Articles and Publications

In the last 15 years the way we have attempted to help women entering menopause has changed dramatically. In the late 90’s we gave almost any woman complaining of menopausal symptoms hormone replacement therapy (HRT) to improve their quality of life. In the early 00’s we took almost every woman off HRT after mounting evidence made us rethink the risks and benefits (1). Then bio-identical hormones began receiving big press coverage and attention. More research soon piled up showing different assessments of benefits and risks, and everyone from researchers to physicians seemed to have a different opinion on what to do. Let’s attempt to clear the confusion.

WHAT IS MENOPAUSE?

Menopause is a natural transition to infertility that every woman goes through (2). The transition usually starts for a woman in her 40’s (but as early as late 30’s), and we call this initial stage perimenopause (2). During this time an irregular decline in the amount of the hormones estrogen & progesterone can make one feel, well, irregular. Many women experience symptoms of this reduction in hormones in the form of hot flashes, night sweats/flushing, palpitations, headaches, insomnia, fatigue, dry skin, vaginal dryness or reduced libido (2).

OK SO WHAT DO I DO ABOUT IT?

There are many ways to help make this natural transition easier. Diet clearly plays a role, and reducing your intake of caffeine, alcohol, and refined carbohydrates all seem to improve flashing and flushing (3). Spreading out your calories through the day and incorporating healthy snacks reduces the adrenaline surge associated with hunger, and the hot flash that usually goes with it (3). And exercise is very important, as women who exercise regularly consistently report fewer flashes, flushes, and insomnia compared to women who don’t (3).

WHAT ABOUT THOSE HORMONES?

It only makes sense that providing a woman with the estrogen and progesterone that is decreasing in this process will reduce or eliminate many of the significant physical symptoms of menopause. Standard HRT uses estrogen obtained from horses and synthetic progestins. Alternatively in the last 20 years many forms of bio-identical hormone replacement have become available. These use forms of estrogen and progesterone that are identical at the molecular level to what is naturally made in the body. And where standard HRT was only available in oral tablets, bio-identical HRT is available in oral forms, topical creams, vaginal creams/ovules, or custom compounded forms.

ARE HORMONES SAFE?

Whether bio-identical or standard, the latest evidence tells us that hormone replacement is safe if it’s used appropriately, at the lowest dose that relieves symptoms, and for the shortest time possible (3). There is a risk of breast cancer, stroke, coronary events and dementia associated with HRT, but the individual absolute risk increases are small and should be weighed against the benefits (3). Using HRT within 10 years of the onset of menopause reduces these risks further, so starting sooner seems to be the best way to time therapy (4,5). In addition to helping with the overt symptoms of menopause (hot flashes, etc), HRT reduces bone loss, reduces the incidence of diabetes, and helps reduce the frequency of urinary tract infections (6).

Ultimately the choice to use hormone replacement should be made after carefully considering your unique situation. Speak to your physician, naturopath or pharmacist to help you weigh the options and make the best choice for your health and well-being.

Bio-Identical Benefits

· Bio-identical hormones are available in traditional manufactured forms, and can also be compounded (custom made at the pharmacy) in specific strengths to meet the unique requirements of each individual.

· Recent evidence suggests that bio-identical progesterone has more favourable effects on cholesterol than synthetic versions(6).

· Topical bio-identical estrogen can be given in lower doses than comparable oral forms, and by avoiding metabolism in the liver they have a milder effects on the vascular system than oral estrogens(6).

· Bio-identical hormones in topical forms can be prescribed by naturopathic doctors with specialized training.

