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Menopause and Heart Disease

ShufeltC-CardioSMALL

Heart disease is the number one killer of women today. Dr. Chrisandra Shufelt, assistant director of the Women’s Heart Center at the Cedars-Sinai Heart Institute, shares valuable information about heart disease during menopause.

Interview with Chrisandra Shufelt, M.D.
Assistant Director of the Women’s Heart Center
at the Cedars-Sinai Heart Institute.

1. Question: How can women approaching or experiencing menopause protect themselves from heart disease?

Chrisandra Shufelt, M.D.: The best protection is in knowing your heart health numbers. By that I mean you should know your blood pressure, LDL and HDL cholesterol, weight, body mass index (BMI) and fasting blood sugar level. If your numbers are out of whack, see your doctor, start exercising, change your eating habits, lose weight if you need to and stop smoking. You also need to be aware of your family medical history. Women who have a first-degree relative diagnosed with heart disease at an early age are at an increased risk of developing heart disease themselves. Heart disease is the number one killer of women so the first step in preventing it is to know your numbers.

2. Question: Does a woman’s heart disease risk increase during menopause?

Dr. Shufelt: One in seven premenopausal women die of heart disease compared to one in three postmenopausal women. We know that blood cholesterol levels can often change for the worse within six months to a year from the onset of menopause, which on average is the age of 51. The risk of high blood pressure triples with menopause; after the age of 55, more women have high blood pressure.

3. Question: Does hormone therapy increase a woman’s risk of developing heart disease?

Dr. Shufelt: Hormone therapy may be an effective way of controlling the moderate to severe night sweats, hot flashes and other menopause symptoms that can wreak havoc in a woman’s life. Start by seeking a certified menopause specialist who can weigh the risks and benefits for each patient. If your doctor considers hormone therapy safe for you, be sure to reevaluate annually. Starting hormone therapy many years after a woman has gone through menopause does increase the risk of heart disease. Women who are not good candidates for hormone therapy do not need to suffer in silence. There are many nonhormonal options to treat menopause symptoms.

4. Question: Are women who take oral contraceptives at an increased risk for cardiovascular disease?

Dr. Shufelt: Oral contraceptives are the most commonly prescribe hormones with approximately 80 percent of women in the U.S. using them at some point. In healthy younger women – young than 35 and nonsmokers – oral contraceptives do not increase a woman’s risk for heart disease. And we know that birth control pills can be helpful in controlling symptoms around perimenopause. That’s why you should re-read my answer to the first question and get to know your heart health numbers!

5. Question: Is it possible to treat menopause symptoms while simultaneously preventing heart disease?

Dr. Shufelt: Yes. That is exactly what we do at the Women’s Heart Center at the Cedars-Sinai Heart Institute. And it’s why menopause transition is such an important time for all women. I want women to know that when they reach menopause, it’s time to take stock of their health and their individual risk factors. Because when we know a patient’s numbers, we can help her assess the side effects and risks that come with all treatments and also help ensure that the second act of her life can be just as vibrant and active as the first.

6. Question: Does estrogen provide heart protection?

Dr. Shufelt: No, estrogen is not prescribed to prevent heart disease.

7. Question: What else should women know about heart disease?

Dr. Shufelt: When it comes to heart disease, women need to recognize that often, our symptoms are different from men’s heart disease symptoms. In addition to chest pain, women are more likely to have shortness of breath as a first sign of heart disease. Women more commonly experience extreme fatigue and persistent chest pain. Unlike men, women generally have major arteries that are clear of plaque, but the smaller coronary blood vessels cease to constrict and dilate properly, creating the lack of blood flow and oxygen to the heart.

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Posted in hormones, ask the expert

Is Botox safe if you have allergies?

Expert: Dr. Carlin Vickery

Partner, 5th Avenue Millennium Aesthetic Surgery
Associate Clinical Professor in Department of Surgery at Mount Sinai Medical Center

Ranked as one of NYC’s top board certified plastic surgeons, Dr. Vickery was one of the first women to train in plastic surgery and reconstructive microsurgery.  Dedicated to innovation throughout her 30 year career, she continues to use cutting edge techniques to achieving long lasting, optimal, aesthetic improvement of the breast, body and face.

Dear Dr. Vickery,

I am 49 and have terrible frown lines between my eyes.  Suffering from bad allergies (Penicillin, aspirin, Cipro and many others), and environmental substances (dander, dust, pollen), is Botox a safe option?

In all likelihood, Botox will be an excellent and safe option for your frown lines.  Reported allergic reactions are limited to patients with a sensitity to Albumin and to those who have already been exposed to Botox and have showed sensitivity.  Many patients with the allergies you describe have successfully had Botox treatment.  Discuss your concerns with a qualified physician, and if you want to be cautious, you could always have a small test dose before you have a full treatment.  Good Luck!

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How to Find Reliable Health Information Online

iStock_000000863840XXXSmallDear Staness,

I am so confused! There is so much conflicting information online about menopause and tests. One website says buy saliva tests to check my hormone levels for $299, and another says these are not good tests and a waste of money. Where do I go for dependable information?

Confused in Connecticut

____________________________________

Dear Confused,

This is a GREAT question! I was shocked at the amount of misinformation online too. The Menopause Makeover co-author Dr. Wendy Klein led me to reliable information sources.

Since menopause is a natural transition, most of us are searching for “natural” management options.

If a website is selling a product, you can bet there will be editorial material supporting their product. How do you know if you can trust what you are reading?

Enter center stage – our leading lady to save the day: science.

The word science comes from the Latin “scientia,” meaning knowledge. Science refers to a system of acquiring knowledge.

Many people associate science with the medical community, and make the assumption that alternative methods are not supported. This is not true.

There are excellent, non-commercial resources supported by science that provide sound information on alternative, complementary and medical menopause treatment options. They are not selling anything. These resources are available to provide you with information supported by scientific research… knowledge based on concerted human effort to understand, or to understand better, the natural world and how the natural world works, with observable evidence as the basis of that understanding.

The North American Menopause Society is a professional, non-profit organization. To find your answer about hormone saliva testing, go to The North American Menopause Society and enter “hormone testing.”

“Saliva testing to determine if a woman has the “right amount” of hormones has not been proven accurate or reliable. Even blood testing of hormone levels has the drawback that levels vary throughout the day as well as from day to day. More important, the desired levels in postmenopausal women have not been established. In addition, an individual woman’s physical comfort may not even be related to her absolute hormone levels.”

On any website, it is wise to read the “About Us” link so you know WHO is providing the information. Generally, non-commercial websites make that information readily available so you can see the credentials and expertise of the people who are providing your advice.

We are all different. Work closely with your healthcare provider to discuss menopause treatment options specific to you.

Dr. Klein says, “Know where your medical health information is coming from, and don’t trust the biased medical information on websites that are selling products.”

I applaud your efforts to get educated on menopause matters. Gather information from reliable sources. My favorites are listed below.

Staness

Reliable resources that are unbiased and supported by science

North American Menopause Society

National Institutes of Health

The National Library of Medicine
MedlinePlus

American College of Obstetricians and Gynecologists

Centers for Disease Control and Prevention?

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Perimenopausal Depression

Wendy Klein MD150Are you suffering from hopelessness, apprehension, and deep sadness for prolonged periods? If so, you may be suffering from depression. During my menopause transition I felt blue for no reason at all. I could not snap out of it, and my friends and family were mystified.

Most perimenopausal women do not experience major depression, but many have symptoms of feeling depressed, stressed, and anxious.

If you are experiencing menopausal symptoms such as severe hot flashes and lack of sleep from night sweats, it may be causing you to feel depressed. Are you in a depressed mood and feeling sad, or are you suffering from clinical depression resulting from a chemical imbalance in the brain?

I recently teamed up with leading menopause expert and co-author of The Menopause Makeover, Dr. Wendy Klein, to get the latest scientific information on perimenopausal depression.

Perimenopause Depression Interview

Staness: What are the most common signs of depression?

