treatments for eczema, both topical and oral, but not all can be given to young kids.

“So, there’s a big need for safe and effective treatments for young children,” said study author Dr Ian Myles. He is a researcher and staff clinician with the US National Institute of Allergy and Infectious Diseases.

Imbalance in microbiome

For the study, his team tested a topical probiotic against eczema in 20 children as young as three years of age. Over four months, 17 of the 20 saw their rashes and itchiness fade by more than 50%.

The children were also able to cut down on topical corticosteroids, a standard treatment for eczema – but one that can cause side effects like thinning of the skin and stretch marks.

The probiotic therapy is a spray solution containing live Roseomonas mucosa bacteria. Those microbes are normally present on the skin, and past research has found that R. mucosa from people with healthy skin can treat eczema in lab mice.

In contrast, samples of the bacteria from people with eczema either had no effect, or made the skin condition worse.

It all fits with evidence that eczema involves an imbalance in the skin’s microbiome. That refers to the vast array of bacteria and other microbes that naturally dwell on the skin and help maintain its health.

Staph infections

The skin, Myles explained, has to repair itself from daily wear-and-tear, and the microbiome assists in that. He said R. mucosa appears to produce oils that aid the skin’s repair capacity.

The treatment also reduced staph bacteria on the children’s skin, and those microbes can worsen eczema symptoms.

Dr John Browning, a paediatric dermatologist, said, “I think this is a really interesting study.” Browning was not involved in the research.

He said people with eczema often get staph infections and need antibiotic treatment. It’s possible R. mucosa could be an alternative, according to Browning, who is based at Children’s Hospital of San Antonio and Texas Dermatology and Laser Specialists.

The findings, published online on 9 September in the journal Science Translational Medicine, are based on 20 children and teenagers who were given the probiotic therapy for four months. They (or their parents) applied the spray solution twice a week for three months, and then every other day for the final month.

Lasting benefits

On average, Myles said, the kids’ itchiness and rash improved by 60% to 75%, with no significant side effects.

And there were signs it could have lasting benefits. Eight months after the therapy was stopped, the good bacteria were still colonising the children’s skin – indicating R. mucosa had “moved in,” Myles explained.

That, he said, suggests the therapy could be one time only. It would still be possible, though, that whatever caused the bacterial imbalance in the skin could do it again.

Myles said a broader goal is to figure out what those factors are – with diet, soaps and antibiotics being among the suspects.

Browning is part of another trial testing R. mucosa for treating eczema. But he does not think it is the only bacterium that matters.

Further development

“There could be a lot of variability patient to patient in whether this approach would be helpful,” Browning said.

Myles agreed, noting that not all study patients responded to the probiotic.

It’s unclear when the R. mucosa therapy could become commercially available. The US National Institutes of Health has licensed it to a private company, Forte Biosciences, to further develop.

Myles said the company worked to freeze-dry the probiotic so it can be reconstituted with water, then sprayed on. That will make it shelf-stable.

“We anticipate this being something you can pick up at the pharmacy,” he said.

Image credit: iStock

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Coronavirus: Teacher writes about ‘horrendous’ Covid-19 battle

After six weeks in hospital, recalling every Covid-19 memory has helped one patient.

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Defying a 150-year-old rule for phase behavior

Frozen water can take on up to three forms at the same time when it melts: liquid, ice and gas. This principle, which states that many substances can occur in up to three phases simultaneously, was explained 150 years ago by the Gibbs phase rule. Today, researchers from Eindhoven University of Technology and University Paris-Saclay are defying this classical theory, with proof of a five-phase equilibrium, something that many scholars considered impossible. This new knowledge yields useful insights for industries that work with complex mixtures, such as in the production of mayonnaise, paint or LCD’s. The researchers have published their results in the journal Physical Review Letters.

The founder of contemporary thermodynamics and physical chemistry is the American physicist Josiah Willard Gibbs. In the 1870s he derived the phase rule, which describes the maximum number of different phases a substance or mixture of substances can assume simultaneously. For pure substances, the Gibbs Phase Rule predicts a maximum of 3 phases.

Professor Remco Tuinier, of the Institute for Complex Molecular Systems: “At the time, Einstein called Gibbs’ thermodynamics the only theory he really trusted. If we take water as an example, there is one point, with a specific temperature and pressure, where water occurs as gas, liquid and ice at the same time. The so-called triple point.” Assistant professor Mark Vis, from the same research group as Tuinier, adds: “This classic Gibbs phase rule is as solid as a rock and has never been defied.”

