hormones

How To Relieve Menopausal Vaginal Dryness

If hot flashes, night sweats, cranky moods aren’t enough to drive you crazy during the menopause transition, get ready for changes to your vagina too!

One common issue is vaginal dryness. As we get older, especially after menopause, the delicate vaginal tissue begins to lose natural oils. Even more, “declining estrogen levels during the menopausal transition can lead to itching, irritation, and painful sex,” says Dr. Alyssa Dweck, gynecologist and sexual health expert. With a number of treatment options out there, it’s important to know that all vaginal moisturizers are not created equal.

Many cleansers on the market, from soaps to body washes, have harsh ingredients and properties which can actually damage your intimate areas. Unlike other feminine care products, Lubrigyn Cleansing Lotion does not foam, which allows the vaginal tissue to maintain its protective barrier. The lotion also contains the super-moisturizer, hyaluronic acid, to keep your tissue hydrated throughout the day.

“Lubrigyn Cleansing Lotion is a rich vaginal moisturizer to prevent and alleviate these symptoms,” Dr. Dweck notes. Lubrigyn has been a feminine care bestseller across Europe since 2004, and is now available in the United States!

Learn more about Lubrigyn Cleansing Lotion and take advantage of the $5 off discount.

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Posted in Blog, homepage, hormones

How To Invest In Your Long-Term Eye Health

Fluctuations in our estrogen levels during menopause bring all sorts of uncomfortable symptoms, from dry vaginas to dry eyes!  I can’t even wear contacts because of dry eyes!

If you’ve already begun or completed menopause, you’ve probably noticed a decline in your overall vision– it simply isn’t as sharp as it once was, even when you’re wearing prescription glasses. One common complaint is driving at night– 40% of drivers over 40 feel uncomfortable behind the wheel after dark.

Why your vision declines after 40

Changes to our eyes occur gradually, over decades, until we suddenly recognize changes in our vision. As we age, our pupils shrink and dilate less in the dark, which reduces the amount of light entering our eyes. This can even make it seem as if we’re wearing dark sunglasses at night.

We’re also at greater risk for age-related macular degeneration (AMD), the deterioration (or thinning) of the macula, a critical part of your eye responsible for your central vision. In some cases of AMD, blood vessels can form under the retina and leak blood and fluid into the eye. Macular degeneration is the number one cause of vision loss in adults over 55.

Two crucial nutrients, zeaxanthin and lutein, can help protect our eyes against further deterioration and support the natural functions of your eyes.

“Zeaxanthin and lutein protect the most important retinal real estate of the eye–-the macula–which allows us to see detail. It is therefore critical to maintain the quality and health of this area of retinal tissue in a modern society that depends upon using computer screens and driving automobiles safely,” said Dr. Stuart Richer, doctor of optometry.

Even through a healthy diet including leafy greens, certain fish, and other foods, you’ll still only absorb  a trace amount of these nutrients. The dose of zeaxanthin and lutein we need to protect and improve our vision can be found only in a supplement like EyePromise Vizual EDGE. The natural supplement helps dim the harsh light from glare, improve contrast when looking ahead, and reduce eye stress from bright lights.

I encourage you to take the time and invest in your long-term eye health and feel more confident driving at night.

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Posted in homepage, hormones

Menopause Makeover & Hot Flash Havoc on PBS

The Menopause Makeover is joining Award Winning Documentary Hot Flash Havoc on PBS as part of their 365 station fundraising drive.  Wahooooo!

When you watch Hot Flash Havoc, executive produced by Heidi Houston and directed by Marc Bennett, you will have the opportunity to donate to PBS and receive a DVD of Hot Flash Havoc, plus a DVD series called, MENOPAUSE TALKS (Think Ted Talks with menopause experts), a copy of The Menopause Makeover, AND Change your Menopause by Dr. Wulf Utian.

Hot Flash Havoc is narrated by Oscar Award Winning Actor Goldie Hawn, and The Public Broadcasting System (PBS) has licensed to air it on stations across the country starting March 5th!

Click here to find out when it airs in your neighborhood.

If you do not see the PBS station in your area showing the movie, please contact them to request the movie.

We encourage you to tell both men and women to take the time to tune in, become engaged and encourage this vital conversation about menopause.

Both Heidi and I released our menopause passion projects the same year, and I am thrilled to have my book included with her film on PBS.

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Posted in hormones

The Other ED™, Estrogen Deficiency

Who likes to talk about v-health? It changes with every life stage, and after menopause it can surprise you with one more change.

Estrogen deficiency (the Other ED™) after menopause can also cause vaginal symptoms that can have a negative impact on your relationship with your partner, your sexuality, quality of life, and self-image.

It may still be taboo to discuss vaginal dryness because it is associated with aging, but we have the chance to break the silence and open the door to individualized treatment.

Seventy-five percent of postmenopausal women suffer from vaginal dryness after going through “the change;” you are not alone!

The first step to initiating change is to become informed, to apply that information to your life, and then take action. Learning, living, doing!

How do we do that?

First, gather information: What are your symptoms? Are you suffering from postmenopausal vaginal dryness?

Second, start talking about it with your friends. How is this affecting your life physically and emotionally? It will help them too if you lead the way. This is when we start breaking down those taboo walls.

Third, discuss your symptoms with a health care provider. This can be awkward, but with some tips on how to start the conversation with the doc and what to ask, you can explore treatment options that may be right for you. We are all different with different needs and preferences.

Somewhere between step 2 and step 3, addressing your symptoms with your partner will help alleviate concerns he may have about pain you may be experiencing during sex.

I am proud to be on the GLAM™ (Great Life After Menopause) team, a women’s health initiative sponsored by Novo Nordisk, and we are on a mission to bring you information that you can apply to your life and share with others.

There is a wonderful site that is loaded with information and is fun to visit that can help you get answers to your questions so you are prepared to LEARN, LIVE, and DO!

Check out TheOtherED.com http://www.theothered.com/staness.

Visit http://www.theothered.com/staness for more information on the vaginal symptoms associated with menopause and tips on how to speak with your health care provider.

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Posted in hormones

Is Vaginal Dryness Out of the Closet?

It has been 4 years since my book co-authored with Wendy Klein MD, The Menopause Makeover, has been out in the world. The topic of menopause was a tough sell for my literary agent, and even tougher to promote. No one wanted to talk about the “M” word. But I knew that women everywhere, including myself, were suffering from this transition without the information they needed to manage a natural part of womanhood.

This month is Menopause Awareness Month, and I am excited to say that I have personally witnessed the word menopause come out of the closet of shame. The topic has starred in media headlines and eased into everyday conversation, because women started talking publically about it.

However, while it may be easier now to discuss hot flashes and menopausal weight gain, there is still one symptom many are still embarrassed to discuss with their doctor and partner…postmenopausal vaginal dryness.1

Since adding vaginal dryness last year as a bookend to my menopause mission, I am happy to report that I feel there has been progress publically, scientifically, and medically.

The North American Menopause Society defines menopause-related vaginal discomfort as:

“The dryness and thinning of the vagina that follows the drop in estrogen around menopause is the most common cause of painful sex at midlife and beyond.”2

Up to 75% of menopausal women may experience vaginal dryness; as well as irritation, burning, pain during urination, pain during sex, and vaginal discharge. 3,4

Unfortunately, the majority of women still do not seek treatment, but I was happy to discover this year that the medical and scientific world has marched forward and progress is being made.1

A survey published in the medical journal Climacteric in February 2014 recommended that health care providers start being proactive in order to help their patients disclose the symptoms related to vaginal dryness so they can discuss treatment options during the menopause discussion.5

I was impressed with a letter from the editors-in-chief of this publication, entitled: “Vulvovaginal Atrophy – A Tale of Neglect.” They acknowledged that “women and their sexual partners are … suffering in silence,” and urged the wider medical profession to urgently address and improve the situation.6

The first step for those who may be suffering in silence from postmenopausal vaginal dryness is to discuss symptoms with their health care provider. Before your first visit, you can track symptoms and use this worksheet to start the conversation.

Your symptoms are treatable and there are therapy options available.

An estimated 1.2 billion women will have reached menopause by 2030. Unlike hot flashes that generally settle down with time, menopause-related vaginal symptoms do not tend to get better with age.7

In just 1 year, I have seen postmenopausal vaginal dryness peek out of the closet. Don’t let this treatable symptom keep you from embracing this natural transition in a woman’s life.
________________

By Staness Jonekos, Author of The Menopause Makeover
I am a member of GLAM™ (Great Life After Menopause), a woman’s health initiative sponsored by Novo Nordisk.
Visit www.theOtherEd.com for more information on the vaginal symptoms associated with menopause and tips on how to speak with your doctor about them.

GLAM™ (Great Life After Menopause) is a trademark of Novo Nordisk FemCare AG.
© 2014 Novo Nordisk      All rights reserved.      0814-00022955-1        September 2014

____________

[1] Nappi RE, Kokot-Kierepa M. Vaginal Health: Insights, Views & Attitudes (VIVA) – Results from an International Survey. Climacteric. 2012;15(1):36-44.

[2] The North American Menopause Society Staff. Vaginal Discomfort. The North American Menopause Society. http://www.menopause.org/for-women/sexual-health-menopause-online/causes-of-sexual-problems/vaginal-discomfort. Publish Date Unknown. Accessed September 3, 2014.

[3] Wines N, Willsteed E. Menopause and the skin. Australasian Journal of Dermatology. 2001;42(3):149-158.

[4] The North American Menopause Society Staff. Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society. Menopause. 2013;20(9):888-902.

[5] Nappi RE, Palacio S. Impact Of Vulvovaginal Atrophy on Sexual Health and Quality of Life at Postmenopause. Climacteric. 2014;17(1):3-9.

[6] Panay N, Fenton A. Vulvovaginal Atrophy – A Tale of Neglect. Climacteric. 2014;17(1):1-2.

[7] Sinha A, Ewies AAA. Non-hormonal Topical Treatment of Vulvovaginal Atrophy: An Up-to-date Overview. Climacteric. 2013;16(3); 305-312.

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Posted in hormones

Managing Overactive Bladder

Managing Overactive Bladder

By Staness Jonekos

Do you map out bathroom locations before leaving home so you aren’t stranded without options when the unstoppable urge strikes?

Bladder control issues can be stressful especially in social situations.  As many as one in six adults over the age 40 suffer from an overactive bladder (OAB), and women between the ages of 45 and 64 are affected more than men.

The North American Menopause Society (NAMS) says:

“Women are much more prone to the occasional episode of urine leakage than men. These symptoms may be partially affected by menopause. As menopause approaches and during the years that follow, lack of estrogen can cause thinning of the lining of the urethra, the outlet for the bladder. With aging, the surrounding pelvic muscles may weaken. As a result, women are at increased risk for urinary incontinence.”

Unfortunately, the majority of women do not seek treatment, assuming it is part of the aging process.  OAB can affect quality of life, and can impact sexual health.

When the muscles of the bladder contract involuntarily, your brain signals the urgent need to urinate.  Often you may not always make it to the bathroom without leaking.

Urgency is the hallmark symptom, as well as frequency and waking up during sleep two or more times to urinate, according to the International Continence Society (ICS).

The ICS defines frequency of urination as:

“…Up to seven episodes during waking hours had been considered normal, but this number is highly variable based upon hours of sleep, fluid intake, medical conditions and other factors like medications, a urinary tract infection and pregnancy or recent delivery.”

The good news is that there are OAB first line treatment strategies you can discuss with your healthcare provider:

  1. Behavioral therapies, including bladder training, pelvic floor muscle training, and fluid management.
  2. Pharmacologic management, with both over-the-counter and prescription options.
  3. Lifestyle changes:
    1. Maintain a healthy weight, because being overweight can contribute to OAB.
    2. Reduce caffeine, tea, alcohol, spicey and acidic foods.
    3. Stop smoking – smoker’s cough can lead to urine leakage.
    4. Support healthy bowel habits. Being constipated can cause extra pressure on the bladder, making you feel like you have to urinate. Exercise and fiber intake can help with regularity.

Chart your symptoms 3 to7 days prior to your first doctor’s visit, and track your progress with these tools:

FREE Bladder Diary

FREE Bladder APP

If you have OAB, don’t suffer in silence.  Johns Hopkins Medicine reports that around 33 million Americans have an overactive bladder – you are not alone.  With proper treatment you can schedule your day around activities not bathroom locations.

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Posted in hormones

Tips from the NIH about Hormones and Menopause

Ladies, finally an easy-to-read brochure that shares the latest science on hormones and menopause.  A MUST read!

This information is based on research and approved by leading scientists in women’s health, so you can be sure it’s reliable.

The NIH is the part of the U.S. government responsible for medical research. They’re working hard to develop cures and treatments, including treatments for menopausal symptoms.

Click on the image to order your copy for FREE.