Dr. Klein: The most common signs of depression are feeling sad, feeling worthless and losing interest in the things that normally engage you. Having no “get up and go,” you would rather sit on the couch doing nothing than get up and do something that would normally engage you. Other symptoms include the loss of libido, changes in appetite – too much or too little – feeling very sleepy and tired and fatigued, or having insomnia, not being able to sleep. A common sign of depression is a change in your normal habits.

A more serious symptom of depression is sustained loss of interest in things that you just can’t seem to break out of, which is called dysthymia. Things seem really bleak and you just can’t quite punch your way out of this paper bag of darkness and it lingers. If it lingers or if you have thoughts that are scary, such as wanting to give up or wanting to hurt yourself or even suicidal thoughts, you must talk to your clinician because there are things that can be done to help you.

Staness: What can cause these feelings of depression during menopause?

Dr. Klein: Depression is multi-factorial. There are many factors that can cause an increased risk for depression. If you have depression in your family, a prior history of depression, and even some medications can cause an increased risk of depression. Certain endocrine disorders, such as hypothyroidism, or other illnesses, such as chronic fatigue syndrome, are also associated with depression.

Depression is an illness that can be triggered by the chemicals in your brain. Serotonin regulates your moods. It is the “feel good” hormone. When serotonin levels drop you can experience extreme episodes of depression.

You also want to look at lifestyle stressors – a change in relationship, finances, loss of a loved one, caring for parents – and consider the many modalities of treatment that are available to help you.

You approach depression in menopause the same way that you would approach depression at any other time: you first want to rule out other medical causes, or other medications that might be contributing.

Staness: Many women live with daily stress and then throw in menopause and a few medications, and it is no surprise menopausal women may suffer from depression. What depression treatment options are available?

Dr. Klein: A number of options are available, including psychotherapy, and antidepressants and can assist you if you are suffering from depression.

There are degrees of depression. Mild depression, feeling blue or sad, can be dealt with cognitive therapy, psychotherapy, meditation, yoga, eating healthfully, and exercise. We know that exercise does boost your endorphins and can lift your mood. Also, engaging in new activities may help, such as making yourself take classes, making yourself get out and do things, and enlisting the support of your family and friends.

If you have lingering or worsening symptoms, you may need medication, because we know that depression can be a malfunction of your neurotransmitters, particularly serotonin, which is the feel good neurotransmitter. Medicines can be enormously helpful, although you will want to incorporate lifestyle changes as well.

In short, if someone is experiencing the signs or symptoms of depression, there are number of things you can do. Eating healthfully, exercising regularly, and seeking support from family and friends may help. Also, you can engage in any activity that gives you a sense of achievement. It may be taking a class, taking up something new such as yoga, or trying the drawing class that you always wanted to take, or volunteering and getting outside yourself. All of these things are very useful.

If you are still feeling very stuck and sad, talk to your clinician so you can get a referral to a good psychotherapist. If you need medication, in the broader context of menopausal symptoms, there is some evidence that hormone therapy can augment treatment and help people who are on anti-depressants feel even better. That is a decision for you and your clinician.

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If you suffer from depression or someone you love is depressed, get support, visit your health care provider and discuss your options for treating depression.

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Suffering from Hot Flashes?

hormonesResize2Hot Flash 101

The most common and often the most irritating symptom associated with menopause is the hot flash. As many as 75 percent of women going through menopause in the United States experience hot flashes with 10% to 15% of women having severe or frequent hot flashes. I had miserable hot flashes that heated up at the most inconvenient times and sometimes flaring up every few hours. I tried every trick in the book to eliminate this miserable symptom – from herbs, to teas, to exercise, to diet, to praying hourly that they would disappear – but they persisted.

With confusing and conflicting information online and in best-selling books, I teamed up with leading menopause expert and co-author of The Menopause Makeover, Dr. Wendy Klein, to get the latest scientific information on alternative, complementary and medical options to relieve hot flashes.

Understanding available hot flash options will give you the opportunity to discuss menopause management with your clinician. This interview with Dr. Klein is the first in a series that addresses the various menopause symptoms.

______________________________________
Hot Flash Interview

Staness: Dr. Klein, what exactly is a hot flash?

Dr. Klein: A hot flash is a sensation of extreme heat in the head and upper body generally associated with sweating.

We know from studying women that the internal core temperature does increase. You can a put a sensor on the skin and before a woman experiences a hot flash she will be able to tell you, “I am going to have a hot flash.” And sure enough, there will be an increase in internal core temperature followed by profuse sweating which is very uncomfortable. As you know, the purpose of sweating is to cool the body so there is often a reflex of sort of chill that follows the hot flash. It is a very uncomfortable and distracting sensation. It can occur at any time of the day. It can occur with tremendous variability, it can happen many times an hour or only just once or twice a day. Some women have one or two hot flashes a day, and get through menopause with no problems while other women have fifteen or twenty a day. We are all different.

Staness: What causes a hot flash?

Dr. Klein: We are still trying to understand exactly what causes hot flashes. We know that they are related to the hypothalamus, which is in the center of the brain and acts like the thermostat for the body. What we don’t understand is why some women are so troubled by them and others are not.

Certain women seem to have triggers. An alcoholic beverage may bring on a hot flash, or a change in external temperature can cause a hot flash for some women. In general, the hormonal flux or variation in hormone levels seems to be related to this sensation in some women.

Staness: Are there other causes?

Dr. Klein: We know that smoking is associated with hot flashes. Women who smoke have a higher risk of troublesome hot flashes, so obviously you should not smoke.

Also certain medicines can cause hot flashes such as certain antidepressants SSRI, Selective Serotonin Reuptake Inhibitors, are common antidepressants that can actually cause an increase in hot flashes. Yet, for some women, a very low dose can actually alleviate hot flashes, making antidepressants an alternative to hormone therapy.

Illnesses and fever can cause hot flashes, as can malignancies, and tuberculosis – many illnesses can cause hot flashes.

Increased BMI, Body Mass Index, has been associated with hot flashes. We used to think that women who were heavy had excess estrogen, and therefore fewer hot flashes. Now from the major study that was done in the SWAN, Study of Women Across the Nation, we know that women who are heavy, who have abnormally high body mass index, are at increased risk for hot flashes.

Staness: What’s a menopausal gal to do if she suffers from hot flashes?

Dr. Klein: The real issue is how troubled are you. Some women find that they can manage their hot flashes with simple lifestyle changes, such as wearing layered clothing, lowering the thermostat, carrying a fan, drinking cool beverages, avoiding triggers like caffeine and alcohol. Some women can have a few hot flashes a day and over time, seventy-five to eighty percent of cases the hot flashes will diminish and disappear. Then there is a subset of women for whom hot flashes are really troubling and don’t go away. Lots of women have recurring hot flashes waking them up over and over again and they can’t go back to sleep. They are not getting enough rest; they wake up grouchy, tired, and sweaty. If it is really a problem, there are hormonal therapies that will alleviate these symptoms. As you know hormone therapy can have side effects, so you must always weigh the benefit versus the risk. There are very low dose hormone therapies that are now available that can be extremely useful for alleviating hot flashes.

There are some other options to consider such as soy and black cohosh. The studies regarding soy are mixed, with some showing that soy can be helpful; while there are other studies that show soy may help with mild symptoms. Soy is benign and easily available and may be worth trying. Black cohosh is another herb and has been used in Europe widely, but you have to be careful because there have been reports of toxicity with high doses. Used in limited amounts in standardized doses black cohosh supplements may help some women with hot flashes. Again, there have been mixed studies, so whatever you do, and with anything you take, you should always discuss with your clinician.

You can also try lifestyle changes – wearing layered clothing, practice deep breathing, meditation and yoga, exercising – all of these things that can be really helpful in learning to live with the symptoms if they are moderate.

Another option to treat hot flashes is gabapentin. This is a drug that was originally developed as an antiseizure medicine. Gabapentin is widely used for pain relief, because it was discovered that with patients in whom it was used for seizures, it helped with pain. It was then found that it helped with hot flashes. Gabapentin is a reasonable alternative to discuss with your clinician if you do not want to or if you cannot take hormone therapy.