SHAPE MATTERS According to this phase rule, the mixture studied by the researchers would also exhibit a maximum of three phases at one specific point at the same time. But Tuinier and his colleagues now show that in this mixture there is a whole series of circumstances in which four phases exist at the same time. There is even one point at which there are five coexisting phases. Two too many, according to Gibbs. At that specific one point, also called a five-phase equilibrium, a gas phase, two liquid crystal phases, and two solid phases with ‘ordinary’ crystals exist simultaneously. And that has never been seen before. “This is the first time that the famous Gibbs rule has been broken,” Vis says enthusiastically.

The crux lies in the shape of the particles in the mixture. Gibbs did not take this into consideration, but the Eindhoven scientists now show that it is precisely the specific length and diameter of the particles that play a major role. Tuinier: “In addition to the known variables of temperature and pressure, you get two additional variables: the length of the particle in relation to its diameter, and the diameter of the particle in relation to the diameter of other particles in the solution.”

RANKED RODS

In their theoretical models, the researchers worked with a mixture of two substances in a background solvent: rods and polymers. This is also called a colloidal system, in which the particles are solid and the medium is liquid. Because the particles cannot occupy exactly the same space, they interact with each other. “This is also called the excluded volume effect; it causes the rods to want to sit together. They are, as it were, pushed towards each other by the polymer chains. In this way, you get a region in the mixture that mainly contains rods, and an area that is rich in polymers,” explains Tuinier.

He continues: “The rods then sink to the bottom, because they’re usually heavier. That’s the beginning of segregation, creating phases.” The lower part, which mainly contains rods, will eventually become so crowded that the rods will interfere with each other. They then take up a preferential position, so that they are less in each other’s way.

With the rods it looks like a neat arrangement next to each other. Eventually you get five different phases, a gas phase with unaligned rods at the top (an isotropic phase), a liquid phase with rods pointing in about the same direction (nematic liquid crystal), a liquid phase with rods lying in different layers (smectic liquid crystal), and two solid phases at the bottom.

MAYONNAISE AND MONITORS

Vis: “Our research contributes to the fundamental knowledge about this kind of phase transition and helps to understand and predict more precisely when these kinds of transition occur.” And that is useful in many areas. Think of pumping complex mixtures around in industrial reactors, making complex products like colloidal mixtures such as mayonnaise and paint, or ice that forms on car windows and black ice on roads.

Even in liquid crystals in monitors, these processes play a role. “Most industries choose to work with a single-phase system, where there is no segregation. But if the exact transitions are clearly described, then the industry can actually use those different phases instead of avoiding them,” says Vis.

CHANCE

It was more or less chance that the researchers arrived at an equilibrium of more than three phases. When simulating and programming plate-shaped particles and polymers, PhD students Álvaro González García and Vincent Peters from Tuinier’s group saw a four-phase equilibrium. Tuinier: “Álvaro came to me one day and asked me what had gone wrong. Because four phases just couldn’t be right.”

Then the researchers tried out multiple shapes, such as cubes and also rods. Tuinier: “With the rods, most phases turned out to be possible, we even found a five-phase equilibrium. That could also mean that even more complicated equilibria are possible, as long as you search long enough for complex different particle shapes.”

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Shape matters for light-activated nanocatalysts

Points matter when designing nanoparticles that drive important chemical reactions using the power of light.

Researchers at Rice University’s Laboratory for Nanophotonics (LANP) have long known that a nanoparticle’s shape affects how it interacts with light, and their latest study shows how shape affects a particle’s ability to use light to catalyze important chemical reactions.

In a comparative study, LANP graduate students Lin Yuan and Minhan Lou and their colleagues studied aluminum nanoparticles with identical optical properties but different shapes. The most rounded had 14 sides and 24 blunt points. Another was cube-shaped, with six sides and eight 90-degree corners. The third, which the team dubbed “octopod,” also had six sides, but each of its eight corners ended in a pointed tip.

All three varieties have the ability to capture energy from light and release it periodically in the form of super-energetic hot electrons that can speed up catalytic reactions. Yuan, a chemist in the research group of LANP director Naomi Halas, conducted experiments to see how well each of the particles performed as photocatalysts for hydrogen dissociation reaction. The tests showed octopods had a 10 times higher reaction rate than the 14-sided nanocrystals and five times higher than the nanocubes. Octopods also had a lower apparent activation energy, about 45% lower than nanocubes and 49% lower than nanocrystals.

“The experiments demonstrated that sharper corners increased efficiencies,” said Yuan, co-lead author of the study, which is published in the American Chemical Society journal ACS Nano. “For the octopods, the angle of the corners is about 60 degrees, compared to 90 degrees for the cubes and more rounded points on the nanocrystals. So the smaller the angle, the greater the increase in reaction efficiencies. But how small the angle can be is limited by chemical synthesis. These are single crystals that prefer certain structures. You cannot make infinitely more sharpness.”

