A: As people get older, they can feel they have less control in their lives. Worries about health, money, and the passing of friends and relatives can trigger serious anxi­ety and depressive symptoms. So, it’s common for people to resist change more and more as they get older. Routines provide security and a level of comfort. Change introduces unpre­dictability into their lives and disrupts some of the things that give them peace of mind.

You can help by being understanding and reassuring that trying something new doesn’t mean giving up anything important in her life. Give your mother the space to feel how she feels, but don’t necessarily give up introducing new experiences into her life. Learning new things, seeing new places, meeting new peo­ple, etc., are all important for cognitive stimu­lation and mood enhancement. You may just need to start small. If she doesn’t want to go to a new restaurant in town, think about getting takeout from there so she can try a new dish in the comfort of her own home. If she likes it, she may be more willing to go to the restau­rant next time. If your mother’s resistance to change is accompanied by other concerning changes in memory or thinking skills, depres­sion or anxiety, or behaviors such as hoarding or diminished hygiene and self-care, then con­sider accompanying her to see her doctor or other medical professional and sharing what you have observed.

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In a study involving 80 participants, researchers from Massachusetts General Hospital (MGH) found that twice-weekly heated yoga sessions, conducted over a period of eight weeks, were associated with reduced depressive symptoms in adults with moderate-to-severe depression. The findings, published in the Journal of Clinical Psychiatry, also suggest that once-a-week sessions may be beneficial, too.

The participants were divided into two groups: one that received 90­minute sessions of Bikram yoga and one (the control group) that was placed on a waitlist and completed their yoga sessions after the first group concluded theirs. The individuals in the heated yoga group experienced significantly greater symptom reduction compared with those in the control group. Though the researchers aimed to have volunteers participate in two yoga sessions per week for eight weeks, by the end of the eight-week study, they attended an average of 10.3 classes.

“Yoga and heat-based interven­tions could potentially change the course of treatment for patients with depression by providing a non-medi­cation–based approach with addi­tional physical benefits as a bonus,” says lead author Maren Nyer, PhD, director of Yoga Studies at the Depression Clinical and Research Program at MGH. 

Yoga and Depression

Previous studies suggest that traditional yoga may be helpful in reducing depressive symptoms. The rhythmic breathing practices, along with the meditative/relaxation elements of yoga, are designed to promote calm and reduce stress, depression, and anxiety.

Dr. Nyer says new studies will try to determine specific benefits of heat and yoga in easing depressive symptoms. David Mischoulon, MD, PhD, a senior author of the study and director of the Depression Clinical and Research Program at MGH, notes that this research is of particular interest given the encouraging findings of studies of whole-body hyperthermia as a depression treatment. Whole-body hyperthermia involves spending supervised time in a personal sauna­like device. Whole-body heating appears to activate cells in the brain that synthesize the neurochemical serotonin, a substance that plays a key role in depression. The treatment also activates certain regions of the brain that tend to have lower activity levels in people with depression.

“Future research is needed to compare heated to nonheated yoga for depression to explore whether heat has benefits over and above that of yoga for the treatment of depression, especially given the promising evidence for whole-body hyperthermia as a treatment for major depressive disorder,”Dr. Mischoulon says.

Hot Yoga and Seniors

Yoga also supports better physical health by improving joint and muscle flexibility, muscle strength, and circu­lation. It can also help with balance.

The addition of a heated environ­ment can further enhance yoga’s ben­efits. The higher temperatures facili­tate safer stretching, for example. Bikram yoga practitioners sweat out toxins from their glands and skin.

Bikram yoga is also well-suited for many older adults, because it steers clear of some of the more ambitious traditional yoga postures, such as headstands or difficult arm balances. Heated yoga classes for seniors are also usually conducted with safety in mind, meaning that if a posture is too difficult or the heat is a problem you can rest or end your session early.

Heated yoga also comes with some important safety concerns. Individuals with cardiovascular problems, who take dehydrating medications, or are in active cancer treatment should consult their doctors before trying heated yoga, or just about any new exercise program.

Because heat helps loosen muscles, it can be easy to overstretch and strain muscles, tendons or ligaments. The extended time spent perspiring in the heat also raises the risk of becoming overheated or of becoming dehydrated. Consume fluids before, during, and after heated yoga. Dr. Nyer suggests trusting your instincts about your body (what you think you’re capable of) and paying close attention to any signs of distress. She adds that older adults may want to start with gentle stretching yoga before trying heated yoga.