Staness: I was on birth control pills for years and had no idea I was perimenopausal until I stopped them, then the hot flashes started erupting. Are birth control pills a good option for hot flashes?

Dr. Klein: Birth control pills are a form of hormone therapy. They are a higher dose than standard menopausal therapy, but there is estrogen in most birth control pills and that keeps hot flashes away. If you are in the perimenopausal phase, birth control pills can also be useful for regulating your periods, plus they keep hot flashes away.

____________________________________________

Understanding the causes and solutions for hot flashes is the first step to managing your menopause. If you suffer from hot flashes, discuss your treatment options (alternative, complementary and medical) with your healthcare provider.

If you need a certified menopause expert in your area, click here and enter your zip code.

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Should I take hormone therapy?

Expert:  Wendy Klein, M.D., co-author of The Menopause Makeover

Dear Dr. Klein,

HELP, I am so confused about hormone therapy after the latest headlines about breast cancer and hormones.  I had a hysterectomy 5 years ago, and my doctor prescribed the Vivelle patch 1.0 mg and I love it.  Should I stop using it?  I am afraid of getting breast cancer even though it does not run in my family. What should I do?

The headlines about breast cancer associated with hormone therapy use, although recent, do not really represent new data. We have known for many years that HT use  greater than 5 years increases breast cancer risk. That said, adverse effects are generally dose related, and all the research showing increased risk was done using doses of estrogen that are 3-4 times higher than what is used today.

The newest headlines reflect a long-term follow up of 2002 WHI results, in which it was found that prolonged use of estrogen and progesterone slightly increased the risk of breast cancer death. Of note is that this was not seen in women like yourself who, after hysterectomy, took estrogen only.

The best approach is to consult with a clinician who can help assess your risk for breast cancer by looking at personal medical history, family history, age, race and ethnicity, reproductive history, and history of breast biopsies. If you have no increased risk, then staying on estrogen for now may be appropriate. The answer in part depends upon personal considerations, such as the age at which you had your hysterectomy, your risk for bone loss, and how long you have been treated with estrogen.

Also, it is reasonable to consider very slowly lowering your dose of Vivelle, so that you are on the lowest effective dose. Above all, consult with your healthcare provider so that you can jointly make a thoughtful and carefully considered decision that meets your individual needs. There is no need to make sudden changes.

Living a healthy lifestyle, such as maintaining an ideal weight, not smoking, regular exercise, consuming low to medium glycemic carbohydrates, and limiting alcohol consumption can also help reduce your risk of breast cancer.

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Posted in hormones, ask the expert

Is perimenopause to blame for my kidney infection?

Expert: Wendy Klein, MD co-author of The Menopause Makeover

Dear Dr. Klein,

As you go through the change of life, is it normal for you to have an increase in bladder/urinary tract/kidney problems?

I had my first kidney infection in November. It was very painful and forced me to go to the ER. There was no warning and the symptoms hit me instantaneously. The doctors said it was a kidney infection and comes from a bladder infection left untreated. BUT I HAD NO SYMPTOMS.  They also said it comes from not drinking enough water or not going to the bathroom enough.  I work in an office, sitting all day for 8 hours.

I’m really baffled as to why I’m having urinary problems now, when nothing has changed in my lifestyle except the onset of perimenopause.

Answer: Many women have recurrent bladder infections, and, as you have already learned, untreated bladder infections can track up the urinary tract and lead to kidney infections. Not good. What you can do to prevent these –

1) Stay hydrated. Keep water with you at work & drink through the day.
2) Do not delay when you feel the need to urinate! Empty your bladder regularly and do not hold your urine.
3) If possible, empty your bladder after sex. Although difficult to prove, there is anecdotal evidence that urinating after sex may help to “wash away” bacteria.
4) Have a healthcare provider dipstick your urine at the first sign of problems to rule out an infection. If your bladder is infected, white blood cells will show up on your dipstick test, indicating a need for antibiotics. If there are no white blood cells, and you are having pain with urination, this may be a sign of low estrogen, which is easily treated with vaginal estrogen tablets or cream.

Also, if there is a history of diabetes in your family, have your blood sugar checked. New onset of recurring bladder or kidney infections can be a sign of diabetes.

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Irregular Periods During Perimenopause

Wendy Klein MD150One of the first symptoms you may notice during perimenopause is irregular periods.

Interview with Dr. Wendy Klein, leading menopause expert and co-author of The Menopause Makeover

Staness: What is one of the first symptoms of perimenopause?

Dr. Klein: The hallmark of perimenopause, which is the phase prior to menopause, is irregularity. We all grow up thinking that when you enter the change of life and become menopausal, your periods just stop. That is not the case.

What happens is your periods start to become irregular. You can have too many periods, you can have too few, you may skip a period and then get regular again, and you may skip a few periods. You may think, “oh my, I am in menopause,” and suddenly your period comes back again.

Staness: Why does this happen?

Dr. Klein: Prior to menopause your periods are usually very regular. The amount of hormone that you are producing is very regular and predictable. However, as you approach menopause, entering the perimenopausal phase, the ovaries are unpredictable. You will have months when you don’t ovulate, and that causes irregular bleeding.

Staness: How long does period irregularity last?

Dr. Klein: How long that lasts is highly individual. Could be a year, could be two years, could be three years and that is all normal variation. I like to say that the ovaries are stuttering. You don’t always ovulate and your previous hormonal milieu begins to change.

Eventually you will experience fewer periods and finally your periods will stop. You are not officially in menopause until you have skipped 12 consecutive periods.

Staness: How does a woman know her periods are irregular?

Dr. Klein: You may get too many periods. You may get too few. You may skip them. The bleeding may become heavier, or it can become lighter.

Staness: What should a perimenopausal woman with irregular periods do?

Dr. Klein: Well the easiest thing to do is keep track of your periods. Write them down in the your calendar and track them. Keep a record of when you are having your periods and what your symptoms are, so when you visit your clinician you can discuss the changes using actual dates.

If you are troubled by irregular periods, you can discuss the option of low dose birth control pills. This can help with regulation, with excessive flow, and also with contraception.

One of the issues of which you should be aware is that even in perimenopause you can still become pregnant and since your periods are not regular you have an increased risk of unintended pregnancy. Birth control is still necessary as long as you continue to ovulate, even if you are irregular.

______________________

Menopause is a normal and natural part of a woman’s life. Arm yourself with knowledge, build a strong relationship with your clinician and manage your menopause empowered.

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My husband’s libido is disappearing, why?

Expert: Ernst Schwarz, M.D., Ph.D.
Director of Multi-disciplinary Heart Failure Research, Cedars-Sinai Heart Institute

Dear Dr. Schwarz,

Now my menopause symptoms are finally under control, something seems to be going on with my husband of 27 years. We used to have a great sex life but now his performance isn’t what it used to be. I have read that he should see a doctor to rule out any physical health issues. But what kind of doctor? And what kind of health problem could be causing this?

Although I can’t diagnose your husband based on an email, I can tell you that it might be a good idea to make an appointment with a cardiologist for a thorough check-up.

You say you have been married 27 years, so your husband probably is getting to the age when a heart check-up is appropriate. Also, reduced sexual performance capabilities can be a warning sign that a man is suffering from a heart or circulation (vascular) problem.

The main underlying cause is unhealthy changes in the functioning of the blood vessels carrying blood to the penis. That condition, called endothelial dysfunction, can be an early sign for underlying vascular diseases and conditions that can affect the heart and the brain among other organs.

Risk factors include diabetes, uncontrolled high blood pressure, elevated cholesterol and triglycerides, smoking and chronic alcohol or drug abuse. Endothelial dysfunction also can be a side effect of many medications, in particular medications to control blood pressure or treat depression.

Erectile dysfunction affects an estimated 30 million to 50 million U.S. men and can be successfully treated in most cases. But treatment requires letting your doctor know and men often shy away from admitting sexual problems to their doctors. That’s why many of my male patients hesitate to make the appointment. They finally come to see me when their wives become aware of the link between health issues and impotence and call my office to schedule an exam.

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Am I menopausal yet?

