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  • Weight Loss Strategies in Menopause: What’s New and What Works

    by JoAnn Pinkerton | Oct 03, 2017

    We're pleased to have a guest post from Dr. Cheryl Kinney.

    Kinney, Cheryl 2015

    Cheryl C Kinney, MD, FACOG 

    NAMS Member

    For many menopausal women, weight gain is one of their major health concerns. And rightly so! Most of us know from personal experience what numerous studies have now demonstrated —that the menopause transition is associated with unfavorable changes in body composition and abdominal fat deposition. Although there is no doubt that diet and exercise are important in weight management, help is on the way in the form new medications and surgical procedures.

    New Surgical Options

    Balloons are changing the surgical strategies for weight reduction. The ReShape Duo is a double balloon that is placed endoscopically during outpatient surgery and filled with salt water (saline). It stays in the stomach to induce feelings of fullness for 6 months, after which it is deflated and removed. Average weight loss is 30 to 40 pounds, with a sustainability rate of 48% at 24 months. The Obalon® is a capsule that contains one balloon. Like the ReShape Duo, the capsule is placed with an endoscope. Once it is in the stomach, the capsule dissolves, and the surgeon fills the balloon with gas. After 4 to 6 months, the balloon is deflated and removed. Weight loss can be 40 pounds or more (or less, depending on how you stick to the protocol). Rare complications have been reported with these procedures, so speak to your healthcare provider about the risks.

    To get around the risks of anesthesia and endoscopy, the Elipse was developed. It is a capsuled balloon that is simply swallowed during a brief office visit. Months later it dissolves and passes into the toilet. The Elipse is still under investigation. Also in development is Gelesis100, a pill that you take before meals. It soaks up water and expands in the stomach, making you feel full. Four to six hours later, it dissolves. Then repeat and eat (or at least try too).

    The vBloc, a pacemaker-like device for the stomach, was approved by FDA in 2015. It is implanted surgically and can lead to a significant weight loss. It requires recharging every night, which might lessen its charm.

    New Medical Options

    FDA has approved five medicines for long-term use, including four relatively new drugs—the first drugs approved for obesity in more than 13 years—with solid data on long-term efficacy and safety. Orlistat is a daily pill that works by reducing the absorption of ingested fat. Phentermine/Topiramate ER, also a daily pill, is a combination of an appetite suppressant and a medication that works at the brain level. The average weight loss is 24 pounds. Lorcaserin is taken twice daily, with an average weight loss of 8% of body weight. Naltrexone SR/Bupropion SR works to control hunger and to decrease cravings. Taken twice daily it can result in more than 12% of body weight loss. Liraglutide is an injectable weight loss medication. In studies, one in three patients lost more than 10% of their body weight, and eight out of ten kept it off for at least a year.

    Several other new drugs and devices are under investigation and show promising results. But if you are ready to lose weight now, talk to your healthcare provider to review the risks and side effects of the available options.


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  • Good News on Hormone Therapy

    by JoAnn Pinkerton | Sep 13, 2017

    We're pleased to have a guest post from Dr. Marla Shapiro.

    Marla Shapiro

    Marla Shapiro, CM, MDCM, CCFP, MHSC, FRCPC, FCFP, NCMP 

    NAMS President

    For many women with severe hot flashes, night sweats, and other disruptive symptoms of menopause, there has been continued concern about the long-term effects of using hormone therapy (HT) for relief. In 2002, the Women’s Health Initiative (WHI) trials tested two of the most common formulations of HT—an estrogen used alone and an estrogen combined with a progestin for women with a uterus—to assess the benefits and risks of HT taken for symptom relief by predominantly healthy, postmenopausal women. The clinical trials and observational study were designed to test the effects of postmenopausal HT, diet modification, and calcium and vitamin D supplements on heart disease, fractures, and breast and colorectal cancer.

    The initial trial results were alarming because they reported an increase in heart disease, stroke, and breast cancer in the study population. Since that time, researchers have looked at the data by age group, and in younger menopausal women aged between 50 and 60 years or within 10 years of menopause, have not seen many of these initial concerns.