Lou, a physicist and study co-lead author in the research group of LANP’s Peter Nordlander, verified the results of the catalytic experiments by developing a theoretical model of the hot electron energy transfer process between the light-activated aluminum nanoparticles and hydrogen molecules.

“We input the wavelength of light and particle shape,” Lou said. “Using these two aspects, we can accurately predict which shape will produce the best catalyst.”

The work is part of an ongoing green chemistry effort by LANP to develop commercially viable light-activated nanocatalysts that can insert energy into chemical reactions with surgical precision. LANP has previously demonstrated catalysts for ethylene and syngas production, the splitting of ammonia to produce hydrogen fuel and for breaking apart “forever chemicals.”

“This study shows that photocatalyst shape is another design element engineers can use to create photocatalysts with the higher reaction rates and lower activation barriers,” said Halas, Rice’s Stanley C. Moore Professor of Electrical and Computer Engineering, director of Rice’s Smalley-Curl Institute and a professor of chemistry, bioengineering, physics and astronomy, and materials science and nanoengineering.

Story Source:

Materials provided by Rice University. Note: Content may be edited for style and length.

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Undersea earthquakes shake up climate science

Despite climate change being most obvious to people as unseasonably warm winter days or melting glaciers, as much as 95 percent of the extra heat trapped on Earth by greenhouse gases is held in the world’s oceans. For that reason, monitoring the temperature of ocean waters has been a priority for climate scientists, and now Caltech researchers have discovered that seismic rumblings on the seafloor can provide them with another tool for doing that.

In a new paper publishing in Science, the researchers show how they are able to make use of existing seismic monitoring equipment, as well as historic seismic data, to determine how much the temperature of the earth’s oceans has changed and continues changing, even at depths that are normally out of the reach of conventional tools.

They do this by listening for the sounds from the many earthquakes that regularly occur under the ocean, says Jörn Callies, assistant professor of environmental science and engineering at Caltech and study co-author. Callies says these earthquake sounds are powerful and travel long distances through the ocean without significantly weakening, which makes them easy to monitor.

Wenbo Wu, postdoctoral scholar in geophysics and lead author of the paper, explains that when an earthquake happens under the ocean, most of its energy travels through the earth, but a portion of that energy is transmitted into the water as sound. These sound waves propagate outward from the quake’s epicenter just like seismic waves that travel through the ground, but the sound waves move at a much slower speed. As a result, ground waves will arrive at a seismic monitoring station first, followed by the sound waves, which will appear as a secondary signal of the same event. The effect is roughly similar to how you can often see the flash from lightning seconds before you hear its thunder.

“These sound waves in the ocean can be clearly recorded by seismometers at a much longer distance than thunder — from thousands of kilometers away,” Wu says. “Interestingly, they are even ‘louder’ than the vibrations traveling deep in the solid Earth, which are more widely used by seismologists.”

The speed of sound in water increases as the water’s temperature rises, so, the team realized, the length of time it takes a sound to travel a given distance in the ocean can be used to deduce the water’s temperature.

“The key is that we use repeating earthquakes — earthquakes that happen again and again in the same place,” he says. “In this example we’re looking at earthquakes that occur off Sumatra in Indonesia, and we measure when they arrive in the central Indian ocean. It takes about a half hour for them to travel that distance, with water temperature causing about one-tenth-of-a second difference. It’s a very small fractional change, but we can measure it.”

Wu adds that because they are using a seismometer that has been in the same location in the central Indian Ocean since 2004, they can look back at the data it collected each time an earthquake occurred in Sumatra, for example, and thus determine the temperature of the ocean at that same time.

“We are using small earthquakes that are too small to cause any damage or even be felt by humans at all,” Wu says. “But the seismometer can detect them from great distances , thus allowing us to monitor large-scale ocean temperature changes on a particular path in one measurement.”

Callies says the data they have analyzed confirm that the Indian Ocean has been warming, as other data collected through other methods have indicated, but that it might be warming even faster than previously estimated.

“The ocean plays a key role in the rate that the climate is changing,” he says. “The ocean is the main reservoir of energy in the climate system, and the deep ocean in particular is important to monitor. One advantage of our method is that the sound waves sample depths below 2,000 meters, where there are very few conventional measurements.”

Depending on which set of previous data they compare their results to, ocean warming appears to be as much as 69 percent greater than had been believed. However, Callies cautions against drawing any immediate conclusions, as more data need to be collected and analyzed.

Because undersea earthquakes happen all over the world, Callies says it should be possible to expand the system he and his fellow researchers developed so that it can monitor water temperatures in all of the oceans. Wu adds that because the technique makes use of existing infrastructure and equipment, it is relatively low-cost.

“We think we can do this in a lot of other regions,” Callies says. “And by doing this, we hope to contribute to the data about how our oceans are warming.”

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