It’s National Wear Red Day, a reminder that women need to take good care of their hearts because heart disease is their number one killer. When women have a heart attack, they may not even realize it because their attacks aren’t like men’s. Men often have dramatic symptoms, such as chest-clutching pain, when the plaque in a clogged artery ruptures and suddenly stops blood flow. But in women’s hearts, blockages often just keep building up slowly, producing heart attacks with subtle symptoms, such as weakness, nausea, lightheadedness, arm pain, fatigue, or feeling short of breath even though your chest doesn’t hurt. So if you have any of these symptoms, and your instinct says this just isn’t right, go to the emergency room.
Meanwhile, we can do our best to make sure a heart attack never happens. Exercise and a healthy diet are essential. And yes, your Valentine’s chocolate can be good for your heart—just without a lot of sugar, so eat it in moderation. And the other flavanoid-rich (and famous) heart health booster is red wine. But have that in moderation, too—one daily 5-ounce glass and not more. If you are 65 or older, a baby aspirin every other day can also be a healthy choice, but for younger women, its risks outweigh the benefits.
If you are currently being treated for breast cancer or if you are a breast cancer survivor, the hot flashes can be miserable, but conventional estrogen-based hormone therapy is not an option. That doesn’t mean you have to keep living in hot flash hell. Women who have been treated for breast cancer and are suffering from menopausal symptoms have more options than previously. These include lifestyle approaches as well as effective nonhormonal medications. Want to learn what can help and what’s safe and effective? Then tune in to this new video where Dr. Marla Shapiro and I discuss the options for you. As you move forward, it makes sense to seek help from a knowledgeable clinician, and you can look for one of those here. The NAMS Certified Menopause Practitioners listed have passed a competency exam in menopause practice and keep up with menopause professional education.
A new year is upon us. It is a great time to think about where you are and where you want to be. What are your personal health resolutions for 2016? Here are a few options to consider:
Research shows that just a few of the benefits of robust and positive social relationships for women are longer life, better health, and better sleep.
Taking on that challenge can improve your brain health even more than regular socializing. Older adults who learned new skills when they took up new hobbies got significant boost in memory—even more than those who socialized regularly.
Studies of people who use step counters show they increase their activity levels an average of 27% and walk at least 2,000 steps per day. Those little numbers can be big motivators.
Trick your brain! Research shows that willpower isn’t limitless, so don’t rely on willpower alone. Try substituting a good habit for a bad one. For example, if you sit and read to relax, try walking while you listen to an audiobook instead.
Being involved in spiritual and religious life has been linked to positive health outcomes, so stick with your meditation or prayer and stay involved with your religious or spiritual community.
People show more improvement in performance when they have specific and ambitious goals rather than easy or general ones. So go for the brass ring!
Volunteering and donating don’t just help change the world for the better. Many studies have shown that helping others makes people happier. Volunteering also boosts your self-confidence, gives you a sense of purpose, combats depression, and helps you get physically healthy, too.
This little trick can help you keep clutter under control. Clutter bombards your mind and sends your brain a message that life is out of control. If you keep it under control, you’ll reduce your stress.
There’s plenty of controversy surrounding the American Cancer Society’s (ACS) updated breast cancer screening recommendations for average-risk women (those without a family history or without dense breasts). The new guidelines recommend that the minimum age to start mammograms should be 45 instead of age 40 and that mammograms be done for women age 55 and older only every other year rather than every year. However, the ACS did qualify their recommendations, saying that women may begin mammograms at age 40 or have annual mammograms at age 55 and older if that’s what they want. The ACS also said that breast exams are not ever recommended.
Not everyone agrees with the ACS recommendations, including the American Congress of Obstetricians and Gynecologists, which continues to support yearly mammograms starting at age 40 as well as having a healthcare provider examine your breasts. Although some research supports the ACS guidelines, not all of it does, as breast-imaging specialist Jennifer Harvey, MD, outlined for NAMS. Regular mammograms reduce breast cancer deaths up to 48% for women ages 40 to 79, she says. She also points out that a high proportion of breast cancer deaths are in younger women, because they tend to have more advanced cancers and their tumors grow faster.
