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MenoPause Blog

  • NAMS and USPSTF statements consistent

    by Margery Gass | Oct 24, 2012

    The United States Preventive Services Task Force (USPSTF) recently released “Hormone Therapy for the Primary Prevention of Chronic Conditions: A Systematic Review to Update the US Preventive Services Task Force Recommendations.”

    There is also a special version for consumers.

    The Task Force conclusions are consistent with the NAMS 2012 Hormone Therapy Position Statement, which is also accompanied by a patient handout.

    An interesting component of this USPSTF publication is a section discussing the public comments that were made during the time the draft was posted online earlier in the year. The Task Force points out that it is not addressing the use of hormone therapy for treatment of menopausal symptoms. These features make the report very consistent with our HT Position Statement and allow room for our Experts Do Agree solidarity statement regarding treatment of menopausal symptoms, also with patient handout.

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  • Daily breather may help calm hot flashes

    by Margery Gass | Oct 15, 2012
    Regular, daily practice of calm or slow breathing is key for this alternative technique to ease hot flashes, shows a new paced breathing study in the NAMS journal Menopause. Women in this study practiced breathing rhythmically, either at a normal pace or slowly, for at least 10 to 15 minutes every day. All of them had fewer and less severe hot flashes, but the ones who had the most relief practiced twice a day.

    Both of these approaches are like meditation, which is known to calm down the autonomic nervous system. That’s the system that controls body functions such as sweating, heart rate, and dilation of blood vessels, which all ramp up during a hot flash. You can try the approach that worked best in this study—breathing slowly and regularly at six breaths a minute for 15 minutes twice a day. These short sessions shouldn’t be too hard to work into your busy day.
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  • A sweet excuse to eat cocoa and chocolate

    by Margery Gass | Sep 28, 2012

    But not too much! The good news keeps on coming about the potential benefits of cocoa flavonols. They may improve your mood, cut through mind fog, and take your blood pressure down a few notches. One of the latest studies on these effects hinted that chocolate with medium and high levels of cocoa flavonols could improve visual attention and verbal skills in elderly people. Cocoa powder, rather than chocolate bars, may be the best way to get your flavonols with the least amount of calories. The short-term visual/verbal study also showed that the chocolate drinkers had decreased insulin resistance (a group of risk factors for diabetes and cardiovascular disease), blood pressure, and lipid peroxidation (which gauges cellular damage).

    A recent dark chocolate/blood pressure study, which reviewed all of the reliable studies published, concluded that dark chocolate can bring down blood pressure a few points—2.8/2.2 mm Hg. Even a couple points helps reduce your cardiovascular risk. Overdoing it on chocolate bars can make you gain weight and wipe out the benefits. Just an ounce should do. 

  • Menopause and the volatile vagina

    by Margery Gass | Sep 27, 2012
    Bothersome symptoms of the vagina and vulva occur in women of all ages, but they become much more common around menopause. Loss of estrogen at this time is a major cause of vaginal dryness, itching, burning, discomfort, and pain during intercourse. These symptoms range in severity from mild annoyance to a point where they significantly affect a woman’s quality of life in the following ways:

    • Vaginal atrophy. Tissues of the vulva and the lining of the vagina become thin, dry, and less elastic.
    • Decreased lubrication. Lack of lubrication is due to diminished vaginal secretions.
    • Pain with intercourse. With severe vaginal atrophy, the tissues of the vagina become dry and sometimes fragile and inflamed. As a result, they are more prone to injury, tearing, and bleeding during sexual intercourse or even a pelvic exam. Over time, especially in the absence of regular intercourse, the vagina may also become shorter and narrower. The resulting discomfort can intensify to the point where sexual intercourse is no longer pleasurable or even possible.

