Women's Health - Women's Hormones

Carol is a 50-year-old female whom I initially evaluated just over two years ago.  Her primary concern was vaginal yeast infections.

Carol had a long history of antibiotic use with increased urinary tract infections starting at age 15. She also had several bouts of ear infections and Sinusitis.  For the two years prior to my initial evaluation, Carol required antibiotics at least four months a year. 

Yeast infections had increased for the previous five years.  Her dentist noted "yeast in the mouth." Topical anti-yeast preparations, as well as oral Diflucan, were ineffective.

Allergy symptoms included perennial post-nasal drip, a history of dark circles her entire life, difficulty swallowing for 1 1/2 years,  increased tinnitus, muscle and joint pain, and a low energy level. The low energy level had existed her entire life, but became worse during the five years prior to her initial office visit.  A decreased attention span and concentration span correlated with her level of energy.  Carol also mentioned that her problems with post-nasal drip, muscle pain, and fatigue were worse with damp weather conditions.

Allergy testing was carried out and showed a number of positive reactions to molds, foods and dust products.  In addition to limiting yeast-related foods, sugar and dairy, I asked Carol to go on a low-carbohydrate diet. I also started her on Acidolphilus with Bifidus and oral Nystatin. After only six weeks of medical intervention, Carol was already feeling much better. 

Problems with post-nasal drip, tinnitus, difficulty swallowing, and chest tightness had already improved.  However, muscle pain, fatigue and decreased attention span persisted.  With this in mind, Carol was started on Diflucan.  At the next visit in October 1998, only three months after her initial visit, Carol had achieved a new level of excellent health.  All of her allergy symptoms were well-controlled, her problems with muscle and joint pain had resolved, and her energy level had improved. 

At the most recent followup visit in March 2000, Carol continued to enjoy better health.  Since starting immunotherapy, Carol has had no infections, her energy level is close to normal, and her problems with joint and muscle aches, nasal symptoms, recurrent yeast infections, tinnitus, and attention span are better.

For the past seven years, my articles in Baltimore Child have addressed children's allergy issues and their relationship to behavior, development and recurrent infections.  Since my medical practice also includes adults, I thought the timing was right to address adult allergy issues.

Recently, I have become more aware of the role of hormonal imbalances in women, which may be playing a role in Carol's health picture.  Specifically, salivary testing of estrogen and progesterone appears to be a more accurate technique for assessing perimenopausal and menopausal symptoms.  After evaluating the levels of estrogen and progesterone in saliva and looking at the ratio of progesterone divided by estrogen, I will be starting some female patients on natural progesterone transdermal cream.  Carol will be one of these patients.

Carol's history is an excellent example of the impact that allergies can have on recurrent infections and multiple medical symptoms such as fatigue, decreased attention span, recurrent infections, muscle and joint pain. Prior to seeing me, Carol had been diagnosed as having a number of subjective multiple symptoms secondary to the emotional stresses in her life.  It is quite obvious to me that Carol, as is the case with a number of my adult patients, has physical reasons to account for her multiple complaints.  I am convinced that stress was not the primary reason for Carol's medical complaints.  However, a certain level of stress is quite normal when one does not feel well.  Once the allergic basis for Carol's medical symptoms was controlled, the stress of not feeling well resolved.  Her history is an excellent illustration of the Mind-Body Connection.