ShufeltC-CardioSMALLExpert: Chrisandra Shufelt, M.D.
Assistant Director of the Women’s Heart Center
at the Cedars-Sinai Heart Institute.

Dr. Shufelt is a certified menopause practitioner and a women’s health expert.

Dear Dr. Shufelt: I am 52 and there is no end in sight to my menstrual cycle. Shouldn’t I have stopped by now?

Like every woman, you should see your healthcare provider every year because annual Pap smears are important in detecting cervical cancer and yearly blood tests help keep track of your heart health. If your menstrual bleeding is prolonged or erratic, make an appointment to have yourself checked. During your period, if you are feeling lightheaded or short of breath, it could be a sign of too much bleeding, so get that checked out also.

But having regular periods at your age isn’t anything to be concerned about. In the United States, the average age for menopause is 51 for non-smokers and 50 for current and past smokers. By age 55, 95 percent of U.S. women will have reached menopause.

Still, if you want to see where you stand, ask your healthcare provider for a blood test to detect the amount of Follicle Stimulating Hormone or FSH. A rise in FSH is the first measurable sign that a woman is entering menopause.

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Posted in hormones, ask the expert

Should I take hormone therapy?

ShufeltC-CardioSMALLExpert: Chrisandra Shufelt, M.D.
Assistant Director of the Women’s Heart Center
at the Cedars-Sinai Heart Institute.

Dr. Shufelt is a certified menopause practitioner and a women’s health expert.

Dear Dr. Shufelt:  I keep reading about the benefits of hormones.  My doctor, however, says I don’t need them.  Why?

Some women do not need hormone replacement therapy during menopause transition because they do not experience moderate to severe hot flashes or night sweats.  That is the only reason to prescribe hormones.  Patients and their healthcare providers need to weigh the severity of each patient’s symptoms and consider the individual’s risks and benefits.

Hormone replacement therapy can result in an increased risk of breast cancer, heart disease and stroke for some patients.  When I prescribe hormones, I prescribe the smallest dose possible and assess each patient’s risk factors annually.    Using hormone therapy as a way to remain looking youthful is not only futile – it’s dangerous.  The best way to stay healthy and youthful is to exercise and eat a healthy diet.

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Am I going crazy or is it menopause?

ShufeltC-CardioSMALL

Interview with Chrisandra Shufelt, M.D.
Assistant Director of the Women’s Heart Center
at the Cedars-Sinai Heart Institute.

Dr. Shufelt is a certified menopause practitioner and a women’s health expert.

Dear Dr. Shufelt:  I stopped having my period three months ago and I didn’t miss a beat.  No crankiness, no hot flashes.  But now, my youngest is heading to college this fall and I can’t stop crying.  Is this menopause or am I going crazy?

Most women do not experience depression during menopause, but I always screen my patients for it.  Recent studies have shown that if you experienced depression at some prior point in your life, you are five times more likely to have a depression during menopause.  Depression also is more likely if you have severe hot flashes or night sweats.  Please see a healthcare provider  if you have a depressed mood for more than two weeks that is marked by the following symptoms: Overwhelming sadness, inactivity, difficulty with thinking and concentration, a significant increase or decrease in appetite and time spent sleeping, feelings of dejection and hopelessness, or suicidal thoughts.

Don’t leave depression untreated, hoping you’ll “snap out of it.”  We are finding more and more evidence that depression is a risk factor for coronary heart disease, the leading cause of death among U.S. women.

Another recent finding of interest is that Vitamin D – the sunshine vitamin – doesn’t just keep your bones healthy and strong.  Studies are finding that Vitamin D deficiencies are implicated in depression, heart disease and cancer.

Your healthcare provider can check your blood level to see if you are running low. If you are, you may need a prescription form of vitamin D just to get you back up to normal level.  How much Vitamin D do you need daily?  The Recommended Daily Allowance is 1,000 international units.  You can get it from being exposed to natural sunlight for 20 minutes a day, but we don’t recommend that because of the risk of skin cancer.  (A sunscreen of just 15 SPF filters out 95 percent of the Vitamin D in sunlight.)  Food and drink is another source, but a cup of fortified milk only has 100 international units and a half cup of orange juice contains just 45.  Better to take a daily multivitamin.

Send your questions for ASK the EXPERT to: Staness@MenopauseMakeover.com

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How To Find A Menopause Clinician

Portrait of a happy mature female doctor with hands foldedDear Crabby,

The past year I have been suffering from night sweats, a low libido, irregular periods and terrible moodiness. I think I am perimenopausal, but my general practitioner says it is stress from my divorce (yes, I am getting a divorce on top of everything else). I live in a small town and irritated that there are few doctor choices. How can I find a menopause healthcare provider in my area? I don’t mind driving a couple of hours; I just want to start feeling better.

Signed,
Irritated in Idaho

_______________________

Dear Irritated,

It is no surprise you are frustrated suffering both physically and emotionally. I applaud your commitment to find a healthcare provider who is right for you.

Fortunately, there is a wonderful nonprofit organization that can help you find a menopause clinician in your area with a click of a button! Founded in 1989, The North American Menopause Society (NAMS) is North America’s leading nonprofit organization dedicated to promoting the health and quality of life of women through an understanding of menopause. What I like about NAMS is that they provide information that is both accurate and unbiased, not for or against any point of view. They have a link on their homepage to “Find a Menopause Clinician.” It is located at the bottom of the homepage. After you click that link, you will be directed to enter either your US ZIP Code, State/Province, or Country, then click “Search” button. A list of clinicians will be presented.

I took the liberty of checking practitioners in your area and noted five NAMS Certified Menopause Practitioners, all accepting new patients!

Signed,
Dear Crabby
Who believes no one should go through menopause feeling “irritated”

Write to Dear Crabby and get advice about your menopausal symptoms.
If you have:
• Hot flashes
• Itchy skin
• Breast tenderness
• Mood swings
• Memory lapses
• Fuzzy thinking
• Night sweats
• Sleep problems
• Loss of libido
• Dry vagina
• Irregular periods
• Headaches
Dear Crabby has tips to make your life easier.
She wants to hear from YOU.
Send your questions to: DearCrabby@MenopauseMakeover.com

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Posted in ask the expert

Irregular Periods During Perimenopause

Wendy Klein MD150One of the first symptoms you may notice during perimenopause is irregular periods.

I was on birth control pills so I did not experience irregular periods. But for those of you not on birth control pills, noticing a change in your period may be an indication you are perimenopausal.

___________________

Interview with Dr. Wendy Klein, leading menopause expert and co-author of The Menopause Makeover

Staness: What is one of the first symptoms of perimenopause?

Dr. Klein: The hallmark of perimenopause, which is the phase prior to menopause, is irregularity. We all grow up thinking that when you enter the change of life and become menopausal, your periods just stop. That is not the case.

What happens is your periods start to become irregular. You can have too many periods, you can have too few, you may skip a period and then get regular again, and you may skip a few periods. You may think, “oh my, I am in menopause,” and suddenly your period comes back again.

Staness: Why does this happen?

Dr. Klein: Prior to menopause your periods are usually very regular. The amount of hormone that you are producing is very regular and predictable. However, as you approach menopause, entering the perimenopausal phase, the ovaries are unpredictable. You will have months when you don’t ovulate, and that causes irregular bleeding.

Staness: How long does period irregularity last?

Dr. Klein: How long that lasts is highly individual. Could be a year, could be two years, could be three years and that is all normal variation. I like to say that the ovaries are stuttering. You don’t always ovulate and your previous hormonal milieu begins to change.

Eventually you will experience fewer periods and finally your periods will stop. You are not officially in menopause until you have skipped 12 consecutive periods.

Staness: How does a woman know her periods are irregular?

Dr. Klein: You may get too many periods. You may get too few. You may skip them. The bleeding may become heavier, or it can become lighter.

Staness: What should a perimenopausal woman with irregular periods do?

Dr. Klein: Well the easiest thing to do is keep track of your periods. Write them down in the your calendar and track them. Keep a record of when you are having your periods and what your symptoms are, so when you visit your clinician you can discuss the changes using actual dates.