    Treatment options:
    • Vaginal moisturizers. Available without a prescription, these nonhormonal products help maintain vaginal moisture in peri- and postmenopausal women. Just like moisturizing your face or hands, the vagina should be moisturized on a regular basis, usually twice weekly at bedtime. There are many effective brands, including Replens and K-Y Long-lasting Vaginal Moisturizer.
    • Vaginal lubricants. These products reduce discomfort with sexual activity when the vagina is dry by decreasing friction during intercourse. There are many options and you should find one that works for you and your partner.
    • Regular sexual stimulation. Intercourse promotes blood flow to the genital area, helping to maintain vaginal health.
    • Developing expanded views of sexual pleasure. If vaginal penetration (intercourse) is difficult or uncomfortable, consider so-called “outercourse” options such as extended caressing, mutual masturbation, and massage. More and more women are using vibrators  for sexual pleasure.
    • Local prescription therapy. For vaginal dryness and discomfort that does not respond to over-the-counter lubricants and moisturizers, low doses of local vaginal estrogen therapy are very effective and safe. Local estrogen increases the thickness and elasticity of vaginal tissues, restores a healthy vaginal pH, increases vaginal secretions, and relieves vaginal dryness and discomfort with intercourse. Government-approved products are available as vaginal creams, a vaginal estradiol tablet (used twice weekly), and a vaginal estradiol silastic ring. All are highly effective.
    • Systemic prescription therapy. Low doses of systemic estrogen in the form of a pill or skin patch used to treat hot flashes are also effective for treating vaginal dryness, although some women might benefit from adding local treatment to their systemic treatment to relieve discomfort. If only vaginal symptoms are present, local therapy described above is recommended.
    • Vaginal dilators. After many years of severe vaginal atrophy, especially if sexual intercourse is infrequent, the vagina may become so shortened and narrowed that it cannot accommodate an erect penis. In addition to regular use of vaginal estrogens and moisturizers, some women also may require several months of daily “exercises” with lubricated vaginal dilators to stretch and enlarge the vagina. Once intercourse becomes comfortable again, dilators typically are no longer needed, as the vagina remains healthy with regular intercourse and low-dose local estrogen therapy. Dilators may be purchased from pharmacies, medical supply stores, and online, and should be used under the guidance of a gynecologist, physical therapist, or sex therapist.
    With their healthcare provider, women can assess the symptoms, causes, and treatment for vulvovaginal distress and find a comfortable and healthy solution for their distress. For more information, visit the sexual health section of our website.

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  • A meno-menu: 6 simple instructions for a healthy diet

    by Margery Gass | Sep 26, 2012
    • Do eat a diet rich in vegetables and fruit. Increasing intake of vegetables and fruits helps meet nutritional and fiber requirements without adding a substantial number of calories. A new study of fruit and veggie intake in midlife and older women shows that the antioxidants in these foods cut their risk of heart attack. Colorful fruits and vegetables tend to be the most nutritious.
    • Don’t add sugar or sweeteners to foods and beverages. Go for naturally sweet options such as fruit daily dietary goals for women at menopause suggest 1 1/2 servings of fruit per day. Keep in mind that many fruit juices are very high in calories. If you drink fruit juices, consider pouring them over a full glass of ice to dilute the calorie load while getting more fluid.
    • Do choose whole grains. While the optimal intake of grains (such as cereal, breads, crackers, rice, or pasta) is 5 to 6 oz, at least 3 oz should be whole grains and for good reason. According to a variety of health studies summarized by the Whole Grains Council, consuming whole grains can reduce risk of cardiovascular disease, diabetes, hypertension, and colorectal cancer, and can also help reduce weight. Yum!
    • Don’t aggravate hot flashes with possible food “triggers” such as spicy foods, alcohol, or caffeine.
    • Do consume fish, especially oily fish such as salmon, at least twice a week. Two servings (about 8 oz) provide a healthy dose of omega-3 fatty acids, which are associated with a decreased risk of sudden death and death from heart disease in adults.
    • Don’t reach for the salt shaker. Reducing sodium intake can prevent or help control high blood pressure.
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  • More Zzzs please: a menopause sleep seminar

    by Margery Gass | Sep 25, 2012
    When a woman’s sleep is diminished, so is her quality of life. It may even be a risk factor for future diseases and breast cancer recurrence after menopause, according to a new sleep/breast cancer study. No matter what the cause of the disturbance -- night sweats, feelings of midlife anxiety -- getting 6 to 9 hours of sleep each night is never easy.