    A new study led by investigators at Brigham and Women’s Hospital in Boston has looked at the long-term death rates from all causes as well as the rates of death from specific causes. The new findings are very reassuring. In the overall study of women aged 50 to 79 years, researchers found no increase or decrease in total mortality or death from cardiovascular disease, cancer, or other major illnesses. Mortality or death rates are the ultimate bottom line when assessing the net effect of a medication on serious and life-threatening health outcomes.

    Mortality or death outcomes were found to be more favorable in younger women who received HT compared with older women who also received therapy. The death rates in the women aged 50 to 59 years tended to be approximately 30% lower in women who received HT compared with women of the same age who received a placebo. Even in women who initiated HT in their 60s and 70s, no effect on death rate was observed.

    In addition, over the extended follow-up period (18 years since the study started), overall deaths from cardiovascular disease and cancer had neither increased nor decreased in women who received HT. The researchers also found that deaths from Alzheimer disease and other forms of dementia were significantly lower with estrogen alone than with placebo during the 18 years of follow-up, and use of estrogen plus progestin was not associated with dementia mortality.

    It should be noted that the WHI HT trials addressed the benefits and risks of the most common formulations of HT used at the start of the study and available at that time. Since then, lower doses, different formulations, and new administration methods (skin patches, gels, sprays) of HT have become available and are increasingly common. Additional research on the long-term benefits and risks of these newer treatments is needed, but it is very reassuring to see no increase in all-cause death rates related to the HT used in the WHI.

    For more details on the new study, please watch this informational video.

     

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  • Hot Stuff: What’s New About Hot Flashes?

    by JoAnn Pinkerton | Aug 14, 2017

    We're pleased to have a guest post from Dr. Rebecca Thurston.


    Rebecca C. Thurston, PhD
    NAMS Board Member

    Most women transitioning through menopause know what hot flashes are (sometimes referred to as night sweats or vasomotor symptoms). It’s the sudden onset of heat that comes out of nowhere, the embarrassing flushing and sweating that comes at the most inopportune times, or the heat, sweating, and sleep disturbance of those overnight hot flashes.

    Who Gets Them?
    About 75% of women will have hot flashes. In the United States, African American women get the most severe and persistent hot flashes. Hispanic and non-Hispanic white women fall in the middle, and Asian women in the United States have the fewest hot flashes. However, many, if not most, women will get them. Smoking is a clear risk factor for hot flashes, so if you are a smoker, stopping may help. Body fat appears to be a mixed story and depends on age or stage of menopause. Women who are overweight or obese have more hot flashes when they are younger and having either regular or irregular menstrual cycles. Yet once these women are well past their final menstrual period, they don’t necessarily have more hot flashes. Stressed and anxious women consistently report having more hot flashes over the subsequent years.

    Are You a Super Flasher?
    It was long thought that hot flashes would last just a few years, right around the last menstrual period. However, we now know that they last much longer. For most women, hot flashes will last about 7 to 10 years; milder hot flashes likely last much longer. However, when women have hot flashes varies dramatically. Some women will have them primarily in their 40s and 50s, when they are still having menstrual cycles, and others will start having hot flashes only when their cycles have stopped. A lucky few (about a quarter of women) will have no or few hot flashes over the menopause transition. Finally, another quarter of women are what investigators for this research have dubbed “Super Flashers.” These women will begin having hot flashes when they are still having menstrual cycles and will continue to have them well after their cycles have stopped. These “Super Flashers” will have hot flashes for well over a decade.

    What Causes Hot Flashes?
    Hot flashes are marked by increased skin temperature, sweating, flushing, and heart rate. We’re sure anyone who has had a hot flash can tell you that. But what causes them? The underlying biology of hot flashes is not fully worked out yet. We know that hormones play a role. Those dramatic hormone changes that signal menopause clearly matter. However, hormones are not the whole story.

    Getting in the Zone
    The body’s internal thermostat also matters. Like the thermostat in your home, your body keeps its core temperature in a zone—like the temperature you set for your home. When your core temperature goes above that zone, you sweat, and when it goes below that zone, you shiver. Like the air conditioning and the heat, this sweating and shivering function is trying to bring your body temperature back into the zone. The sweating during a hot flash can be seen as your body’s attempt to get rid of heat. However, this hot flash often occurs when the internal body temperature is just fine (well within the zone). So it appears that the internal thermostat of women having hot flashes is malfunctioning and detecting small changes in body temperature as too hot. Why this happens is not totally clear, but likely involves an interplay between those changes in hormones and the body’s thermostat (its controller lives in the brain). There is likely more to the story, and we are working on it, so stay tuned.

