ThE MEdiCiNE CabiNET

wiTh dr. hOward LEwiNE

HeLp foR menopausaL women’s HaiR Loss

q: since menopause my hair keeps getting thinner. why do older women lose their hair? what treatments are available? a: Among postmenopausal women, as many as twothirds develop hair thinning or bald spots.

The main type of hair loss in women is the same as it is men. It’s called androgenetic alopecia, or female (or male) pattern hair loss. In women, androgenetic alopecia begins with gradual thinning at the part line, followed by increasing diffuse hair loss radiating from the top of the head. A woman’s hairline rarely recedes, and women rarely become bald.

There are many potential causes of hair loss in women, including medical conditions, medications, and physical or emotional stress. If you notice unusual hair loss of any kind, it’s important to see your primary care provider or a dermatologist, to determine the cause and appropriate treatment.

Almost every woman eventually develops some degree of female pattern hair loss. It can start any time after the onset of puberty, but women tend to first notice it around menopause, when hair loss typically increases. The risk rises with age, and it’s higher for women with a history of hair loss on either side of the family.

Medications that can help with hair loss in women include: pRostate canceR scReening afteR age 70 q: i just celebrated my 70th birthday and am due for my yearly doctor visit. How does a man decide whether to continue psa testing for prostate cancer? a: While some guidelines suggest stopping prostate cancer screening after age 70, the decision to continue depends on your general health and life expectancy. The reason: Most prostate cancers are lowgrade and will not shorten a man’s life or diminish his quality of life. On the other hand, diagnosing higher-grade cancer at an earlier stage could lead to treatment to keep the cancer from spreading.

• Topical minoxidil: The FDA originally approved over-the-counter 2% minoxidil to treat hair loss in women. Since then a 5% solution has also become available when a stronger solution is needed for a woman’s hair loss.

While it can produce some new growth of fine hair in some — not all — women, it can’t restore the full density of the lost hair. It’s not a quick fix, either for hair loss in women . You won’t see results until you use the drug for at least two months. The effect often peaks at around four months, but it could take longer, so plan on a trial of six to 12 months. If minoxidil works for you, you’ll need to keep using it to maintain those results. If you stop, you’ll start to lose hair again.

• Anti-androgens: Androgens include testosterone and other “male” hormones, which can accelerate hair loss in women. Some women who don’t respond to minoxidil may benefit from the addition of the anti-androgen drug spironolactone (Aldactone) for treatment of androgenic alopecia. This is especially true for women with polycystic ovary syndrome (PCOS) because they tend to make excess androgens.

• Iron supplements: Iron deficiency could be a cause of hair loss in some women. Your doctor may test your blood iron level. If you do have iron deficiency, you will need to take a supplement and it may stop your hair loss. However, if your iron level is normal, taking extra iron will only cause side effects, such as stomach upset and constipation.

In the past, a man with a high or rising PSA level would have to choose between having an immediate prostate biopsy (to locate any cancer and assess its severity) or living with some uncertainty. Today, other tests can help predict the presence of cancer, especially cancer that is more likely to spread. Examples include MRI (magnetic resonance imaging), specific subtypes of PSA blood tests, and urine testing for specific genetic markers. For men who do opt for prostate cancer screening but may not want immediate treatment even if cancer is likely, the two main strategies are watchful waiting or active surveillance. expected memoRY Lapses oR eaRLY dementia? q: when should a person start worrying about becoming more forgetful? How can you tell if it’s normal memory loss, or something more serious? a: For many of us, memory blips become more common as we get older. Our brains are forming fewer connections now, so our memory is not as strong as it used to be. It may take us longer to remember basic information, such as names, dates or where we left our car keys. As we get older, the processing speed of our brain slows down, so we can’t recall information as quickly as we used to.

Watchful waiting: Watchful waiting either before or after a biopsy means you don’t get regular PSA tests or other monitoring. Only if symptoms occur would you have further diagnostic testing to determine whether and how to treat the symptoms.

Active surveillance: An active surveillance strategy requires a prostate biopsy first to identify the cancer’s size and probability of spreading. High-grade and many intermediate-grade prostate cancers don’t qualify for active surveillance because treatment usually begins right away. However, this strategy is an option for men who would be comfortable with close monitoring for low-grade cancer. Active surveillance involves more frequent PSA testing (to look for any rise in the level over time) and likely periodic prostate biopsies. Your doctor might order an MRI or a urine test for genetic markers to determine when a repeat biopsy is needed. If and when evidence arises that the cancer has become more active, then treatment would begin.

Studies comparing men with low-grade prostate cancer who choose active surveillance rather than immediate surgery or radiation show similar outcomes and life expectancy. By choosing active surveillance, a man can delay or even avoid treatment side effects, such as erectile dysfunction and incontinence. The downside is the small risk of delaying treatment of a cancer that grows faster than expected.

Memory lapses are unsettling, but they don’t necessarily herald impending dementia. The key is in how often these slips occur. You really need to figure out the pattern. Is it happening several times a week or is it happening once or twice a month? Is it a change compared to five or 10 years ago? Is it getting gradually worse?

Forgetfulness can be a normal part of growing older. Memory lapses can also stem from several other conditions, including lack of sleep, stress, medications, alcohol or depression.

Any of these conditions can be treated. For example, you can adjust your sleep schedule, try deep breathing or other techniques to reduce stress, change the dose or type of medications you take, cut down on your drinking or get treated for depression.