    Improving sleep routine is the key in treating sleep disturbances:
    • Maintain an environment that is conducive to sleep. Think quiet, cool, and dark.
    • Limit use of the bedroom to sleep and sexual activities.
    • Try relaxation techniques. Relaxation-inducing CDs or meditation can help you fall asleep.
    • Abide by the 15-minute rule. Those who don’t fall asleep within 15 minutes should get up, leave the bedroom to engage in relaxing activities elsewhere, and return to bed when drowsy.
    • Follow a sleep routine. Try to wake up and go to bed about the same time every day, even on weekends.
    • Wake up with the sun, if possible. Sunlight helps set the body’s biological clock.
    • Bring back the bedtime snack. While a large, heavy meal before bed can interfere with sleep, a light snack with protein and carbohydrates is recommended. A glass of warm milk may also induce sleep.
    • Avoid stimulants such as alcohol, caffeine, and nicotine throughout the entire day, not just during the evening.  
    • Exercise. Daily exercise may help ease insomnia for many women, but strenuous exercise close to bedtime can have the opposite effect.
    When lifestyle changes fail to alleviate sleep disturbances, a clinician should be consulted to discuss other options and to rule out medical causes of disrupted sleep. Women with serious sleep disturbances may benefit from referral to a sleep center.
    For more information about sleep disorders, check out the 70-page online booklet, Your Guide to Healthy Sleep, from the National Heart, Lung, and Blood Institute.  

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  • Get positive about body image

    by Margery Gass | Sep 24, 2012
    The dictionary defines body image as a person’s perception of their own physical appearance. Body image is formed from a variety of experiences and, while not exclusive to the female gender, it can be a problem for many women throughout their lives. Many things affect how a woman feels about her body -- from puberty to pregnancy to menopause and every media or personal influence in between.

    Menopause may be one such influence. Body image may be affected by the physical, emotional, and social changes of approaching menopause. Menopause at an earlier age caused by surgery or chemotherapy can have an even greater effect on self-perception. Taking steps to improve health will transform and enhance every woman’s sense of well-being and may help create a more positive body image. Need a little motivation?

    Try these simple suggestions to get started:
    • Compliment yourself: Some women focus on their flaws. Instead, they should try focusing on their finer features. Write down a compliment or two and refer to it when you find yourself obsessing about those not-so-favorite traits.
    • Feed your inner self (zero calories!): Engaging in enjoyable activities helps women feel good about themselves. Activities that are social or relaxing or spiritual can help eliminate the stress and anxiety that may keep women critical of their bodies.
    • Exercise tends to make women feel better about their body whether they lose weight or not: A poor body image can lead to emotional distress, low self-esteem, anxiety, depression, and disordered eating. Learning to take care of and love your body is crucial to happiness and wellness.
  • Say no to diabetes at midlife

    by Margery Gass | Sep 21, 2012

    Age and overweight (or obesity) are the most common traits that make someone likely to develop type 2 diabetes, but hormones may also have something to do with it. A family history of diabetes, prediabetes, minority ethnicity (Hispanic, African American, Native American, Asian, or Pacific Islander), high blood pressure, cardiovascular disease or abnormal cholesterol levels, and inactivity also put people at higher risk of developing diabetes. For women, having high blood pressure develop during pregnancy (called preeclampsia), diabetes during pregnancy (called gestational diabetes), or polycystic ovary syndrome raise the risk even more.

    What do the experts say?
    • Get tested. The CDC estimates that more than a quarter of people who have diabetes haven’t been diagnosed. The American Diabetes Association recommends that you get tested every 3 years starting at age 45, especially if you are overweight. The US Preventive Services Task Force recommends that adults with blood pressure above 135/80 be screened every 3 years. If you have some additional risks, such as a family history of diabetes, then you should get tested more frequently.
    • Diet and exercise. Yes! The best way to prevent diabetes is with a healthy lifestyle. The National Institutes of Health sponsored a Diabetes Prevention Program trial that used “intensive” lifestyle training. The participants in this large clinical trial were overweight and had prediabetes. More than two thirds of them were women, and nearly half were from an ethnic minority group. Some got intense training to change their diet, physical activity, and habits with the goal of losing just 7% of their body weight. Another group took the diabetes drug metformin and got standard advice about diet and exercise. A third group got the standard advice only. The modest but focused lifestyle change did more than anything else to prevent diabetes. It reduced the number of new diabetes cases 58% more than standard advice alone. In contrast, metformin plus standard advice didn’t do nearly as well, reducing the number of diabetes cases 31% compared with standard advice. The message is that many people can benefit from adopting such habits.
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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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