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MenoPause Blog

  • 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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  • Immunizations for Adult Women

    by JoAnn Pinkerton | Feb 08, 2017

    We're pleased to have a guest post from Dr. Lisa Larkin.

    Larkin Lisa 2014
    Lisa Larkin, MD, FACP, NCMP, IF
    NAMS Member

    Many adult women are incompletely vaccinated, even though immunizations are an important part of disease prevention and wellness. Barriers to immunization include lack of patient knowledge about vaccination, insurance coverage issues, and shorter office visits that focus on disease management and not disease prevention. Women should educate themselves on current vaccine guidelines, and during their wellness visits with their providers, if immunizations are not addressed, ask their providers whether their vaccines are up to date.

    The Advisory Committee on Immunization Practice (ACIP) sets US immunization practices, and in 2016 an updated immunization schedule for adults was approved, with several notable changes from prior guidelines. The American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), and the American College of Obstetricians and Gynecologists (ACOG) endorse the 2016 ACIP guidelines.

    The ACIP guidelines include these recommendations:

    1. All adults should receive an annual influenza vaccine.
    2. All adults should receive a tetanus booster (Td) every 10 years; one of those boosters should be a booster containing both tetanus and pertussis (Tdap).
    3. A two-series vaccine to prevent human papillomavirus (HPV) infection is recommended for boys and girls between 11 and 14 years old. In adults not previously vaccinated, a three-dose series is recommended for women up to age 26 and for men up to age 21.
    4. Two pneumococcal vaccines are available: a 23-valent pneumococcal polysaccharide vaccine and a newer 13-valent pneumococcal conjugate vaccine. Healthy adults older than age 65 and younger adults with certain medical conditions should receive both vaccines, but not on the same visit.
    5. Vaccination for herpes zoster (shingles) is indicated for all healthy adults older than age 60, irrespective of a prior history of shingles. The herpes zoster vaccine is a live vaccine; pregnant adults and adults with severe immunodeficiency should not be vaccinated.
    6. Hepatitis A and B vaccine is recommended for any adult with specific risk factors for hepatitis A or B (chronic liver disease, men who have sex with men, drug users, healthcare workers) and is appropriate for any adult wishing protection against hepatitis A or B.
    7. Other vaccines, such as meningococcal, Haemophilus, and varicella, are indicated for certain adults with specific risk factors. It is important to discuss vaccination with your provider.

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  • Discussing Sexual Health With Your Clinician

    by JoAnn Pinkerton | Feb 01, 2017

    We're pleased to have a guest post from Dr. Sheryl Kingsberg.

    Kingsberg, Sheryl 2016

    Sheryl A. Kingsberg, PhD
    NAMS Board Member

    Don’t be embarrassed to discuss your sexual health concerns with your clinician. Sexual health is a basic right and is important to your quality of life. If your clinician doesn’t ask, feel free to start the discussion. We address some recommendations on being your own advocate in the new NAMS video, Discussing Sexual Health With Your Clinician. You don’t need to suffer in silence.


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  • Vaginal Moisturizers and Lubricants: Finding Your Way Through the Drugstore Aisles

    by JoAnn Pinkerton | Jan 18, 2017

    We're pleased to have a guest post from Dr. Lisa Astalos Chism.

    Lisa Astalos Chism, DNP, APRN, NCMP
    NAMS Board Member

    Many women experience vaginal dryness to varying degrees throughout their lives. Stress, medications, and the vaginal changes associated with menopause can contribute to vaginal dryness, which may lead to painful intercourse.

    Frequently, women may try to find a remedy for vaginal dryness in their drugstore aisles. It may be confusing for women to figure out what all these products are for or how to use them.

    Vaginal moisturizers are used to moisturize the vagina and may be used on a regular basis, every 4 days or so. They provide moisture around and inside the vagina (if used with an applicator) and help with the ongoing symptoms of vaginal dryness.

