‘I feel like me again’

Having a women's health specialist look at the whole picture made all the difference for this 46-year-old.

‘I feel like me again’

By the time Amie Quist reached her mid-30s, she no longer felt like herself.

She underwent a partial hysterectomy at age 25 after a difficult pregnancy that led to the birth of twins at 27 weeks.

“My boys were in the neonatal unit at Spectrum Health, but one of my babies passed away,” Quist said. “Hayden lived, and he wouldn’t have survived without the care he received there. He weighed 2 pounds.”

Today, Hayden is preparing for his wedding. Quist couldn’t be prouder.

Quist gazes out at the cold waters of Lake Michigan. She left Grand Haven for some years, but she returned because the lake drew her back. This is home.

Having worked as a paramedic, but now at the Grand Rapids branch of Ferris State University in pharmaceuticals, Quist understands what good medicine can do. When it came to her own health care, however, she sometimes felt adrift.

“I’m 46 now, and I’ve been going to different providers to find out why I feel like garbage,” she said. “I’ve been treated for depression, but I knew I wasn’t depressed—I’m well-adjusted and in a happy marriage with a good life—but everyone kept treating something else. Oh, it’s your thyroid. Oh, it’s your low iron. Oh, it’s chronic fatigue. I felt like I was losing my mind with all these different diagnoses.”

Getting the whole picture

Quist likes the analogy of the blind men in a room with an elephant. In the ancient Indian parable, one blind man touches the elephant’s foot and likens the animal to a tree trunk. Another touches the trunk and likens the elephant to a thick snake. Yet another touches the elephant’s ear and describes the animal as fan-like.

“It was very frustrating to feel like I was being tossed around from doctor to doctor and put in a bucket with each diagnosis,” Quist said. “Everyone seemed to look at only one symptom at a time.”

Then her new provider suggested Quist visit the Spectrum Health Midlife, Menopause & Sexual Health Clinic, where she met Julie Ondersma, FNP. Ondersma specializes in obstetrics and gynecology and is certified in menopause medicine.

Quist first visited the clinic in November 2019.

“Amie was feeling very frustrated,” Ondersma recalled. “We needed to look at her symptoms as a group. We talked for a long time, so that I could get to know my patient and what’s important to her, what her lifestyle is like.”

Hormones, Ondersma said, can affect everything and Quist’s lab tests showed evidence of hormonal changes.

Ondersma did an inventory of Quist’s lifestyle, noting how much water she drank, her exercise habits, sleep patterns and diet.

Quist already had healthy habits in regard to diet and regular exercise. She typically ran 10 to 15 miles each week, although her distance had recently fallen to 5 miles.

The two talked for nearly an hour.

Different for every woman

Generally speaking, menopause is divided into perimenopause, early menopause, menopause and post-menopause. Hormones fluctuate through all these stages and symptoms include hot flashes, night sweats, weight management issues, decreased sex drive, vaginal dryness, and behavioral and emotional changes. Heart health may also be affected.

“We go by a timeline called STRAW—Stages of Reproductive Aging Workshop,” Ondersma explained. “(The stages of menopause) can take as long as a decade of your life—with the average age of menopause around 51—so that’s why our clinic exists, to help women through all that.”

Quist’s partial hysterectomy may also affect this timeline, as such surgery could expedite menopause. Since she hadn’t experienced hot flashes or night sweats, however, Ondersma ruled out menopause and determined Quist’s symptoms were related to perimenopause changes.

Perimenopause can last anywhere from one to seven years, and hormones may still look normal at that point.

“But a lab test is just a snapshot of one day,” Ondersma said. “We treat people, not numbers.”

She decided Quist could do well with a low-dose estrogen patch.

“Finally, somebody listened to me and connected the dots,” Quist said. “After four or five months on the patch, wow, I was feeling like myself again.”

Quist felt her energy return bit by bit. By her second visit to the clinic in January 2020, she felt a big difference in her health and well-being.

“When you start feeling better, then you realize just how bad you were feeling before,” she said.

Back on the run

In the past, Quist ran marathons and completed challenging triathlons.

Getting back on the road felt great.

Soon, she even had enough energy to spare to return to school to work on a master’s in public health at Ferris State University.

When Quist felt a slight decline in her well-being, Ondersma made a small adjustment in the dosage of her estrogen patch, and Quist resumed her active lifestyle.

Ondersma said women shouldn’t fear hormone therapy.

The Women’s Health Initiative results 10 years ago scared many women away from using hormone therapy altogether, Ondersma explained.

“We’ve learned a lot since then about the risks and benefits of hormone therapy,” she said. “For most women, experts agree that (it) is recommended to control moderate to severe menopause symptoms, such as hot flashes and vaginal dryness, within 10 years of menopause and up to age 59. Individualization is key in the decision to use hormone therapy. Consideration should be given to the woman’s quality of life priorities as well as her personal risk factors such as age, time since menopause, and her risk of blood clots, heart disease, stroke and breast cancer.”

