Can stress influence conception??
A recent study examined whether women’s stress levels were associated with their chance of conception. A group of 501 couples, women aged 18-40, were examined for 12 months. 401 completed the protocol.
They collected saliva specimens to test for biomarkers of stress (cortisol and alpha-amylase). A questionnaire and daily journals were also completed.
Reassuringly pregnancy occurred in 87% over the 12 months follow-up; it was more likely in women who were more educated, had higher income and didn’t smoke.
Time to pregnancy in those with the highest levels of alpha-amylase was longer compared to the lowest levels; a 29% reduction in fecundity was seen, after adjusting for age, race, alcohol, caffeine and cigarette use. Levels of coital activity were not different. Cortisol levels had no correlation with fecundity or infertility. Those in the highest group had twice the risk of infertility.(RR 2.07, 95% CI 1.04-4.11)
The mechanism is not known however stress reduction (yoga, meditation, mindfulness training) would be worth considering in those trying for more than 6 months without success.
Pre-conception stress increases the risk of Infertility. CD Lynch et al. Human Reproduction 29 (5) : 1067-1075
Venlafaxine for Hot Flushes
Women who wish to, or need to avoid estrogen now have another option.
A recent double blind placebo controlled trial found venlafaxine as good as low dose estradiol for controlling vaso-motor symptoms. 339 perimenopausal or post-menopausal women were randomized to 8 weeks treatment with estradiol (0.5mg/day) , venlafaxine (75mg/day) or placebo.
Both estradiol and venlafaxine reduced vasomotor symptoms compared to placebo. 70% were happy with estradiol and 51% with Venlafaxine.
Low dose estradiol and the Serotonin-Norepinephrine Reuptake Inhibitors Venlafaxine for Vasomotor symptoms. H Joffe et al .JAMA Intern Med 2014:1891
Topical Lidocaine for painful sex
Breast cancer survivors who cannot use estrogen often develop severe atrophic changes in the vagina making intercourse very painful. A recent blinded study of 46 breast cancer survivors with an average age of 56 years randomized women to pre-coital application of 4% lidocaine or saline for 4 weeks. This was followed by an open trial for 2 months. At the end of this phase 90% reported comfortable intercourse. Pain scores were decreased. Partners had no adverse effects.
This interesting study suggests the problem may be a form of vestibulitis rather than atrophy alone. It offers an interesting option for these women and a larger study would be interesting to see.
Topical Lidocaine makes Sex less painful. Medscape May 01 2014