The post MGH Study: Hot Yoga May Help Ease Depression Symptoms, but Be Mindful of Health Concerns appeared first on University Health News.

Signs and Symptoms of Ramsay Hunt Syndrome

Varicella-zoster virus remains in nerve cells after chickenpox. When they reactivate, they follow the path of the nerve where they live. In shingles, it may be a nerve that wraps around your chest or belly. In RHS, they follow the facial nerve. On each side of your head, your facial nerve leaves your brain near your inner ear and comes out in front of your outer ear, where it branches out to supply the muscles of your face.

Because it is a reactivation of a viral infection, you may have early symptoms of fever and fatigue followed by weakness or complete loss of movement on one side of the face, a chicken pox-like rash on your ear or face, and pain one side of your face or ear. These signs and symptoms may appear all at once or in any order.

Facial weakness or paralysis makes your face droop. You will lose the wrinkles in your forehead and your eye will stop blinking. You may not be able to close your eye completely. The rash may be in your ear canal, outside your ear, or on your face. Over time, the rash develops tiny blisters, called vesicles (vesicular rash), that may burst, drain clear fluid, and scab over. The fluid contains live virus and can spread the virus to other people causing chickenpox if they have not had chickenpox or been vaccinated for varicella zoster. Like shingles, the pain of RHS can be severe and can last longer than the other signs.

In addition to supplying the muscles of your face, the facial nerve also has branches that supply parts of your inner ear and your tongue, so other symptoms may be sensitivity to loud noise and a change or loss of taste. The infection may also spread to the inner ear and cause hearing loss, ringing in the ear, and dizziness.

Diagnosis and Treatment of Ramsay Hunt Syndrome

The signs and symptoms of RHS – facial paralysis, vesicular rash, and pain – do not occur with any other diseases, so they are usually enough to make the diagnosis. An MRI imaging study may show the inflammation of the facial nerve, but it is rarely needed for diagnosis.

In about 70 percent of cases, signs and symptoms of RHS improve without treatment, but it may take weeks or even up to a year. Treatment is given to improve recovery and prevent long-term complications.

“It’s important to start treatment early so symptoms don’t become too severe and you minimize the risk of long-term complications. The first-line treatments include an antiviral, such as valacyclovir, and a steroid, such as prednisone,” says Dr. Yasser Hussain, Neurologist at Austin Neuromuscular Center.

Antiviral drugs and steroids may be given for up to 21 days. Another important treatment is treatment to protect the eye. Because you can’t close your eye with facial paralysis, dryness can damage the outer surface of the eye. To prevent this damage, the eye may be taped shut and artificial tears used frequently to keep it moist. Pain control is important, because the pain of RMS, like shingles can be severe. Medications may also be used to reduce dizziness.

Prognosis and Complications

About 30 percent of people with RHS will not have complete recovery of facial nerve function. There may be some residual weakness or abnormal facial nerve function called synkinesis. Synkinesis occurs when facial nerve fibers regenerate, but make abnormal connections. This may result in movement of the eye when moving the mouth, or flowing of tears when you produce saliva while eating. People with more severe paralysis at the beginning of RHS are more likely to have these long-term complications. Another complication is pain that continues long after other symptoms are gone, called post-herpetic neuralgia. This can also occur with shingles. Pain medications and physical therapy may be need for people with long-term complications.

RHS can occur at any age but is most common in people between the ages of 70 to 80. The reactivation of varicella-zoster virus may be triggered by physical stress, an infection, or a weakened immune system from cancer treatment or poor nutrition. Although it is not 100 percent effective, getting the shingles vaccine is the best way to prevent RHS. Treatment helps if started within the first week after symptoms start, so let your doctor know right away if you have one-sided facial weakness, pain, or a vesicular rash on your face or ear.

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How Common Are UTIs in the Elderly?

According to a recent review in the journal Drugs in Context, UTIs are more common in women at any age because they have a shorter urethra, which is the tube that carries urine out of the bladder. This allows bacteria from the rectum to move up the urethra and infect the bladder. The majority if UTIs are caused by bacteria called E. coli. E.coli do not cause infections in the colon or rectum, but they do in other parts of the body like the bladder or kidneys.