Proponents of the ACS guidelines cite the anxiety that false-positive mammogram results can cause as one reason for the changes, but Dr. Harvey says that this is usually just temporary and reminds us that finding breast cancer earlier may decrease the amount of treatment needed. For example, it can make the difference between having just a lumpectomy or needing additional therapies such as radiation, chemotherapy, or antiestrogen therapy. As for women age 55 and older, Dr. Harvey says, it’s difficult to figure out who is at average risk. It’s harder to see cancers in dense breasts, raising the risk of missing cancers. Depending on their risk, women who have dense breasts are candidates for 3D-tomosynthesis or other screening modalities that show more than regular mammograms but do have more radiation exposure.
Although annual mammography increases radiation exposure and increases risk of false alarms, mammography saves lives. Today, it is difficult to predict who has an early cancer that won’t progress, although that is being researched. If you want to have the best chance of detecting breast cancer early or if you are at higher risk because of your family history or you have dense breasts, you should discuss with your provider what your best screening starting age and frequency should be.
A NAMS-conducted survey of 3,700 US women aged 40 to 84 years found that about a third of those who use hormone therapy (HT) at menopause are using compounded hormones. There is a common and mistaken belief that compounded hormones are safer and offer more benefits than FDA-approved therapies. Concerns over health risks have prompted many women who want to take hormones to seek out practitioners who prescribe compounded hormones, which are marketed as natural or bioidentical and therefore perceived as safer than FDA-approved hormones. The so-called bioidentical hormones are plant-derived and chemically similar to those produced by the body. These hormones include commercially available products approved by FDA along with compounded preparations that are not regulated by FDA. The phrase bioidentical hormone therapy has been recognized by FDA as a marketing term and not one based on scientific evidence. Compounded hormones are custom made by a compounding pharmacist from a healthcare provider’s prescription and specifications, unlike FDA-approved drugs that are manufactured and sold in standardized dosages. Compounded drugs lack an FDA finding of safety, efficacy, and manufacturing quality. Prescribing patterns about compounded hormones are difficult to obtain because prescriptions of compounded hormones aren’t tracked the way those for FDA-approved drugs are. Adverse effects of hormone therapy were not common among the survey respondents, but the women who used compounded HT reported higher rates of vaginal bleeding and acne than women who used FDA-approved hormones, and four women who used compounded hormones reported that they had endometrial cancer (cancer of the uterine lining), whereas none who used FDA-approved hormones reported a case.
The survey was supported by a grant from TherapeuticsMD, and the survey results were published online in Menopause.
As many as 75% of perimenopausal women in North America experience hot flashes, and for a quarter of these women, hot flashes are so disturbing that they seek help.
There is no question that hormone therapy is the most effective treatment for bothersome hot flashes, but in many cases, hormone therapy is not appropriate, and some women simply choose not to try it. In fact, from 50% to 80% of perimenopausal women try nonhormonal therapies for hot flashes, but without any real guidance on what works (and what doesn’t), woman experiment with different products, often delaying their chance at finding effective treatment, wasting capital, or they suffer in silence.
A number of nonhormonal products and techniques are promoted for hot flashes, but they are often untested and unproven. To learn what really works, a NAMS panel of experts looked at the evidence and made recommendations in the Position Statement, “Nonhormonal Management of Menopause-Associated Vasomotor Symptoms.”
The NAMS panel found solid evidence that a few therapies do work, including two behavioral approaches (a combination behavioral approach and clinical hypnosis) and certain nonhormonal prescription medications. Other lifestyle and behavioral approaches, treatments, and a supplement under study (S-equol) look beneficial, but the evidence is not as strong.
Evidence for other lifestyle approaches, herbs, and supplements is insufficient, inconclusive, or just plain negative. The panel found no evidence that exercise, yoga, paced respiration, and acupuncture work on hot flashes, although they may offer other health benefits. They are not recommended as hot flash therapy. Over-the-counter and herbal therapies (such as black cohosh, dong quai, evening primrose, flaxseed, maca, omega-3s, pollen extract, and vitamins), relaxation, calibration of neural oscillations (a brain-training technique), and chiropractic intervention also were not found to work, and risk-free approaches such as stay-cool techniques and avoiding hot flash “triggers” have no studies testing their effectiveness, so these are not recommended therapies either.
The NAMS panel prepared this Position Statement to educate healthcare providers and menopausal women. With this careful, critical look at all the available studies, NAMS has highlighted the need for further research. In the meanwhile, women are better informed on how to handle hot flashes without hormones.
The Position Statement has been published online in the NAMS journal, Menopause.
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JoAnn V. Pinkerton, MD, NCMP