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PD AND HORMONES PART ONE OF FIVE
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hi everyone;

this is a chronological 'thread' of messages and information posted to the list
over the last year and a half. all to do with pd and hormones, both male and
female, but with the emphasis on female hormones, the menstrual cycle, and
menopause.  i've put a number in the first line of each item for reference. the
postings have been fairly heavily, but arbitrarily, edited by yours truly, in
an effort to reduce the overall size of this thread, without losing the 'hard'
information. in some cases, i've included the message simply because the
parkie involved is taking hormone supplements.

janet


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1994 An Algorithm For The Management Of Parkinson's Disease

a supplement of the American Academy of Neurology
Reprinted in Neurology 1994;44:S1-S52.

Editors:
William Koller, M.D. Ph.D
Dee Silver, M.D.
Abraham Lieberman, M.D.
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SEXUAL PROBLEMS

Little attention has been paid to the sexual dysfunction common in patients
with PD. Most treatment is aimed at impotence in men, with virtually nothing
being known about the sexual function of women with PD. In men, the most common
problem is achieving or sustaining an erection.

Management. Propranolol or other beta-adrenergic blockers, sometimes used to
control postural or action tremor in patients with PD, are common offenders.
Other possible problem drugs include antihypertensives (alpha-adrenergic
blockers such as clonidine, methyldopa, and guanfacine). Guanethidine, although
less frequently used, is a potential offender, as are thiazide diuretics,
anxiolytics, digoxin, and cimetidine.

Looking for depression is often rewarding; medical evaluation is mandatory but
rarely helpful. Although depression is a frequent cause of sexual dysfunction,
it is noteworthy that antidepressant drugs (particularly the serotonin uptake
inhibitors fluoxetine, paroxetine, sertraline) can cause impotence. Tricyclics
also have been implicated as a less frequent cause of impotence. Depressed
patients should be treated with either tricyclic antidepressants or serotonin
uptake inhibitors, despite the problems described above. Tricyclics (with
anticholinergic properties) have the added advantage of alleviating some of the
parkinsonian symptoms, but the best approach is to use the most efficacious
drug to lift depression in a given patient. Some patients with anxiety- or
stress-associated sexual dysfunction benefit from low-dose anxiolytics.

Endocrine function can be ascertained with serum levels of prolactin
testosterone, and luteinizing hormone and studies of thyroid function. If no
medical or psychologic reasons seem to be causing impotence, one can try
yohimbine, 5 mg tid for 1 month. Further treatment, under consultation with an
expert urologist, can include local injection of phentolamine(an alpha-
adrenergic blocker) and papaverine. This combination provides a short-term
vasodilator effect by acting on smooth muscle. More invasive approaches, such
as implants, are less easily accepted by patients and treating physicians.
Previously untreated patients may find that starting treatment with levodopa
can help sexual dysfunction, probably by alleviating bradykinesia and
increasing desire. In fact, some patients on high doses of antiparkinsonian
agents become hypersexual, even in the face of inability to perform.

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Date:         Sat, 17 Dec 1994 08:21:27 -0700
From:         Darlene Newman <[log in to unmask]>
Subject:      Seeking Information
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I was diagnosed with Parkinson's 4 years ago and have been doing a lot of
talking and research but have some questions that I am hoping your network can
help me with.  I am 42 years old and am experience a real change in tremor,
stiffness and freezing movements just prior to and a couple of days into my
menstrual cycle.  I am wondering if their are others with the same and what are
you doing to help make things better during that time.

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1995 Young Parkinson's Handbook
Edited by Arlette Johnson, Coordinator
APDA Young Parkinson's Information and Referral Center
The American Parkinson Disease Association, 1995
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Hormone Fluctuations

While we don't understand the mechanisms involved, we do know that the
fluctuations of female hormones - particularly progesterone and estrogen - can
result in a diminished or fluctuating response to anti-Parkinson's medication.