UTIs increase with age in both men and women. After age 65, about 10 percent of women will experience a UTI, by age 85 almost 30 percent will get a UTI. For both older men and women, the risk of infection is much higher if they are living in a nursing home or a long-term care facility.

Why Are UTIs Overtreated in the Elderly?

The reason is a condition that is quite common in elderly men and women called asymptomatic bacteriuria. Up to 20 percent of older men and women may have this condition, and it occurs in up to 50 percent of elderly people in hospitals or nursing homes. Asymptomatic bacteriuria means you have bacteria in your urine without any other symptoms.

Asymptomatic bacteriuria is not dangerous. It may even be beneficial. Some studies show that low levels of asymptomatic bacteriuria may protect the bladder from more infectious bacteria. The danger of this condition is the unnecessary use of antibiotics. Multiple studies show that this does more harm than good. Antibiotic treatment may lead to antibiotic resistant bacteria that cause more dangerous and harder-to-treat UTIs.

Why Do Older Adults Have More UTIs?

One reason is that our body’s natural defense system – our immune system – becomes a little weaker with age. Another reason is that older adults may have long-term diseases that weaken the immune system or make it hard to maintain good bathroom hygiene. Having to be catheterized or have a catheter in place is a major risk, even up to two days after as catheter is removed. The biggest risk factor is a history of recurrent UTIs, which means a person has had three UTIs in the past year or two UTIs in the past six months.

When Do UTIs Need to Be Treated in Seniors?

Guidelines say that if an elderly person has bacteria in their urine and they have at least two symptoms of UTI, they should be treated. Some people assume that an older person who becomes confused (delirious) probably has a UTI. UTI can cause delirium in the elderly, but dehydration is a more common cause. These are the symptoms to watch out for at any age:

• Fever or chills
• Increased need to pass urine, called frequency and urgency
• Pain while passing urine, usually described as burning, called dysuria
• Tenderness in the lower belly (bladder pain), or tenderness in the back and flank (kidney pain)

Older adults may have any or all of these symptoms, but they may also have delirium, lethargy, incontinence, and loss of appetite. The good news is that once a diagnosis is made most UTIs will respond well to an oral antibiotic selected for E. coli and other common UTI bacteria.

Preventing UTIs in Older Adults

Avoiding dehydration and having good bathroom hygiene are effective preventive strategies. Two prevention strategies that many people try are cranberry juice and probiotics. A host of recent studies have not found that either of these strategies is effective. However, there are two new product that do seem to prevent UTIs, according to the studies:

• D-Mannose is a type of sugar supplement that sticks to receptors in the bladder that coli bacteria use when they cause an infection. This supplement has few side effects and is supported by some research studies.
• Xyloglucan is a natural substance extracted form tamarind seeds. It forms a protective film inside the bladder that seals bladder cells off from bacteria. Xyloglucan is combined with hibiscus extracts and gelatin in a product called Utipro Plus. Studies suggest that this product reduces the risk of UTI and also reduces symptoms like frequency, urgency, and incontinence.

Both D-Mannose and Utipro Plus are available at pharmacies without a prescription.

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Jump to: Gastric Sleeve Surgery | Gastric Bypass Surgery | Gastric Band Procedure

All bariatric surgeries have pros and cons you need to consider with your surgeon. In most cases, before surgery you will also meet with a psychologist and a dietician to talk about life after bariatric surgery. Benefits of bariatric surgery include weight loss between 40 and 90 pounds, and a decreased risk of obesity-related diseases like heart disease, stroke, high blood pressure, fatty liver disease, sleep apnea, and type 2 diabetes.

Risks of bariatric surgery include surgery risks like bleeding, infection, blood clots, and the risk of general anesthesia. Long-term risks include heartburn, vomiting, diarrhea, ulcer, and malnutrition. In most cases, bariatric surgery is done using an operating scope and long, thin surgical instruments inserted through small incisions in your belly, called laparoscopic surgery.

Gastric Sleeve Surgery

This surgery removes about 80 percent of your stomach. You are left with a small, tubular stomach, like a sleeve. Part of the stomach that is removed is responsible for the chemical messenger (hormone) that controls your appetite. After this procedure, you will be less hungry and you will feel full much sooner due to your small stomach size.

The advantages of this procedure are that your small intestine is left intact, that means there is less chance of not absorbing enough vitamins or minerals and developing malabsorption. The disadvantage is that this procedure is not reversible since most of your stomach is removed. There is also a higher risk of heartburn and gastric reflux, so if you need to take medications that increase the risk of heartburn and ulcers, your surgeon may choose another option.

