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A recent Food and Drug Administration (FDA) MedWatch Safety Alert warns women to make sure children and pets do not come into contact with Evamist that they have sprayed on their skin.    Evamist is a transdermal spray containing estradiol, a form of estrogen. It is sprayed inside of the forearm between the elbow and wrist to reduce hot flashes during menopause. Each squirt of spray delivers 90 mcL which contains 1.53 mg of estradiol and is FDA approved for this use.
The FDA has received reports of side effects in children who were unintentionally exposed to Evamist.   Side effects include:

• nipple swelling and breast development in girls
• Breast enlargement in boys

FDA has also received reports of unintentional exposure in pets, which may show signs of mammary/nipple enlargement and vulvar swelling.
The FDA recommends that you do not allow children to come in contact with area of the arm where Evamist was sprayed.  If a child is exposed to Evamist, wash the child’s skin with soap and water as soon as possible.      Contact the child’s health professional if nipple or breast swelling or breast tenderness occurs in girls, or breast enlargement occurs in boys.    Do not allow pets to lick or touch the arm where Evamist was sprayed.   Small pets may be especially sensitive to Evamist.   Contact a vet if your pet shows any signs of illness, including enlargement of the nipples or vulva.
Women who use Evamist should wear clothing that covers the arm sprayed with the drug if they cannot prevent accidental contact.
The FDA

Study finds association between stress level in early cycle, severity of symptoms
Women who report feeling stressed early in their monthly cycle were more likely than those who were less stressed to report more pronounced symptoms before and during menstruation, according to a study by researchers at the National Institutes of Health and other institutions. The association raises the possibility that feeling stressed in the weeks before menstruation could worsen the symptoms typically associated with premenstrual syndrome and menstruation.
Women who reported feeling stressed two weeks before the beginning of menstruation were two to four times more likely to report moderate to severe symptoms than were women who did not feel stressed.
Premenstrual syndrome is a group of physical and psychological symptoms occurring around the time of ovulation, which may extend into the early days of menstruation. Symptoms include feelings of anger, anxiety, mood swings, depression, fatigue, decreased concentration, breast swelling and tenderness, general aches, and abdominal bloating.
The study was conducted by researchers in the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the University of Massachusetts-Amherst, and the State University of New York, Buffalo. The study was published online in the Journal of Women’s Health.
To read more on the study, click here.

No, you did not open the wrong page.   Yes, this blog is posted by the Institute for Women’s Health Research at Northwestern. As an advocate for better  sex and gender based research, we support all avenues that increase our knowledge about sex differences and that includes  a better understanding of  hormone changes in women AND MEN.
Furthermore, women are generally the source of health information for their families and that includes their male partners! So, women and men, read on!

Low testosterone levels to blame for low libido, fatigue and weight gain
While most frequently associated with women’s health, age-related hormone changes, often dubbed menopause, can occur in men as well, causing symptoms of fatigue, mood swings, decreased desire for sex, hair loss, lack of concentration and weight gain. Experts estimate that more than 5 million men are affected, yet worry the number may be considerably higher since symptoms are frequently ignored.  Male hypogonadism, as it’s referred to in the medical community, occurs when the testicles do not produce enough testosterone, the hormone that plays a key role in masculine growth and development. When hormone levels drop, men can experience significant mental and physical changes.
“This is a highly prevalent disorder,” said Robert Brannigan, MD, urologist at Northwestern Memorial Hospital. “Unfortunately, we estimate that 95 percent of cases are undiagnosed and therefore untreated. When ignored, symptoms can seriously disrupt one’s quality of life.”
Brannigan explains hormone variations are a normal aspect of getting older. “In females, ovulation comes to an end and hormone production declines in a relatively quick period of time, whereas men experience hormone shifts more slowly, with testosterone levels dropping around one percent each year beginning in a man’s late thirties,” adds Brannigan. He goes on to explain that by age seventy, the reduction in a male’s testosterone level could be as high as fifty percent or more compared to baseline levels, but notes that aging men are not the only ones at risk. A number of genetic causes can impact males from birth and are usually diagnosed with failure to progress normally through puberty during the teenage years.
Treatment options for male hypogonadism include hormone replacement therapy (HRT) via absorbable pellet implants, topical gels, patches, and injections. Through HRT, doctors can restore sexual function and muscle strength. In addition, men often experience an increase in energy and an improved overall sense of well-being.
“We are seeing more men affected by male hypogonadism than we saw ten years ago,” said Brannigan. “However, many men continue to suffer in silence due to a lack of awareness surrounding the disorder. Because male hypogonadism can significantly impact the quality of one’s life, it’s important that men pay attention to their body and openly discuss symptoms with their physician in order to prevent overlooking the cause and avoid missing an opportunity for appropriate therapy.”
Although research to determine the exact association continues, doctors also warn that male hypogonadism has been linked to chronic medical conditions such as high cholesterol, diabetes and cardiovascular disease. It’s also closely associated with infertility.
“This disorder is not something that should be ignored,” said Brannigan, who is working to educate patients and physicians about the symptoms and treatments available in order to ensure therapies are made available to men in need.
Male hypogonadism is most commonly diagnosed through a simple blood test. Brannigan notes hormone replacement therapy is not appropriate for all patients especially those with history of prostate and breast cancer and men trying to conceive. He suggests consulting your doctor if you are experiencing symptoms.