If you are troubled by irregular periods, you can discuss the option of low dose birth control pills. This can help with regulation, with excessive flow, and also with contraception.

One of the issues of which you should be aware is that even in perimenopause you can still become pregnant and since your periods are not regular you have an increased risk of unintended pregnancy. Birth control is still necessary as long as you continue to ovulate, even if you are irregular.

______________________

Menopause is a normal and natural part of a woman’s life. Arm yourself with knowledge, build a strong relationship with your clinician and manage your menopause empowered.

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Posted in hormones, ask the expert

Finding balance — your secret weapon to good health and happiness

Businesswoman jugglingConstantly Cranky in North Carolina

Dear Crabby,

I had a total hysterectomy April 2008 at the age of 30 for endometriosis and a tumor on my right ovary. I was put on birth control pills, but decided I didn’t like the side effects and got off November 2009. After stopping the birth control pill I tried to go on my own, however I found myself hysterical. I was having so many emotions that I really thought I was having a mental breakdown. I was forced into seeing a therapist from my employer because they thought I was “stressed.” I don’t think that fits. I think psychotic fit’s better.

I am now on estrogen therapy (Premarin 0.625mg). After two weeks of being on this, I was forced to take a two-week stress-free vacation, I am actually feeling somewhat better.

I’m not married and therefore the lack of sexual desire doesn’t really bother me but the mood swings do. I feel like a 50 year-old in a 32 year-old body that is 5’2” at 186 pounds. How do I get past the happy one-minute and foaming at the mouth the next? I’m tired all the time and working 40 to 50 hours per week that makes me want to sleep all weekend. It’s a good thing I’m not married and have no children, because at the end of the day I’m exhausted.

Constantly Cranky in North Carolina

Dear Constantly Cranky,

You have a reoccurring theme in your quest for answers – the need for balance. As a busy woman, balance can be hard to find. Balance with your body, mind and spirit is a necessary step to being happy.

Step #1: Body, discuss your ET dose with your doctor

Per Dr. Klein, leading menopause expert and co-author of The Menopause Makeover, “after abrupt surgical menopause, it is generally necessary to start with a higher dose of HT, and taper down as tolerated.” Estrogen alone is prescribed for postmenopausal women who have had a total hysterectomy. This is because, without a uterus, the risk of uterine cancer is essentially absent, so there is no need for the uterine protection of progesterone.

Based on this information, I am not surprised you did not like the effects of being on the birth control pill that usually has progesterone and estrogen. Going off the birth control pill no doubt sent your hormones into chaos possibly contributing to feeling “hysterical.” Now that you feel better being on estrogen therapy (ET), you may wish to discuss your dose with your healthcare provider.

The hormone ups and downs you have experienced may be contributing to other imbalances, including moodiness.

Once you and your doctor manage hormone levels you will start to feel better.

Step #2: Make a commitment to lose weight

Being 5’2” at 186 pounds puts you in an unhealthy category according to the BMI chart. Your BMI is 34, anything over 30 is considered obese.

It is time to make a commitment to your health with weight loss being a major focus. Carrying extra weight can put you at risk of type 2 diabetes and heart disease.

Start eating five to six mini-meals a day to jumpstart your metabolism and reduce those blood sugar crashes that may be contributing to mood swings. Include lean proteins, low glycemic carbohydrates and healthy fats. Reduce your calorie intake. Use the calculators on the homepage. Take the full body analysis to determine your calorie intake for your ideal weight.

Start exercising at least 30 minutes four to five days a week. Forcing yourself to find time for exercise will help you find balance with work. Pamper yourself.

Join a dance class. Start moving for FUN. You will meet great people, and socializing will help you find balance too.

Step #3: Mind and spirit, find balance in your life

You are working long hours, and you wonder why you are tired on the weekend? You are living a stressful lifestyle that is not helping your health situation. It is time to also find balance in your LIFE. Making time for exercise and fun activities can help bring balance.

I invite you to join the Menopause Makeover online community at eharlequin.com. It is a group of supportive women who will cheer you on, share recipes and ideas. You are not alone.

Finding balance is your secret weapon to good health and happiness

Signed,
A balanced Dear Crabby

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Posted in ask the expert

Weight Gain and Menopause

CAN’T ZIP UP HER PANTS IN MINNESOTA

Dear Crabby,

My menopause symptoms have been moderate and I feel lucky to have escaped hot flashes. But I am getting fatter by the second. I am 5 foot 3 inches tall, 46 years old and have weighed 130 pounds most of my life. Within one year I have gained a whopping 15 pounds. I am having problems with high blood pressure and I look and feel terrible. I would rather have hot flashes than turn into the Pillsbury Dough Girl. Help!

Signed,
The Pillsbury Dough Girl from Minnesota

Dear Pillsbury Dough Girl:

Weight gain may be the most difficult change that occurs during menopause. We live in a society that celebrates young, skinny women. When we start to gain weight, whether it’s from childbirth, bad eating habits, lack of exercise, aging or menopause it is emotionally depressing. Your weight history seems stable and healthy, no doubt you have good eating and exercising habits. As your hormones fluctuate during menopause you start shifting fat to your mid-section because your progesterone and estrogen levels decrease. Progesterone increases your metabolism. As it decreases during menopause, so does your metabolism.

Women gain an average of one pound per year starting in their late thirties due to a loss of muscle mass and slowing metabolism. This can add weight as well. You are 46 years old, and if you started gaining that one pound per year starting at 38, that equals eight pounds. Over half the additional weight you are now noticing during menopause.

Fluctuating hormones during menopause can cause an increase in weight and natural aging. Poor food choices and lack of exercise are unforgiving at this time in your life. If you already have a good exercise program, you may need to increase the time and intensity of your routine. If you eat well, cutting portions may yield results.

Start keeping a food and exercise diary. Record your menopause symptoms. According to the BMI (Body Mass Index) charts you are not obese, but considered slightly overweight for your height. This is the perfect time to make food and exercise adjustments. As you have experienced, being overweight raises your risk of many diseases such as high blood pressure. Doing 30 minutes of exercise most days of the week may help maintain your current weight. Exercising one hour a day is optimum. Studies have shown that people who briskly walk 30 minutes daily lost up to 30 pounds over time and lowered their blood pressure.

Try incorporating a 30-minute power walk most days of the week, cutting your eating portions and discuss hormone therapy with your doctor. For faster results, exercise 60 minutes a day.

Signed,
A Zipped Up Dear Crabby

Write to Dear Crabby and get advice about your menopausal symptoms.
If you have:
• Hot flashes
• Itchy skin
• Breast tenderness
• Mood swings
• Memory lapses
• Fuzzy thinking
• Night sweats
• Sleep problems
• Loss of libido
• Dry vagina
• Irregular periods
• Headaches

Dear Crabby has tips to make your life easier.
She wants to hear from YOU.
Send your questions to: DearCrabby@MenopauseMakeover.com

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Posted in ask the expert

Stress and Menopause

STRESSED OUT AND NOT IN THE HOLIDAY TO-DO MOOD

Dear Crabby,

It’s been a rough year suffering from miserable menopause symptoms. I have gained a lot of weight, I am always cranky, my skin has started to drastically age, my hot flashes hit me every few hours, and I feel like no one understands what I am going through. I am not in the “giving” mood this year, freaking out that I won’t get through my holiday “to-do” list, and feeling stressed out.
Bah, Humbug from Minnesota

Dear Bah Humbug,

Holiday responsibilities can be difficult with 99 percent of all women experiencing stress and panic attacks this time of year. Throw in one of the biggest transitions of your life, menopause, and it is no surprise you are freaking out, not in the “giving” mood, and feeling stressed out.

First, let’s address your physical menopause symptoms. Weight gain, irritability, skin changes and hot flashes may be symptoms of fluctuating hormones. Make an appointment with your doctor to discuss your symptoms and possible treatments. Once you decide on a symptom treatment program, you will hopefully start to feel better. Going through physical changes can be stressful.

Second, menopause usually happens as the natural aging process kicks in. If you’ve practiced a lifetime of poor eating choices and lack of exercise, it’s unforgiving during menopause. Now is the time to start eating nutritiously, exercising regularly, and dedicating time to pampering.