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Posted in hormones

What’s in a Name? Vaginal Atrophy Rebranded

As a health advocate for menopausal women, I often see uncomfortable responses when I mention “vaginas,” from excessive feet tapping and unnecessary shifts in body position to painful grimaces. Even the word “menopause” evokes a squirm encouraging a change of subject. Combine these two words and it is no surprise the terminology used to diagnose menopausal vaginal symptoms needs rebranding.

Last year, Novo Nordisk invited a small group of menopause bloggers to brainstorm
solutions that would help knock down those taboo vagina barriers, so women and
their health care providers could openly discuss vaginal atrophy … you may know it
as thinning and drying of vaginal walls due to declining estrogen.

One solution tossed on the vaginal atrophy think-tank table was changing the name
since the word “vagina” is already shunned in the media.

As reported in the New York Times a couple of years ago, three networks rejected a Kotex commercial, because it used the word vagina. When they subbed it with “down there,” one of the networks aired it.

Per the Merriam-Webster Dictionary, atrophy is defined as “a wasting away or progressive decline, decrease in size or wasting away of a body part or tissue.”

The 2012 Vaginal Health: Insights, Views & Attitudes (VIVA) survey found that as many as 75% of postmenopausal women felt vaginal atrophy had a negative impact on their life. Combine the word “vagina” with “atrophy” and this duo leaves many women feeling uncomfortable talking about this, leaving them to suffer in silence. Its taboo nature may be causing women to avoid seeking help.

How does a woman know if she should seek help? Common symptoms of vaginal atrophy are vaginal dryness and itching, painful urination, recurrent urinary tract infections and pain during intercourse.

If you suspect you are suffering from vaginal atrophy, discuss your symptoms with your health care provider. A symptom tracker with tips on how to discuss this potentially embarrassing topic with your health care provider is available at:

www.vaginaldiscomfort.com

With so many treatments available, including over-the-counter lubricants, vaginal moisturizers and prescribed systemic and/or local hormonal and non-hormonal options, there is no reason a woman’s vaginal health needs to be compromised or her sex life retired because of terminology that can evoke shame or embarrassment.

So what’s in a name? When it comes to vaginal atrophy, a woman’s health and even her relationship may be compromised. No matter the name, don’t suffer in silence. Speak to your health care provider.

By Staness Jonekos, Co-Author The Menopause Makeover
Medical reviewer: Wendy Klein, MD, FACP

I am a member of  GLAM™ (Great Life After Menopause), a women’s health
initiative sponsored by Novo Nordisk.

Visit www.VaginalDiscomfort.com for more information on the vaginal
symptoms associated with menopause and tips on how to speak with your doctor
about them.

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Posted in hormones

Interview with Dr. Mache Seibel, My Menopause Magazine

I had the most amazing conversation/interview with Dr. Mache Seibel who has dedicated his life to women’s health!

He is known as America’s Most Innovative Health Educator, and after meeting him… HE IS!

We discussed the 8-step 12-week Menopause Makeover program.  He is so committed to health and has an incredible website, www.DoctorSeibel.com, with tons of info on menopause and overall health!

You can subscribe to his My Menopause Magazine, by clicking here.

My Menopause Magazine, interview with Staness and Dr. Seibel, click this link to read.

http://bit.ly/18wu8bo

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Posted in Blog, hormones

Painful Sex? How to Relieve Vaginal Dryness

Many women suffer in silence during painful sex, unaware that there are treatment options for vaginal dryness, and its effects are far-reaching.

Vaginal dryness affects a woman’s health, intimate relationships and quality of life. I know because it affected my health and love life.

It occurs most often after menopause, but it can also develop during breast-feeding or at any other time your body’s estrogen production declines.

Estrogen, important for maintaining vaginal health and lubrication, is the hormone that actually plumps up the cells in the vagina. When estrogen levels decline, the vaginal walls can become thinner, less elastic and dryer.

The result is vaginal dryness, also known as vaginal atrophy (VA), which is a chronic progressive condition contributing to painful intercourse.

According to the North American Menopause Society (NAMS), up to 75% of menopausal women may experience vaginal dryness as they age. I was not alone, but I must admit no one was talking about it, other than my extremely supportive husband.

Are you suffering from vaginal dryness?  Or is your partner?

Symptoms include:

  • Vaginal dryness
  • Burning and itching
  • Irritation or soreness
  • Pain and bleeding during intercourse or urination
  • Shortening and tightening of the vaginal canal

When a woman experiences pain during intercourse, it is no surprise that her desire for sex may decrease.  A physical condition such as vaginal dryness can avalanche into an emotional response affecting both relationship and self-esteem.

With severe vaginal dryness, the tissues of the vagina become dry and sometimes fragile and inflamed. As a result, they are more prone to injury, tearing, and bleeding during sexual intercourse or even a pelvic exam. Over time, especially in the absence of regular intercourse, the vagina may also become slightly shorter and narrower. The resulting discomfort can intensify to the point where sexual intercourse is no longer pleasurable or even possible.

Not only does the physical act of intercourse become a challenge, the increased emotional stress can be a double whammy for a healthy sexual relationship.

The Partners’ Survey, which is a part of a larger global survey called CLOSER Research (Clarifying Vaginal Atrophy’s Impact OSex and Relationships) sponsored by Novo Nordisk, revealed that 65% of men worried that sex would be painful for partners, and almost a third of both men and women reported that they discontinued having sex with their partners as a result of discomfort.

This survey, which included 4,167 post-menopausal women ages 55 to 65, found that 57% of women avoided being intimate, and 65% said they lost their libido.

The good news is the majority of the 4,174 men in the survey were concerned about what was going on with their partner. Unfortunately, this taboo subject has partners turning off the lights at night rolling over, confused and frustrated.

Margery L.S. Gass, MD, NCMP, NAMS Executive Director says,

“This topic is so sensitive that, according to the International Menopause Society, 70% of women say their healthcare professionals have only rarely or never raised the subject with them.”

James A. Simon, MD, NCMP, FACOG, Clinical Professor of Obstetrics and Gynecology at The George Washington University School of Medicine in Washington, DC, says,

“In my experience treating patients, most women are not comfortable talking about vaginal symptoms, especially related to pain and discomfort. The word ‘vagina’ is somewhat taboo, so it’s no wonder no one talks about vaginal atrophy.”

Taboo or not, vaginal dryness is manageable and treatable.  The North American Menopause Society recommends:

  • Vaginal Lubricants: Decreases friction during intercourse.  There are many over-the-counter (OTC) water and silicon-based options. Water-based lubricants are popular and easy to wash off. Silicon-based lubricants tend to last longer, but are not as easy to wash off.
  • Vaginal moisturizers: Non-hormonal OTC, generally used twice a week.  Moisturizers are absorbed by the skin and adhere to the vaginal lining, keeping it moist.
  • Regular sexual stimulation: Intercourse promotes blood flow to the genital area, helping to maintain vaginal health.
  • Developing expanded views of sexual pleasure: If vaginal penetration (intercourse) is difficult or uncomfortable, consider so-called “outercourse” options such as extended caressing and massage.
  • Local prescription therapy: For vaginal dryness and discomfort that does not respond to over-the-counter lubricants and moisturizers, low doses of local vaginal estrogen therapy are very effective and safe. Local estrogen increases the thickness and elasticity of vaginal tissues, restores a healthy vaginal pH, increases vaginal secretions, and relieves vaginal dryness and discomfort with intercourse.
  • Systemic prescription therapy. Low doses of systemic estrogen in the form of a pill or skin patch or gel used to treat hot flashes are also effective for treating vaginal dryness, although some women might benefit from adding local treatment to their systemic treatment to relieve discomfort. If only vaginal symptoms are present, local therapy as described above is recommended.

During my menopause transition, I was very aware that vaginal dryness was a common symptom and assumed this was a natural part of aging.  I made assumptions that if my skin was aging, why would my vagina be any different? Then, I became aware of the many options for treatment.

I started out using OTC silicon-based lubricants and that worked for a few months.  It solved the friction problem, but not the pain.  Then, I tried vaginal moisturizers and the pain was relieved for a few more months. However, since vaginal dryness tends to be a progressive condition, the situation only got worse for me.

Per the Partners’ Survey, 56% of women and 57% of men whose partners used local estrogen therapy reported that sex was less painful.  This was true for me.  Painful sex disappeared once those vaginal cells were plumped up with local estrogen therapy, restoring my love life.

Recently, I asked Wen Shen, MD, Assistant Professor of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, about the safety of vaginal hormonal treatment:

“Vaginal estrogen comes in very low doses, as light as ten micrograms used twice a week.  There have been premarketing studies that show women who use vaginal estrogen do not increase their systemic estrogen levels above the post menopausal level.  After treatment, the levels actually go back down again to really low levels.

The vaginal skin and bladder are very well treated with vaginal estrogen, and they have more elasticity and thickness, so that the vagina can serve as a sexual organ again and the bladder can be less irritated.”

It is important to discuss vaginal dryness with your healthcare provider to confirm that you are not suffering from a vaginal infection.  If left untreated, it can lead to long-term complications in some women.

According to Dr. Shen:

“Vaginal dryness is one of the easier symptoms of menopause to treat that carries the least amount of risk.”

I was so happy there was a solution to vaginal dryness that I started talking about it with my girlfriends.  Many confessed that they too suffered from extreme dryness during intercourse and were losing interest in sex, leaving their partners feeling confused and distanced.

My friends and colleagues in the menopause community started calling me “Vagina Girl” because I always asked, “How’s your vagina?” It was perfect when asked to join the GLAM TM (Great Life After Menopause) team to bring awareness to vaginal dryness.

My message to woman, and to the men who love them, vaginal dryness is treatable. Talk to your healthcare provider. If you are menopausal or suffering from hormonal changes, you don’t have to suffer in silence.

Vaginal health is more than sexual health – it is good women’s health.

By Staness Jonekos, Co-Author The Menopause Makeover

Medical reviewer: Wendy Klein, MD, FACP

Disclosure: I am a member of GLAM™ (Great Life After Menopause), a women’s health initiative sponsored by Novo Nordisk. www.VaginalDiscomfort.com

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Posted in hormones

Vaginal Atrophy

Are You Suffering from Vaginal Atrophy?

When I went through menopause everything about the experience was still in the closet. Five years later, we have an official month celebrating menopause. Today we are freely talking about hot flashes, weight gain, aging and no longer feeling sexy.

Big progress in half a decade, BUT there is one area of women’s health that is so taboo many health care providers aren’t talking about it. Up to 75 percent of postmenopausal women may experience symptoms of it, yet only 25 percent seek medical help.1

Many of us suffer in silence from this natural part of aging, yet are too embarrassed to discuss this condition. What is it?

VAGINAL ATROPHY

Blushing? Uncomfortable? Squirming? Wondering if YOU have it? Asking yourself if your partner has it and that is why she is not interested in sex anymore?

An estimated 1.2 BILLION women worldwide will have reached menopause by 2030 – so it is time we start talking about vaginal atrophy.4

Good news! Novo Nordisk, a leader in women’s health, invited my favorite menopause influencers and me to form a team committed to raising awareness about vaginal atrophy (VA). We call ourselves GLAM™ (Great Life After Menopause), and we even have a logo and website.

As a GLAM™ (Great Life After Menopause) spokesperson, I will be able to share the latest science on VA, discuss symptoms and give you tools so you can proactively discuss VA with your health care provider.

Do you suffer from VA? 2

  • Vaginal dryness
  • Soreness
  • Itching
  • Pain and bleeding during intercourse
  • Irritation
  • Painful urination

GREAT NEWS! VA is treatable. Visit vaginaldiscomfort.com to complete the vaginal atrophy symptom identifier and bring it to your next medical appointment. You can use it to start the conversation.

In contrast to hot flashes, which generally settle with time, VA symptoms tend to progressively get worse.1

I know, because I suffered with VA, and I kept hoping it would go away. I thought the dryness was a normal part of aging and I should learn to live with the consequences. Unfortunately it was affecting my love life. After studying the latest research I was thrilled to learn there were treatment options.

If you think you may be suffering from VA, you are not alone! I will share information, conduct online chats, be available via Facebook and Twitter — I WILL BE TALKING ABOUT VAGINAS and VAGINAL ATROPHY! I invite you to join me in breaking the taboo, let’s talk about IT!

I am a member of  GLAM™ (Great Life After Menopause), a women’s health initiative sponsored by Novo Nordisk.

For more information: VaginalDiscomfort.com

Vaginal Atrophy by Staness Jonekos, MenopauseMakeover.com

1 The North American Menopause Society. The role of local vaginal estrogen for treatment of vaginal atrophy in postmenopausal women: 2007 position statement of The North American Menopause Society. Menopause. 2007; 14(3): 357–369.

2 Simon, J.A., et al. The Partners’ Survey: Impact of vaginal discomfort and its treatment – Insights, views and attitudes of postmenopausal women and their partners. North American Menopause Society (NAMS) Annual Meeting, October 2012. Abstract #1400532.