References

1. Women’s Health Initiative [website]. Bethesda, Maryland: Women’s Health Initiative; 2010. Available at: http://www.nhlbi.nih.gov/whi. Accessed 2016 September 20

2. Facts about Menopasual Hormone Therapy. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, NIH Publication No. 05-5200. Available at: http://www.nhlbi.nih.gov/files/docs/pht_facts.pdf. Accessed 2016 September 20

3. Managing Menopause: Journal of Obstetrics and Gynaecology Canada; J ObstetGynaecol Can 2014;35(9):830–833. Available at: http://sogc.org/wp-content/uploads/2014/09/gui311CPG1505Erev.pdf. Accessed 2016 September 20

4. Kaunitz AM. Update on Menopause. OBG Management. 2015;27(6):37-40,42,43.

5. Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women’s Health Initiative randomized trials. JAMA. 2013;310(13):1353-1368.

6. Sood R, Faubion SS, Kuhle CL et al. International Journal of Women’s Health. 2014(6):47-57

Nasal congestion, runny nose, and sneezing? Itching in the nose, roof of the mouth, throat, eyes, or ears? If this sums up your symptoms, you could have allergic rhinitis, a condition in which the lining of the ears, nose and throat become inflamed or irritated. Allergic rhinitiscauses your body to produce an immune reaction to certain substances you are allergic to, called allergens. Common allergens include plant pollen, animal dander, dust mites & molds. This immune reaction leads to all those annoying symptoms that allergy sufferers experience.

Certain types of plant pollen and molds are more predominant in different geographic regions and at different times of the year. In Springwater we experience several different “pollen seasons”:

· March, April & May: Tree Pollen

· June & July: Grass Pollen

· Mid-Summer: Mold blooms begin increasing, and can cause increases in allergies and asthma

· August, September & October: Ragweed

A few ways to reduce your exposure to plant allergens include:

· Check the local pollen count (https://www.theweathernetwork.com/ca/forecasts/pollen/ontario/barrie) and stay inside when it’s high (especially between 5am-10am when it usually peaks)

· Air conditioned spaces can reduce allergies, but make sure your furnace filter and vents are cleared of dust regularly

· Wear a filter mask and gloves if you’re doing yard work

· Sheets and clothes that are hung out to dry can trap pollen –if you love hanging out your wash, consider using the dryer at times when your allergies are flaring up

While limiting your exposure to an allergen is the best way to reduce symptoms, that’s not always a realistic solution as you may not be sure what is causing the reaction. Luckily, if your symptoms are consistent with an allergy we would generally treat it the same way no matter the culprit. Some treatment options you can consider:

· Saline Nasal Sprays and Rinses: Rinsing the sinus passages with saline helps clean out offending allergens, and with regular use you can reduce the congestion and the amount of nasal secretions in your sinuses. This is a great way to reduce symptoms without medication

· Antihistimines: These have been the standard of allergy drug therapy for decades. They are extremely effective at treating and preventing allergy symptoms. 

· Decongestants: These come in oral forms and nasal sprays. While they don’t stop the allergic reaction, they work quickly to reduce sinus congestion and provide relief. Be careful, as oral decongestant medicines are stimulants that can raise blood pressure, and cause agitation and insomnia. Nasal spray decongestants are alright to use for a couple days, but regular use can actually make your congestion worse. 

· Corticosteroid Nasal Sprays: Now available without a prescription, these medications are very effective at reducing nasal congestion.

Before using any medication, speak to your pharmacist or physician to make sure it will be safe and effective for your allergies. Don’t let allergies prevent you from having a great summer and enjoying the outdoors!

There’s nothing like enjoying a beautiful summer day in the sun! But a nasty sunburn can really ruin the fun. Make sure that you’re taking the right steps to keep you and your family safe this summer.