    Are Hot Flashes Such a Big Deal?
    For some women, hot flashes are no big deal and are pretty mild. But for many other women, having severe or frequent hot flashes really interferes with life. Women with hot flashes, particularly frequent or severe hot flashes, have poorer sleep quality and may be more likely to have depression or anxiety during the menopause transition. For these women, quality of life and even work productivity are diminished. Hot flashes do matter.

    So What Can You Do About It?
    There are two broad approaches to treating hot flashes: medical and behavioral. Because I don’t prescribe medications myself, I will only briefly comment on medication approaches.

    • Hormone therapy remains the most effective treatment for hot flashes during menopause; however, hormone therapy may not be for everyone. NAMS has prepared the consumer-oriented MenoNote “Deciding About Hormone Therapy Use” to help you to decide whether hormone therapy is for you. MenoNotes are available on the NAMS website.
    • Another FDA-approved medication for treating hot flashes belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRIs). You may know them as antidepressants.
    • Beyond SSRIs, other medications have shown some effectiveness and are widely used for helping women manage hot flashes, including serotonin norepinephrine reuptake inhibitors and gabapentin. These are not FDA-approved for treatment of hot flashes, but they are often used for this purpose.

    This isn’t the complete list of available medications, and keep in mind that everyone is different, so you may need to experiment with different approaches to find what works best for you. Hang in there and try different things.

    Are Drugs the Only Answer?
    You have options. I am a proponent of behavioral approaches, because although these approaches may take more active engagement from you, they can eliminate the need to take a medication and may have other mental or physical health benefits. Menopause is the time to adopt positive health behaviors. These behaviors can help not only improve quality of life, but also improve health later in life. Although much more research is needed on behavioral treatments for hot flashes, here are some of my personal recommendations that I often discuss with women:

    • Hypnosis has the potential to help reduce both the occurrence of hot flashes and their effect on a woman’s life. It’s one of the few approaches that can do both. However, there is a very specific protocol that your healthcare provider should follow.
    • Mindfulness-based stress reduction. This 8-week program involves meditation, relaxation, and gentle yoga and has helped some to cope with hot flashes and, importantly, improve sleep. This is particularly relevant because many women report that the primary irritant for them with hot flashes is the disrupted sleep. This approach has been tested for a lot of different mental and physical health issues, so it may help with more than your hot flashes. Meditation is the cornerstone of this approach, so if you want to learn meditation, this is the way to go.
    • Cognitive-behavioral therapy has shown similar effects in helping women cope with hot flashes. This approach helps women to target what they are telling themselves about their hot flashes and also engage proactively in activities that may be helpful.
    • Weight loss may have some beneficial effect on hot flashes for women who are overweight or obese when they are early in the menopause transition (but not necessarily when they are years past their final menstrual period). Weight loss matters for many aspects of health. For women who need to lose weight, menopause is the time to do it for the prevention of obesity-related diseases later in life.
    • Keep your environment cool, especially for sleep. This is particularly important if you are having nighttime hot flashes and problems with sleep. We know that in order to get a good night’s sleep, a drop in core body temperature is critical. A woman’s internal thermostat is malfunctioning during menopause, so women need all the help they can get from the environment. If you get grumbling from your bed partner, keep extra blankets handy!
    • Yoga has had very mixed findings on helping with hot flashes and likely depends on the type of yoga. Yoga does have some support for improving sleep, quality of life, and overall well-being, but may or may not decrease the hot flashes themselves. If you are new to yoga, make sure you are working with a certified yoga instructor who has experience working with midlife women. I say this as a yoga teacher myself to prevent yoga-related injuries. Go slow and listen to your limits.
    • What about exercise? Moderate physical exercise (eg, brisk walking) sadly does not appear to improve hot flashes. However, exercise is so important to many aspects of health, that this should not discourage exercising! Keep your exercise routine strong. It is important to your brain, heart, and bones (among other things).