Regarding your skin, treat yourself to a holiday makeover. Visit your favorite make-up counter. A new cleansing/moisturizing program may restore your radiant complexion.

Visit your practitioner to discuss symptoms. Start eating a healthy diet and exercising. Make time to pamper yourself.

If you practice a few of these Stress-Free Holiday Tips you may just survive your “to-do” list and the holiday season.

10 Tips for a Stress-Free Holiday

1. Keep expectations reasonable. Planning parties and decorating are stressful tasks. Instead of planning a big holiday party, plan a day to celebrate the holiday at the spa with your closest friends. Keep your schedule open to attend a few parties, not give them. Instead of decorating your home and a Christmas tree, put a lovely wreath on the front door, place a small-planted evergreen in the living room and enjoy colorful candles around the home.

2. Communicate with your loved ones. Let them know you are going through changes, and that you plan to get some rest this holiday and would appreciate their support.

3. Limit your alcohol intake. Holiday parties are often centered on drinking. Try to “nurse” one glass of wine for the evening. Remember alcohol is loaded with extra calories. I ask for “water on the rocks with a twist” – it is fun, always gets a reaction, is calorie free and keeps you hydrated.

4. Quiet time. Plan a half hour a day to sit quietly. Find a spot in your home in a comfy chair. Close your eyes, and take long deep breathes. Breathe in thinking of good health and happiness and breathe out stress and frustration.

5. Eat a healthy diet. Eat more vegetables, whole grains, fruits and low-fat foods. You will have more energy.

6. Start exercising. Take a 30-minute walk. Not only will you burn calories, you will feel more relaxed.

7. Manage your time. Cut your to-do list in half this year.

8. Send e-cards this year. It is fast, easy, free and fun. This will save you time, money, paper and postage.

9. Have a sense of humor. Dealing with relatives over the holidays can be stressful. If relatives are visiting you for the holiday, ask them to book a hotel for their stay. Keeping your home a sanctuary during your menopause transition is important. If a relative is driving you crazy, try to be cheerful and laugh it off.

10. Keep a budget. Dealing with extra holiday expenses is also extremely stressful. To buffer this a bit, try making homemade gifts or let your loved ones know that this year the gift theme is ‘to spend less than $20 per person per gift’. Don’t forget, shopping on-line will save time and frustration at the malls.

Remember menopause is a natural transition. The holidays can be a joyful time if you embrace your changes and make a few holiday stress-free adjustments to your agenda. The greatest gift you can give…. is to take care of yourself, and when you do, you will want to give to others.

Signed,
A less stressed Dear Crabby wishing you a Happy Holiday!

Write to Dear Crabby for information on menopause symptoms.

If you have:
• Hot flashes
• Itchy skin
• Breast tenderness
• Mood swings
• Memory lapses
• Fuzzy thinking
• Night sweats
• Sleep problems
• Loss of libido
• Dry vagina
• Irregular periods
• Headaches

Dear Crabby has tips to make your life easier.
She wants to hear from YOU.
Send your questions to: DearCrabby@MenopauseMakeover.com

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Posted in ask the expert

Suffering From Hot Flashes?

hormonesResize2Hot Flash 101

The most common and often the most irritating symptom associated with menopause is the hot flash. As many as 75 percent of women going through menopause in the United States experience hot flashes with 10% to 15% of women having severe or frequent hot flashes. I had miserable hot flashes that heated up at the most inconvenient times and sometimes flaring up every few hours. I tried every trick in the book to eliminate this miserable symptom – from herbs, to teas, to exercise, to diet, to praying hourly that they would disappear – but they persisted.

With confusing and conflicting information online and in best-selling books, I teamed up with leading menopause expert and co-author of The Menopause Makeover, Dr. Wendy Klein, to get the latest scientific information on alternative, complementary and medical options to relieve hot flashes.

Understanding available hot flash options will give you the opportunity to discuss menopause management with your clinician. This interview with Dr. Klein is the first in a series that addresses the various menopause symptoms.

______________________________________
Hot Flash Interview

Staness: Dr. Klein, what exactly is a hot flash?

Dr. Klein: A hot flash is a sensation of extreme heat in the head and upper body generally associated with sweating.

We know from studying women that the internal core temperature does increase. You can a put a sensor on the skin and before a woman experiences a hot flash she will be able to tell you, “I am going to have a hot flash.” And sure enough, there will be an increase in internal core temperature followed by profuse sweating which is very uncomfortable. As you know, the purpose of sweating is to cool the body so there is often a reflex of sort of chill that follows the hot flash. It is a very uncomfortable and distracting sensation. It can occur at any time of the day. It can occur with tremendous variability, it can happen many times an hour or only just once or twice a day. Some women have one or two hot flashes a day, and get through menopause with no problems while other women have fifteen or twenty a day. We are all different.

Staness: What causes a hot flash?

Dr. Klein: We are still trying to understand exactly what causes hot flashes. We know that they are related to the hypothalamus, which is in the center of the brain and acts like the thermostat for the body. What we don’t understand is why some women are so troubled by them and others are not.

Certain women seem to have triggers. An alcoholic beverage may bring on a hot flash, or a change in external temperature can cause a hot flash for some women. In general, the hormonal flux or variation in hormone levels seems to be related to this sensation in some women.

Staness: Are there other causes?

Dr. Klein: We know that smoking is associated with hot flashes. Women who smoke have a higher risk of troublesome hot flashes, so obviously you should not smoke.

Also certain medicines can cause hot flashes such as certain antidepressants SSRI, Selective Serotonin Reuptake Inhibitors, are common antidepressants that can actually cause an increase in hot flashes. Yet, for some women, a very low dose can actually alleviate hot flashes, making antidepressants an alternative to hormone therapy.

Illnesses and fever can cause hot flashes, as can malignancies, and tuberculosis – many illnesses can cause hot flashes.

Increased BMI, Body Mass Index, has been associated with hot flashes. We used to think that women who were heavy had excess estrogen, and therefore fewer hot flashes. Now from the major study that was done in the SWAN, Study of Women Across the Nation, we know that women who are heavy, who have abnormally high body mass index, are at increased risk for hot flashes.

Staness: What’s a menopausal gal to do if she suffers from hot flashes?

Dr. Klein: The real issue is how troubled are you. Some women find that they can manage their hot flashes with simple lifestyle changes, such as wearing layered clothing, lowering the thermostat, carrying a fan, drinking cool beverages, avoiding triggers like caffeine and alcohol. Some women can have a few hot flashes a day and over time, seventy-five to eighty percent of cases the hot flashes will diminish and disappear. Then there is a subset of women for whom hot flashes are really troubling and don’t go away. Lots of women have recurring hot flashes waking them up over and over again and they can’t go back to sleep. They are not getting enough rest; they wake up grouchy, tired, and sweaty. If it is really a problem, there are hormonal therapies that will alleviate these symptoms. As you know hormone therapy can have side effects, so you must always weigh the benefit versus the risk. There are very low dose hormone therapies that are now available that can be extremely useful for alleviating hot flashes.

There are some other options to consider such as soy and black cohosh. The studies regarding soy are mixed, with some showing that soy can be helpful; while there are other studies that show soy may help with mild symptoms. Soy is benign and easily available and may be worth trying. Black cohosh is another herb and has been used in Europe widely, but you have to be careful because there have been reports of toxicity with high doses. Used in limited amounts in standardized doses black cohosh supplements may help some women with hot flashes. Again, there have been mixed studies, so whatever you do, and with anything you take, you should always discuss with your clinician.

You can also try lifestyle changes – wearing layered clothing, practice deep breathing, meditation and yoga, exercising – all of these things that can be really helpful in learning to live with the symptoms if they are moderate.

Another option to treat hot flashes is gabapentin. This is a drug that was originally developed as an antiseizure medicine. Gabapentin is widely used for pain relief, because it was discovered that with patients in whom it was used for seizures, it helped with pain. It was then found that it helped with hot flashes. Gabapentin is a reasonable alternative to discuss with your clinician if you do not want to or if you cannot take hormone therapy.

