16 - Gender-Specific Health Issues Flashcards
Who are the highest users of NHPs?
women with higher education
Why are women with higher education among the highest users of NHPs?
- Frustration over adverse effects of mainstay pharmacological therapies
- Concern over long-term safety of hormonal agents (Women’s Health Initiative)
- Misconception that NHPs are safer
What are concerns that people may have?
- Drug interactions
- Safety
- Allergies
What women’s health issues are a part of this lecture?
- Premenstrual Syndrome
- Mastalgia
- Dysmenorrhea
- Perimenopause/Menopause
What is PMS?
-Both physical and behavioural symptoms occurring repetitively in 2nd half of the menstrual cycle & interfere with aspects of the woman’s life
Etiology of PMS?
Unknown; women who suffer ate ++ sensitive to normal hormonal fluctuations associated with menstrual cycle
What are some affective symptoms of PMS?
- depression
- irritability
- anxiety
- nervousness
- decreased concentration
What are some somatic symptoms of PMS?
- breast pain
- bloating and swelling
- headache
- tiredness
- body aches
What are some treatment approaches to PMS?
- Exercise, relaxation techniques (mild, moderate and severe) EFFECTIVE ?
- SNRIs, SSRIs (mod-severe)
- Cyclic OC use (drospirenone) or continuous OC use (any progestin)
- Role of NHPs ?
What is Mastalgia?
- Breath tenderness or pain: Dull ache, heaviness, tightness, burning sensation
- Cyclic vs non-cyclic nostalgia; can be variable depending on hormonal fluctuations
- New onset must always be evaluated by MD; rule out pathology (breast cancer)
Describe Cyclic Mastalgia
- 70% of women experience some mild pain/swelling cyclically, before menstruation (approx 1 week); 11% of affected experience mod-severe pain
- Usually presents initially between ages of 20-40 yo
- Generally bilateral; can radiate to axilla area
- Caused by hormonal changes related to ovulation that stimulate the proliferation of normal glandular breast tissue = pain!
Calcium can be used to treat ____
PMS
Forms of calcium ?
- Calcium carbonate
- Calcium citrate
Natural sources of calcium ?
- dairy products
- fortified orange juice
- soy milk
- fish canned with it’s bones
- dark green vegetables
- nuts, seeds, tofu
Is Calcium safe ?
Likely safe when taken orally, within tolerate upper intake levels (2000-2500 mg per day) - must consider all intake sources
SE of calcium ?
GI upset, constipation
Is Calcium effective for PMS?
Likely effective - approx 1000mg daily improves mood, water-retention and pain of PMS
Mechanism of Calcium for PMS?
Variations in estrogen levels during premenstrual period may limit calcium absorption and metabolism»_space; lower Ca2+ levels, may contribute to mood & other symptoms associated with PMS
Ca2+ involved in production of serotonin
Vitamin B6 is used for ?
PMS and mastalgia
Natural sources of Vitamin B6?
- cereal grains
- legumes
- vegetables
- liver
- meat
- eggs
Is Vitamin B6 safe?
possibly safe when taken orally, exceeding RDA (recommended dietary allowance)
SE of Vitamin B6
- n&v
- heartburn
- loss of appetite
- headache
Sensory neuropathy @ high dose (>1000mg daily)
Is Vitamin B6 effective?
Possibly effective:
-50-100mg may improve nostalgia and possibly PMS-related depression (limited evidence); more evidence as combo with Mg2+
Mechanism of Vitamin B6?
Unclear; may possess some anti-inflammatory properties. Some theories suggest minor Vitamin B6 deficiency
What can Chasteberry be used for?
PMS and mastalgia
Active components of Chasteberry?
Berry “fruit”: iridoid glycosides, flavonoids, linoleic acid, progestins
Is Chasteberry safe?
Likely safe - when taken orally & appropriately; safe use in studies up to 1.5 years
SE of Chasteberry?
mild, GI reactions, itching, rash, headache, fatigue, acne & menstrual disturbances
Effectiveness of Chasteberry?
Possibly effective:
-20-40mg daily (typical dose) may improve nostalgia and PMS-related symptoms
Mechanism of Chasteberry?
Some women with PMS and nostalgia have elevated prolactin levels; components of chaste berry inhibit prolactin release through dopamine receptor agonism (D2)
Magnesium food sources
Legumes, whole grains, vegetables (especially broccoli, squash, green leafy vegetables), seeds and nuts (almonds)
Is magnesium safe?
likely safe when taken orally, below UL (UL = 350 mg daily)
SE of magnesium ?
diarrhea
Is magnesium effective?
Possibly effective:
-200mg elemental Mg2+ (common dose) may improve PMS-related symptoms (mood, fluid retention), often combined with B6 (50mg) to help with PMS-related anxiety symptoms (nervous tension, mood swings, irritability)
What is magnesium used for?
