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MenoPause Blog

  • 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


    Go comment!
  • 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.

    Go comment!
  • 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.

    Go comment!
  • 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.

    Go comment!
  • 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.


    Go comment!
  • 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.

    Go comment!
  • 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. 

    Go comment!
  • 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!

    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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