Gastric Bypass Surgery

The most common gastric bypass procedure is called the Roux-en-Y gastric bypass. During this surgery, your stomach is divided into an upper and lower pouch. The upper pouch is only about the size of a walnut. This has the effect of making you feel full quickly and decreasing your appetite. A second part of the procedure divides your small intestine. The lower part of the intestine is attached to the upper pouch. The upper part of the intestine that is still attached to your lower stomach is attached to a lower part of your small intestine. This allows the digestive juices from your stomach to start digestion lower down in your digestive system, so you absorb less calories.

The main advantage of this procedure is that it causes reliable weight loss that is more likely to prevent or reverse obesity-related conditions like diabetes. This procedure also has less risk of heartburn or reflux. The disadvantages are a higher risk of surgical complications because the procedure is longer and more complex, and a greater risk of vitamin or mineral deficiency because this procedure bypasses a portion of the small intestine.

Another type of bypass procedure is called the biliopancreatic diversion with a duodenal switch. This is done as two separate procedures. First comes a sleeve gastrectomy. This is followed by a bypass procedure. Although this surgery causes significant weight loss, it also causes more long-term complications related to loss of minerals and vitamins and proteins, so it is rarely recommended.

Gastric Band Procedure

The gastric band is called a procedure rather than a surgery because nothing is removed or bypassed. This procedure places an inflatable silicone band around the top of the stomach to limit the amount of food that passes into the stomach and create a feeling of fullness. The opening can be adjusted by injecting a salt water solution into the band through a port placed under the skin.

The advantage of this procedure is that it has very few complications due to the procedure, however it has several long-term disadvantages. It does not cause as much weight loss as the bypass or gastric sleeve and it does not reduce obesity-related disorders as reliably. It requires frequent follow-up visits and adjustments and it often needs to be removed, because the band is a foreign body that may fail or be rejected. For these reasons, the gastric band is used less frequently than the sleeve or bypass.

What Is the Safest Form of Weight Loss Surgery?

The gastric sleeve, bypass, and gastric band are all considered safe surgeries. The gastric band has the least surgical complications but gives less weight loss and may have more long-term problems. The best long-term results come from bypass surgeries, but they may cause vitamin or mineral deficiencies. The gastric sleeve also has good results but may cause heartburn or reflux. There are many factors that determine which procedure is best for you. Talking to your bariatric team is the best way to weigh the risks and benefits.

Recovery From Weight Loss Surgery

After all these surgeries, you will start resuming your normal diet slowly. You may start with clear liquids before moving to a soft diet. When you eventually resume your normal diet, you will need to eat smaller meals and chew your food well. Your bariatric dietician will guide you through these steps. In some cases, your dietician may add vitamin and mineral supplements. Maintaining physical activity and following a diet designed to provide nutrition without excess calories is the key to success of weight loss surgery. You can gain lost weight back if you do not follow your diet and exercise plan.

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What to Do Before Your Physical

Write a list of questions you want to ask and prepare for questions your health care provider may ask you:

• Have any diagnostic tests that your provider has ordered done before your visit, so you can go over the results together.
• Let your health care provider know about any changes in your medications, including supplements, or herbal medications.
• Make a list of any changes since your last visit including new symptoms, procedures, accidents, or illness.

What to Expect From Your Health Care Provider

Your visit will probably start with a review of all that has happened since your last visit. This is called the history part of a history and physical exam. It may include questions about your family history, your diet, how much exercise you get, your mental health, and your use of alcohol or tobacco. If you are over age 65, you may be asked if you have had any falls or any problems with thinking, memory, vision, or hearing.

Expect your provider to check your vital signs, height, and weight, including your pulse, blood pressure, and oxygen level. You may have a head-to-toe physical exam. As your provider does the exam, you may be asked questions about signs or symptoms related to each body part. For example, as your provider listens to your lungs, you may be asked if you have been coughing or short of breath. During the physical exam your provider may:

• Listen to your heart and lungs
• Check your ears, nose, and throat
• Listen to blood flow in your neck vessels
• Check your body for swollen lymph nodes
• Examine your skin
• Feel your belly for any tenderness or liver enlargement
• Do a breast exam for women
• Do a testicle exam for men
• Do a rectal exam to check the prostate for men ages of 50 to 70
• Do a cervical cancer exam for women over age 21
• Check the pulses in your feet
• Look for any signs of fluid retention or swelling in your feet or ankles
• Check your muscle reflexes

A Checklist for Blood Tests, Vaccines, and Other Studies

Click the image to view The Annual Physical Exam Checklist.