Menses

According to Dr. Caroline Tanner, of the Parkinson's Institute in Sunnyvale,
California, she has never treated a pre-menopausal woman with PD who didn't
encounter problems as menses approached. For most, difficulties occur
immediately before menses every month. For these women, anti-Parkinson's drugs
seem simply to quit working. Some women experience this difficulty from several
days before the onset of their periods all the way through their menses. Others
find that when their periods begin, the problems disappear.

While Dr. Tanner's attempts to formally study Parkinson's and menses have been
thwarted by the irregularities of her patient's cycles, her informal
observations and efforts to find methods to counteract these drug failures are
well worth discussing with your own neurologist. Just as no two people have the
same experience with Parkinson's itself, the female response to various
approaches to alleviate the menses/Parkinson's difficulties also varies widely.

However, a number of approaches have each worked... for some. These (which we
emphasize again must be discussed with your own physician) include:

1. Prescribing birth control pills in an effort to stabilize hormones
throughout the cycle and thus minimize the fluctuations before and during
menses.

2. Prescribing Diamox (generic: acetazolamide) can help by stabilizing the
membrane while it acts as a diuretic to eliminate excess water build-up. The
use of this drug, Dr. Tanner explained, has been found to be useful for women
with epilepsy, as well, minimizing the flurry of seizures that can be
experienced just before their menses begins each month. Diamox should be taken
for 5 to 7 days before menses and should continue for 1-2 days into the
patient's period. Diamox has also been found to be helpful for people with
atypical tremor, suggesting the possibility of other mechanisms at work, as
well.

3. Adding low dosages of anticholinergics can also be helpful, something that
Dr. Tanner discovered through a patient who benefited, before and during
menses, by taking Benedryl.

4. Finally, increasing the Sinemet dosage during the difficult times of the
female patient's cycle helps some patients, though others Dr. Tanner has worked
with reported no benefit from as much as doubling their daily dose.

5. Some patients find, too, that difficulties experienced just before and
during menses can be reduced by avoiding alcohol, caffeine, concentrated sweets
and tobacco during the second half of the menstrual cycle. Regular exercise and
relaxation techniques may be beneficial, as well.

Menopause

Women entering menopause experience hormonal fluctuations too, which means
they'll probably experience the same kinds of problems premenopausal women have
with their menses.

According to Julie Carter, R.N., M.N., A.N.P. at Oregon Health Sciences
University in Portland, Oregon, the two problems are definitely related; both
are caused by hormone fluctuations. For the woman experiencing menopause
problems, the challenge will be to keep hormone levels as consistent as
possible. Work closely with your gynecologist during this time.

"Once a woman is through menopause or stabilized on hormonal replacement
therapy, she generally returns to predictable response to her anti-Parkinson's
medications," Carter says.

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Date:         Sun, 12 Mar 1995 08:26:25 +0800
From:         Erwin and Pam Matthews <[log in to unmask]>
Subject:      PD in a Country Town
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Friends on PARKINSN,

Pam was diagnosed with PD at age 48 with idiopathic PD affecting the right side
of the body.

Pam's present medication is:
Morning
-one  Sinemet 100/25
-one & a half  Sinemet CR 200/50
-one Parlodel 10mg
-Premarin 0.625 (HRT)
Midday
-half  Sinemet CR 200/50
-one Parlodel 5 mg
Evening
-one & a half Sinemet CR 200/50
-one Parlodel 5 mg
Bedtime
-100mg Prothiaden (anti-depressant)
Before each meal
-10mg Domperidone (anti-sickness)

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Date:         Sat, 1 Jul 1995 11:32:19 -0700
From:         "J.R. Bruman" <[log in to unmask]>
Subject:      SCIENCE
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Current Science Reviews                                  July 1995

Giladi N: Neur 1995;45:1028

Cyclic menstrual hormone changes profoundly
affect PD symptoms and the amountof medication needed.

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