    Lubricants are to be used at the time of sexual activity and applied to the vaginal opening and to your partner to provide lubrication and reduce pain associated vaginal dryness. Water-based lubricants are safe to use with condoms; however, they may dry out quickly. Silicone lubricants are also safe to use with condoms and will not dry out as quickly. There are oil-based lubricants, but they can cause latex to become porous, and latex condoms may even rip or tear with their use.

    Vaginal moisturizers and lubricants may be used together, but moisturizers help to reduce vaginal dryness with or without sexual activity. Don’t hesitate to ask your healthcare provider or pharmacist about vaginal moisturizers or lubricants to decide what products are best for you.

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  • Nine Ways to Manage Holiday Stress and Hot Flashes

    by JoAnn Pinkerton | Dec 19, 2016


    Menopause and hot flashes can add unnecessary stress to an already busy time of year. Here are some tips on what you can do to help manage your menopause symptoms during the holidays.

    • Exercise – Physical activity reduces stress and enhances your sense of well-being. It’s one of the best things you can do to help clear your mind and relax. Plus, during the holidays many yoga studios and fitness centers offer great deals on classes. Learn how to fit exercise into your schedule during the holiday season.
    • Avoid Caffeine and Alcohol – It’s definitely harder to do during the holidays, but sticking to herbal teas and non-alcoholic beverages will help reduce hot flashes. Why? Caffeine elevates levels of cortisol, the “stress” hormone which in turn can bring on a hot flash. Plus, alcohol can interfere with your sleep quality.
    • Pamper Yourself – It’s the holidays, you deserve a little relaxing treat such as a massage, manicure, or pedicure. Plus, it’s a great way to step away from the hustle and bustle and focus on yourself.
    • Maintain a Healthy Diet – It’s so easy for a healthy diet to get off track during the holidays. Try to practice the 80/20 rule—eat 80% healthy and 20% holiday and also try to use smaller plates. Learn the benefits of eating a well-balanced diet during menopause.
    • Sleep – Getting adequate sleep is so important at any time of your life, but especially during the holidays. If you are well-rested you are less likely to feel the need to fill up on caffeine and sugary treats.
    • Dress in Layers – So when a hot flash hits, you can easily cool down by removing layers like a sweater or jacket during your holiday event.
    • Keep a Cool Drink Nearby – It never hurts to be prepared by having a cool drink of water or sparkling juice close by when a hot flash occurs.
    • Laugh – Take time to enjoy the events to come, laugh and smile with friends and family. A good laugh can instantly reduce stress and make you feel better.
    • Deep Breaths – When stress is at its highest, stop and take a deep breath. This will help you focus and reduce stress. View our breathing techniques to get started.

    Just remember, take time to relax and enjoy the spirit of the season. 

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  • Obesity and Menopause: A Growing Concern

    by JoAnn Pinkerton | Dec 14, 2016

    We're pleased to have a guest post from Dr. Gloria A. Richard-Davis.

    Gloria A. Richard-Davis, MD, FACOG, NCMP
    NAMS Board Member

    Obesity is an epidemic and a serious US public health concern. The prevalence of obesity, which is closely associated with cardiovascular risk, increases significantly in American women after they reach age 40; the prevalence reaches 65% between 40 and 59 years, and 73.8% in women over age 60.

    According to the Healthy Women Study, the average weight gain in perimenopausal women was about five pounds; however, 20% of the population they studied gained 10 pounds or more. Not only is the weight increase from a drop in estrogen but it’s also because of a decrease in energy expenditure. Some women may notice an overall weight gain, whereas others may not see a difference on the scale but may notice that their pants aren’t buttoning as easily. Both are surprising to many women because they may not notice a difference in their dietary intake or activity.

