Expert: 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.

Ask the Expert

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

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.

Dear Crabby,

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.

NAMS does not recommend custom-compounded products over well-tested, government-approved products for the majority of women – and does not recommend saliva testing to determine 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.

Signed,
A Less Confused
Dear Crabby

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?

Dear 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

One 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.

Constantly 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

Are 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.

_________
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.

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

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