Many of these will depend on your age and history. You should ask your doctor about these blood tests and studies:

• Cholesterol blood testing
• Blood sugar testing for diabetes
• PSA blood testing for men ages 55 to 69
• A blood test for hepatitis C, done at least once after age 18
• Sexually transmitted disease (STD) testing for people who are sexually active
• Yearly mammogram for women after age 40
• Colon and rectal cancer testing after age 45
• Lung cancer imaging for people with a history of heavy smoking
• Osteoporosis testing for women after age 50 and for men after age 70
• An imaging study of the abdomen to rule out abdominal aneurism after age 65

Ask what vaccines you need, including:

• Flu shot
• COVID vaccine
• HPV vaccine for young adults
• Vaccines for measles-mumps-rubella (MMR) and diphtheria-tetanus (Tdap) depending on your vaccine history
• Pneumonia vaccine
• The shingles vaccine after age 50

Everyone’s physical exam is different depending on your health, your age, your history, and your health care provider. A good wellness exam should help you develop a relationship with your health care provider, get your questions answered, update your medicines and vaccinations, schedule important tests, and develop a plan for your health goals. Finally, don’t forget to make your next appointment.

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What Is Metabolic Syndrome?

Metabolic syndrome is a combination of conditions that include belly fat, high blood pressure, high blood sugar, high levels of a blood fat called triglyceride, and low levels of healthy cholesterol called HDL cholesterol. Metabolic syndrome is increasing in America, so it is not surprising that nonalcoholic fatty liver disease is also increasing. In addition to fatty liver, metabolic syndrome increases your risk for heart disease, stroke, and diabetes.

People with metabolic syndrome tend to be overweight and about 80 percent of people that are severely overweight have nonalcoholic fatty liver disease. You may be at higher risk for metabolic syndrome and nonalcoholic fatty liver disease if you have these risk factors:

• Older age
• African American of Mexican ethnicity
• Obesity
• A family history of diabetes
• Smoking
• Drinking alcohol
• High-fat diet
• Inactive lifestyle

What Happens to Your Liver With Nonalcoholic Fatty Liver Disease?

The buildup of fat in your liver is just the first stage of fatty liver disease. This stage can last for many years and it can be revered with lifestyle changes. In about 10 to 20 percent of fatty liver disease, the liver cells become further damaged by inflammation. At this stage the disease is called nonalcoholic associated steatohepatitis or NASH. Steatohepatitis means fatty inflammation. NASH may still be reversible with lifestyle changes but if these changes are not made, the inflammation can lead to scarring of the liver, called cirrhosis. Cirrhosis is not reversible and will lead to liver failure.

Nonalcoholic Fatty Liver Disease Symptoms

Nonalcoholic fatty liver disease has been called silent liver disease because it does not cause symptoms. If fatty liver disease becomes NASH you may start to have symptoms of liver damage. These can include:

• Yellowing of the skin and eyes
• Dark urine
• Loss of appetite, nausea, and weight loss
• Broken blood vessels beneath the skin
• Itching
• Fatigue and weakness

Nonalcoholic Fatty Liver Disease Diagnosis and Treatment

Because nonalcoholic fatty liver disease has no symptoms or warning signs, the diagnosis is usually suspected when routine blood tests of liver function show changes, or an imaging study of the liver done for another reason shows fat.

If you have metabolic syndrome, your doctor may order liver blood tests or an imaging study using sound waves (ultrasound) to look for possible nonalcoholic liver disease or NASH. Further testing may include more blood tests and imaging studies, but the surest way to diagnose fatty liver disease is with a liver biopsy.

There is no treatment needed or available for nonalcoholic fatty liver disease other than lifestyle changes. Some medications are being studied for NASH, but none have been approved and there is no cure for NASH. The best treatment for NASH is also lifestyle changes. These include

• Losing weight
• Getting daily exercise
• Avoiding alcohol
• Eating a healthy diet to lose weight and increase your good cholesterol

Other treatments may be done for metabolic syndrome. These may include taking medication to lower your triglycerides, blood pressure, and blood sugar if needed. The best diet for fatty liver is a Mediterranean diet with more fruits and vegetables, whole grains, nuts, lean meats, olive oil, and less red meat, salt, and sugar.