    The reasons for increasing obesity in menopausal women are not clear. Some researchers argue that the absence of estrogens may be an important obesity-triggering factor. Estrogen deficiency enhances metabolic dysfunction predisposing to type 2 diabetes mellitus, the metabolic syndrome, and cardiovascular diseases. Estrogen plays a vital role in fat storage and distribution. Before perimenopause, estrogen deposits fat in your thighs, hips, and buttocks. During and after menopause, the drop in estrogen leads to an overall increase in total body fat but now more so in your midsection. Studies have consistently shown that this waistline increase is different from when you were younger. An increase in visceral (abdominal) fat is linked to an increase in insulin resistance, diabetes, and inflammatory diseases.

    Another factor contributing to weight gain in perimenopause may be the increased appetite and calorie intake that occurs in response to hormone changes. In one study, levels of the “hunger hormone” ghrelin were found to be significantly higher in perimenopausal women compared with premenopausal and postmenopausal women.

    The low estrogen levels in the late stages of menopause may also impair the function of leptin and neuropeptide Y, hormones that control fullness and appetite. Therefore, women in the late stages of perimenopause who have low estrogen levels may be driven to eat more calories and store fat.

    Make weight gain a modifiable risk factor

    So, you may be thinking—I’m destined for failure! But this isn’t true. Although the risk of weight gain as a middle-aged woman is higher, this does not mean that it is required. It does mean that we may have to work a little harder to prevent this from happening. It is important to keep in mind that many of the health risks found in the menopause transition are also affected by weight. If we are able to keep a healthy weight, or at least minimize any weight gain, then we are likely to minimize these additional health risks. Now that you know the risks, here are some ways to stay healthy during this midlife transition and avoid a midlife crisis:

    • Reduce calories. During menopause, our energy expenditure decreases even if our activity level and nutrient intake stays the same. This is secondary to the hormone changes with menopause as well as the natural muscle loss that is occurring. We need about 200 fewer calories in our 50s than we did in our 30s and 40s. This means that we’ve got to move more and eat less to keep our healthy weight. To help decrease portion sizes, try splitting your meals with a friend, ordering the lighter portion when available, or put half in the takeout box right away. Swap out dessert for fruit or yogurt.
    • Reduce carbs. Cut back on carbs in order to reduce the increase in belly fat, which drives metabolic problems
    • Add fiber. Eat a high-fiber diet that includes flaxseeds, which may improve insulin sensitivity.
    • Work out. Engage in strength training to improve body composition, increase strength, and build and maintain lean muscle. The American Heart Association recommends 150 minutes of moderate exercise per week. Add ANY activity to your day. Strength and resistance training help maintain bone mass. This will help to prevent osteoporosis, which is bone loss that can lead to easy fractures.
    • Rest and relax. Try to relax before bed and get enough sleep in order to keep your hormones and appetite under control.
    • Get support and learn to cope without food. Many women (and men) admit to eating under stress. And, let’s face it, middle age can bring some tough times. Children are often departing from the home, and some are returning. Your parents now need more help and guidance. This can be disruptive to our everyday lives. Focus on using nonfood stress relievers. Try going for a walk, deep breathing, or scheduling some “me” time with your favorite book to unwind. Seek out support from friends and loved ones who may have gone through a similar situation.

     Get moving and stay healthy through menopause and in later life!

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  • Contraception for Perimenopausal Women

    by JoAnn Pinkerton | Dec 05, 2016

    We're pleased to have a guest post from Dr. Andrew Kaunitz.

    Andrew Kaunitz, MD, NCMP

    NAMS Board Member

    Much confusion surrounds contraception (birth control) for perimenopausal women. Before getting started with specific methods of contraception, let’s start with a few definitions:

    • Menopause refers to the permanent cessation of menstruation; the average age of menopause is approximately 52 years.
    • Perimenopause refers to the years of transition from regular menstrual cycles to menopause. The transition tends to begin sometime between a woman’s mid-40s and her early 50s. For most women, the first sign of perimenopause is that menstrual cycles become less predictable; skipped cycles or more frequent cycles are common. A second common symptom of perimenopause is the occurrence of hot flashes and night sweats that may come and go.