3 American Congress of Obstetricians and Gynecologists (ACOG). Women’s health: Stats & facts. 2011.

4 Hill K. The demography of menopause. Maturitas. 1996;23(2):113-127.

Press Release, here.

Novo Nordisk Launches GLAM™ (Great Life After Menopause) to Ignite the Conversation on Vaginal Health

GLAM™ (Great Life After Menopause)

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Posted in hormones

Latest Hormone Therapy Study

The Menopause Makeover
By Staness Jonekos

A respected colleague, David Katz MD, MPH, Director Yale Prevention Research Center, with founder of the Yale Menopause Program, Dr. Philip Sarrel, just released the results of their latest study on hormone therapy.

Could estrogen have saved lives?

Dr. Katz wrote an insightful article starting that nearly 50,000 women may have died prematurely after they stopped taking hormone therapy to treat menopause symptoms following the much-publicized 2002 study that revealed the treatment increased the risk of heart disease and breast cancer.

This study validates what many experts and organizations, including The Menopause Makeover co-author Dr. Wendy Klein, have been saying for years … that hormone therapy is an acceptable option for the relatively young (up to age 59 or within 10 years of menopause) and healthy women who are bothered by moderate to severe menopausal symptoms.  Individualization is key in the decision to use hormone therapy.  Consideration should be given to the woman’s quality of life as well as her personal risk factors such as age, time since menopause, and her risk of blood clots, heart disease, stroke and breast cancer.

Lethal Placebo

By David L. Katz, MD, MPH

Everyone seems to love a riveting conspiracy theory- except, of course, the victims of it. We enjoy the gathering momentum of our collective outrage, and casting our passionate aspersions at some malefactor in the military industrial complex. In my world, that malefactor is often Big Pharma. Everyone loves to hate the harms that drugs do and the profits they generate along the way. Denigrating Big Pharma is a cultural pastime, and rollicking good fun.

And in the larger context of health care, it even makes sense. The prime directive of medicine, after all, is primum non nocere. Medicine becomes a legitimate target for scorn when it is a purveyor of net harm.

But what truly matters here is not the means, but the ends- the harm itself. What matters is life lost from years, and in the more extreme cases, years lost from life. And I have just such a tale to tell, but the means are peculiar. It’s not the drug that’s killing people- it’s the placebo.

My Yale colleague, Dr. Phil Sarrel, has devoted his career in large measure to a detailed knowledge of the overall health effects, and in particular the vascular effects, of ovarian hormones. Ovarian hormones- estrogen and its metabolites, and progesterone – profoundly influence a woman’s health from menarche to menopause, and then influence a woman’s health some more by disappearing.

Dr. Sarrel was in the vanguard of those who saw serious problems with the large, randomized clinical trials, published just at the turn of the millennium, that refuted our prior faith in the disease-preventing potential of hormone replacement therapy. The HERS trial, and the massive and massively influential Women’s Health Initiative (WHI), purportedly showed that we had been wrong about the advantages of hormone replacement, and that the practice resulted in net harm.

Even I was among those who noticed right away that the net harm was very, very slight- and grossly exaggerated in media headlines. But Dr. Sarrel was among those with the expertise to induce bigger worries.

Both trials had used the exact same form of hormone replacement, so-called “Prempro,” a combination of Premarin and medroxy-progesterone acetate. Premarin is estrogen derived from the urine of pregnant horses, and thus not native to humans. Medroxy-progesterone acetate is a synthetic progesterone, not native to any species, and many times more potent than human progesterone. Most experts, including my colleague, had long preferred other forms of hormone replacement, considering Prem/Pro a dubious choice.

But when HERS and the WHI tarred the practice of hormone replacement, it was with a broad brush. The news was not that Prem/Pro, one questionable approach to hormone replacement, resulted in benefits for some women and harms for others, with a very slight net harm at the population level. The news was: hormone replacement therapy harms women!

We already had potentially serious problems at this point, but the plot thickens considerably. Dr. Sarrel was also among those to note that these clinical trials administered Prem/Pro to women a decade after menopause. They did this to be sure the women were not just merely, but most sincerely post-menopausal. But we had cause to suspect then, and abundant reason to know now, that the benefits of ovarian hormone replacement accrue right at the time of menopause, and in the decade that follows. Timing is often crucial in medicine, as in life. Administer, for instance, a potent diuretic while a patient is fluid overloaded, and it can be lifesaving. Give just the same drug after they have already eliminated that excess fluid, and the result is apt to be hypotension and even death. Timing matters- and the hormone replacement trials got it seriously wrong.

All of this suggests that many women who might have benefited from good hormone replacement administered with good timing have missed out on those benefits because of the headlines engendered by HERS and the WHI. But the story does not end here, either. It ends, as noted, with a lethal placebo.

Quite a few months ago, Dr. Sarrel and I had the first of our recent intense flurry of meetings at my lab. He had brought me a paper published in JAMA in 2011, reporting on one particular subgroup included in the WHI: women who had undergone hysterectomy. The only reason to include progesterone in hormone replacement is to protect the uterine lining from overgrowth, so women who have had a hysterectomy are prescribed (or were, back in the days when hormone replacement was not the bogeyman) estrogen only.

Dr. Sarrel’s read of this paper was that the younger women- those age 50 to 59 and therefore just on the far side of menopause- had a considerably higher mortality rate when given placebo, rather than when given estrogen. I am formally trained in biostatistics and epidemiology, so my colleague asked me to verify this impression, which I did. Our project, and the resulting publication of our paper yesterday in the American Journal of Public Health, grew from there.

Working with a team from my lab, we devised a very simple formula to translate the excess death rate seen in the estrogen-only arm of the WHI to the entire population of such women in the United States: women in their 50’s, who had undergone hysterectomy. Hysterectomy is very common, arguably too common, so this population numbers in the many millions. We then needed to add into the formula the most reliable estimates we could find for the precipitous drop in estrogen prescriptions following the publication of the original WHI results back in 2002.

We, of course, had to run the details of our analysis through the gauntlet of peer review. And our paper now stands, in a highly esteemed journal, on full display before a jury of peers. So I can spare you the details of our methods, and focus on the punch line.

We estimated that over the past decade, due to a wholesale abandonment of all forms of hormone replacement for all categories of women by both the women themselves and their doctors, minimally 20,000, and quite possibly more than 90,000 women have died prematurely. We were very careful to incorporate only reliably conservative figures into our formula, so the numbers might actually be higher still. Being extremely cautious, we report that over 40,000 women have died over the past ten years for failure to take estrogen.

This death toll of estrogen avoidance, or better still, estrogen ‘aversion,’ represented some 4,000 women every year. Whatever the emotional impact of that figure, it should be greater- because any one of those women could be your spouse, or mother, or sister, or daughter, or friend. And the impact should be greater because the massively over-simplified, over-generalized, distorted “hormone replacement is bad” message continues to reverberate, and rates of all kinds of hormone replacement use continue to decline.

Stated bluntly, we think the mortality toll of estrogen avoidance is not merely a clear, present, and on-going danger, it is a worsening one. More women are dying from this omission every year. And the next one in that calamitous line could be a woman you love; it could be you.

I write this column, as my colleagues and I wrote our paper: with a sense of urgency, and even desperation. My career is entirely devoted to the prevention of avoidable harms, and the protection of years of life, and life in years. This is as clear-cut a case of preventable harms, and as readily fixable, as we are ever likely to see.

Here, then, are the take-away messages:

1) All forms of hormone replacement for all women at menopause was never right, but nor is NO forms of hormone replacement for NO women at menopause. There was always baby and bathwater here, and we have egregiously failed to distinguish between the two.

2) The millions of women who have undergone hysterectomy are candidates for estrogen-only hormone replacement at menopause, and when that treatment is provided at the time of menopause and for the years that immediately follow, it can both alleviate symptoms AND save lives. It could save the lives of thousands of women every year in the U.S., and no doubt many thousands more around the world where the tendency toward hormone replacement aversion also prevails.

Every woman who has had a hysterectomy should be open to the option of estrogen therapy at menopause, and should discuss it with her doctor. Every health care professional needs to know that some forms of hormone replacement for some women at menopause remain potentially life saving, and needs to address the topic accordingly.

3) Medical news is often translated into provocative headlines that abandon the nuances of the actual findings for the sake of maximal impact. This certainly happened when we learned that one form of hormone replacement resulted in a very slight excess of total net harm for one particular group of women, but is a far more systemic problem; it happens all the time. All of us plying our wares where medicine and the media come together need a bracing reality check: there are lives at stake! When headlines distort the actual state of medical knowledge and take on a life of their own, they can affect patient behavior and clinical practice-and the result can be the very harm medicine is pledged to avoid. I call upon my colleagues involved in the reporting of medical news to embrace the great responsibility that comes with the great power of the press, and to deliver their headlines accordingly. How many avoidable deaths is a maximally titillating, but misleading, headline really worth?

We’ve all seen the commercials on television; drug companies are required to report the various potential harms of their products, as they should be. But no one is required to report the potential harms of placebo. For the past decade, millions of women who might have enjoyed more life in years, and tens of thousands who might have enjoyed more years of life by taking estrogen, were, in essence, taking a “placebo” instead. And in this case, it was the placebo causing the harm. In this case, the placebo was- and all too often remains- lethal.

-fin

Dr. David L. Katz; http://www.davidkatzmd.com/

www.turnthetidefoundation.org

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Osteoporosis: Are You at Risk?

What is osteoporosis?

Osteoporosis (OS-tee-oh-poh-ROH-sis) is a disease of the bones. People with osteoporosis have bones that are weak and break easily.

A broken bone can really affect your life. It can cause severe pain and disability. It can make it harder to do daily tasks on your own, such as walking.

What bones does osteoporosis affect?

Diagram of osteoporosis in the vertebrae

Osteoporosis affects all bones in the body. However, breaks are most common in the hip, wrist, and spine, also called vertebrae (VUR-tuh-bray). Vertebrae support your body, helping you to stand and sit up. See the picture below.

Osteoporosis in the vertebrae can cause serious problems for women. A fracture in this area occurs from day-to-day activities like climbing stairs, lifting objects, or bending forward. Signs of osteoporosis:

  • Sloping shoulders
  • Curve in the back
  • Height loss
  • Back pain
  • Hunched posture
  • Protruding abdomen

What increases my chances of getting osteoporosis?

There are several risk factors that raise your chances of developing osteoporosis. Some of these factors are things you can control, while some you can’t control.

Factors that you can’t control:

  • Being female
  • Getting older
  • Menopause
  • Having a small, thin body (under 127 pounds)
  • Having a family history of osteoporosis
  • Being white or Asian, but African American women and Latinas are also at risk
  • Not getting your period (if you should be getting it)
  • Having a disorder that increases your risk of getting osteoporosis, (such as rheumatoid arthritis, type 1 diabetes, premature menopause, anorexia nervosa)
  • Not getting enough exercise
  • Long-term use of certain medicines, including:
    • Glucocorticoids (GLOO-koh-KOR-ti-koids) — medicines used to treat many illnesses, including arthritis,asthma, and lupus
    • Some antiseizure medicines
    • Gonadotropin (GOH-nad-oo-TROO-pin) -releasing hormone — used to treat endometriosis (en-doh-mee-tree-O-sis)
    • Antacids with aluminum — the aluminum blocks calcium absorption
    • Some cancer treatments
    • Too much replacement thyroid hormone

Factors that you can control:

  • Smoking
  • Drinking too much alcohol. Experts recommend no more than 1 drink a day for women.
  • A diet low in dairy products or other sources of calcium and vitamin D
  • Not getting enough exercise

You may also develop symptoms that are warning signs for osteoporosis. If you develop the following, you should talk to your doctor about any tests or treatment you many need:

  • Loss in height, developing a slumped or hunched posture, or onset of sudden unexplained back pain.
  • You are over age 45 or a post-menopausal and you break a bone.

How can I find out if I have weak bones?

There are tests you can get to find out your bone density. This is related to how strong or fragile your bones are. One test is called dual-energy X-ray absorptiometry (DXA or dexa). A DXA scan takes X-rays of your bones. Screening tools also can be used to predict the risk of having low bone density or breaking a bone. Talk with your doctor or nurse about this test or tools to assess risk.

When should I get a bone density test?

If you are age 65 or older, you should get a bone density test to screen for osteoporosis. If you are younger than 65 and have risk factors for osteoporosis, ask your doctor or nurse if you need a bone density test before age 65. Bone density testing is recommended for older women whose risk of breaking a bone is the same or greater than that of a 65?year?old white woman with no risk factors other than age. To find out your fracture risk and whether you need early bone density testing, your doctor will consider factors such as:

  • Your age and whether you have reached menopause
  • Your height and weight
  • Whether you smoke
  • Your daily alcohol use
  • Whether your mother or father has broken a hip
  • Medicines you use
  • Whether you have a disorder that increases your risk of getting osteoporosis

How can I prevent weak bones?