Staness: I was on birth control pills for years and had no idea I was perimenopausal until I stopped them, then the hot flashes started erupting. Are birth control pills a good option for hot flashes?

Dr. Klein: Birth control pills are a form of hormone therapy. They are a higher dose than standard menopausal therapy, but there is estrogen in most birth control pills and that keeps hot flashes away. If you are in the perimenopausal phase, birth control pills can also be useful for regulating your periods, plus they keep hot flashes away.

____________________________________________

Understanding the causes and solutions for hot flashes is the first step to managing your menopause. If you suffer from hot flashes, discuss your treatment options (alternative, complementary and medical) with your healthcare provider.

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Posted in hormones, ask the expert

Irregular Periods

In No Mood for a Period during Vacation

Dear Crabby,

My husband and I are going on a cruise in about 3 weeks. I thought I would have my next period by now but haven’t. Actually I had one in June on the regular date and skipped July and had another in August but about 2 weeks before the normal date.

This all does not bother me because I do know these are all symptoms of menopause starting. But my question is, about anything I can do to control my period not starting on the trip.

I can’t get into my regular doc before we go.

Thanks!

In No Mood for a Period during Vacation

__________________

Dear In No Mood for a Period,

The most common symptom women notice during perimenopause is both menstrual flow and frequency changes. Per the North American Menopause Society, approximately 90% of women experience 4 to 8 years of menstrual changes before natural menopause. Some women experience lighter bleeding while others have heavier bleeding. The cycle length may also change, or you may completely skip a period. Every woman will experience a pattern that is irregular for her. We are all different.

Changes in your menstrual patterns and flow are considered normal during perimenopause, and are attributed to decreased frequency of ovulation and changing levels of ovarian secreted hormones.

Whether a woman is menopausal or not, wishing to manipulate your period start date, so it does not occur on a special occasion, is an age-old desire!

Many women who have irregular periods find success using a low-dose combination estrogen-progestin oral contraceptive. Clinical trails have demonstrated that oral contraceptives have normalized irregular bleeding and decreased menstrual flow.

Seasonale and Seasonique are oral contraceptive products that are formulated so you get your period about once every three months. Lybrel is another low-dose extended-use combined oral contraceptive that is formulated to be taken for one year with no breaks, no periods. These products also provide birth control, something perimenopausal women must consider until they have reached menopause (12 months without a period). Oral contraceptives may also provide relief for hot flashes, night sweats and menopausal crankiness.

Discuss these options and your risk factors (are you a smoker, high blood pressure, personal history of stroke, heart attack, blood clot or liver disease, breast or uterus cancer, or history of thrombosis) with your doctor.

You mentioned that you cannot get in to see your doctor, try a phone call – a brief conversation may answer your questions and/or requests.

If you are not a good candidate for oral contraceptives or prefer not to take them, consider embracing Mother Nature.

Have a wonderful cruise!

Signed,
Dear Crabby

Write to Dear Crabby and get advice about your menopausal symptoms.
If you have:
• Hot flashes
• Itchy skin
• Breast tenderness
• Mood swings
• Memory lapses
• Fuzzy thinking
• Night sweats
• Sleep problems
• Loss of libido
• Dry vagina
• Irregular periods
• Headaches

Dear Crabby has tips to make your life easier.
She wants to hear from YOU.
Send your questions to: DearCrabby@MenopauseMakeover.com

Resources:
The North American Menopause Society, “Menopause Practice a Clinician’s Guide”
www.menopause.org
Mayo Clinic
www.mayoclinic.com

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Posted in hormones, ask the expert

Heart Palpitations

POUNDING HEART FROM OREGON

Dear Crabby,

How long do heart palpitations last going through menopause? I have had them for almost 2 years. I already had my heart checked and all is okay. I am on oral natural progesterone which helps some. Is this a fairly common symptom of menopause?
Signed,
Pounding Heart from Oregon

Dear Pounding Heart,

Yes, for some, heart palpitations can be a common occurrence during menopause.

During menopause, heart palpitations can be scary, happening at inappropriate times. Sometimes palpitations accompany hot flashes.

Keep a hot flash/heart palpitation diary.

No one knows for sure why some women suffer from heart palpitations during menopause. It is often attributed to hormonal fluctuation. You may wish to discuss hormonal balance with your healthcare provider. Usually heart palpitations go away within a few months after your hormones have settled down. Hormonal balance often relieves heart palpitations.

If you suspect heart disease or if heart disease runs in your family, discuss these symptoms with your healthcare provider. From your inquiry it appears that you have had your heart health checked by your doctor. This is good news.

The most common non-hormonal cause of heart palpitations is ingesting too many stimulants: alcohol, nicotine, caffeine, decongestants, and diet pills all contain chemicals that stimulate the heart. Too much of these stimulants can confuse your heart and cause it to beat out of control.

Other causes of heart palpitations could be more serious and require medical attention: anemia, hypoglycemia, and certain thyroid conditions.

Stress can also cause irregular heartbeats. Practice relaxation techniques.

Consider:

-Limiting alcohol and caffeinated beverages
-Do not smoke
-Exercise regularly, after discussing with your doctor
-Avoid stimulant medications
-Decrease stress
-Keep blood pressure and cholesterol under control
-Manage a healthy weight
-Practice relaxation techniques
-Avoid activities that tend to activate or increase your palpitations
-Tracking your heart palpitations may help identify triggers.
-Make sure to share your heart palpitation journal with your clinician. Even if you have previously talked with your doctor regarding your heart palpitations, it is still important to inform her that they are continuing.

I am not a doctor, and encourage you to continue communication with your healthcare provider. I applaud your commitment to seek out information. We are all different. It is important to maintain good health, eat healthy and exercise during menopause.

Once I obtained hormone balance my heart palpitations disappeared. It took a few tries with different hormone therapies before finding a program that effectively managed my menopause symptoms.

If you need a second opinion, The North American Menopause Society has a wonderful list of healthcare providers:

http://www.menopause.org/cliniciansus.pdf

I hope the next heart pounding experience you encounter is one stimulated by love – not fluctuating hormones.

Signed,
A calmer Dear Crabby

NOTE: Pounding Heart from Oregon continued her search for heart palpitations solutions working closely with a naturopath. She discovered taking a compounded progesterone lozenger place under the tongue helped with heart palpitations. If her symptoms worsen she will consider estrogen/progesterone therapy. I applaud Pounding Heart for her extensive research and exercising an open conversation with her healthcare provider. It is the first step to managing menopause. We are all different. Each of us will have different solutions to treating menopause symptoms.

Write to Dear Crabby and get advice about your menopausal symptoms.
If you have:
• Hot flashes
• Itchy skin
• Breast tenderness
• Mood swings
• Memory lapses
• Fuzzy thinking
• Night sweats
• Sleep problems
• Loss of libido
• Dry vagina
• Irregular periods
• Headaches

Dear Crabby has tips to make your life easier.
She wants to hear from YOU.
Send your questions to: DearCrabby@MenopauseMakeover.com

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Posted in hormones, ask the expert

Do you need birth control during perimenopause?

IN THE MOOD FOR LOVE IN CINCINNATI

Dear Crabby,

My doctor has informed me that I am in perimenopause. My children are grown and it would be a relief if I no longer had to worry about birth control. I have used a diaphragm most of my adult life with great success, but it is inconvenient and kills “the mood”. In addition, my periods have been irregular. Do I still need to use birth control?

IN THE MOOD FOR LOVE IN CINCINNATI

DEAR IN THE MOOD:

The good news is you are “in the mood”. Many women experiencing perimenopausal symptoms lose their interest in sex. If your only concern is birth control-lucky you!

One of the benefits of menopause or post menopause is not worrying about birth control.

First, let’s define the three stages of menopause:

Perimenopause begins about 6-8 years before you reach menopause. During this time the levels of hormones produced by your ovaries start to fluctuate leading to irregular menstrual patterns; such as, irregularity in the length of the period, the time between periods, and the level of flow. At this time you are ovulating on and off, so you could become pregnant. Other common perimenopause symptoms are: hot flashes, night sweats, mood swings, vaginal dryness, weight gain, fluctuations in sexual desire, fuzzy thinking, trouble sleeping, fatigue and depression.

