Tissue Talk: The most estrogen-dependent tissue in the body

You might be thinking the uterus, ovaries, or mammary glands. But no, we're talking the urethra. Yes, that's right, the urethra. It is the most estrogen-dependent tissue in the body for both men and women.

The urethra depends upon sufficient estrogen levels to maintain proper lubrication, which is essential for normal functioning, especially in women. Women lack an internal urinary sphincter. Instead, the urethra must compensate through an adequate bladder neck angle (also called a urethral angle) and a process called coaptation. The urethral angle refers to the angle the urethra exits your bladder. Too small an angle may contribute to diminished flow. More common, too great an angle may contribute to incontinence. Coaptation means that the tissue must open and close in response to external (to that tissue, not to your body) stimuli. In order to do that, it requires sufficient lubrication provided by the mother of lubrication--estrogen.

Several of my menopausal and post-menopausal patients have found that a topical cream has been part of the solution to their incontinence. The cream does not carry the risks associated with oral hormone replacement therapy. You may benefit from the topical if you have low, or borderline, estrogen levels, have bladder issues and especially if your stream is affected (diminished, increased, spurting, etc).

Lumpy forearms

I've had several female patients present with lumpy, painful forearms after significant hormonal changes (postpartum, perimenopause). The nodules feel very similar to those that formed on my thighs after I had suffered multiple fractures to my pelvis. They showed up months after the trauma, were massaged out over a period of six months, and recur on occasion. The difference seems to be that these women have pain with use of the arms; I had pain only with pressure on the nodules. Both feel like the beginnings of scar tissue if they don't get worked out. Fortunately, both tend to be responsive to friction. 

It's not uncommon for women to have major, unexpected changes in their bodies after hormonal changes. Many women report that their health changed either for the better or for the worse after a pregnancy. Some women experience change in hair texture (straight to curly) or a change in how fast their hair or nails grow. But the lumpy, painful forearms is something I've not heard of before.

A Google search yielded no relevant results. If you have experience with this, please let me know.

Stress, Sleep & TCM

I have a lot of people in my life experiencing sleep issues and personal crises lately so I thought it would be a good time to publish this article on stress and Traditional Chinese Medicine:

The more I study physiology, the more impressed I am by how stress impacts our health.  It is a ubiquitous, varied specter that demands our attention.  Indeed, stress has many pathways through our bodies and its effects can vary—the stress we experience when we are sleep deprived is not the same stress we experience when we’re sitting in rush-hour traffic.  But any stress that becomes chronic lays waste to our bodies.  Acupuncture works directly on the HPA stress axis producing changes in neurotransmitters.

We are all familiar with how stress feels to us and we’ve heard about cortisol.  There are fascinating facts about stress of which you may be unaware:

• Chronic stress exposes us to levels of cortisol that consume muscle tissue.  It will literally eat away at our muscles. 

• Chronic stress can cause the hippocampus to shrink. The hippocampus is integral in higher cognitive abilities such as memory, judgment, and decision making.

• Pain produces stress and stress can exacerbate pain. Haslam & Laycock (2008) cite research that indicates that “When pain persists, even after healing has taken place, the nerve cell membranes undergo a change in conformation, establishing new receptor sites and the formation of new neural pathways that become imbedded into the central nervous system. Once established, the chronic pain pathways are difficult to eradicate.”  Difficult, but not impossible.

• Many neurotransmitters are hormones, so when one system is affected it effects a cascade of imbalance. Exercise and sleep can not be emphasized enough in any topic concerning health maintenance—their effects are vast. We produce more neurons when we exercise. 

Here are some ways to promote homeostasis that you may not have heard: 

• Scientists point out that we have evolved to recognize song bird melodies as a signal of safety—when the birds sing, predators are not nearby. Hearing them elicits a parasympathetic (relaxation) response in us. Try listening to bird songs at least five minutes every day.

• With all the recent research showing the many health benefits of companion animals, it’s not surprising to see this latest study that petting animals, even those who are not furry (like turtles), reduces stress regardless of one’s attitude toward them.  The study controlled for petting with stuffed toys.1 

• Placing gentle, even pressure on your closed eyes for one minute can provide instant parasympathetic bliss. Traditional Chinese medicine has offered this through Shiatsu and Chi Nei Tsang modalities. Western medicine has determined its mechanism—a direct link from eyes to heart via ocular nerves to trigeminal nerves to vagus nerves called the cardio-ocular response. 

1    Shiloh, S., et. al., Reduction of state anxiety of petting animals in a controlled laboratory experiment,  Anxiety, Stress & Coping, Volume 16, Issue 4 December 2003 , pages 387 - 395   http://www.informaworld.com/smpp/content~content=a713637880~db=all