Don’t be alarmed by everyday forgetfulness. The time to call your doctor is when you have more persistent or worsening memory loss that’s interfering with your daily activities and routine and starting to affect your daily functioning.

There are three things you can start doing right now to preserve mental function as you age:

1. Exercise: Exercise promotes the release of a powerful molecule called brain-derived neurotrophic factor, which repairs brain cells, strengthens their connections, promotes new brain cell growth, and enlarges the size of your hippocampus (a part of the brain involved in the storage and retrieval of memories). Exercise also increases blood flow to your brain and may protect the brain’s system for flushing out toxins.

2. Eat a healthy diet: To protect yourself, generally avoid processed and sugary foods and animal fats (other than from fish): they’re associated with poor cardiovascular health. Opt instead for a Mediterranean-style diet, which is tied to lower risks for cardiovascular disease and cognitive decline. The diet is rich in fruits, vegetables, beans, whole grains, nuts, seeds, olive oil, and fish, as well as moderate amounts of poultry and dairy.

3. Get more sleep: We should aim for seven to eight hours of sleep each night to help the body rest and the brain conduct important duties. During sleep, the brain’s glymphatic system flushes out waste produced by the brain, including Alzheimer’s disease–related toxins (such as the protein amyloid-beta).

Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.

TinniTus:

Ringing oR Humming in youR eaRs? sound tHeRaPy is one oPtion

matthew solan, Harvard Health blog, premium Health news service

That recurring sound that you hear but nobody else does? It’s not all in your head. Well, not exactly.

You may be one of the estimated 50 million-plus people who suffer from tinnitus. The mysterious condition causes a sound in the head with no external source. For many it’s a high-pitched ringing, while for others it’s whistling, whooshing, buzzing, chirping, hissing, humming, roaring or even shrieking.

The sound may seem to come from one ear or both, from inside the head, or from a distance. It may be constant or intermittent, steady or pulsating. One approach to managing this condition is different forms of sound therapy intended to help people tune out the internal soundtrack of tinnitus.

What causes tinnitus?

There are many possible causes of tinnitus. Long-term exposure to loud noises is often blamed. But other sources include middle ear problems like an infection, a tumor or cyst pinching nerves in the ear, or something as simple as earwax buildup. Tinnitus also can be a symptom of Meniere’s disease, a disorder of the balance mechanism in the inner ear.

Even old-fashioned aging can lead to tinnitus, which is common in people older than age 55. As people get older, the auditory nerve connecting the ear to the brain starts to fray, diminishing normal sounds.

“Neurons (nerve cells) in areas of the brain that process sound make up for this loss of input by increasing their sensitivity,” says Daniel Polley, director of the Lauer Tinnitus Research Center at Harvard-affiliated Massachusetts Eye and Ear. “The sensitivity knobs are turned up so high that neurons begin to respond to the activity of other nearby neurons. This creates the perception of a sound that does not exist in the physical environment. It’s a classic example of a feedback loop, similar to the squeal of a microphone when it is too close to a speaker.”

At times, everyone experiences the perception of a phantom sound. If it only lasts for a few seconds or minutes, it’s nothing to worry about. However, if it pulsates in sync with your heart rate, it’s definitely something to get checked out by a physician, says Polley. If it’s a relatively continuous sound, you should see an audiologist or otolaryngologist (ears, nose, throat specialist).

can sound therapy help tune out tinnitus?

There is no cure for tinnitus, but it can become less noticeable over time. Still, there are ways to ease symptoms and help tune out the noise and minimize its impact. Treatments are a trial-and-error approach, as they work for some people but not others.

One often-suggested strategy is sound therapy. It uses external noise to alter your perception of or reaction to tinnitus. Research suggests sound therapy can effectively suppress tinnitus in some people. Two common types of sound therapy are masking and habituation.

• Masking: This exposes a person to background noise, like white noise, nature sounds, or ambient sounds, to mask tinnitus noise or distract attention away from it. Listening to sound machines or music through headphones or other devices can offer temporary breaks from the perception of tinnitus. Household items like electric fans, radios and TVs also can help. Many people with tinnitus also have some degree of hearing loss. Hearing aids can be used to mask tinnitus by turning up the volume on outside noises. This works especially well when hearing loss and tinnitus occur within the same frequency range, according to the American Tinnitus Association.

• Habituation: Also known as tinnitus retraining therapy, this process trains your brain to become more accustomed to tinnitus. Here, you listen to noise similar to your tinnitus sound for long periods. Eventually your brain ignores the tone, along with the tinnitus sound. It’s similar to how you eventually don’t think about how glasses feel on your nose. The therapy is done with guidance from a specialist and the time frame varies per person, usually anywhere from 12 to 24 months.

additional approaches may help With tinnitus

Depending on your diagnosis, your doctor also may recommend addressing issues that could contribute to your tinnitus.

• Musculoskeletal factors: Jaw clenching, tooth grinding, prior injury or muscle tension in the neck can sometimes make tinnitus more noticeable. If tight muscles are part of the problem, massage therapy may help relieve it.

• Underlying health conditions: You may be able to reduce the impact of tinnitus by treating conditions like depression, anxiety and insomnia.

• Negative thinking: Adopting cognitive behavioral therapy and hypnosis to redirect negative thoughts and emotions linked to tinnitus may also help ease symptoms.

• Medication: Tinnitus can be a side effect of many medications, especially when taken at higher doses, like aspirin and other nonsteroidal anti-inflammatory drugs and certain antidepressants. The problem often goes away when the drug is reduced or discontinued.