    Although the likelihood that a perimenopausal woman might become pregnant is lower than for younger women, pregnancy can and does occur in women who are in the of this transition phase. Few of my perimenopausal patients wish to become pregnant. Furthermore, pregnancy in women in their late 40s or early 50s is often associated with increased health risks for the mother and the baby. For these reasons, contraception is important for perimenopausal women.

    Although barrier contraceptives such as condoms are notoriously ineffective for younger women, perimenopausal women who are motivated to use condoms consistently may have more success with this over-the-counter contraceptive method compared with their younger counterparts. After all, as we get older, we become more disciplined regarding many activities, and that can include condom use.

    Another factor reducing the failure rate of condoms in perimenopausal women is that women undergoing the transition are less fertile than younger women. In addition to birth control, condoms protect women against sexually transmitted infections. Having acknowledged that perimenopausal women can use condoms effectively, I must also acknowledge that few of my patients in the transition are interested in using this approach to birth control.

    What about birth control pills (which contain estrogen and progestin)? Although many women believe that the pill should not be used for more than 5 to 10 years, in fact, there is no time limit applicable to duration of pill use. Furthermore, use of the pill (along with the birth control patch and vaginal ring) has particular benefits for perimenopausal women. The irregular bleeding and hot flashes that commonly accompany the transition are prevented by using the pill, patch, or ring. In addition, the decline in bone mineral density often associated with perimenopause is prevented by use of the pill. Finally, perimenopausal women who use the pill long term will experience a significantly lower risk of ovarian and uterine (endometrial) cancer.

    It is important to be aware, however, that some perimenopausal women cannot safely use the pill, patch, or ring (each of these methods contain estrogen and progestin). Specifically, older reproductive-aged women who smoke; have hypertension, diabetes, or migraines; or are obese should not use these estrogen-containing methods of birth control.

    Older reproductive-aged women who are doing well on the pill can continue until menopause. Rather than checking hormone levels, a practical approach is to continue until age 55. At that time, the likelihood of menopause is very high, and then a woman can simply stop the pill, or if she prefers, transition to hormone therapy.

    In the last decade, more and more US women who are using contraceptives are using intrauterine devices (IUDs) and the contraceptive implant—these methods are more effective and convenient than condoms or the pill. Furthermore, because IUDs (hormone-releasing models as well as a copper IUD are available) and the implant do not contain estrogen, they can be used by women who are not good candidates for the pill, patch, or ring.

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  • All About Dem Bones and Truth About Calcium

    by JoAnn Pinkerton | Nov 16, 2016

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

    Nanette Santoro, MD
    NAMS Board Member

    We just celebrated my mother-in-law’s 90th birthday with a big family party. My mother-in-law has Paget disease of the pelvis and had been taking Fosamax for about 10 years when her doctor had her go on a “drug holiday.” That was about 3 years ago, and her bone density has been relatively stable since. Paget disease of the bone affects up to 10% of women older than age 80. It causes excessive bone resorption, but as opposed to the much more common postmenopausal osteoporosis, this process happens only in selected areas of certain bones.

    To understand both of these problems, it’s important to understand how bones are made, and how they are maintained. The processes of bone formation and bone resorption are coupled to each other. When all is well, and growth has ended, bone is formed at a rate exactly equal to the rate at which it is resorbed. These two processes are happening at different areas of the bone, but over time, bone remodeling occurs. When these processes are in perfect alignment, they keep bony tissues healthy throughout the body. I think of it like a highway repair system: work teams do surveillance and fix the potholes and cracks periodically, maintaining the integrity of our roads.

    After menopause, the loss of estrogen may lead to a slight excess of resorption over formation, but both processes are still ongoing. The net effect, over time, is bone loss. If the bones were relatively weak to begin with or resorption is happening rapidly, a woman will develop osteopenia or osteoporosis. These conditions differ only in degree, with osteoporosis being the more serious condition. They are important problems, because thinning bones can lead to a greater risk of fracture. Elderly women are typically terrified of fractures, and rightly so. Hip fractures are a common cause of death in the elderly and a frequent reason for a loss of independent living.