PMS
Mechanism of magnesium for PMS
intracellular levels of Mg2+ found to be lower in women with PMS
What is Ginkgo biloba used for?
PMS and mastalgia
Is ginkgo biloba safe?
Likely safe:
When used orally and appropriately (trial data up to 6 years), BUT some concern over carcinogenic effects in animals (high doses; hepatic, thyroid, gastric & nasal CA observed)
SE of ginkgo biloba
mild GI upset, headache, dizziness, palpitations, constipation & allergic skin reactions
Is Ginkgo biloba safe?
Possibly effective
-may reduce breast tenderness and other physical/psychological PMS symptoms (start on Day 16 of cycle and continue until Day 5)
Mechanism of Ginkgo biloba?
unclear - possibly due to anti-inflammatory properties
What is primary dysmenorrhea?
- refers to the presence of recurrent, cramps, lower abdominal pain that occurs during menses in the absence of demonstrable disease that could account for these symptoms
- pain begins at onset of menses and improves over 12-72 hours; nausea, diarrhea, fatigue, headache often accompany pain
What is the general treatment approach for dysmenorrhea ?
- Heat, exercise, yoga, sexual activity, diet ?
- Acupuncture
- NSAIDs, oral contraceptives, IUDs, injectable contraception (Depo-Provera)
List 4 NHPs that can be used for dysmenorrhea
- omega 3
- vitamin E
- vitamin B1
- magnesium
Active components of omega 3 fatty acid
EPA, ALA, DHA
Natural sources of omega 3 fatty acid
fish oil, flax, nuts, eggs, soy beverage, edamame
Is Omega 3 fatty acid safe?
Likely safe when used orally and appropriately (fish oil doses < 3 grams daily) at higher doses, concerns regarding anticoagulant effect and bleed risk
SE of omega 3 fatty acids?
halitosis, fish burps, heartburn, loose stool
Are omega 3 fatty acids effective for dysmenorrhea?
Possibly effective:
-Taking fish oil seems to decrease pain, NSAID consumption, and interference with daily activities in women with dysmenorrhea
Mechanism of omega 3 fatty acids?
Unclear - possibly due to anti-inflammatory properties (blockade of inflammatory cytokines)
Natural sources of Vitamin E?
wheat germ oil, vegetable oils, cereal grains, animal fats, meat, poultry, eggs, fruits and vegetables
Is Vitamin E safe?
Likely safe at standard doses
-in unhealthy patients, recommend 400IU or less
SE of vitamin E?
nausea, diarrhea, intestinal cramps, fatigue, weakness, headache, bleed risk at elevated doses
Is Vitamin E effective?
Possibly effective:
-200 IU BID or 500 IU daily starting 2 days before menstruation, continuing through the first 3 days of bleeding, decreased pain severity/duration and blood loss
Mechanism of action of vitamin E
unclear - may block prostaglandin release
_______ is likely safe and possible effective for dysmenorrhea
Vitamin B1
Is there evidence for using Magnesium for dysmenorrhea
-not indicated
Mechanism of magnesium for dysmenorrhea
- Unclear; some resources cite possible Mg2+ deficiency as root cause
- Calcium agonist effect of Mg2+ ion on smooth muscle? Used in prevention of preterm birth (IV) to inhibit uterine contractions - possibly via similar mechanism for dysmenorrhea
What is menopause?
Permanent cessation of menstrual periods..after a woman has experienced 12 months of amenorrhea without any other obvious pathological or physiological cause .. medium age of 51.4 years
What is perimenopause (PM) ?
Menopausal transition starting - 4 years before cessation of menstruation. Includes a number of physiologic changes: irregular menstrual cycles, marked hormonal fluctuations, hot flashes, sleep disturbances, mood symptoms and vaginal dryness
Long-term effects of menopause?
- bone loss and osteoporosis
- increased CV disease risk
What is PM a chance for?
to implement some preventative medicine
What is the treatment strategy for menopause?
- Treat symptoms
- Prevention plan for post-menopausal complications
List 4 NHPs that can help with perimenopause/menopause ?
- Black cohosh
- Evening Primrose Oil
- Soy/isoflavones
- Calcium
Active component in black cohosh ?
Rhizomes
Is black cohosh safe ?
Possibly safe:
- When used orally and appropriately
- Some concern regarding liver toxicity - case reports of liver failure, acute hepatitis, monitor liver function
Is black cohosh effective for menopause ?
Possibly effective:
- Evidence is very conflicting depending;
- Modest benefit on decreasing hot flashes;
- Conclude very weak evidence for menopausal symptoms
Mechanism of black cohosh for menopause?
Estrogen-like effects, mechanism unknown
What is some risk information with black cohosh ?