Benefits shown in middle-aged and elderly women
Middle-aged and elderly Swedish women who regularly ate a small amount of chocolate had lower risks of heart failure risks, in a study reported in Circulation: Heart Failure, a journal of the American Heart Association.  The nine-year study, conducted among 31,823 middle-aged and elderly Swedish women, looked at the relationship of the amount of high-quality chocolate the women ate, compared to their risk for heart failure. The quality of chocolate consumed by the women had a higher density cocoa content somewhat like dark chocolate by American standards. In this study, researchers found:

• Women who ate an average of one to two servings of the high-quality chocolate per week had a 32 percent lower risk of developing heart failure.
• Those who had one to three servings per month had a 26 percent lower risk.
• Those who consumed at least one serving daily or more didn’t appear to benefit from a protective effect against heart failure.

The lack of a protective effect among women eating chocolate every day is probably due to the additional calories gained from eating chocolate instead of more nutritious foods, said Murrray Mittleman, M.D., Dr.P.H., lead researcher of the study.  “You can’t ignore that chocolate is a relatively calorie-dense food and large amounts of habitual consumption is going to raise your risks for weight gain,” said Mittleman, director of the Cardiovascular Epidemiology Research Unit at Harvard Medical School’s Beth Israel Deaconess Medical Center in Boston. “But if you’re going to have a treat, dark chocolate is probably a good choice, as long as it’s in moderation.”
High concentration of compounds called “flavonoids” in chocolate may lower blood pressure, among other benefits, according to mostly short-term studies. However, this is the first study to show long-term outcomes related specifically to heart failure, which can result from ongoing untreated high blood pressure.   In the observational study, researchers analyzed self-reported food-frequency questionnaire responses from participants 48-to-83-years-old in the Swedish Mammography Cohort. Combining the results with data from national Swedish hospitalization and death registries between 1998 through 2006, the researchers used multiple forms of statistical modeling to reach their conclusions on heart failure and chocolate consumption.
Mittleman said differences in chocolate quality affect the study’s implications for Americans. Higher cocoa content is associated with greater heart benefits. In Sweden, even milk chocolate has a higher cocoa concentration than dark chocolate sold in the United States.    Although 90 percent of all chocolate eaten across Sweden during the study period was milk chocolate, it contained about 30 percent cocoa solids. U.S. standards only require 15 percent cocoa solids to qualify as dark chocolate. So, by comparison, American chocolate may have fewer heart benefits and more calories and fat per equivalent amounts of cocoa content compared to the chocolate eaten by the Swedish women in the study.   Also, the average serving size for Swedish women in the study ranged from 19 grams among those 62 and older, to 30 grams among those 61 and younger. In contrast, the standard American portion size is 20 grams.
“Those tempted to use these data as their rationale for eating large amounts of chocolate or engaging in more frequent chocolate consumption are not interpreting this study appropriately,” said Linda Van Horn, Ph.D., R.D., immediate past chair of the American Heart Association Nutrition Committee and professor in the Department of Preventive Medicine at Northwestern University’s Feinberg School of Medicine in Chicago. “This is not an ‘eat all you want’ take-home message, rather it’s that eating a little dark chocolate can be healthful, as long as other adverse behaviors do not occur, such as weight gain or excessive intake of non-nutrient dense ‘empty’ calories.”
Heart failure occurs among about 1 percent of Americans over age 65. A condition in which the heart can’t pump enough blood to the rest of the body, heart failure rates are increasing as our aging population grows.“Anything that helps to decrease heart failure is an important issue worth examining,” Mittleman said.
Co-authors are Elizabeth Mostofsky, M.P.H.; Emily Levitan, Sc.D.; and Alicja Wolk, Dr.Med.Sci. Author disclosures and funding support are on the manuscript.
Source: Press release prepared by the American Heart Association