    What we know about hot flashes is constantly evolving. You may need to try multiple approaches or switch them up as you age. The bottom line is that you don’t have to suffer in silence. Get help if you need it. We as a scientific community want to offer you a range of effective approaches and are working hard on developing new treatment options. Stay tuned!

     

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  • The Exercise Habit

    by JoAnn Pinkerton | Jul 05, 2017

    We're pleased to have a guest post from Dr. Nanette Santoro.


    Nanette Santoro, MD
    NAMS Board Member

    Most every day, I get out of bed and perform some sort of early morning exercise. Whether it’s a machine workout in my basement on my trusty elliptical and stationery bike, or it’s a hike in the mountains. It just doesn’t feel right to me if I have not done some movement to start my day. There are many reasons to believe that this daily habit will extend my years of healthy living and reduce my health liabilities in the future. Here are some reasons why you should get into or stick with the exercise habit:

    • You’ll have more energy. Once you are past the fatigue that comes with aerobic training, you will have improved your endurance and have more energy to give to your work and home life.
    • You’ll sleep better. There’s nothing like knocking yourself out in the gym (or on the trail, or in the pool) to bring on a sound, deep, refreshing sleep.
    • You’ll have better bones. Reams of data tell us that impact exercise is one of the best ways to keep your bones healthy.
    • You’ll have better balance. Working your muscles, especially with activities like yoga that emphasize accessory muscles that you seldom use, will help prevent accidents and falls.
    • You can eat more. The calorie deficit that you incur from a 45-minute bout of exercise may entitle you to a treat that you would otherwise not be able to have.
    • It’s good for your soul. Meditative exercise such as swimming lets your brain roam free and can lead to more creativity. Some find that running or jogging lets them put their brain on autopilot and get into a meditative state. Others find that just being alone or with loved ones in a naturally beautiful setting is restorative.
    • You’ll stave off arthritis. People who are extremely active may get overuse injuries, but for those of us who are middling athletes, it’s good for the joints to be subject to movement. Swishing around the synovial fluid prevents problems later on.
    • You’re more likely to maintain your weight. Even if you are “playing for the tie” with calories, physical activity is the #1 way to prevent weight gain in midlife and beyond. 

    I could go on . . . but I’ve got to go for a jog!

     

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  • Timing May Be Everything

    by JoAnn Pinkerton | Jun 07, 2017

    We're pleased to have a guest post from Dr. Peter Schnatz.

    Peter F. Schnatz, DO, FACOG, FACP, NCMP

    NAMS Board Member

    So you’re thinking about taking hormone therapy (HT) for your hot flashes and wondering whether that’s a good idea. Are you aware that there’s a huge difference in the risks and benefits of HT, depending on your individual life situation and medical background? One of the biggest factors with regard to the risks and benefits of HT is your age and the amount of time since menopause. If you are younger than age 60 or within 10 years of menopause, the data show that the risks are significantly less than originally thought. In fact, some data suggest a decrease in heart disease, breast cancer, and all-cause mortality for women in that age range. In addition, for women who are younger than the average age of menopause (age 52) and whose ovaries have stopped functioning, the use of HT is not only suggested but is also important to help prevent the damaging consequences of significant bone loss (leading to osteoporosis), heart disease, and other effects of premature estrogen deficiency (provided there are no contraindications).

    Unfortunately, data that made the news from studies in older women left many younger women scared out of using the most effective therapy for menopause symptoms and a therapy that, in some cases, may be necessary to prevent major complications of estrogen loss. If you are not sure what to do, see a NAMS Certified Menopause Practitioner to help navigate your individual and unique situation. One size does not fit all, and a menopause specialist can help you with your challenging questions.

     

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  • Are Your Television Habits Putting You at Risk?

    by JoAnn Pinkerton | May 03, 2017

    We're pleased to have a guest post from Dr. Marla Shapiro.

    Marla Shapiro

    Marla Shapiro, C.M., MDCM, CCFP, MHSC, FRCPC, FCFP, NCMP 

    NAMS Board Member

    One of many people’s favorite pastimes is watching TV, and with the advent of video streaming and downloading, people may binge watch for hours. For North Americans, the term “binge-watching” to describe viewing multiple episodes of television programs in one sitting has become popular. A study published by the American Heart Association reports that watching a lot of television every day may increase your risk of dying from a blood clot in the lung.