The best way to prevent weak bones is to work on building strong ones. No matter how old you are, it is never too late to start. Building strong bones during childhood and the teen years is one of the best ways to keep from getting osteoporosis later. As you get older, your bones don’t make new bone fast enough to keep up with the bone loss. And after menopause, bone loss happens more quickly. But there are steps you can take to slow the natural bone loss with aging and to prevent your bones from becoming weak and brittle.

1. Get enough calcium each day.

Bones contain a lot of calcium. It is important to get enough calcium in your diet. You can get calcium through foods and/or calcium pills, which you can get at the grocery store or drug store. Getting calcium through food is definitely better since the food provides other nutrients that keep you healthy. Talk with your doctor or nurse before taking calcium pills to see which kind is best for you. Taking more calcium pills than recommended doesn’t improve your bone health. So, try to reach these goals through a combination of food and supplements.

Here’s how much calcium you need each day.

Daily calcium requirements
Ages
Milligrams(mg) per day
9-18
1,300
19-50
1,000
51 and older 1,200

Pregnant or nursing women need the same amount of calcium as other women of the same age.

Here are some foods to help you get the calcium you need. Check the food labels for more information.

Foods containing calcium
Food
Portion
Milligrams
Plain, fat free yogurt
1 cup
452
Milk (fat-free)
1 cup
306
Milk (1 percent low-fat)
1 cup
290
Tofu with added calcium
1/2 cup
253
Spinach, frozen
1/2 cup
146
White beans, canned
1/2 cup
106

The calcium amounts of these foods are taken from the United States Department of Agriculture’s Dietary Guidelines for Americans.

2. Get enough vitamin D each day.

It is also important to get enough vitamin D, which helps your body absorb calcium from the food you eat. Vitamin D is produced in your skin when it is exposed to sunlight. You need 10 to 15 minutes of sunlight to the hands, arms, and face, two to three times a week to make enough vitamin D. The amount of time depends on how sensitive your skin is to light. It also depends on your use of sunscreen, your skin color, and the amount of pollution in the air. You can also get vitamin D by eating foods, such as milk, or by taking vitamin pills. Vitamin D taken in the diet by food or pills is measured in international units (IU). Look at the pill bottle or food label for the IU amount.

Here’s how much vitamin D you need each day:

Daily vitamin D requirements
Ages
IU per day
19-70
600
71+
800

Although it’s difficult to get enough vitamin D through food, here are some foods that can help. Check the food labels for more information.

Foods containing vitamin D
Food
Portion
IU
Salmon, cooked
3 1/2 oz
360
Milk, vitamin D fortified
1 cup
98
Egg (vitamin D is in the yolk)
1 whole
20

These foods and IU counts are from the National Institutes of Health Office on Dietary Supplements.

White milk is a good source of vitamin D, most yogurts are not.

3. Eat a healthy diet.

Other nutrients (like vitamin K, vitamin C, magnesium, and zinc, as well as protein) help build strong bones too. Milk has many of these nutrients. So do foods like lean meat, fish, green leafy vegetables, and oranges.

4. Get moving.

Being active helps your bones by:

  • Slowing bone loss
  • Improving muscle strength
  • Helping your balance

Do weight-bearing physical activity, which is any activity in which your body works against gravity. There are many things you can do:

  • Walk
  • Dance
  • Run
  • Climb stairs
  • Garden
  • Jog
  • Hike
  • Play tennis
  • Lift weights
  • Yoga
  • Tai chi

5. Don’t smoke.

Smoking raises your chances of getting osteoporosis. It harms your bones and lowers the amount of estrogen in your body. Estrogen is a hormone made by your body that can help slow bone loss.

6. Drink alcohol moderately.

If you drink, don’t drink more than one alcoholic drink per day. Alcohol can make it harder for your body to use the calcium you take in. And, importantly, too much at one time can affect your balance and lead to falls.

7. Make your home safe.

Reduce your chances of falling by making your home safer. Use a rubber bath mat in the shower or tub. Keep your floors free from clutter. Remove throw rugs that may cause you to trip. Make sure you have grab bars in the bath or shower.

8. Think about taking medicines to prevent or treat bone loss.

Talk with your doctor or nurse about the risks and benefits of medicines for bone loss.

How can I help my daughter have strong bones?

Act now to help her build strong bones to last a lifetime. Girls ages 9-18 are in their critical bone-building years. Best Bones Forever!® is a national education effort to encourage girls ages 9-14 to eat more foods with calcium and vitamin D and get more physical activity. There is also a website for the parents. This site gives parents the tools and information they need to help their daughters build strong bones during the critical window of bone growth — ages 9-18.

What if dairy foods make me sick or I don’t like to eat them? How can I get enough calcium?

If you’re lactose intolerant, it can be hard to get enough calcium. Lactose is the sugar that is found in dairy products like milk. Lactose intolerance means your body has a hard time digesting foods that contain lactose. You may have symptoms like gas, bloating, stomach cramps, diarrhea, and nausea. Lactose intolerance can start at any age but often starts when you get older.

Lactose-reduced and lactose-free products are sold in food stores. There’s a great variety, including milk, cheese, and ice cream. You can also take pills or liquids before eating dairy foods to help you digest them. You can buy these pills at the grocery store or drug store. Please note: If you have symptoms of lactose intolerance, see your doctor or nurse. These symptoms could also be from a different, more serious illness.

People who are lactose intolerant or who are vegans (eat only plant-based foods) can choose from other food sources of calcium, including canned salmon with bones, sardines, Chinese cabbage, bok choy, kale, collard greens, turnip greens, mustard greens, broccoli, and calcium-fortified orange juice. Some cereals also have calcium added. You can also take calcium pills. Talk to your doctor or nurse first to see which one is best for you.

Do men get osteoporosis?

Yes. In the U.S., over two million men have osteoporosis. Men over age 50 are at greater risk. So, keep an eye on the men in your life, especially if they are over 70 or have broken any bones.

How will pregnancy affect my bones?

To grow strong bones, a baby needs a lot of calcium. The baby gets his or her calcium from what you eat (or the supplements you take). In some cases, if a pregnant woman isn’t getting enough calcium, she may lose a little from her bones, making them less strong. So, pregnant women should make sure they are getting the recommended amounts of calcium and vitamin D. Talk to your doctor about how much you should be getting.

Will I suffer bone loss during breastfeeding?

Although bone density can be lost during breastfeeding, this loss tends to be temporary. Several studies have shown that when women have bone loss during breastfeeding, they recover full bone density within six months after weaning.

How is osteoporosis treated?

If you have osteoporosis, you may need to make some lifestyle changes and also take medicine to prevent future fractures. A calcium-rich diet, daily exercise, and drug therapy are all treatment options.

These different types of drugs are approved for the treatment or prevention of osteoporosis:

  • Bisphosphonates (bis-fos-fo-nates) — Bisphosphonates are approved for both prevention and treatment of postmenopausal osteoporosis. Drugs in this group also can treat bone loss, and in some cases, can help build bone mass.
  • SERMs — A class of drugs called estrogen agonists/antagonists, commonly referred to as selective estrogen receptor modulators (SERMs) are approved for the prevention and treatment of postmenopausal osteoporosis. They help slow the rate of bone loss.
  • Calcitonin (kal-si-TOE-nin) — Calcitonin is a naturally occurring hormone that can help slow the rate of bone loss.
  • Menopausal hormone therapy (MHT) — These drugs, which are used to treat menopausal symptoms, also are used to prevent bone loss. But recent studies suggest that this might not be a good option for many women. The Food and Drug Administration (FDA) has made the following recommendations for taking MHT:
    • Take the lowest possible dose of MHT for the shortest time to meet treatment goals.
    • Talk about using other osteoporosis medications instead.
  • Parathyroid hormone or teriparatide (terr-ih-PAR-a-tyd) — Teriparatide is an injectable form of human parathyroid hormone. It helps the body build up new bone faster than the old bone is broken down.

Your doctor can tell you what treatments might work best for you.

More information on osteoporosis

For more information about osteoporosis, call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

Provided by: WomensHealth.gov

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Can Red Wine Reduce Your Risk for Breast Cancer?

Breast cancer remains the leading cancer in U.S. women. Over the last decade headlines have warned us that alcohol consumption, including wine, can increase the risk of breast cancer.

A recent study in the Journal of Women’s Health, found that chemicals in the skins and seeds of red grapes slightly lowered estrogen levels while elevating testosterone in premenopausal women who each drank eight ounces of red wine – just under two glasses (eight ounces) – daily for about a month.

The more estrogen that women are exposed to over a lifetime, the higher the risk of breast cancer. Based on this new study, co-authored by Chrisandra Shufelt, MD, assistant director of the Women’s Heart Center at the Cedars-Sinai Heart Institute, red wine may serve as a nutritional aromatase inhibitor (AI) that prevents the conversion of androgens to estrogen, thus lowering a woman’s risk for breast cancer.

The AI activity in red wine has been attributed to the phytochemicals and not to the alcohol content. The isoflavone phytoestrogens found in red wine has been identified as a protective chemical. Other chemicals in wine, such as resveratrol, have not been clearly established as inhibiting aromatase, even at higher doses than those found in wine.

Dr. Shufelt, says,

“If you enjoy a glass of wine with dinner, you may want to consider opting for red wine.”

Drinking red wine in moderation may reduce a risk factor for breast cancer, acting as a natural weapon. White wine does not have the same protective attributes. Sorry chardonnay lovers.

Good news for our nondrinkers:

Glenn Braunstein, MD, chair of the Cedars-Sinai Department of Medicine and co-author of this study, says,

“For those who don’t drink, don’t start. Just eat red grapes.”

Per George Krucik, MD, Healthline.com Breast Cancer Learning Center:

“So the bottom line is if you choose to drink alcohol in the form of wine, try red vs. white based on this small study.”

Combined with a healthy lifestyle, drinking red wine could reduce your risk factor for breast cancer. I’ll drink to that!

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Vaginal Atrophy – Do You Have It?

I have it, my Mom has it, most of my girlfriends have it, their daughters may get it, and our partners will be affected by it.

Vaginal atrophy will affect many women as they age.  According to the North American Menopause Society, up to 75 percent of menopausal women may experience vaginal dryness, a symptom of vaginal atrophy.

Last September the Partners’ Survey, conducted by StrategyOne and sponsored by Novo Nordisk, was announced at the North American Menopause Society (NAMS) conference.  The results showed that women are not the only ones affected.  Sixty-five percent of men worried that sex would be painful for his partner, and almost a third of both men and women reported that they have discontinued having sex with their partners altogether as a result of discomfort.

Vaginal atrophy affects a woman’s health, intimate relationships and quality of life.  Another international survey revealed that many women do not discuss the topic with their healthcare professionals because they feel vaginal atrophy is a natural part of growing older and nothing can be done about it.

Estrogen, important for maintaining vaginal health and lubrication, is the hormone that actually plumps up the cells in the vagina. When estrogen levels decline, the vaginal walls can become thinner, less elastic and dryer.

The result is vaginal atrophy, which is a chronic condition. Symptoms include vaginal dryness, burning and itching, irritation or soreness, pain and bleeding during intercourse, or urination.

Margery L.S. Gass, MD, NCMP, NAMS Executive Director says,

With severe vaginal atrophy, the tissues of the vagina become dry and sometimes fragile and inflamed. As a result, they are more prone to injury, tearing, and bleeding during sexual intercourse or even a pelvic exam. Over time, especially in the absence of regular intercourse, the vagina may also become shorter and narrower. The resulting discomfort can intensify to the point where sexual intercourse is no longer pleasurable or even possible.

Not only does the physical act of intercourse become a challenge but the increased emotional stress can be a double whammy for a healthy sexual relationship.

The Partners’ Survey, that included 4,167 post-menopausal women aged 55 to 65, found that 57% of women reported that they avoid being intimate with their partner, and 65% said they lost their libido.

The good news is the majority of the 4,174 men in the survey were concerned about what was going on with their partner. Unfortunately, this taboo subject has partners turning off the lights at night rolling over confused and frustrated.

This topic is so sensitive that, according to the International Menopause Society, 70% of women say their healthcare professionals have only rarely or never raised the subject with them.

James A. Simon, M.D., C.C.D., N.C.M.P., F.A.C.O.G., clinical professor of obstetrics and gynecology at The George Washington University School of Medicine in Washington D.C., says,

In my experience treating patients, most women are not comfortable talking about vaginal symptoms, especially related to pain and discomfort. The word ‘vagina’ is somewhat taboo so it’s no wonder no one talks about vaginal atrophy.

