 |
 |
-------------------------------------------------------------------------- PD AND HORMONES PART ONE OF FIVE -------------------------------------------------------------------------- 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 -----1------------------------------------------------------------------- 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. -------------------------------------------------------------------------- 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. -----2------------------------------------------------------------------------ Date: Sat, 17 Dec 1994 08:21:27 -0700 From: Darlene Newman <[log in to unmask]> Subject: Seeking Information ------------------------------------------------------------------------------ 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. -----3----------------------------------------------------------------------- 1995 Young Parkinson's Handbook Edited by Arlette Johnson, Coordinator APDA Young Parkinson's Information and Referral Center The American Parkinson Disease Association, 1995 ------------------------------------------------------------------------------ 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. -----4------------------------------------------------------------------------ Date: Sun, 12 Mar 1995 08:26:25 +0800 From: Erwin and Pam Matthews <[log in to unmask]> Subject: PD in a Country Town ------------------------------------------------------------------------------ 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) -----5------------------------------------------------------------------------ Date: Sat, 1 Jul 1995 11:32:19 -0700 From: "J.R. Bruman" <[log in to unmask]> Subject: SCIENCE ------------------------------------------------------------------------------ Current Science Reviews July 1995 Giladi N: Neur 1995;45:1028 Cyclic menstrual hormone changes profoundly affect PD symptoms and the amountof medication needed. ------------------------------------------------------------------------------ [log in to unmask]