Learn more about how to follow the Mediterranean diet.

You could be living with nonalcoholic fatty liver disease right now or you could be at risk. Getting all the risk factors under control now is the best way to prevent a fatty liver or to reverse a fatty liver you already have. If you have any of the risk factors, talk to your doctor about a plan to avoid any long-term liver damage.

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Retinols are weaker versions of retinoids that can be purchased in many over-the-counter skin creams and serums. As your skin ages, it loses its thickness because it produces less of a skin protein called collagen. Loss of collagen makes your skin thinner and drier, leading to fine wrinkles.

“Retinol removes dead skin cells from the upper skin and helps in stimulation and regeneration of collagen elastic fibers by penetrating deep inside the skin,” says Dr. Jagdish Sakhiya, Chief Dermatologist at the Sakhiya Skin Clinic. “This process is called neocollagenesis, where the human body removes dead skins and stimulates new cells.”

Retinol Benefits and Possible Side Effects

The ADA says that a retinol skin product is beneficial for someone with mild wrinkles, acne, or skin spots (pigmentation irregularities). However, if you tend to have skin allergies or dryness you should check with a skin doctor before using a retinol skin product. Retinols can also make your skin more sensitive to the sun, so you should only use it at night and use a sunscreen during the day.

Retinol can also cause skin dryness and irritation, so a skin doctor may advise using the cream or serum every other day and gradually increasing to daily use. Skin care needs to continue for up to 12 months to get the best results, although you may see some improvement in six months. Once you stop using the cream or serum the results will fade as the normal aging process takes over.

Best Anti-Aging Skin Care

According to the ADA, the two best anti-aging skin care products are moisturizer and a sunscreen. You can also use a combination of moisturizer and sunscreen products. You should use sunscreen with a sun protection factor (SPF) of at least 30 every time you are in the sun. A moisturizer traps water in your skin which helps reduce fine lines. Your sunscreen and moisturizer should fit your skin type. You may need different types for oily skin or sensitive skin. Ask your skin doctor for a recommendation. It is helpful to look for products that are hypoallergenic. Other ADA tips for skin aging include:

• Protect your skin from the sun by wearing long sleeves and a wide brim hat.
• If you want a tan, use a self-tanning product.
• Stop smoking. Smoking speeds up the aging of the skin.
• Eat a diet with more fruits and vegetables and less sugar.
• Avoid or don’t drink too much alcohol. Alcohol dehydrates your skin and speeds aging.
• Exercise regularly. Exercise increases blood supply to the skin and slows skin aging.
• Avoid scrubbing your face. Use a gentle cleanser and clean your face about twice each day.
• Avoid any skin products that sting or burn, these cause inflammation that ages your skin.

There are many skin products to choose from. Avoid products that over-promise, even if they say the product is clinically proven. That term only means it has been tried by consumers. It does not mean the claims have been tested and approved by the U.S. Food and Drug Administration. Before using a new product on your face, try it on the inner side of your arm to make sure it does not burn or irritate your skin. Avoid using several different products at the same time, this just increases the chance of a skin reaction.

Finally, remember that fragrances added to moisturizers can irritate dry skin. To avoid irritating fragrances, look for a product that says fragrance-free. Unscented is not the same as fragrance-free. These products have chemicals that mask the smell of ingredients in the product.

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Symptoms | Treatment | Home Remedies

The American College of Obstetricians and Gynecologists (ACOG) explains that perimenopause – the period before menopause – is caused by your ovaries shrinking and making less estrogen. Perimenopause symptoms can last for several years before full menopause, diagnosed when you have not had a period for one year. The average age of full menopause is 51. _[2]

Johns Hopkins Medicine says that perimenopause occurs as your ovaries gradually shut down and stop producing eggs. Hormone levels that used to be balanced become irregular with periods of being too high and too low. As hormone levels rise, high estrogen level symptoms may be similar to premenstrual syndrome (PMS). As estrogen falls, your low estrogen symptoms may include night sweats and hot flashes.

How Long Does Perimenopause Last?