Taboo or not, vaginal atrophy is manageable and treatable.  The North American Menopause Society recommends:

  • Vaginal Lubricants: Decreases friction during intercourse.
  • Vaginal moisturizers: Non-hormonal OTC generally used twice a week.
  • Regular sexual stimulation. Intercourse promotes blood flow to the genital area, helping to maintain vaginal health.
  • Developing expanded views of sexual pleasure. If vaginal penetration (intercourse) is difficult or uncomfortable, consider so-called “outercourse” options such as extended caressing and massage.
  • Local prescription therapy. For vaginal dryness and discomfort that does not respond to over-the-counter lubricants and moisturizers, low doses of local vaginal estrogen therapy are very effective and safe. Local estrogen increases the thickness and elasticity of vaginal tissues, restores a healthy vaginal pH, increases vaginal secretions, and relieves vaginal dryness and discomfort with intercourse.
  • Systemic prescription therapy. Low doses of systemic estrogen in the form of a pill or skin patch used to treat hot flashes are also effective for treating vaginal dryness, although some women might benefit from adding local treatment to their systemic treatment to relieve discomfort. If only vaginal symptoms are present, local therapy described above is recommended.

Per the Partners’ Survey, 56% of women and 57% of men whose partners used local estrogen therapy reported that sex was less painful.

At the NAMS Conference, I asked Wen Shen, MD, Assistant Professor of Gynecology & Obstetrics at Johns Hopkins University School of Medicine, about the safety of vaginal hormonal treatment:

Vaginal estrogen comes in very low doses, as light as ten micrograms used twice a week.  There have been premarketing studies that show women who use vaginal estrogen do not increase their systemic estrogen levels above the post menopausal level.  After treatment, the levels actually go back down again to really low levels.

The vaginal skin and bladder are very well treated with vaginal estrogen, and they have more elasticity and thickness, so that the vagina can serve as a sexual organ again and the bladder can be less irritated.

It is important to discuss vaginal atrophy with your doctor to confirm that you are not suffering from a vaginal infection.  If left untreated, vaginal atrophy can lead to long-term complications in some women.

According to Dr. Shen:

Vaginal atrophy is one of the easier symptoms of menopause to treat that carries the least amount of risk.

Vaginal health is more than sexual health – it is good women’s health.

By Staness Jonekos, Co-Author The Menopause Makeover

Posted November 2012

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Hormone Therapy, Finally the Experts Agree

It’s been ten years since the Women’s Health Initiative hormone trials announced that there was an increase in breast cancer, heart attacks and strokes with the use of hormone therapy. Headlines warned women against taking hormone therapy without fully disclosing all the facts and issues pertaining to this study.

The public fear was so great that within a year of the WHI publication 66% of hormone therapy users aged 50 and older discontinued therapy. There was so much confusion regarding the safety of hormone therapy, even the experts did not agree.

Dr. Margery Gass, Executive Director of the North American Menopause Society (NAMS) says:

We believe that too many symptomatic women are missing out on the proven benefits of hormone therapy because the results of the WHI, which studied the long-term use of hormones to prevent chronic disease, were misinterpreted for women with menopausal symptoms…Women and clinicians are frustrated by the many conflicting recommendations.

Finally 15 top medical organizations have come together to issue a statement of agreement regarding the benefits of hormone therapy for symptomatic menopausal women.

The North American Menopause Society states:

We believe that women deserve to know the facts that can inform their decision to use or not to use hormone therapy.

Ladies, here are the latest hormone therapy recommendations:

Overview message: Systemic hormone therapy is an acceptable option for relatively young (up to age 59 or within ten years of menopause) and healthy women who are bothered by moderate to severe menopausal symptoms. Individualization is key in the decision to use hormone therapy.

Consideration should be given to the woman’s quality-of-life priorities as well as her personal risk factors such as age and time since menopause. Risk of blood clots, heart disease, stroke, and breast cancer should also be acknowledged.

Symptom Relief Benefits: Systemic hormone therapy is the most effective treatment for most menopausal symptoms, including vasomotor symptoms and vaginal atrophy.

Women who still have a uterus need to take a progestogen along with the estrogen to prevent cancer of the uterus. Women who have had their uterus removed can take estrogen alone.

Local estrogen therapy is effective and preferred for women whose symptoms are limited to vaginal dryness or discomfort with intercourse; low-dose vaginal estrogen therapy is recommended in this situation.

Duration of therapy: The lowest dose of hormone therapy should be used for the shortest amount of time to manage menopausal symptoms. Although fewer than five years is recommended for estrogen with progestogen therapy, duration should be individualized. For estrogen therapy alone, more flexibility in duration of therapy may be possible.

Breast Cancer: An increased risk of breast cancer is seen with five years or more of continuous estrogen with progestogen therapy, possibly earlier with continuous use since menopause. The risk is real but not great, and the risk decreases after hormone therapy is discontinued.

Vascular Risks: There have been many other studies this past decade focusing on hormone therapy and heart disease, revealing that menopausal women between the ages of 50 to 59 who took hormone therapy for less than ten years did not have an increased risk of adverse effects.

Transdermal estrogen therapy and low-dose oral estrogen therapy have been associated with lower risks of blood clots and stroke than standard doses of oral estrogen.

Leading medical societies devoted to the care of menopausal women agree that the decision to initiate hormone therapy should be for the indication of treatment of menopause-related symptoms. Although research is ongoing and these recommendations may be modified over time, there is no question that hormone therapy has an important role in managing symptoms for women during the menopausal transition and in early menopause.

There is a growing body of evidence that formulation, route of administration, and timing and duration of therapy may produce different effects.

Every woman different and treatment must be individualized. There is no “one size fits all” when it comes to managing menopause symptoms.

Finally, the experts agree on key points regarding the safety and role of hormone therapy in menopause management based on scientific evidence collected over the last ten years.

By Staness Jonekos
Co-Author, “The Menopause Makeover”

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How to Find Reliable Menopause Information Online

By Staness Jonekos, Co-Author, The Menopause Makeover

Seventy-two percent of women have not received any treatment for menopausal symptoms, according to recent study conducted by Lake Research Partners for the Endocrine Society.

Of those polled, 45 percent said they thought current available information was confusing and 41 percent weren’t sure what to trust.

There are over 10 million menopause websites, many with misinformation about menopause, treatment options, tests, and strategies.

How do we find reliable menopause information online so we can have a productive conversation with our health care providers?

Different types of information are provided by a variety of websites: unbiased sites from scientific organizations, commercial sites with medically reviewed content, hospital sites, online health news, blogs and communities.

My go-to site for the latest unbiased scientific information is Menopause.org, provided by the North American Menopause Society, a non-profit organization.

According to a report from Pew Internet, 41 percent of web surfers are more comfortable reading about somebody else’s health experiences or medical issues online. I, too, am able to gain perspective from reading blogs and personal opinions.

Healthline.com, a commercial website, has launched a Menopause Center, providing content that is objective. It is reviewed by experts and includes popular menopause bloggers as well. This site combines science with personal stories so the information is digestible and easy to find. Healthline.com has an advanced search technology that refers the reader to scientific material, thus saving time visiting individual websites and making it a one-stop informational resource for individuals.

HealthyWomen.org, a nonprofit organization, has a long history of providing unbiased and accurate health information. The website contains health information that is original and reviewed by medical experts. The content is reflective of the advances in evidence-based health research. They, too, include personal stories and top-notch bloggers.

Other reliable resources for menopause information are hospital websites. According to a recent U.S. News report, Cleveland Clinic, Johns Hopkins, Brigham and Women’s Hospital, Massachusetts General Hospital, and Mayo Clinic are in the top five ranked.

Menopause is different for every woman. The experience is not “one size fits all,” and there is no simple recipe to manage menopause. Once we gather credible, reliable information, applying it can be frustrating. Not only are hormones fluctuating and mood swings occurring, each of us needs to respond to menopausal issues based on personal and family history and personal comfort level.

According to the North American Menopause Society:

An informed decision about menopause-related symptom relief also includes knowledge of the risks and benefits of other prescription therapies, complementary and alternative medicine (CAM) approaches, and lifestyle strategies, as well as awareness of the option to do nothing at all and let the symptoms take their natural course — which for most women means resolution over time.

Being informed is a woman’s first step to managing menopause.

If a website is selling a product or program that is promoted in the content, the material may be biased.

When reading a blog or chatting in a community, remember the content is based on personal opinions and/or experiences. What works for one woman may not work for another.

On any website, it is wise to read the “About Us” link so you know who is providing the information.

We are all different. The internet is a rich resource for menopause inquiries. Be diligent in qualifying your material, so you can take control of your health during menopause and work closely with your health care provider.

Additional reliable health resources that are unbiased and supported by science:

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Posted in hormones

Is Hormone Therapy Right for You?

New information can help you make an informed decision with your healthcare provider.

It’s been ten years since the results of the Women’s Health Initiative (WHI) were announced claiming there was an increase in breast cancer, heart attacks and strokes with the use of hormone therapy (HT) for postmenopausal women. Many women were afraid to use hormone therapy, thinking it was harmful.

There has been a lot of confusion regarding the safety of HT. Headlines warned women against taking HT without fully disclosing all the facts and issues pertaining to this study.

The HT public fear was so great 56% of HT users aged 50 and older tried to discontinue therapy after this study. What was not revealed in those headlines was that the WHI was not studying treatment of menopausal symptoms. It was a study focused on determining whether HT prevented chronic illness. The average age of the participants was 63, with two-thirds of them starting hormone therapy more than ten years after menopause.

Women with severe symptoms were generally not included in the WHI. A few years later, the WHI narrowed its focus on a second trial, looking at the health effects of HT in younger (under 60 years old) versus older women. They found that younger postmenopausal women actually experienced a lower risk of adverse health effects from HT than their older counterparts.

There have been many other studies focusing on HT and heart disease, revealing that menopausal women between the ages of 50 to 59 who took HT for less than ten years did not have an increased risk of adverse effects.

March 2012, The North American Menopause Society published a new Hormone Therapy Position Statement based on the latest studies that further distinguishes the emerging differences in the therapeutic benefit-risk ratio between estrogen therapy (ET) and combined estrogen-progestogen therapy (EPT) at various ages and time intervals since menopause onset.

A great deal has been learned in the 10 years since the first results emerged from the Women’s Health Initiative (WHI). Hormone therapy (HT) remains the most effective treatment available for menopausal hot flashes and night sweats. However, there is a growing body of evidence that formulation, route of administration, timing of therapy, and duration of therapy may produce different effects.

It is essential to evaluate a personal benefit-risk profile for each woman considering HT. Individual factors contributing to the HT decision include the severity of menopausal symptoms and effect on quality of life.

The absolute risks of HT in healthy women ages 50 to 59 are low. In contrast, long-term HT or HT initiation in older women is associated with greater risks.

SUMMARY
• The recommendation for duration of therapy differs for EPT in women with a uterus, and ET in women who have had a hysterectomy.
• For EPT, duration is limited by the increased risk of breast cancer associated with more than 3 to 5 years of use. ET has a more favorable benefit-risk profile with no apparent increase in risk of breast cancer during an average of 7 years of use, a finding that allows more flexibility in duration of therapy.
• Individualizing is still key in the decision to use HT and should incorporate the woman’s health and quality-of-life priorities as well as her personal risk factors, such as risk of blood clots, heart disease, stroke, and breast cancer.
• For relief of hot flashes, women with a uterus should take EPT so that a progestogen will protect the lining of the uterus from the cancer-promoting effects of estrogen alone.
• Low-dose vaginal ET is advised when symptoms are limited to vaginal dryness or discomfort with intercourse.
• Neither ET nor EPT increases the risk of heart disease in healthy women under age 60 or within 10 years of menopause. The risk of stroke can be increased but is considered rare in the 50s.
• Women with premature or early menopause who are otherwise appropriate candidates can use HT until the average age of natural menopause (age 51). Longer duration of treatment can be considered if needed for symptom management.
• There is a lack of safety data supporting the use of HT in breast cancer survivors.
• Both ET delivered through the skin and low-dose oral ET have been associated with lower risks of blood clots and stroke than standard doses of oral estrogen, but confirmation of benefits in randomized trials is not yet available.
• Additional research is needed to understand the different effects of ET and EPT and how they apply to individual women.

Hormone therapy is still the most effective treatment for menopausal symptoms. We are all different. Discuss your concerns with your practitioner, who can help you decide whether to take HT, and, if so, at what age, the dosage and for how long. Combined with a healthy lifestyle and attitude towards aging, going through “the change” can be a time of reinvention.

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Posted in hormones

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 ask the expert, hormones

10 Ways to Lower Your Risk of Getting Breast Cancer

10 Ways to Lower Your Risk of Getting Breast Cancer

by Staness Jonekos

The Menopause Makeover

Why don’t most women perform monthly breast exams? I confess, I have done three self-breast exams in my entire life! Considering I have spent a lifetime on birth control pills to manage endometriosis and ovarian cysts, and now on post menopause hormone therapy, I should be doing monthly breast exams, but I don’t – why?

Maybe it was my Catholic upbringing – “Don’t touch yourself” was the message from my Sunday catechism teacher. Maybe it was the social messages I got from the media – boobs are for babies and hubbies.