Quist attested: “Julie and this estrogen patch have given me a new life.”

She is looking forward once again to earning a master’s degree, to a new career, to more marathons and to her son’s wedding.

Source : Health Beat More   

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Can a daily pill lighten heavy menstrual bleeding caused by fibroids?

Many women develop benign uterine fibroids, which may cause heavy menstrual bleeding, a problem that may be more severe among Black women. A new daily medication approved by the FDA may help some women by lightening blood loss during monthly periods. The post Can a daily pill lighten heavy menstrual bleeding caused by fibroids? appeared first on Harvard Health Blog.

Can a daily pill lighten heavy menstrual bleeding caused by fibroids?

Fibroids are generally benign (not cancerous) tumors that form within the tissues of the uterus. They are very common in reproductive-age women: studies report that up to 70% of white women and 80% of Black women may develop fibroids by age 50. And research suggests Black women are more likely to experience severe or very severe symptoms related to fibroids, such as heavy and sometimes prolonged monthly periods.

In some cases, women seek medical care due to menstrual bleeding so heavy that they develop anemia and require iron supplements or, much more rarely, blood transfusions. Now, a new medicine taken as a daily pill may help some women reduce heavy bleeding caused by fibroids.

Surgery and injections help some women

Until recently, the treatment options for heavy bleeding due to fibroids were limited to surgical procedures or an injection of a medication called leuprolide, which is given monthly or every three months to help shrink fibroids and lighten bleeding. While these treatments are effective for some women, each has risks and disadvantages:

  • Any surgical procedure comes with a risk of infection. Additionally, excess bleeding requiring transfusion, hysterectomy (removal of the uterus), injury to other pelvic or abdominal organs, and recurrence of the fibroids are possible. In some cases, fertility is affected as well.
  • Regular injections of leuprolide have significant side effects, as this medication essentially puts women into medically induced menopause. Therefore, it is typically used only as a bridge to surgery.

What does research tell us about a new approach to fibroid-related heavy menstrual bleeding?

The new medicine approved by the FDA to treat heavy menstrual bleeding due to fibroids is Oriahnn. It’s a daily pill that combines two hormones (a form of estrogen called estradiol, plus norethindrone acetate) with a medication called elagolix. Elagolix helps inhibit a hormone that causes a woman’s body to release estrogen and progesterone during her monthly menstrual cycle.

A recently published trial demonstrated that elagolix effectively decreases blood loss during menses, and causes high rates of amenorrhea (no bleeding at all). The trial was performed in conjunction with AbbVie, the company that produces and markets Oriahnn. It studied 433 women who had fibroids and heavy menstrual bleeding for 12 months per woman over a period of 2.5 years.

One strength of the study is that 67% of the women who participated were Black. Black women have higher rates of uterine fibroids, so their inclusion in this study is particularly important.

The study compared two groups of women for one year: one group received just elagolix, and the other received elagolix with estradiol and norethindrone acetate (“add-back therapy”). Because elagolix suppresses hormonal release of estrogen and progesterone, it may cause hot flashes, night sweats, and decreased bone mineral density (a marker indicating bone loss) that can predispose women to bone fractures. In theory, the add-back therapy might decrease the risk of hot flashes, night sweats, and bone loss.

For women taking elagolix with add-back therapy, the researchers found that by the end of 12 months:

  • Nearly 90% of women had less blood loss during their period; compared with their blood loss before starting the medicine, these women experienced at least a 50% reduction in blood loss.
  • 64% of women on elagolix with add-back therapy did not get a period at all.
  • Among women who were anemic at the beginning of the study period, nearly 73% showed a statistically significant improvement in their blood count.
  • The size of the uterus also decreased, although the size of the fibroids did not.

The most common side effects in both groups were hot flashes and headaches. Severe side effects were rare. However, compared with women taking only elagolix, women on elagolix with add-back therapy had fewer and less severe hot flashes and night sweats, and experienced much less loss of bone mineral density (although both groups demonstrated bone loss).

Based on a questionnaire given to both groups, women taking elagolix with add-back therapy reported a better quality of life.

Who might find this new option helpful?

This new FDA-approved medication could potentially be an excellent option for women who would like to avoid surgery and try medical management of their fibroids instead. The caveat is that the trial studied this drug for 12 months. The FDA has not approved its use for more than 24 months, so this may not be a lifelong solution for patients.

However, elagolix with add-back therapy could be an excellent option for women who are perimenopausal, will likely go through menopause in one to two years, and want to avoid a hysterectomy. It would also be an excellent option for women who are interested in conceiving in one to two years, and would like to decrease menstrual bleeding without resorting to surgery.

Women seeking long-lasting relief from heavy menstrual bleeding due to fibroids have long been told that their best option is a hysterectomy. This new data may have the potential to change that advice.

The post Can a daily pill lighten heavy menstrual bleeding caused by fibroids? appeared first on Harvard Health Blog.

Source : Harvard Health More   

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