Mayo Clinic explains that perimenopause is a natural transition that all women go through, but they may experience it

differently. Most women start having perimenopause symptoms around their mid-forties, but for some women, symptoms start in their late 30s.  In the early stages, as estrogen rises and falls irregularly, your periods may become irregular, shorter or longer. As estrogen continues to fall, periods become less frequent. When you have gone one year without a period, you are officially in menopause. _[4]

Harvard Medical School says the average length of perimenopause is three to four years.

Menopause can be broken out into three stages with different symptoms.

Perimenopause Symptoms

Some women will have symptoms that are very bothersome, while others will hardly be bothered at all. _[3] These are the most common perimenopause symptoms: _{[1, 3-5]}

• Hot flashes and night sweats, probably the most common symptoms
• Vaginal dryness and painful sexual intercourse
• Trouble sleeping
• Mood swings, including irritability and depression
• Loss of interest in sex
• Trouble concentrating

Low estrogen does not cause obvious symptoms, as a loss of estrogen can also contribute to fragile bones (osteoporosis) and high cholesterol. Loss of estrogen also causes irregular ovulation and loss of fertility. However, it is important to know that if you are still having your periods, it is possible to get pregnant, so you should continue to use birth control until you have gone a year without a period. _[4]

Diagnosis and Treatment for Perimenopause Symptoms

There is no test to diagnose perimenopause. The diagnosis is made based on your age, symptoms, and menstrual history. Testing estrogen levels is rarely useful, says Mayo Clinic. _[4] Perimenopause is a natural part of aging and does not need to be treated unless the symptoms are bothersome. The most effective treatment is estrogen replacement, called hormonal therapy. _[4,5] These are some common treatments:

• Estrogen replacement with a pill, patch or cream is the best treatment for hot flashes and night sweats. Your doctor will prescribe the lowest dose that controls your symptoms. You may also take a medication called progestin to balance the estrogen. _[4]
• For vaginal dryness, an estrogen cream or vaginal tablet may relieve dryness and pain during intercourse. A water-based lubricating jelly may also be used. _[4,5]
• If you want to avoid estrogen, a type of antidepressant called an SSRI may reduce hot flashes. Another option is a seizure medication called gabapentin. _[4]
• A low dose birth control pill is a good treatment for irregular periods, hot flashes, vaginal dryness, and bone loss. Taking a birth control pill will also prevent pregnancy and can be taken until you reach menopause. _[5]

Although there are many over-the-counter supplements that claim to relieve perimenopause symptoms, both Johns Hopkins and Mayo Clinic say these products are not regulated by the FDA and they do not have any consistent research to support their use. _[4,5] They include black cohosh, phytoestrogens, bioidentical hormones, and DHEA. Talk to your doctor before trying any of these supplements. _[3,4]

Lifestyle and Home Remedies for Perimenopause Symptoms

Whether you need medications are not, there are some things you can do on your own to make perimenopause easier:

• Don’t smoke. Smoking prolongs perimenopause and causes it to occur earlier. _[4]
• Learn your hot flash triggers. Hot flashes can be triggered by hot foods or spicy foods, getting overheated, alcohol, tea, or coffee. Keep a record of what triggers hot flashes to avoid them. _[3,5]
• Eat a low-fat, high fiber diet with plenty of fruits vegetables and whole grains. Include foods high in calcium and vitamin D. This diet will help prevent high cholesterol and osteoporosis. Ask your doctor if you need to take a calcium or vitamin D supplement. _[2,4]
• Get at least 30 minutes of exercise daily. Exercise will help keep your bones strong and may relieve mood swings and depression. _[3,4]
• Avoid caffeine later in the day and any overuse of alcohol. Both can make it harder to sleep. _[5]
• Reduce your stress with mind body exercises like yoga or tai chi. Try some meditation or guided relaxation exercises. _[4]

Remember that perimenopause is a normal transition. You do not need to treat it, but if you have symptoms that bother you, work with your doctor to find the best treatment. Always let your doctor know if you have: _[2,4]

• Very heavy or prolonged menstrual periods
• Vaginal bleeding between your periods
• Vaginal bleeding after menopause.
• Vaginal bleeding after sexual intercourse

These could be symptoms that are not natural and may require diagnosis and treatment.

Sources:

1. Chapel Hill Gynecology, Estrogen dominance – Chapel Hill Gynecology
2. ACOG, Perimenopausal Bleeding and Bleeding After Menopause | ACOG
3. Johns Hopkins, https://www.hopkinsmedicine.org/health/conditions-and-diseases/perimenopause
4. Mayo Clinic, Perimenopause – Symptoms and causes – Mayo Clinic
5. Harvard Health, Perimenopause: Rocky road to menopause – Harvard Health

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Symptoms | Causes | Treatment

What are the Symptoms of High Estrogen in Men?