Feeling embarrassed that I don’t do monthly breast self-exams, I decided to talk with other women. I interviewed 100 women, ages 25 to 75. My first question, “Do you perform monthly breast self-exams?” I was shocked that 92 percent of these women said, “No.” I was not alone.

Curious, I asked, “Why not?” The majority of women admitted that they, too, did not feel comfortable touching their breasts. The second reason was the fear of finding something scary, a lump – breast cancer.

Breasts have many connotations: sexuality, femininity, and motherhood. We do lots of things to our breasts: strap them into brassieres, augment their size, pierce them, and use them to get attention. I actually hide mine. I don’t like people looking at them. I would rather have them look at my face. Perhaps residual Catholic fear that showing my cleavage would conjure up some form of trouble, I dress around my 34DDs with higher necklines.

I am not the only one with a story about my breasts. I have many friends who have had “boob jobs.” Most of them had breast augmentation in their 20s and 30s. They claimed it was for their self-esteem, but most finally admitted they loved the attention. Many altered their breasts after nursing. The remainder decided to have their boobs lifted after menopause in an effort to hold onto their youth. That’s a lot of attention and money spent on an area of the body most of us don’t personally touch!

My husband loves my breasts. I know it is time for me to love them too. I looked at them in the mirror just this morning. At 52 my boobs have shifted four inches south of their origins. I cupped them and held them up – unfortunately they did not look like they did in the beginning. I bent over and looked at the effects of gravity – unfortunately they did not look like they did in the beginning. Then I jumped up and down, and fortunately I felt better at the humor of actually looking at my breast move naturally after being strapped in most of the day. It was an interesting moment. Funny, curious, and insightful, and then it happened. I just stared at them without judgment and realized how beautiful they are, and how lucky I am that they are healthy.

Over ten years ago, my dear friend Leslie died of breast cancer. She decided to bypass her yearly check-up for financial reasons, and it cost Leslie her life. Leslie’s husband and two children lost the center of their universe to breast cancer, and I lost a friend. I remember weeks before her death, she grabbed my hand that was nervously knitting to avoid the inevitable truth that she was dying, and drew me near. She whispered, with the little energy she had, “Never miss your yearly check-up, I am dying an angry woman because I did.” I still weep over Leslie’s death. She was only in her 40s.

I have seven other friends who had breast lumps that were discovered during their annual check-ups. Two of those seven friends had stage 2 and 3 cancer but they caught it early enough and were able to manage it. I am happy to report they are now cancer free. The others did not have cancer. Leslie was right, early detection can save lives.

According to the American Cancer Society, “Breast cancer is the second leading cause of cancer death in women, exceeded only by lung cancer.” About 1 out of every 7 women will get breast cancer over a 90-year life span. All women are at risk for breast cancer.

This year about 207,090 new cases of invasive breast cancer will be diagnosed in women. About 40,000 moms, daughters, sisters, granddaughters and best friends that will die from breast cancer this year.

The American Cancer Society states, “Death rates from breast cancer have been declining since about 1990, with larger decreases in women younger than 50. These decreases are believed to be the result of earlier detection through screening and increased awareness, as well as improved treatment.”

The chance that breast cancer will be responsible for a woman’s death is about 1 in 35 (about 3%). At this time there are over 2.5 million breast cancer survivors in the United States.

A woman’s risk of breast cancer approximately doubles if she has a first-degree relative (mother, sister, daughter) who has been diagnosed with breast cancer. About 20-30% of women diagnosed with breast cancer have a family history of breast cancer.

About 70-80% of breast cancers occur in women who have no family history of breast cancer due to genetic abnormalities that happen as a result of the aging process and life in general, rather than inherited mutations.

There are ways to reduce your risk.

What can you do to lower your risk of getting breast cancer?

1. Maintain an ideal weight: The chance of developing breast cancer after menopause is higher in women who are overweight or obese.
2. Exercise: The American Cancer Society recommends engaging in 45-60 minutes of physical exercise 5 or more days a week.
3. Alcohol consumption: Alcohol can limit your liver’s ability to control blood levels of the hormone estrogen, which in turn can increase risk. The Harvard Nurses’ Health study, along with several others, has shown that consuming more than one alcoholic beverage a day can increase breast cancer risk by as much as 20-25 percent.
4. Exposure to estrogen: The female hormone estrogen stimulates breast cell growth, so exposure to estrogen over long periods of time, without breaks, can increase the risk of breast cancer.
5. Oral contraceptive use: Recent use may slightly increase a woman’s risk for breast cancer.
6. Fruits and vegetables: Broccoli, cabbage, Brussels sprouts, kale, spinach, carrots, tomatoes, cauliflower, berries and cherries are all breast cancer fighters.
7. High glycemic carbohydrates: Eat low to medium glycemic foods and avoid white rice, white potatoes, and sugar products, because these foods may trigger hormonal changes that promote cellular growth in breast tissue. Eat whole grains and legumes.
8. Smoking: Smoking is associated with an increase in breast cancer risk, and in the risk of other cancers.
9. Stress and anxiety: There is no clear proof that stress and anxiety can increase breast cancer risk, but some research suggests that practicing yoga, prayer, and meditation to manage stress can strengthen the immune system.
10. Perform monthly breast self-exams, get routine screenings and work closely with your healthcare provider.

We cannot control our gender, age, race, or family history of breast cancer, but early detection can save lives. Performing a monthly breast self-exam is something you can control.

Nearly 70% of all breast cancers are found through self-exams, and with early detection the 5-year survival rate is 98%.

Dr. Wendy Klein, leading women’s health expert and co-author of The Menopause Makeover says, “Discuss your breast self-exam technique with your healthcare provider, and report any asymmetrical changes in your breast right away. Regular breast self-exams in conjunction with other screening methods, working closely with your doctor, are simple common sense for good breast health.”

Today I celebrate my health by lowering my breast cancer risk factors. Today I honor my breast health empowered. Today I do a breast self-exam.

What is your risk of getting breast cancer?

Click here for the National Cancer Institutes Breast Cancer Risk Assessment Tool:

http://www.cancer.gov/bcrisktool/

How to do a breast self-exam:

http://www.nationalbreastcancer.org/about-breast-cancer/breast-self-exam.aspx

References

NationalBreastCance.org. National Breast Cancer Foundation® Official Site – Information, Awareness & Donations, “Self Examination – National Breast Cancer Foundation.” 10 September 2010. < http://www.nationalbreastcancer.org/about-breast-cancer/breast-self-exam.aspx>

Jonekos, S. and W. Klein.  The Menopause Makeover.  Ontario, Canada: Harlequin Enterprises; 2009.

Smith RA, Cokkinides V, Brawley OW. Cancer screening in the United States, 2008: A review of current American Cancer Society guidelines and cancer screening issues. CA Cancer J Clin. 2008;58:161-179.

Cancer.org. National Cancer Institute – Comprehensive Cancer Information, “ Breast Cancer Risk Assessment Tool.” 02 October 2010 <http://www.cancer.gov/bcrisktool/>

NationalBreastCancer.org. National Breast Cancer Foundation® Official Site – Information, Awareness & Donations,  “Self Examination – National Breast Cancer Foundation.” 02 October 2010 <http://www.nationalbreastcancer.org/about-breast-cancer/breast-self-exam.aspx>

Cancer.gov. National Cancer Institute – Comprehensive Cancer Information, “Breast Cancer Prevention – National Cancer Institute.” 12 March 2010. <http://www.cancer.gov/cancertopics/pdq/prevention/breast/patient>

CDC.gov. Centers for Disease Control and Prevention, “CDC- Screening for Breast Cancer.” 31 August 2010. <http://www.cdc.gov/cancer/breast/basic_info/screening.htm>

BreastCancer.org. Breast Cancer Treatment Information and Pictures, “Lower Your Risk for Breast Cancer.” 07 August 2008. <http://www.breastcancer.org/risk>

Cancer.org. American Cancer Society:: Information and Resources for Cancer: Breast, Colon, Prostate, Lung and Other Forms, “Breast awareness and self exam.” 02 October  2010 <http://www.cancer.org/Cancer/BreastCancer/MoreInformation/BreastCancerEarlyDetection/breast-cancer-early-detection-a-c-s-recs-b-s-e>

MedlinePlus, National Library of Medicine – National Institutes of Health, “Breast self exam: MedlinePlus Medical Encyclopedia.” 02 October 2010  <http://www.nlm.nih.gov/medlineplus/ency/article/001993.htm>

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Posted in hormones

How to Sleep Through Menopause

By Staness Jonekos

Co-author of The Menopause Makeover

We have all had sleepless nights, but for millions of post-menopausal women it happens 61 percent of the time, affecting their quality of life and their relationships. I, too, suffered from insomnia, thanks to irritating night sweats provoked by fluctuating hormones. Being sleepless through menopause made me irritable and fatigued daily. I had difficulty concentrating and it created tension with my husband because I was cranky and impatient.

There are two types of insomnia. According to the National Institutes of Health, primary insomnia is its own disorder. A number of life changes can trigger primary insomnia, including long-lasting stress and emotional upset. Primary insomnia generally occurs for periods of at least one month.

Secondary insomnia is a symptom or side effect of some other problem, and is the most common type. Most menopause-related sleeplessness is secondary insomnia.

What causes secondary insomnia?

• Certain medical conditions: sleep apnea, arthritis, chronic pain, headaches, asthma, overactive thyroid, hot flashes, heartburn, sleep disorders (restless leg syndrome, sleep-related breathing problems)
• Medicines: asthma medicines, allergy and cold medicines, beta blockers
• Substances: caffeine, stimulants, tobacco, alcohol

Being a busy woman, daily exhaustion is normal. Throw in menopausal aging and it was no surprise that I was staring at the ceiling nightly trying to fall and stay asleep.

Karen Giblin, Founder of Red Hot Mamas North America, recently conducted a sleep survey with Sunovion Pharmaceuticals Inc.

Giblin says, “Of the 900 sleep survey participates who suffer from insomnia, 79 percent of menopausal women have trouble staying asleep, and 63 percent struggle just trying to fall to sleep.”

I was not alone! Most of us blame night sweats for insomnia, but I was surprised to find out that many menopausal insomniacs don’t suffer from night sweats at all. So what’s keeping us up at night?

Empty nest syndrome, caring for aging parents, relationship changes, career adjustments and mid-life stress, bundled together with hormones in flux is a recipe for sleepless nights. Progesterone is our sleep-promoting hormone, so a decrease in this hormone contributes to a night of tossing and turning. Declining estrogen can make you more susceptible to stress, fueling this sleepless potion.

I suffered from several of the sleep depriving offenders. It took just one severe night sweat to start the cycle of thrashing around, changing my PJs and laying in bed awake, waiting for a repeat performance.

Insomnia during menopause clearly can affect the quality of your life. Women suffering from insomnia live with daily fatigue and irritability, and that can contribute to intimacy issues with her partner.

Giblin says, “62 percent of women ages 40 to 65 said they have not talked to their healthcare provider about insomnia.”

I was one of them, because I never considered insomnia an actual symptom worth discussing with my clinician.

A former menopausal insomniac herself, Giblin continues, “Sleeplessness during menopause can compromise your health, both physically and mentally. People who get too little sleep develop poor health and higher percentages of chronic diseases.”

Indeed, insomnia can increase your risk for high blood pressure, heart disease, diabetes and problems with your immune system. Getting proper sleep is important to your health!

Let’s not forget the recent studies last year that found a lack of sleep contributes to weight gain. When you are sleep-deprived, your metabolism does not function properly. Sleep is also necessary for the nervous system to function properly.

Sleeping tips during menopause

• Create a sleep schedule, and follow it each night
• Do not go to bed until you are tired
• Avoid caffeine, nicotine and alcohol right before bed
• Enjoy decaf tea
• Do not watch the news right before going to bed
• Do not watch TV in bed
• Take a soothing bath or shower before bedtime
• Your bedroom should be a sleeping sanctuary and a place for lovemaking
• Avoid daytime naps
• Clear your mind before you get under the covers
• Make sure your room is dark
• Keep your bedroom cool to prevent night sweats, keep a fan nearby
• Wear cotton pajamas, and have an extra pair handy
• Exercise daily. Vigorous exercise should be done during the morning or afternoon.
• Yoga may help promote good sleep
• Try aromatherapy for relaxation
• Own a comfortable bed
• Wear socks to bed to help control core body temperature

We are all different and require different amounts of sleep to feel rested during the day. The North American Menopause Society (NAMS) says, “Most adults require 6 to 9 hours of sleep each night.” I was lucky to get 3 hours of uninterrupted sleep a night – what’s a menopausal gal to do?

