Randi Hutter Epstein M.D. M.P.H.

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Does Love-Making Stop when Dementia Starts?

I was giving a menopause talk the other day and as it often happens when I talk to small groups of women, the lecture morphed into a conversation. That is to say, that people in audience shared their own stories—low libido, vaginal dryness, hot flashes, to name a few.

We had spent the better part of the hour talking about the history of hormone replacement therapy and the current guidelines—most it was research from my book. But here’s was struck me. When I was walking out of the conference room, a 78-year-old woman—the oldest women in the audience by far—approached me to say that her sex life was nearly as good as ever. She and her husband still have intercourse at least once a week, not as active as they were a half-century ago but going strong enough. The flames of attraction are flickering.

And yet, for an increasing number of elderly couples, the issue is not so much about sex drive or partnership, but whether to maintain a physical intimacy when a partner shows signs of dementia.

Until now, this has been a topic considered taboo.

“The lack of basic information about sexual behavior, function and desires in this growing population is a problem,” said Stacy Lindau, a professor of obstetrics and gynecology at the University of Chicago and director of WomanLab, a web-based platform for information about sex and aging that offers resources about sex and dementia.

Because of the dearth of information, Lindau’s team conducted one of the first nationally representative sex surveys of the elderly, including 3,196 adults. These latest results, reported in the September issue of the Journal of the American Geriatrics Society. found that for home-dwelling people with dementia and with a partner, more than half are still have sex.

Dr. Monica Christmas, a gynecologist who works with Lindau and directs the Menopause Program at the University of Chicago, told me that years ago an elderly couple came to see her regarding painful intercourse. The wife was showing signs of Alzheimer’s disease; she often didn’t recognize her husband.  Christmas worried about the ethics of it all. Was the husband forcing himself on his wife? After a lengthy discussion, she didn’t think so.

“You have this man taking care of his wife, someone he was married to for 40 years, and she’s not the same person as she was but he’s accepting her for who she is,” said Christmas. “In an innate sense, somehow the intimacy brought her back to the wife he loved, for a brief moment you feel like you’re the couple you used to be.” And she added, would there be something in the intimacy of the moment, something innate, that resonated with the patient?

For now, many of these questions are unanswered—and may continue to be unanswerable. But they are ones that need to be addressed. Lindau’s study is a step in the right direction. Or as she added, “Our study does point to the potential value of adding sexual life planning to advance directives. The idea of sexual advance directives would enable a person to both say what they’d want in terms of a sex life with dementia and to say what would be acceptable in terms of spouse having an extra-marital sexual relationship.”

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The Secret Behind the World’s First IVF Baby

Behind Every Successful Man is Strong woman. Or is it “wise woman”? Or maybe it’s this: “Behind every successful man is a woman who provides a strong foundation.” I read that somewhere.

Whatever. This week was the 40th birthday of Louise Brown, the world’s first test tube baby. (July 25th to be precise). We celebrate Louise but we really celebrate Dr. Robert Edwards, the Cambridge University doctor who made it all happen.

But guess what? There was a woman behind his greatness. Back in the late 1970s, Dr. Georgeanna Jones, director of reproductive endocrinology at Johns Hopkins hospital, told Edwards to tweak with the chemicals in the culture media into one that she knew would allow the sperm/egg union to flourish.

When Edwards won the Nobel Prize in 2010, Hopkins had their own tiny ceremony in the department of obstetrics and gynecology. I was there when about a dozen of us watched the unveiling of a small plaque commemorating Dr. Georgeanna Jones and Dr. Howard W. Jones, Jr. (her husband) for providing the advice that led to Edward’s Nobel Prize.

Dr. Howard was there that day ,too. .He told me the advice was all Georgeanna, not him. I never met Dr. Georgeanna. She died in 2005. (Howard Jones died at the age of 104, in 2015, mentally sharp until his very last breath.)

The Joneses went on to create America’s first test tube baby in 1981.

But on this week, when we celebrate Brown’s 40th birthday (she was born, July 25th, 1978), we should also raise a toast to the woman who made it all possible. Dr. Georgeanna Seegar Jones.
You can read more about her accomplishments in my book, AROUSED: The History of Hormones and How They Control Just About Everything. And if you happen to have been born because of the Joneses—and knew either of them—I’d love to hear your story.

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Pregnancy Hormones but No Panda Pregnancy

The National Zoo in Washington D.C. announced today that Mei Xiang, a 19-year-old panda isn’t pregnant after all. It was just a “pseudo pregnancy,” or fake pregnancy. Seems she had all the signs (nesting, eating less) and even hormonal changes. But the one thing she didn’t have was a fetus in her womb.