You are officially in menopause when you haven’t had a period for 12 consecutive months. At this point there are no more eggs left for your ovaries to release and pregnancy is impossible.

Post-Menopause is the period of life after you have reached menopause.

Since you are perimenopausal and still having periods it is advisable to continue practicing birth control because your ovaries have not completely stopped producing hormones. You may still ovulate and could become pregnant.

When your ovaries start producing lower levels of hormones you begin to experience symptoms associated with perimenopause. Irregular periods can be the first symptom you notice. Because your natural cycle is changing, some months you may ovulate and some months you may not. Menopause happens when the ovaries stop making enough hormones to stimulate your monthly cycle then your periods stop permanently. Only then can you stop worrying birth control. It is advisable you get confirmation from your doctor.

Since using a diaphragm for birth control can be inconvenient, and “kill the mood”, you may wish to consider one of these other methods of birth control.

Top five most popular forms of birth control

-Birth control pill, 96-99% effective. Using “the pill” is not only effective at birth control (diaphragms are only 85-90% effective) but the pill can help with perimenopausal symptoms. You may wish to discuss this option with your doctor.
-Condoms, 90-95% effective.
-Vasectomy, 100% effective. Many couples opt for this option after they have had their children.
-IUD (Intrauterine device) last six to ten years. This permanent device allows you to be “in the mood” without disrupting spontaneity.
-Norplant, a chemical contraceptive, is a match-sized rod that is inserted into the woman’s arm. It is time released into the woman’s system for up to five years.

Of course, abstinence is 100% full proof, but you signed your letter “in the mood,” so I’m sure that wouldn’t be an option. Continue practicing birth control until your doctor confirms that you are in menopause. If you have more than one partner, practice SAFE sex to avoid any sexually transmitted diseases.

Signed,
Less Crabby practicing birth control

Write to Dear Crabby and get advice about your menopausal symptoms.
If you have:
• Hot flashes
• Itchy skin
• Breast tenderness
• Mood swings
• Memory lapses
• Fuzzy thinking
• Night sweats
• Sleep problems
• Loss of libido
• Dry vagina
• Irregular periods
• Headaches

Dear Crabby has tips to make your life easier.
She wants to hear from YOU.
Send your questions to: DearCrabby@MenopauseMakeover.com

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Low Libido and Vaginal Dryness

NO LONGER INTERESTED IN SEX AND THE DREADED DRY VAGINA

Dear Crabby,

My husband and I have been married for over 10 years and we’ve always enjoyed an active, healthy sex life. Lately, I have been losing sleep because I am no longer interested in sex. When we do make love, my vagina is completely dry and it makes intercourse almost impossible. My sex drive is completely gone. My husband has become very “Crabby”, and I have completely shut down physically.

I am 46 years old, and my periods have become irregular. I suspect that I may be perimenopausal. It has been almost six months since our last sexual encounter and I’m afraid my husband will start looking somewhere else for it. I feel guilty of not “pleasing” him anymore, but even more guilty of not even “wanting” to. Once a woman’s period stops, is it normal to not want sex because we are no longer “baby makers”? Am I “guilty” of losing interest in sex and not pleasing my husband?

GUILTY IN SEATTLE

DEAR GUILTY IN SEATTLE:

The only thing you may be “guilty” of is not having all the facts so you can continue to have a healthy sex life.

Vaginal dryness is a common menopause symptom. Intercourse can be painful if you are experiencing vaginal dryness. When estrogen levels drop, vaginal dryness can occur. Your vagina can tear more easily from friction, and the vagina tissues can lose their elasticity. Estrogen plumps up the cells in the vaginal wall so they produce more lubrication.

It is important to discuss this with your doctor to confirm that you are not suffering from a vaginal infection. Not only does the physical act of intercourse become a challenge with vaginal dryness, the emotional dialogue that goes on in your head when you no longer lubricate naturally, makes the whole encounter stressful. You ask yourself, “Why am I not turned on? He’s doing all the things I like.” Then you think, “What must HE be thinking? Does he think HE doesn’t turn me on?” Next you suspect, “It’s me, what’s wrong with me?” Your only option is to say, “I have a headache”, then roll over and cry yourself to sleep. No wonder you are sleepless and no longer interested in sex.

There is good news. Option #1: Low dose hormone therapy may bring relief. Option #2: A bioadhesive lubricant, such as AstroGlide that can be purchased over-the-counter, may bring instant relief. Option #3: If vaginal dryness is your only menopause symptom, you may consider using local estrogen treatment.

The loss of libido is another common symptom of perimenopause straight through post menopause. The loss of libido can also result from fluctuating hormone levels. Don’t let a decrease in hormone levels blow the flame of desire out of your love life, visit your doctor, take the appropriate tests and discuss treatment options.

Certain medications may also contribute to a declining libido: blood pressure, depression, heart disease, or diabetes medications.

If you need to treat your relationship, visit a counselor.

Besides the effects of menopause, it is also normal for your libido to decline with age. Between the ages of 55 and 65 sexual activity slows for men and women.

A healthy sex life is possible during and after menopause.

If buying lubrication, getting blood tests, and discussing hormones with your doctor seem like an effort, check out the amazing benefits of sex:

-Sex burns about 200 calories during 30 minutes of active sex.
-Regular sex promotes circulation and lubrication!
-Having sex three times a week can make you look and feel ten years younger, thus boosting self esteem.
-Sex is the safest sport you’ll ever enjoy.
-Sex releases endorphins into the bloodstream producing a sense of euphoria, that can reduce depression.
-Sex is a stress reliever. It is ten times more effective than Valium.
-Sex can relieve headaches by releasing the tension that restricts blood vessels in the brain.
-Sex is a natural antihistamine that can help with asthma and hay fever.
-Sex can lower your cholesterol by tipping the HDL/LSL (good kind/bad kind) cholesterol balance towards the HDL (good) side.
-Regular sex can boost estrogen levels. Estrogen keeps your hair shinny, skin smooth; helps reduce the chances of getting dermatitis, and rashes.
-The actual sex act triggers the release of oxytocin that promotes more good feelings.
-Sex can help you sleep better because the levels of oxytocin, a sleep-inducing hormone, can be 5 times higher than normal during love making.

Now, let’s chat about your “guilt”. Women get joy out of pleasing the people we love, especially our wonderful partners. Of the two species, women are usually the “pleasers”. When something changes and we can’t please everyone as we used to, it is common to feel guilty. During perimenopause, menopause and post menopause our bodies are going through natural changes. This is nothing to feel guilty over. Just as our bodies go through a transition during puberty, our bodies also go through a transition as we end our childbearing years. This is a time when we need to pamper ourselves. We may have a little less time to give to others as we devote time to ourselves during this menopausal transition. This is a good time to find other friends going through the same thing, share information, lend support and compare experiences. Talking about “it” can make you feel better. It is a perfect time to build strong communication skills with your partner. The more your partner understands your menopausal journey the more supported you may feel regarding your insecurities.

Purchase a bioadhesive lubricant (Astroglide), visit your practitioner and discuss treatment options, take time for pampering, and being sleepless should only happen because you are making love to your Prince Charming.

Signed,
Less Crabby and More Loving

PS. A note to menopausal women who are in the dating world with more than one partner…. practice safe sex. You may be able to get pregnant and you want to avoid getting a sexually transmitted disease or AIDS.

Write to Dear Crabby and get advice about your menopausal symptoms.
If you have:
• Hot flashes
• Itchy skin
• Breast tenderness
• Mood swings
• Memory lapses
• Fuzzy thinking
• Night sweats
• Sleep problems
• Loss of libido
• Dry vagina
• Irregular periods
• Headaches

Dear Crabby has tips to make your life easier.
She wants to hear from YOU.
Send your questions to: DearCrabby@MenopauseMakeover.com

  • Share/Bookmark
Posted in hormones, relationships, ask the expert