Signs of high estrogen symptoms in men can be difficult to differentiate from low testosterone symptoms. However, the most eight most common symptoms of high estrogen in men include:

1. Sexual dysfunction (low libido, decreased morning erections, decreased erectile function)
2. Enlarged breasts
3. Lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH)
4. Increased abdominal fat (can also be a symptom of low estrogen)
5. Feeling tired
6. Loss of muscle mass
7. Emotional disturbances, especially depression
8. Type 2 diabetes

Men with too much estrogen aren’t just at risk for non-serious symptoms like decreased sexual function and enlarged breasts. They are also at high risk for more serious problems such as type 2 diabetes.

What Causes High Estrogen in Men?

A number of factors can throw the estrogen/testosterone balance out of whack in males, leading to high estrogen symptoms. Some of these factors include:

1. Aging

Advancing age is associated with an increase in aromatase, the enzyme that converts testosterone to estrogen. Older men actually have higher estrogen levels than postmenopausal women.

2. Increased fat relative to muscle

A loss of lean muscle tissue and an increase in fat tissue also typically occurs with advancing age, as well as with metabolic disorders such as obesity and type 2 diabetes. Fat tissue contains aromatase and thus converts testosterone to estrogen. Fat also serves as a reservoir for storing estradiol. Both these factors lead to increased estrogen levels in men.

3. Testosterone therapy

Males who are treated with injectable forms of synthetic testosterone almost always make too much estrogen. Bioidentical (natural) testosterone therapy can also lead to high estrogen levels in men, especially when used in excess or used in men with obesity.

4. Faulty feedback

Once a man has too much estrogen in his system, a vicious cycle can ensue in which the high estrogen levels lead to a faulty feedback system, tricking the brain and testes into producing even less testosterone. This can lead to even higher levels of estrogen and more severe estrogen dominance, magnifying the high estrogen symptoms. 

Symptoms of Estrogen Deficiencies in Men

Males can also have too little estrogen and suffer from symptoms of estrogen deficiency. Some of these symptoms are the same as those of estrogen excess. A recent study examining the important role of estrogen in the regulation of body fat and sexual function in men found that the most severe effects of estrogen deficiency in men were on sexual desire, with estrogen deficient men reporting dramatic declines in arousal and erectile function.

Additionally, the men with decreased estrogen showed higher levels of the type of inner abdominal fat known to increase the risk of cardiovascular disease, diabetes, and metabolic syndrome. Men with estrogen deficiency also have decreased bone strength and are at increased risk for fractures.

What is the Treatment for High Estrogen in Men?

The important lesson may be that hormonal balance of estrogen with testosterone is key, rather than absolute levels of estrogen itself. Fortunately, a number of diet, lifestyle, and natural therapies have been found to keep estrogen levels balanced. The best-researched treatments for how to reduce estrogen levels in males and improving estrogen balance are:

• Eat cruciferous vegetables multiple times per week. Cruciferous vegetables, such as broccoli, cauliflower, cabbage, Brussels sprouts, bok choy, and turnip greens, contain high amounts of glucosinolates, which the body transforms into bioactive compounds that help to decrease estrogen activity and increase estrogen detoxification.
• Supplement with indole-3-carbinol (I3C) and 3,3′-diindolylmethane (DIM). Cruciferous vegetable intake can be supplemented with their most beneficial compounds, I3C (200 mg per day) and DIM (100 mg per day), in supplement form.
• Get enough vitamin B12, folate, betaine, and choline. These nutrients, known as methyl donors, help to improve the biochemical process known as methylation, which is an important function in estrogen metabolism and detoxification. Good dietary sources include meat, fish, shellfish, eggs, spinach, beets, and quinoa.
• Increasing fiber, exercising, and reducing weight are also important natural treatments for reducing high estrogen symptoms in men.

If the high estrogen levels and/or low testosterone doesn’t provide any relief within a few months of implementing these natural therapies, it’s important to see a healthcare practitioner who can evaluate these symptoms and test hormone levels. Hormone replacement therapy and/or a more intensive natural treatment regimen may  be beneficial.

Originally published in 2016, this post is regularly updated.

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