Talk to your healthcare provider about insomnia

• Keep a sleep diary
• Track a typical night
• Document what keeps you up at night.
• How long did it take for you to fall asleep?
• How long did you sleep in total?
• How did you feel the next day?
• Talk to your partner and see if he/she has noticed any differences in your sleeping habits.
• Discuss any lifestyle changes you’ve made to improve your sleep.
• Ask if menopause is affecting your sleep
• Are there any current medications that could be contributing to your insomnia
• What lifestyle changes do you need to make to get better sleep
• Are you experiencing more stress?
• Discuss a strategy to manage your insomnia

When lifestyle changes fail NAMS recommends consulting a clinician to rule out sleep disorders or breathing problems.

Dr. Wendy Klein, co-author of The Menopause Makeover, says, “It is best to tailor therapy for menopausal insomnia to the needs of the individual woman. Generally, combining medical and non-medical therapies is better than either one alone.”

Supplements such as botanical valerian have been found to improve sleep after two weeks of use. Talk to your doctor about the risks and benefits before taking over-the-counter products to treat insomnia. If depression is contributing to your sleep problems, your healthcare provider may prescribe an antidepressant or other prescription medications.

For some women, prescription sleep medications can help bring relief. The National Institutes of Health states: some medications are meant for short-term use, while others are meant for longer use. Side effects can occur, so talk to your healthcare provider about the risks and benefits of using medicines to treat insomnia.

Getting a good night’s rest during menopause benefits your health, both physically and emotionally, and can contribute to a smoother transition.

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Posted in homepage, hormones

Acupuncture: A Drug-Free Option for Chronic Pain

By Staness Jonekos, Co-author of The Menopause Makeover

According to the American Academy of Pain Medicine, pain affects more Americans than diabetes, heart disease and cancer combined. I was one of them until acupuncture, and I now live relatively pain free.

Over 30 years ago I injured my left ankle. After a debridement surgery, injections, supplements, heat and cold therapy, and activity adjustments my injury was getting worse. This past year suffering from osteoarthritis and inflammation has taken a toll on my life. I am allergic to aspirin and ibuprofen, so over-the-counter medication was not a solution for pain management. Living with daily pain- rated an eight with ten being the worst pain possible – I visited the doctor who informed me after a recent MRI that the only option to permanently relieve the pain was an ankle fusion. I am a healthy 53-year-old, and for me this was not a realistic option.

Noting my reaction, the doctor advised me to consider acupuncture for pain relief. My only knowledge about acupuncture was that needles are inserted to stimulate healing by balancing energy. I was skeptical that correcting an imbalance of energy was going to ease my chronic pain. Desperate for relief, I reluctantly made an appointment with his recommended acupuncturist.

When I arrived at the acupuncturist’s office I was impressed with her scientific credentials. We discussed my chronic pain, and I lay back on the padded table to begin the process. I was apprehensive as she opened the box of disposable needles. She proceeded to place needles in my arms, legs and around my injured ankle — there may have been other needles, but I had my eyes shut. I was surprised there was no pain from the actual needle insertion, but when she inserted a needle in my leg I felt a bizarre throbbing sensation. It felt like a rushing river running along the left side of my body. The acupuncturist asked if I was OK. I told her that the left side of my body felt electric. She said, “this is good, you are feeling the flow of qi.”

Ping Gu, O.M.D., M.D. (Japan), Director of Institute of Alternative Medicine says:

Acupuncture is one of the key components of traditional Chinese medicine and has been practiced for thousands of years. Health is achieved by maintaining the body in a balanced state. Disease is due to an internal imbalance that leads to blockage in the flow of qi, the vital energy that circulates along pathways known as meridians, or energy-carrying channels. Illness is caused by a disruption of qi, which leads to an imbalance of energy. Acupuncture can correct this energy disruption using the meridian system to locate and treat many conditions.
It is no surprise many are skeptical of acupuncture, how do you see energy under a microscope? I could not “see” this flow of energy, but I was feeling it.

She turned on a heat lamp and placed it over my injured ankle, turned on mellow music, set an egg time for 20 minutes and suggested I take a nap. I had no idea how this was actually going to relieve my pain, but I was intrigued by the experience.

Ping Gu, continues:

Pain is a feeling triggered in the nervous system. When acu-points are stimulated near nerves, causing a feeling of heaviness, tingling or fullness in the muscle, a signal is sent to the brain and spinal cord. This causes a release of endorphins and other neurotransmitters that block the message of pain from being delivered up to the brain.
The egg timer went off and the acupuncturist came in to remove the needles and turned off the heat lamp. I sat up, put my shoes on and stepped off the table, and then it happened.

I stood up and walked out and felt nothing! No pain! I kept walking, how is this possible? I always feel pain, like knives with every step. I walked to the car thinking this positive effect would wear off by the time I got home. I shared the great news with my husband, and we decided to look at my ankle. My deformed ankle from years of swelling was almost 50 percent smaller. I was happy, but still skeptical that it would wear off like a dose of aspirin.

The next morning I stepped into my slippers, and no pain. A few more days, still no pain. The next week I scheduled two appointments a week for the next two months. I will continue to respect my injury and work closely with my orthopedic surgeon, but acupuncture helped reduce the inflammation and pain. The quality of my life is greatly improved. I am now an advocate for acupuncture.

The World Health Organization endorses acupuncture, and clinical studies have shown it to be a beneficial treatment for many conditions, including:

  • Chronic pain: migraines, neck and back pain, tendonitis, sciatica, carpal tunnel syndrome, fibromyalgia and rheumatoid arthritis
  • Digestive disorders: irritable bowel syndrome, colitis, gastritis and constipation
  • High blood pressure
  • Urinary and reproductive disorders: menstrual cramps, irregular or heavy periods, infertility and menopausal symptoms
  • Addictions to nicotine, alcohol and drugs
  • Overweight or obesity, when coupled with diet and exercise
  • Psychological and emotional disorders: depression, anxiety, stress and insomnia
  • Symptom management for adverse reactions to chemotherapy and radiation, including fatigue, generalized pain, dry mouth, peripheral neuropathy, nausea and vomiting
  • Seasonal allergies

Many women suffering from hot flashes have reported relief from regular acupuncture treatments.

Cleveland Clinic states:

Although acupuncture is not a “cure-all” treatment, it is very effective in treating several diseases and conditions. Acupuncture also can improve the functioning of the immune system (the body’s defense system against diseases). For certain conditions, such as cancer, acupuncture should be performed in combination with other treatments.

For those living in pain, the bridge between Eastern and Western medicines may provide options. This skeptic is thrilled to have been nudged across into unknown territory and presented a drug-free solution for living with chronic pain.

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Posted in hormones

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 ask the expert, hormones

How To Feel Sexy During Menopause

by Staness Jonekos, co-author of The Menopause Makeover

The baby boomers may have been the generation of the sexual revolution, but for many slamming into menopause, sex is the last thing on their minds!  Both sexes can suffer from a declining libido as we age, but women don’t have a little blue pill to pop to get their mojo back. What’s a menopausal girl do to reignite the flame of desire?

After women pass through perimenopause into menopause, almost 50 percent are left with an unanticipated loss of libido and vaginal dryness.  Vaginal dryness can affect the libido.

Estrogen, important for maintaining vaginal health and lubrication, is the hormone that actually plumps up the cells in the vagina. When estrogen levels decline, the vaginal walls can become thinner, less elastic and dryer.

Not only does the physical act of intercourse become a challenge as a result of vaginal dryness, but the emotional dialogue that goes on in one’s head when lubrication no longer comes naturally, can increase stress levels for the woman and the man.  This double whammy can end in frustration and confusion.

Treatment Options

  • Bioadhesive lubricant, such as AstroGlide, can provide immediate relief.   Replens, a vaginal moisturizer, may be applied twice a week. Lubrication can offer vaginal protection and both are available over-the-counter.
  • If vaginal dryness is your only menopause symptom, you may consider using local estrogen treatment.
  • Low dose hormone therapy may bring relief.

It is important to discuss vaginal dryness with your doctor to confirm that you are not suffering from a vaginal infection.

Approximately 47 percent of women experience sexual difficulties, according to the National Health and Social Life Survey and the Global Study of Sexual Attitudes and Behaviors, with a decrease of sexual desire being the most common.

Other aspects that may contribute to a declining libido are pain during intercourse, lack of sexual thoughts, aversion to sexual activity, lack of receptivity and relationship dissatisfaction.

Addressing the physical, emotional, and environmental changes that often accompany mid-life, can make a proper diagnosis challenging.

Factors that affect sexual health

  • Emotional: Feeling unattractive, being depressed, feeling tired, suffering from lack of sleep, moodiness, feeling isolated, not being happy
  • Fluctuating hormones
  • Medications:
    • Antidepressants
    • Mood stabilizers
    • Contraceptive drugs
    • Antihistamines
    • Sedatives
    • Antihypertensives
    • Blood pressure medications
  • Medical conditions:
    • Depression
    • Thyroid disease
    • Androgen insufficiency
    • Diabetes
    • Cardiovascular disease
    • Neurological disorders
  • Cultural issues
  • Relationship satisfaction
  • Midlife stress:  career change, relationships, loss, divorce, caring for parents and financial concerns

If you are suffering from hot flashes and a poor self-image, combined with taking antidepressants and blood pressure medications, can be a recipe for a declining libido.

As many as half the patients who take SSRIs report some sexual dysfunction.

Per The North American Menopause Society (NAMS): “In contrast, the antidepressant bupropion (Wellbutrin), which works in a different way from SSRIs, was found to improve sexual functioning compared with placebo in a small study of nondepressed women and men with desire and arousal difficulties. This finding is interesting but requires more study to confirm it before bupropion should be used specifically for treating sexual problems.”

Once you find the culprit that kidnapped your mojo, you have options.

Managing a declining libido

  • Discuss options with your practitioner.  If fluctuating hormones are affecting your libido, there are therapies available.
  • Review current medications and medical conditions.
  • Talk to your partner
  • Consider counseling or sex therapy, or both
  • Adjust lovemaking activities: try warm baths before genital sexual activity, extend foreplay, incorporate massages, change your sexual routine, experiment with positions, discuss sexual fantasies
  • Use lubrication
  • Maintain a healthy lifestyle, exercise most days of the week, and consume alcohol moderately
  • Commit to new stress-management practices, like acupuncture, biofeedback, yoga

When women notice that their sex drive is diminishing; many seek out a prescription from their doctor for a does of testosterone thinking it will fix the problem.

Dr. Wendy Klein, co-author of The Menopause Makeover, says  “The use of testosterone to treat a diminished libido is still controversial.  The FDA has not approved testosterone therapies for women suffering from a declining libido, but there have been preliminary scientific studies and extensive anecdotal reports that support the use of this therapy for improving the libido.”

A little compounded testosterone gel may be worth considering, but keep in mind that it has not been FDA-approved to treat a declining libido and long-term safety data is lacking.  Women who are on testosterone therapy should be monitored for increased lipids, excessive hair (hirsutism) and acne.

DHEA is another hormone that is often promoted as a libido booster.  When you purchase DHEA, it is a dietary supplement, not a drug that is regulated by the government.

Dr. Wendy Klein says, “If your DHEA level is tested and shown to be below normal, then it may be reasonable to take a supplemental dose of 25-50 mg daily.  However, if your DHEA level is normal, then there is no reason to take DHEA as a supplement.”

If you do decide to use an alternative therapy be sure to tell your healthcare provider so that he or she can be on the lookout for side effects and interactions.

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, but don’t give up.

There are many benefits to having a healthy sex life:

  • 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 and 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 five times higher than normal during love making.

Discussing your declining libido with your healthcare provider and partner is the first step to managing a healthy sex life. It is also 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.   If less sex is agreeable to you and your partner, enjoy other bonding activities.  Men may also notice changes that can affect their libido. Being able to discuss your libido will open the door for him to connect and communicate as well.

Going through menopause can be exhausting.  Feeling good about yourself when everything is changing, from your waistline to your sex life, can be challenging.  Often, nonhormonal options may rescue a lagging libido and spice up your sex life.

Once you have passed through the doors of perimenopause, feeling sexy is possible with proper management.  With continued interest, you can get your groove back and feel sexy during menopause and beyond.

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Posted in homepage, hormones, relationships

Keeping It Cool

hot flash Keeping it Cool

Article provided by Cleveland Clinic’s Speaking of Women’s Health

Just as the beginning of menstruation is a transition for young girls, the end of menstruation is a normal transition in a woman’s life.

Contrary to what many believe, menopause is not a disease or an illness to be dealt with. It is, for many, a challenge.

For some women, the symptoms experienced prior to and during menopausal years can diminish their vitality and well-being. What’s happening is that during menopause, a woman’s body slowly makes less of the hormones estrogen and progesterone. This often happens between the ages of 45 and 55 years old. A woman has reached menopause when she has not had a period for 12 months in a row, and there are no other causes for this change.

For some women, menopause comes and goes with little or no problems. For others, the symptoms can be a challenge.

Here are some ways to relieve those symptoms.