    A lung blood clot, or pulmonary embolism, as the researchers point out, usually begins as a clot in the leg or pelvis as a result of inactivity and slowed blood flow. If the clot breaks free, it can travel to a lung and become lodged in a small blood vessel, where it can be dangerous and even lead to death.

    A study done by Japanese researchers between 1988 to 1990 asked 86,024 participants ages 40 to 79 years many hours they spent watching TV. Over the next 19 years, 59 of these participants died of a pulmonary embolism. Compared with the participants who watched TV fewer than 2.5 hours each day, deaths from a pulmonary embolism increased by 70% if TV was watched 2.5 to 4.9 hours per day, and there was an overall 2.5 times increased risk of death if TV was watched 5 or more hours per day.

    What is even more concerning is that the risk is likely greater than the findings suggest because deaths from pulmonary embolism are believed to be underreported, and diagnosis is difficult. The most common symptoms of pulmonary embolism—chest pain and shortness of breath—are the same as for other life-threatening conditions. The diagnosis requires imaging that many hospitals are not equipped to provide.

    Other risks for a blood clot include

    • Obesity
    • Diabetes
    • Cigarette smoking
    • Hypertension
    • Some hormone therapies
    • And of course, sedentary behavior


    What to Do
    Well, the obvious answer is get moving and push away from your TV, computer screen, and smart phones. People who watch a lot of TV can take a couple of easy steps to reduce their risk of developing blood clots in their legs that may then move to their lungs. This advice is similar to that given to travelers on long plane flights:


    1. After an hour or so, stand up, stretch, and walk around
    2. While watching TV, tense and relax your leg muscles for 5 minutes
    3. Drinking water may also help
    4. In the long run, shedding pounds if overweight also is likely to reduce risk

     

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  • Bioridiculous

    by JoAnn Pinkerton | Apr 05, 2017

    We're pleased to have a guest post from Dr. Nanette Santoro.


    Nanette Santoro, MD
    NAMS Board Member

    In my practice, I have seen smart, professional women who really ought to know better endure these horrors:

    • One of my patients brought to the office a Ziploc bag filled with her hair that had fallen out. She was rubbing a compounded testosterone cream into her skin every day and was massively overdosed. Her testosterone levels were higher than my husband’s when they were measured.
    • Another woman, 49 years old, has osteoporosis because she has been treated for a decade with high-dose pig thyroid preparations, even though there was no reason for her to be taking them. Overdosing on thyroid hormone causes a progressive loss of bone density.
    • A 52-year-old nurse had estrogen levels that were higher than during her two pregnancies from a pellet insertion for menopause symptoms—months after it was placed.

    All these women believed that they were taking natural hormones that were reasonable alternatives to mainstream medicine, and all of them had suffered as a result. But why would they take them? And how did we get here?

    The stage was set for the bioidentical hormone movement well before its spokesperson, Suzanne Somers, ever went through menopause. The bioidentical hormone movement is an unintended consequence of the Dietary Supplement Health and Education Act (DSHEA) of 1994, which purpose was to exempt substances that were considered dietary supplements such as vitamins and herbs from FDA oversight. This is an important distinction to make, because FDA requires relatively stringent standards for efficacy and safety for drugs. All drugs must go through this process to get the FDA stamp of approval, a process that usually costs millions of dollars and takes up to 10 years or more.

    The thinking behind the DSHEA was that it is un-American to make the consumption of herbs that you could grow in your backyard or other relatively unprocessed substances that you could eat regulated by the government. But it hasn’t quite turned out that way. The DSHEA took a very broad view of what it considered a supplement, and for reasons that are not entirely clear, compounded hormones that are not eaten but that are rubbed into the skin, injected, or given as pellets are also considered supplements.

    The only basis on which FDA will intervene to regulate a dietary supplement is if there is reason to suspect that it is causing harm. So far, FDA has intervened only three times.

