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.

10 Ways to Lower Your Risk of Getting Breast Cance

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>

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.

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.

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.

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 an estradiol cream or tablets applied vaginally.
• 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.

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.

Expert: Chrisandra Shufelt, M.D

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.

Expert: Chrisandra Shufelt, M.D

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.

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.