    The bisphosphonates were a breakthrough in the treatment of osteoporosis and osteopenia in postmenopausal women. By inhibiting osteoclasts, they decrease resorption. By decreasing resorption, they bring the equation of formation = resorption toward zero, slowing bone loss. Bisphosphonates were one of the very first nonhormone tools that could control bone loss in menopausal women. Their safety record was awesome for about 15 years. If you didn’t get heartburn, and your kidneys were healthy, they appeared to have very few contraindications and virtually no complications.

    Over time, the use of bisphosphonate drugs increased, and doctors began questioning why we should wait until women had osteoporosis to treat them for bone loss. After all, there were no known drugs that could actually increase bone formation—all we could do was stop women from losing any more. If we waited too long, we would miss women who had already developed severe osteoporosis before we ever screened them. Why not screen and treat earlier? Only a few dissenting voices could be heard among the enthusiasts. Typically, these were the doctors who had done the most research on the science of bone. They appreciated the see-saw equation of formation and resorption and worried that if you inhibited resorption, you would also inhibit formation and over time would reduce or even halt bone turnover, a condition called adynamic bone.

    There wasn’t much attention paid to this until the reports began to accrue about just this type of fracture. The initial information was reported by dentists, when women who were taking bisphosphonates and had jaw fractures or dental implants or other procedures that involved bone growth for proper healing did not heal. Then the femur (thigh bone) fractures started to appear. These fractures are usually found in women who have taken the highest doses of medication for the longest time.

    On the way to my mother-in-law’s party last weekend, two good friends, a married couple, were walking from the parking lot to the restaurant, and the wife tripped on the sidewalk . . . and broke her hip. My friend, whose mother has severe osteoporosis, had been treated with Fosamax for more than 10 years. She suffered a hip and femur fracture and just had her bones set. Unluckily, she has developed adynamic bone. They are predicting a long recovery.

    So what are the lessons we can learn from my mother-in-law and my friend? First of all, it’s a great idea to do everything you possibly can to avoid having to take a medication for osteoporosis. Make sure you are taking enough calcium (the National Osteoporosis Foundation Website has the calcium content of most foods on it—I find it very handy: www.nof.org). It’s best to get calcium through the diet. Recent studies indicate that women who take lots of calcium supplements might be at a slightly higher risk of heart attacks. Women should aim for about 1,200 mg of calcium a day. It’s important to remember that your body won’t absorb all of your daily calcium in one meal—so most of the time, calcium should be taken with food, and if you are taking in more than 600 mg, it’s unlikely that you will absorb the excess.

    Weight-bearing exercise is a terrific preventive. Forty-five minutes a day, most days of the week, walk, run, or do step aerobics. Swimming and biking won’t do. Make sure you are getting enough vitamin D. If you hate milk as much as I do, this means you may need a supplement—vitamin D3, 1,000 to 2,000 units a day, is plenty for most women. Get a bone density checked, especially if you have risk factors or relatives with osteopenia or osteoporosis. Even if you have no risk factors, it is recommended that ALL women get a screening bone density test by age 65. A shout-out to women of color: don’t assume you can’t get osteoporosis. Darker skinned women tend to have lower levels of vitamin D, and this factor can combine with other osteoporosis risk factors to cause the disease.

    Finally, you should know your own risks for fracture. The FRAX algorithm factors in a number of factors that influence your fracture risk (www.shef.ac.uk/FRAX/). It’s one thing to worry about bone density, but thin bones won’t break unless you fall. Preserving muscle strength and balance will help prevent a fall, as will making your home safer by avoiding common household hazards. Area rugs, slippery steps, and bathroom mats should all be addressed. Shower rails can be installed inexpensively.

    Hope this is helpful. Gotta go. Just ate my yogurt (400 mg calcium), took my vitamin D3(2,000 IU), and am suited up for a run.

    Go comment!

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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