    So let’s talk about menopause. It’s not pretty for many of us women. A series of changes occur to a woman as she approaches 50. All of a sudden, sleep is a precious gift to which she is not necessarily entitled. Then she gets a few hot flashes. She thinks: what’s the big deal? I can do this. Then she gets a few more. And they are worse. Then sex can become painful. And sometimes she feels exhausted, moody, and even depressed.

    That’s the time to turn to an expert in hormones—an endocrinologist. We will give you behavioral strategies and, when appropriate, medication to help you deal with these symptoms, and we will tell you the best news: for most women, this is a temporary state. Treatment need not be a lifelong commitment. We will explain to you what is happening in your body. We have hormone and nonhormone treatments that can help menopause symptoms. We will talk with you, get a sense of your worst symptoms and your preferences, and make recommendations based on your medical history and the scientific evidence. There’s actually a lot of scientific evidence, and the experts are more in agreement than ever on the risks and benefits of the various treatments for menopause. We are in an era where high-quality clinical trials are being conducted all the time.

    Why, then, do women turn to predatory, nonscientific methodologies for coping with this common life passage? There is nothing inherently evil about producing compounded medication. It is a choice that is made when FDA-approved alternatives either do not exist or are not appropriate. It is a technique that our pharmacist colleagues wish to preserve, and it is an important option for the rare patient who is allergic to the colorings or fillers in common medications. Yet, the marketing of bioidentical hormones as a truly safe and effective alternative to FDA-approved hormone treatments for menopause cannot be condoned when FDA-approved preparations that are exactly the same as the hormones made by the body are available and will work superbly well for almost everyone.

    My goal is to treat you and have your symptoms get better or go away completely. I have an entire toolbox of treatments—there are more than 100 FDA-approved compounds that have potential to alleviate common menopause symptoms—and I will use the best tool I’ve got for you to do the job when prescription medications are indicated.

    My point? There is very good reason to beware the inflated promises made by the bioidentical industry and to take better care of yourself during your menopause transition by going to the real experts—licensed medical professionals who have knowledge of the process of menopause and its treatment. Be leery of websites and experts who provide only their own product and recommend only their own tests. If it sounds too good to be true—it probably is. There are better and safer ways to cope with this important life transition, and most women will not require treatment for more than a few years, when risks remain very low.

    So choose science.


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  • Why Don’t Men Have Menopause?

    by JoAnn Pinkerton | Mar 08, 2017

    We're pleased to have a guest post from Dr. Lynnette Leidy Sievert.









    Lynnette Leidy Sievert, BSN, PhD
    NAMS Member


    Mick Jagger is in his seventies and has just fathered a new baby. Why don’t men have menopause? Because men are like fish. From an evolutionary perspective, human anatomy and physiology have been shaped over a long period of time by gradual processes such as mutation and natural selection. Humans are vertebrates, and like all vertebrates, we have a lot in common with fish—for example, our bilateral symmetry (two arms, two legs). In terms of reproduction, male fish continue to make sperm from stem cells in their testes, and female fish continue to make eggs from stem cells in their ovaries. This production of new sperm and new eggs continues throughout their entire lives. Humans are also tetrapods (four-limbed animals), and we share a lot in common with amphibians—for example, the ability to breathe air. In terms of reproduction, male and female amphibians continue to make sperm and eggs from stem cells all their lives. Humans are also mammals, and like all mammals, we maintain a constant internal temperature. In terms of reproduction, female mammals do not continue to make eggs across the entire lifespan. Unlike fish, amphibians, and most reptiles, female mammals make all of the eggs they will ever have in their ovaries right away, during fetal development or shortly after birth. This is why only female mammals can have a menopause: menopause is “uncovered” by longevity in mammals when females outlive their egg supply. Some research suggests that stem cells can persist in the ovaries of female mice and humans for some time after birth, but that doesn’t change the fact that female humans eventually run out of eggs. Unlike female mammals that evolved a new reproductive strategy, male mammals conserved the pattern of fish, producing new sperm all their lives. Although some men experience age-related changes in their semen and sperm, it is not surprising from an evolutionary perspective that men (eg, Mick Jagger) can father children into their seventies and beyond.


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MenoPause Blog

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. 


JoAnn V. Pinkerton, MD, NCMP
Executive Director

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