  • Hot Flashes – A hot environment, eating or drinking hot or spicy foods, alcohol, or caffeine, and stress can bring on hot flashes. Try to avoid these triggers. Dress in layers and keep a fan in your home or workplace. Regular exercise might also bring relief from hot flashes and other symptoms. Some women find that topical progesterone creams provide relief from hot flashes, while others believe that antidepressant medications work well. Talk to your pharmacist or health care practitioner to make the right choice for you.
  • Vaginal Dryness – Consider an over-the-counter vaginal lubricant or a prescription estrogen replacement cream.
  • Problems Sleeping – One of the best ways to get a good night’s sleep is to get at least 30 minutes of physical activity on most days of the week. But avoid a lot of exercise close to bedtime. Also reduce your intake of alcohol and caffeine, and avoid eating large meals and working right before bedtime. Establish a routine of waking and going to bed at the same time each night.
  • Mood swings – Try to get enough sleep and be physically active. Consider relaxation exercises such as deep breathing, yoga or meditation to help keep you calm. This is a good time to think about the person you want to be and focus on not allowing yourself to be emotionally-hijacked by your hormonal imbalances. Accept responsibility for your actions and words.

Try these steps to stay healthy during this time in your life:

  • Be active. Try to get at least 30 minutes of physical activity on most days of the week. Try weight-bearing exercises, like walking, running, dancing or lifting free weights.
  • If you smoke, quit.
  • Eat healthy foods. Eat a variety of fruits and dark green veggies, such as broccoli, kale, and spinach. Include calcium-rich foods and whole-grain cereals, breads, crackers, rice, or pasta. Choose lean meats and poultry and limit saturated fats and salt.
  • Limit alcohol. If you drink alcohol, limit to no more than one drink each day.
  • Maintain a healthy weight.
  • Be aware that a lack of estrogen means that the protective qualities of this hormone put you at greater risk for heart disease, osteoporosis and other illness. Ask your doctor what tests you need. Have your blood pressure, cholesterol, and blood sugar checked. Be sure to do monthly breast self-exams and get a mammogram as recommended.
  • Learn about bone health. Be sure you’re getting enough calcium and vitamin D. After menopause, you need 1,500 mg. of calcium daily. Engage in weight-bearing exercise such as walking and working with free weights to help maintain bone tissue and mass.
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Posted in hormones

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 ask the expert, hormones

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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Posted in ask the expert, hormones

10 Hormone Therapy Facts Every Woman Should Know

SATC2150Some know her as the sexually outspoken Samantha Jones, but today her three closest gal pals from Sex and the City 2 call her, “The hormone whisperer.” The oldest of four friends, Samantha, is finally a 50-something woman who is not about to give up her uninhibited lusty appetite or her youth to menopause.

To survive the inconvenience of menopause, Samantha takes daily doses of supplements by the handful and rubs hormones on her arms and privates. When Miranda asks Samantha about the logic of taking so many supplements, and where she got her menopause treatment strategy, she replies, “from Suzanne Somers.” Surprised, Miranda asks, “you are getting information from someone who invented the thigh master?”

When her hormones are confiscated at customs in Abu Dhabi, Samantha resorts to consuming and applying yams and chickpeas, hoping she is getting a “natural” dose of hormones so she does not “ricochet back into menopause.” This Somers devotee makes for good comedy, but propagates gross misinformation about hormones and menopause management options.

Many remember and love Suzanne Somers from Three’s Company, but it is time to come clean. I was a victim of Suzanne Somers’ irresponsible claims that her way of managing menopause is the “natural” way using compounded bioidentical hormones. Today I want to set the record straight.

I slammed into menopause, suffering from hourly hot flashes, itchy skin, horrible weight gain and miserable moodiness. Desperately wanting to feel normal and sexy again, I purchased Suzanne Somers’ book, Ageless: The Naked Truth About Bioidentical Hormones.

I assumed Somers word to be trustworthy, because a publisher printed her book. Living in Southern California, I splurged for Somers’ expensive Beverly Hills doctor recommendation, assuming he must have the answers. He confirmed I was menopausal and gave me tubes of compounded triple estrogen gel and compounded 10 percent micronized progesterone gel, with orders to apply them regularly. I was just like Samantha in Sex and the City 2. It was also suggested that I apply the estrogen gel to my face to “soften your wrinkles.” I dutifully rubbed in the compounded “bioidenticals” religiously.

After a few months of visiting this overpriced Beverly Hills doctor, my menopause symptoms were exaggerated and my moodiness turned into depression. Once again desperate and now at the lowest point of my life, I returned to a previous gynecologist. A blood test revealed that my estrogen levels were seven times higher than normal, my increased weight now placed me into the overweight BMI category, and my severe crankiness made it impossible to work.

What went wrong? I trusted a resource not supported by science. I was taking unregulated hormones. Like many other women, I was gullible and uneducated about my options, leaving me vulnerable to buying anything labeled HOPE in a bottle.

After the 2002 Women’s Health Initiative results, many women were scared of hormone therapy, myself included. Somers repackaged hormone therapy using the buzzwords “natural,” “bioidentical” and “compounded” as the new healthy menopause management option.

What I found when I started to burrow into the scientific research was a far cry from the claims made by Suzanne Somers. It was eye-opening to learn that natural compounded bioidentical hormones were unregulated by the FDA. There was no standardization for producing the product, and no tests on the formulations. There are NO real natural hormone products available.

When we see Samantha from Sex and the City 2 rubbing yams on her face in hopes of getting a dose of estrogen, the only thing she got was a good laugh.

10 Hormone Therapy Facts Every Woman Should Know

1. Natural: The word “natural” is a marketing term. There is no scientific evidence that custom-compounded bioidenticals are safer or more effective or more “natural” than standard pharmaceutical bioidentical prescriptions. The only “natural” hormones are the hormones being made by your body.

2. Bioidenticals: Laboratories create formulations that are either identical (bioidentical) or not (non-bioidentical) to those in your body. There are FDA approved prescription estradiol products that are bioidentical that are not “compounded.”

3. Compounded hormones: Made in a pharmacy by combining, mixing or altering ingredients to create a customized hormone for an individual patient. Compounding pharmacies must be licensed and regulated by the State Pharmacy boards. However, they do not have to demonstrate the safety, effectiveness and quality control, based on large, scientific studies, that the FDA requires of pharmaceutical manufacturers. Compounding pharmacies use chemically synthesized hormones made from plants — the same government-approved ingredients that are used in a manufacturer’s laboratory. “Compounded” formulations are neither safer nor more “natural.”

The North American Menopause Society, a non-profit organization of expert scientists and clinicians, “does not recommend custom-compounded products over well-tested, government-approved products for the majority of women.”

The Endocrine Society has stated that, “Post-market surveys of such (compounded) hormone preparations have uncovered inconsistencies in dose and quality.”

4. All estrogen products are chemically synthesized, primarily from an active ingredient called diosgenin, a molecule extracted from the tubers and flowers of various plants including Dioscorea, a wild yam.

All hormones, whether made in compounding pharmacies or in manufacturer’s laboratories, are synthetic in the sense that they are made by a chemical process. All estradiol, even “compounded,” is derived from similar chemical compounds.

5. To determine whether hormone therapy is appropriate and safe, one’s risk factors must be assessed based on personal and family medical history, as well as personal preference. There is no “one size fits all.”

6. Low dose hormone therapy, used judiciously, still remains the most effective way to treat the troubling symptoms of menopause for those who need it and who can use it safely.

7. There is no need for testing of hormone levels, either in saliva or blood. The science has shown that there is no predictable correlation between hormone levels in saliva or in blood and severity of symptoms. Unless there are unusual complications, it is the standard of care to treat symptoms if needed and adjust medications according to response, not saliva levels.

The North American Menopause Society says, “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.”

8. Standard prescription hormone therapy is the safest form available. It has been tested by the FDA and manufactured in a highly regulated manner. Doses are consistent.

9. There are also FDA approved non-hormonal therapies available to treat menopause symptoms for those who cannot take hormones.

10. Whether hormone therapy is needed depends on severity of symptoms, including hot flashes, night sweats, vaginal dryness and irritability. Hormone therapy should be individualized, which may mean trying different doses and schedules, as well as different routes of administration.

When we see Samantha squirting hormones on her arms in Sex and the City 2, we are watching drug dosing that is uncontrolled and dangerous. Hormone therapy, whether bioidentical or not, whether compounded or manufactured, is a drug with benefits and risks that must be taken seriously.

Somers says in her blog, “I just wanted to feel good when I went into menopause and I didn’t want to take drugs… When I found total and complete relief from natural non-drug hormones … I thought wow, women and men need to know this. And that’s how it began.”

While Somers had good intentions in sharing her “natural” hormone therapy strategy, she remains misinformed and misleading. Her “non-drugs” are still drugs, and her “natural” products are derived from synthesized chemical compounds.

Unregulated formulas and inconsistent compounded dosing can be dangerous and has jeopardized the health of many women, including myself. I wished I had known the dangers involved with compounded-hormones.

The North American Menopause Society reviewed Somers’ book saying, “Ageless is a tribute to pseudoscience, to safe and wishful thinking against facts, to claims of safety without proof … the uninformed reader is misled to believe the fallacies rather than the truth … the result is a book with overwhelming misinformation. The dangers are to women who may be misled into ‘buying into’ the products, thereby putting themselves potentially at greater risk than protection.”

After my menopause symptoms were stabilized with a standard prescription of bioidentical estradiol, I found a new way of eating, lost 30 pounds and updated my beauty regime without cosmetic surgery or alterations. I have never been healthier.

Being informed is the first step to managing your symptoms. Know where your health information is coming from. Make your decisions based on the solid scientific research that is readily available. You CAN take control of your health and beauty during menopause.

References

The North American Menopause Society. Menopause Practice: A Clinician’s Guide,
3rd Edition. Cleveland: The North American Menopause Society, 2007.

Sturdee, David W., The Facts of Hormone Therapy for Menopausal Women. New York: The Parthenon Publishing Group, 2004.

Somers, Suzanne. Ageless: The Naked Truth About Bioidentical Hormones. New York, NY: Three Rivers Press; 2006.

International Menopause Society, Recommendations on Postmenopausal Therapy, 27 February 2007

The North American Menopause Society, Early Menopause Guidebook. Cleveland: NAMS, 2006.

Hemelaar, Marjorie; van der Mooren, Marius J.; van Baal, W. Marchien; Schalkwijk,Casper G.; Kenemans, Peter; Stehouwer, Coen D A, “Effects of Transdermal and Oral Postmenopausal Hormone Therapy on Vascular Function: a Randomized,Placebo-controlled Study in Healthy Postmenopausal Women,” biomedexperts, New York, 2005;12(5):526-35.

Simon, James A. “Understanding the Controversy: Hormone Testing and Bioidenticals Hormones” 17th Annual Meeting of The North American Menopause Society, October 11, 2006, p. 5, 6, 7

Vogel, John J. “Understanding the Controversy: Hormone Testing and Bioidentical Hormones” 17th Annual Meeting of The North American Menopause Society, October 11, 2006, p. 23, 24, 26

Richardson, Marcie K. “Understanding the Controversy: Hormone Testing and Bioidentical Hormones” 17th Annual Meeting of The North American Menopause Society, October 11, 2006, p. 28

Allen, Loyd V. “Understanding the Controversy: Hormone Testing and Bioidentical Hormones” 17th Annual Meeting of The North American Menopause Society, October 11, 2006, p. 12, 13

The Endocrine Society. Bioidentical Hormones. Position Statement.

Patsner, Bruce. “Understanding the Controversy: Hormone Testing and Bioidentical Hormones” 17th Annual Meeting of The North American Menopause Society, October 11, 2006, p. 10, 11

Department of Health and Human Services, “Questions and Answers About the WHI Postmenopausal Hormone Therapy Trials“, National Heart, Lung and Blood Institute, April 2004.

Haimov-Kochman, Ronit and Hochner-Celnikier, Drorith, “Are There Second ThoughtsAbout the Results of the WHI Study?“, University Medical Center, Jerusalem, Israel. Department of Obstetrics and Gynecology, 4 March 2006, p. 387-393.

Kalvaitis, Katie, “Compounded Hormone Therapies: Unproven, Untested – and Popular“, Endocrine Today, 25 March 2008.

Pines A.; Sturdee, D.W.; Birkhauser, M.H.; de Villiers, T.; Naftolin, F.; Gompel, A.; Farmer, R.; Barlow, D.; Tan, D.; Maki, P.; Lobo, R.; Hodis, H., et. al., “HRT in the Early Menopause: Scientific Evidence and Common Perceptions“, International Menopause Society, 29-30 March 2008. The Hormone Foundation, January 2008

Medline Plus, “Complementary and Alternative Approaches to Health,” 2008.

National Center for Complementary and Alternative Medicine.

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Posted in hormones

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 ask the expert, hormones

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.

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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 ask the expert, hormones