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Blog: MenoPause ~ take time to think about it

  • Approaching menopause? Don’t forget about birth control

    by Margery Gass | Nov 06, 2014
    If you’re having hot flashes and other menopause symptoms but still getting your period now and then, there is a slight chance you could become pregnant, unless you have already taken care of that. If not, and if you would like to avoid pregnancy, birth control is recommended until one year after your last period. Many options are available for midlife women:

    • Birth control pills, patches, or rings—added benefits include more regular cycles with perhaps lighter bleeding, perhaps fewer hot flashes and a reduced risk of cancer of the uterus and ovaries. Note that these methods are not recommended for women who are smokers over age 35, have high blood pressure, migraines or who have had a blood clot in their legs or lungs. 
    • Progestin-alone pills, implants and injections—a potential option for those who smoke, have certain cancers,  high blood pressure, diabetes (without kidney, retina, or neurologic complications), history of blood clots, or obesity. These conditions should be discussed with your healthcare provider.
    • Barrier methods (condoms, diaphragm, spermicide)—condoms are the only method than provides some protection from HIV and other sexually transmitted infections. Note that these methods depend upon one of the two partners using the method with intercourse every single time.
    • Intrauterine devices with or without hormones—safe, highly effective, convenient, and long-term.
    • Sterilization (Tubal ligation, fallopian tube inserts, or vasectomy for men)—very effective and permanent methods, but require a surgical procedure.
    • Note that the last two methods, as well as progestin implants, require procedures that produce long-lasting contraception. They are highly effective, but they are more costly up front and in the short term. If you are quite close to menopause, they may not be worth the cost and the necessity of undergoing a procedure. 
    For all of these methods be sure to review the pros and cons with your healthcare provider in order to be sure the method is a good choice for you.
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  • MenoPro, a free app for women

    by Margery Gass | Oct 17, 2014

    Are you bothered by menopause symptoms and wondering what to do about it? Try our free MenoPro app available in the iTunes store. You can also read about it here.


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  • Invitation to women with low desire and sexual dysfunction

    by Margery Gass | Sep 23, 2014

    The time has come. This is your opportunity to discuss your concerns and to share your thoughts on the need for treatment with the United States Food and Drug Administration (FDA). There have been many products brought to market over the last 15 years for male sexual dysfunction, but we still have nothing for women.

    The most common female sexual dysfunction is female sexual interest/arousal disorder, often referred to as “low desire” or “low libido.” The FDA wants to hear from women who have this condition. How does it affect your life? What is the most distressing aspect of it? Has anything helped?

    On October 27, 2014, the FDA is holding a Patient-Focused Drug Development public meeting on Female Sexual Dysfunction in Silver Springs, Maryland. You can apply to appear in person or submit your comments online. Webcast participants will also have an opportunity to provide input through webcast comments. A panel of patients and patient advocates will present comments to start the dialogue, followed by a facilitated discussion with all patients and patient representatives in the audience. I will be there in person in the audience to hear your comments, and I will also be participating on the scientific panel the following day.

    All parts of the event are free but you must register online and by October 20, 2014. For event details and to learn more visit Eventbrite: Patient-Focused Drug Development Public Meeting and Scientific Workshop on Female Sexual Dysfunction event page.

    For more information, refer to the FDA meeting website.

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  • Does menopause cause moodiness and depression?

    by Margery Gass | Sep 04, 2014

    In recent years we have learned that menopause may increase the occurrence of clinical depression in some women, especially those women who have had depression in the past. Some perimenopausal women report symptoms of tearfulness and mood swings that resolve on their own once the transition is completed. Sleep deprivation associated with night sweats often results in fatigue, irritability, and moodiness. Abrupt hormonal fluctuations during perimenopause may also have an impact on these symptoms, much like PMS. During the reproductive years, most women become accustomed to their own hormonal rhythm. During perimenopause this rhythm changes, and the erratic hormonal ups and downs—although normal—can create a sense of loss of control that can be upsetting. Some women, however, may experience clinical depression.

    Coping skills and lifestyle changes are often not sufficient to relieve clinical depression. It is important to discuss all of these symptoms with a healthcare provider who can provide assistance, discuss options, and prescribe appropriate treatment. If your provider does not offer this service, ask for a referral to a professional who does.

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  • Do you need a yearly pelvic exam?

    by Margery Gass | Aug 22, 2014

    Some medical societies are calling into question the annual pelvic exam, at least for those women who have no symptoms and are not pregnant. As you might expect, this topic is being hotly debated.  