Prevention is Key

Being active out in the sun has numerous health benefits, but unfortunately there is no agreed upon “healthy” amount of sun. Exposing your skin to the sun allows your body to produce Vitamin D, and sunlight has other hidden benefits such as protecting against depression and insomnia. There are, however, harmful consequences to having too much UV exposure. Just two blistering sunburns during childhood can double the risk of melanoma later in life. Ways to reduce sun damage include:

· Avoid tanning beds as they increase the risk of melanoma and non-melanoma skin cancer

· Try to avoid outdoor activity at peak UV irradiance times (10am-4pm when your shadow is shorter than you, or when the UV index is high)

· Choose shady areas for outdoor activities if possible

· Wear protective clothing, wide brimmed hats, and sunglasses that provide 100% UV absorption

· Some medications increase the risk of skin sensitivity and can cause phototoxic reactions. Talk to your pharmacist to make sure you know all the risks associated with any medication you take.

Sunscreen and Sunblock

Using a sunscreen has been shown to prevent melanoma & non-melanoma skin cancers as well as reducing skin aging. Sunscreen ingredients are absorbed into the skin and products that contain them are labeled with an SPF (sun protection factor) rating. Choose products with an SPF of at least 15 and preferably 30. Sunscreens that are labeled “broad spectrum” have met Health Canada requirements to protect against a wide range of UVA/UVB radiation. Sunblocks or physical sunscreens are unabsorbed compounds that sit on the surface of the skin and reflect or scatter UV and visible light (zinc or titanium are the most common of these in commercial products). Sunblocks are generally thicker and leave more of a “shiny” appearance to the skin, but newer products offer micronized titanium or zinc that are less occlusive and still provide good protection. Many products contain both sunscreens & sunblocks together, and provide the best protection. Some things to remember when applying sunscreen:

· Sunscreens are absorbed and therefore need to be applied 15-30 minutes before exposure in order to work.

· About 30mLs (shot glass sized amount) of a typical sunscreen lotion is needed to cover the average adult body

· Reapply frequently during prolonged sun exposure. Water-resistant products should be reapplied after as little as 40 minutes of swimming/sweating.

· Make sure to cover the “most missed” areas: lips, tops of the ears, and tops of the feet.

Talk to us at Springwater Pharmacy about choosing the sunscreen and/or sunblock that is right for you. Have a great summer!

We often think of keeping up to date on vaccines for our children, but adults can also benefit from reviewing their immunization status. There are several vaccines that are important well into adulthood, and that are often overlooked. Here is a quick rundown of the more important vaccines to consider.

Tetanus/Diphtheria/Pertussis

You don’t need to wait until you step on a rusty nail to get a tetanus shot! It’s a good idea to get one about every ten years (and if you can’t remember your last one, it’s easy to ask your doctor for an update). The pertussis vaccine is now recommended for every pregnant woman (and close family) as it helps keep baby safe after birth.

Shingles

We’ve had a single dose shingles vaccine for many years, but a new 2 dose product called Shingrix is vastly more effective, so much so that we now recommend that everyone receive the updated vaccine. If you’ve ever had the chicken pox you are at risk for shingles, and that risk increases significantly when you’re over 50.

Human Papillomavirus (HPV)

Kids now receive the HPV vaccine in Ontario schools as part of their regular publicly funded vaccines. Recently a newer version of this vaccine (Gardasil 9) was introduced that covers more strains of the virus and will be offered in schools soon. It is recommended that women up to age 45 consider this vaccine as HPV is responsible for nearly all cases of cervical cancer, and many other types of cancer as well.

Meningitis

Young children receive meningitis vaccines, but the protection often wanes as we get older and the risk for meningitis increases for people living in close quarters (for example, living in residence at college/university or those in the military). Those aged 18-25 should consider getting a booster; there are two vaccines that cover several types of meningitis (ACYW-135 & B).

Flu Shot

It’s that time of year again! It’s important to renew your flu shot every year to provide a lower risk of contracting influenza. This also lowers the chance of spreading the disease to those who have a higher risk for flu complications, like children or the elderly. Flu vaccine usually becomes available through physicians in October (ages 6 months and older) and through pharmacies in November (ages 5years and older), so check with your doctor or pharmacy and stay protected.

As always if you have any questions about vaccines or other health matters, talk to us at Springwater Pharmacy – we’re here to help.