Turmeric supplements safe to try for arthritis
Dear Dr. Roach: I recently read about turmeric for osteoarthritis. I’m on a limited income. Please tell me more about it, like how much it costs and where I can get it. W.C.
Dear W.C.: Turmeric, a spice that has been used for millennia, is the source of curcumin, which has been shown to improve symptoms of osteoarthritis, at least in short-term studies. It is generally thought to be safe, as most people have no side effects or only occasional stomach upset, nausea or diarrhea.
A theoretical concern is bleeding, in combination with anticoagulants, but this appears to be rare. I have had many patients try curcumin, and it has improved symptoms in about half of those who tried it.
Turmeric is easy to find at any grocery store, but when curcumin is used as a supplement, it is usually combined with other supplements to help with absorption. A common one is piperine, derived from black pepper. It’s difficult to use turmeric from food to get a pharmacologic effect. The usual dose is 400-500 mg two or three times daily. A month’s supply from a reliable online retailer I found cost about $10.
Dear Dr. Roach: I need information about vaginal atrophy. I am 75 years old and have suffered for two and a half years. I am in misery. H.
Dear H: Vaginal atrophy is a common condition of older women, or any woman who is more than a few years post-menopause. The lining of the vagina is dependent on estrogen to maintain its normal health. As estrogen levels decrease after menopause, the lining of the vagina may become thinned, leading to symptoms of dryness and discomfort. Women often find that sexual intercourse is painful. Recurrent urinary tract infections may be the first way the problem is recognized. The vulva is affected, too, and in severe cases, the labia can even fuse.
I routinely see women with symptoms who haven’t been diagnosed. I don’t often see women who have been diagnosed and who are still suffering. The hard part, at least in my experience, is making the diagnosis: Some women don’t know to ask, or are embarrassed to do so, and some doctors (especially internists like me) don’t routinely ask or perform a regular examination. Once the diagnosis is made, treatment is straightforward and effective: an estrogen cream or gel usually does a good job of relieving symptoms and reducing urine infection risk.
Estradiol, the bioidentical female hormone, works well topically and is not absorbed very much into the blood, so it is considered safe. However, women with a history of estrogen-sensitive breast or uterine tumors absolutely should discuss use of vulvovaginal estrogen with the doctors taking care of these cancers. Men can be reassured that there is no risk to them, although one expert group recommends estrogen be applied at least 12 hours prior to intercourse.
I am sometimes asked about laser treatment. Since I last wrote about vaginal atrophy, the U.S. Food and Drug Administration has issued a warning against laser devices that purport to treat symptoms or improve the appearance of the vulva and vagina. The FDA warned, and the American College of Obstetricians and Gynecologists agreed, that the effectiveness of these devices is unproven and that they have the potential to cause serious harm, including burns and scarring that result in worsening pain. Until there is better data to support the efficacy and safety of these treatments, I recommend against them.
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