    Those in favor of annual screening pelvic exams argue that sometimes there are abnormalities found in women who have no symptoms. Those opposed to the yearly exam counter that the pelvic exam is not helpful in detecting ovarian cancer or  bacterial vaginosis, and was not associated with improved health outcomes or reduction of ovarian cancer mortality rates. They further point out that women can now screen themselves for the common sexually transmitted infections like chlamydia and gonorrhea in the privacy of their own homes.

    Harms of testing included false positives, unnecessary surgical procedures, fear, anxiety, embarrassment, pain, and discomfort – particularly for women with a history of sexual violence and/or post-traumatic stress disorder.

    Pelvic exams should be tailored to what is in the best interest of each individual woman. Most women do not need a pelvic exam every year but should be sure to see a healthcare provider if they have a new problem or concern. It is important to remember that screening for cervical cancer (with a pap smear, cervical cytology or high risk human papilloma virus test) is still recommended. That is a separate and important issue. The timing interval for cervical cancer screening depends on your age and the findings on your last pap smear.

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  • Women reap big benefits from healthy lifestyle changes

    by Margery Gass | Jun 12, 2014

    Diet and exercise can keep prediabetes from turning into diabetes, but it also does much more for women. It also prevents heart disease and reduces deaths. These were findings of a very long (23 years!) study in Da Qing, China, of people who had prediabetes. A group of them went through a 6-year program of diet and exercise. For those who were overweight or obese, the diet was designed for weight loss, and those who were normal weight just reduced their simple carb and alcohol consumption. In the group that went through the program, only 73% had diabetes develop compared with 90% of those who just had standard medical care. The rates of diabetic eye disease were also significantly lower in those who participated in the intensive lifestyle change program. In addition, the number of deaths from heart disease and deaths overall were also lower—for women. After menopause, women with prediabetes are more prone to developing type 2 diabetes, but this study shows that women can stave it off and reap huge benefits as a result. Not only will they stave off diabetes but also heart disease, eye disease, and other killers. Women around the world can take advantage of this good news!

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  • Check your mood swing

    by Margery Gass | Jun 04, 2014

    It may not be menopause that’s making you bark at your spouse. You may be getting angry just because you’re hungry. Researchers at Ohio State University measured couples’ blood sugar in the morning and at night and found low nighttime levels predicted who would lash out at a spouse that evening. Measuring just how angry took a creative approach. All the participants got a voodoo doll representing their spouse and 51 pins and were told to stick in pins each night in a way that showed their level of anger. The researchers found that the number of pins tracked with the blood sugar levels. In addition, with low blood sugar, the participants were also more likely to blast their spouse with loud sounds when they beat them at a competitive game. Eating something sweet can raise blood sugar quickly, so a little desert after dinner may not be a bad thing. But if that shot of sugar calms you down, avoid the blood sugar highs and lows by eating small, healthy snacks through the day, and keep fruit on hand, which can raise your blood sugar and give you some healthy fiber as well.

    1 Comment
  • Long or heavy periods not uncommon in your 40s, but…

    by Margery Gass | Apr 16, 2014

    If you’re heading toward menopause and you have more bleeding than usual, you are not alone. Women often worry when that happens because they have heard that menstrual periods become less frequent and lighter during perimenopause. Some periods do, some don’t. The Study of Women’s Health Across the Nation (SWAN), that included 1,200 women ages 42 to 52, found that over the course of three years, 91% of the women had as many as three periods that lasted 10 days or more, and 78% had three or more days of heavy flow. This news can be reassuring, but it doesn’t mean you should keep quiet about noticeable bleeding changes, especially if you are overweight.  Overweight women have a higher risk of uterine cancer (called endometrial cancer), and frequent or heavy bleeding can be a sign of cancer for any woman. Note also that the study said 3 long periods occurring over 3 years. If a woman is experiencing heavier and/or longer periods every month or bleeding frequently throughout the month, that should also be reported to your healthcare provider sooner rather than later.

    2 Comments

MenoPause: the blog!

Posts to our Blog are written by NAMS staff members and Dr. Margery Gass. All posts are reviewed and edited by Dr. Gass. We strive to bring you the most recent and interesting information about various aspect of menopause and midlife health. We accept no advertising for our website. We want you to have accurate, unbiased, evidence-based information. 

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

An internationally recognized leader in the field of menopause, Dr. Gass became Executive Director of The North American Menopause Society in 2010. Dr. Gass has been an investigator on numerous research projects, including serving as a principal investigator for the Women’s Health Initiative, and has published and presented on a wide range of topics related to menopause, including osteoporosis, sexual dysfunction, and hormone therapy.

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