- Use with caution during hormone therapy
- Not to be confused with BLUE cohosh which is CARDIOTOXIC
- Products may not always contain the proper herb
Active components in evening primrose oil?
gamma-linolenic acid, linoleic acid
Is evening primrose oil safe?
Likely safe when used orally and appropriately. Evening primrose has been used safely in doses up to 6 grams daily for up to 1 year
SE of evening primrose oil
mild, transient GI SE’s
Is evening primrose oil effective for treating menopause symptoms?
Possibly ineffective
-Research has shown it does not help menopausal symptoms
Mechanism of action behind evening primrose oil?
Gamma linolenic acid (GLA) has anti-inflammatory properties
natural source of soy ?
soy beans
Is Soy safe for treating menopausal symptoms?
likely safe
SE of soy
minor GI reactions, allergic response
Is Soy effective for treating menopausal symptoms?
Possibly effective:
Consuming soy protein 20-60 grams providing 34-100 mg of isoflavones daily seems to modestly decrease the frequency and severity of hot flashes in some menopausal women. Also shown to increase bone mineral density (important for osteoporosis related to menopause)
Mechanism for soy for treating menopausal symptoms?
weak estrogenic activity, may act as SERMs
What is BPH
Benign Prostatic Hyperplasia:
-enlargement of prostate gland that occurs more frequently as age advances, can be asymptomatic initially but often results in symptoms and bladder, urinary tract and kidney complications
What is the typical presentation of BPH
Storage symptoms: Increased daytime frequency, nocturne, urgency, and urinary incontinence
Voiding symptoms:
Slow urinary stream, splitting or spraying of the urinary stream, intermittent urinary stream, hesitancy, straining to void, and terminal dribbling - increases risk for UTI
Complications of BPH
untreated BPH can cause acute urinary retention, recurrent UTIs, hydronephrosis & renal failure
What are some Rx options for BPH
- Alpha 1 adrenergic antagonists
- 5 alpha reductase inhibitors
- Anticholinergic agents
- Phosphodiesterase-5 inhibitors
What are some NHP for BPH
- saw palmetto
- pygeum
- phytosterol/beta-sitosterol
- pumpkin seed
Natural sources of saw palmetto
soybeans
Is Saw palmetto safe for BPH
likely safe, when used orally and appropriately, studies of up to 3 years duration
Is saw palmetto effective for BPH?
- Study results are highly contradictory
- Overall it appears that saw palmetto does not offer significant benefit for symptoms of BPH. Any benefits are modest at best.
Mechanism behind saw palmetto?
Reduces prostate specific antigen (PSA); mechanism unclear
Active component in Pygeum?
bark
Is Pygeum safe for BPH?
likely safe when used orally and appropriate up to 12 months, 75-200mg capsules of standardized pygeum extract taken daily
Is Pygeum effective for BPH
Likely effective
-Taking pygeum orally reduces the functional symptoms of BPH. Pygeum decreases nocturne by 19%, increases peak urine flow by 23% and reduces residual urine volume by 24% in men with BPH
Mechanism behind Pygem for BPH ?
Appears to inhibit prostatic 5-alpha reductase (not as good as finasteride tho). Reduction of urethral obstruction and improvement of bladder function have been observed
What are phytosterols/beta-sitosterol ?
found in plants, similar to human cholesterol, beta-sitosterol is most common dietary phystosterol
Natural sources of phytosterols/beta-sitosterol ?
fruits, vegetables, soybeans, breads, peanuts, plant oils
Are phytosterols/beta-sitosterol safe for BPH?
Likely safe when used orally and appropriately up to 18 months
SE of phytosterols/beta-sitosterol ?
nausea, indigestion, gas, diarrhea, constipation, reduced appetite
Is phytosterols/beta-sitosterol effective ?
Likely effective
-Taking beta-sitosterol 60-130 mg orally in 2-3 divided doses daily significantly improves urinary symptoms, increases maximum urinary flow .. it does not affect prostate size
**only helping with symptom management, not treating the underlying problem
Mechanism of phytosterols/beta-sitosterol ?
animal studies: might inhibit 5 alpha reductase activity
finasteride is more potent tho
Pumpkin seed used in combo with ?
saw palmetto
Is pumpkin seed safe ?
possibly safe when used orally and appropriately
SE of pumpkin seed
nausea, indigestion, gas, diarrhea, constipation, reduced appetite
Is pumpkin seed effective for BPH?
possibly effective:
- 480mg orally in 2-3 divided doses daily (with or without saw palmetto)
- may help BPH symptoms, limited evidence
Mechanism of pumpkin seed?
Possibly diuretic effect, relieve bladder discomfort, causing the perception of reduced prostate gland swelling without reducing the gland size