So, what was going on with her hormones? In short, some animals after sex or artificial insemination, have a rise in certain pregnancy hormones can rise for a few weeks.   Then without a fetus gestating, the levels eventually go back to the non-pregnant state. That seems to have been Mei Xiang’s  story. She had a progesterone surge but an ultrasound didn’t find a fetus

In an article aptly called, “Pseudopregnancy in the Bitch,” and published in the Journal of Small Animal Practice in 1986, the authors explain that the condition has to do with the way post-coital hormones are released from the pituitary gland, a gland that dangles off the brain.  It’s not uncommon in mammals that go through estrus, which is different from humans that menstruate. (Estrus means that the lining of the womb is absorbed back into the body after the egg is released but there is no conception. For many species, the females are only sexually active during estrus. Humans menstruate—that means they bleed and sometimes have sex  when they aren’t fertile.) In humans (but not pandas) “pseudopregnancy” also called pseudocyesis and is listed in the DSM-5, the psychiatrists bible of mental disorders.

At 20, the Mei Xiang is considered on the older end for giving birth, but the National Zoo veterinarians aren’t giving up hope yet.

For further reading on pregnancy hormones and a pioneering researcher, check out Chapter Six in my latest book: Aroused: The History of Hormones and How They Control Just About Everything 

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Hungry: Could it Be Your Hormones

For many of us, the fourth of July means fireworks and food. But here’s the thing: unlike colder weather festivals, such as Thanksgiving, it’s harder to cover up our bulging bellies. Can’t we just have a little self-control?

Well, maybe not. Emerging evidence reveals that our drive to eat may be controlled by our hormones.

People with glitches in the hormone, leptin, for instance—or in the way the body responds to it, are voraciously hungry all the time. Left to their own desires, they become morbidly obese and suffer from all of the consequences that go along with that. Scientists have developed leptin shots that help many people with this rare disorder, allowing them to enjoy hunger and fullness for the first time in their lives. But some folks with a leptin defect have enough of the hormone, but their bodies do not respond to the “I-feel-full” signals. That means that all the leptin in the world won’t stop their cravings. Scientists are beginning to understand their chemical dysfunction. There are a few drugs in the pipeline but no cure yet.

What about the rest of us? Do these exciting clues mean that we can tweak our appetite hormones so we can feel fuller sooner and shed those extra pounds? Can we pop a pill before the weekend barbeque and control the urge to go for seconds?

To be sure, there are self-help books and supplements galore with all sorts of dubious claims to boost your leptin hormone. But here’s the thing: Leptin has been in the spotlight ever since it was discovered in 1994, yet there are so many other chemical signals that control how much we eat, how we burn calories, and what we choose to pile on our plates.

We are a complicated stew of chemicals. When it comes to hunger and satiety, there’s neuropeptide Y, agouti-related peptide, melanocyte-stimulating hormone, ghrelin, insulin-like peptide and the list goes on and on.

So sure, blame your hormones for driving you to the dessert table. But don’t try to “cure” your urges with some dubious supplement.

And sometimes, well, we eat even when we don’t feel those hormonally driven hunger pangs. Sometimes we eat when we’re not hungry because we are, after all, human.

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Why Can’t We Talk About Pain

When my husband was wheeled into the recovery room after a hernia operation, the nurse leaned over and asked him to give his pain a number between one and 10. I could see him woozy and wincing so I whispered (rather loudly), “Ten! Just say ten!” I wanted him to get much-needed painkillers.

“Miss,” the nurse huffed at me, “he can speak for himself.”

Well that’s the problem. Few of us can express our aches and hurts accurately, particularly when we are in the throes of them.

Last week, I wrote a review of Abby Norman’s memoir Ask Me About My Uterus. It’s about endometriosis, a chronic and debilitating illness triggered by uterine-like cells growing outside of the womb. Women with the disorder have heavy, agonizing periods along with a litany of other symptoms depending on where the rogue cells lurk: bowel and urinary tract disorders, leg pains, and on rare occasions breathing problems if endometriosis lands in the lung.

Lena Dunham, Whoopi Goldberg and Padma Lakshmi are among a slew of celebrities who have gone public with their stories about suffering from this illness that typically gets ignored or dismissed for years.

What struck me reading Norman’s book was more than the information about endometriosis. Yes, this disease needs more attention and more research that will, I hope, lead to better treatments.

But the broader message is about communicating pain. Our language for letting doctors know how we really feel is so limited. Stabbing? Throbbing? A two? A ten? To be sure, the smiley faces can help young children communicate the level of their discomfort—pointing to sad face or cheery one may be easier than talking to a grown-up.

David Biro, in Listening to Pain: Finding Words, Compassion and Relief elaborated on this issue. (Biro, by the way, has got an M.D. and did his Ph.D. studying the language of pain.) All of us have had something hurt at some point—some of us worse than others—but without explicit words it’s often hard not only to let our loved ones know how we feel but most importantly it’s nearly impossible to convey these crucial clues to our doctors.

The big push in medical schools these days is learning to listen to patient’s full story (as opposed to simply jotting down lab findings). What we truly need to help doctors and patients understand each other are better ways to express what we are feeling inside. We need to devise a better system so people in pain do not need to rely on their loudmouth wives yelling “Ten! He’s a Ten!”