Sunday, May 5, 2019

The Change

Many of my patients and friends are women that, like me, are experiencing perimenopausal and post-menopausal changes. This period of changes starts around age 40 and it lasts into the early 60s. The physiologic changes are inevitable and are part of the normal aging process. However, I find that for many, this is a process that is difficult to face.
During this time, women's bodies start to change in shape. The hour-glass figure starts to look like a cube. Weight gain happens and those that want to fight this weight gain find that it requires a lot more work than what they used to do before. At the same time, skin starts to dry and wrinkles that we thought would never happen to us, start to show in the neck, around the lips and forehead. We start looking at the mirror thinking that perhaps cosmetic surgery is not such a bad idea and perhaps could be our big 50 or 60 year old gift. Then hot flashes occur very severely for some whereas probably not a problem for others. Hair starts to fall and gray, this is unacceptable for many. Palpitations, sweating, insomnia, depression and anxiety are frequent symptoms of low estrogen.
Wow. The changes that I described do not sound good. But there is a good side. 
The changes that I described do not sound good because we have been made believe since we were young that beauty is equivalent to having the look, health and energy of a 20 year old woman. With progress and knowledge about the benefits of diet, exercise and sunscreen, many women are doing a great job maintaining their young looks longer. However, nature is set to declining estrogen levels after age 40. That is because the human body of a woman was set to be optimized for childbearing between ages 20 and 30. Many women have very healthy pregnancies in their 30s but it is a fact that the number and health of the eggs available for reproduction decline clearly after age 35. But once that phase is over, the body will no longer maintain the eggs. Hence, the estrogen decline.
What is next?
When I see a patient in this struggle, I ask my patient to look forward to age gracefully. Because the fact is that we are going to age. We can slow down the process but we cannot avoid it. So we may as well embrace it.
The good news is that with age, we have more experience so we are wiser. Most women have learned to ride the waves and that there is always a light a the end of every tunnel.
We can see the results of our life in our children, family and friendships that we have accumulated.
Some are in retirement age or move on to new jobs that make them happier.
Some are enjoying a beautiful marriage and some move on to leave the one that hurt them and live better lives.
From treating so many patients, and knowing so many people, I can tell you that beauty is, indeed, inside. It is irradiated from within.
I could have a Barbie-looking person that blames everyone including her doctors for her unhappiness and makes everyone's lives miserable only because she is miserable. That is not a beautiful person.
I admire the patients, men and women, that despite visible scars of many surgeries, cancers, and trauma, are so beautiful in and out that you just need to learn from them. This people usually are full of love for everyone and you can feel it. They are grateful for the life they have and not for what they are missing.
Aging gracefully
I think we have to walk the journey in our terms, within the body that has been given to us. This body will age. So lets age gracefully. With modern medicine and lifestyle changes, we could live another 40-50 years. Enjoy the ride!

#menopause #hotflashes  #healthyaging #aging  #aginggracefully #hormones

Saturday, February 11, 2017

The pituitary gland

No one talks much about the pituitary gland. That is strange, since the pituitary gland is the commander in chief of many vital functions of the body.
The pituitary gland is located in the center of the head, below the hypothalamus.
The pituitary gland has two sections, the anterior pituitary and the posterior pituitary.
The anterior pituitary is composed of cells that produce certain hormones upon control of the hypothalamus, which in turn modulates the system based on the feedback messages from the body. These hormones control the adrenal system ( adrenocorticotropin hormone or ACTH), the thyroid system ( thyroid stimulating hormone or TSH) , the gonadal axis ( luteinizing hormone LH,  follicle stimulating hormone or FSH). The pituitary gland also produces Prolactin,  Growth Hormone (GH), melanocyte stimulating hormone (MSH) and alpha subunit.
The posterior pituitary gland is composed of nerve endings that control sodium/water balance (through the antidiuretic hormone or  ADH) and multiple other reflex functions of the body (oxytocin).
The most common disorders of the pituitary gland are adenomas. Adenomas are benign tumors that secrete in excess one or more of the pituitary hormones and are not subject to the normal feedback controls of the body. The most common one is called prolactinoma. A prolactinoma secretes prolactin in excess. It usually presents with breast milk discharge in a woman that is not pregnant. In a man, it may present with breast enlargement. This benign tumors can grow to cause pressure in the optic nerve that crosses above the pituitary gland. When that happens the person may experience blindness in peripheral vision. Prolactinomas are one of the few tumors that can be shrunk with medication and does not need surgery.
Pituitary tumors of other kinds usually present with elevated prolactin but not as high as with a prolactinoma. Because prolactin inhibits sexual hormones, the patient may complain of no periods if female, or impotence if male.
Some pituitary tumors may cause disorders of metabolism that cause typical body changes, such as acromegaly ( GH excess) and Cushing's disease ( ACTH excess). These usually require surgery to remove the tumor.
Other tumors, occur more commonly in older patients, do not secrete hormone but are more likely to grow so that it causes a problem due to size. Patients may present with peripheral blindness or headaches.
Patients that experience these problems should discuss them with their primary care doctors and a prolactin level should be done. It is usually elevated when a pituitary tumor is present.