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Blog: MenoPause ~ take time to think about it

  • You got your wish! Nonhormonal alternatives have arrived

    by Margery Gass | Aug 12, 2013
    Earlier this year, we asked women whether they thought there was a need for prescription nonhormonal treatments for menopausal symptoms. Overwhelmingly (89%), women said “yes!” We took that message to the FDA. The good news is that now there are two new approved treatment options for menopausal symptoms. Ospemiphene (Osphena) received FDA approval in February for painful sex that can be a consequence of the changes in and around the vagina that can come with low estrogen levels. Then in June, the FDA approved low-dose paroxetine (Brisdelle) for moderate to severe hot flashes. Ospemiphene acts like an estrogen in some tissues, but not others. The major advantage is its estrogen-like activity in the vagina and surrounding tissues, which keeps them supple and moist. It acts on the uterus as well, so you and your healthcare provider need to be alert to any unusual vaginal bleeding. Paroxetine is a name you might have heard before because in higher doses, it’s sold as the antidepressant Paxil. It doesn’t take much to reduce hot flashes, so the dose is lower than that used for antidepressant activity. It carries the same warnings as the antidepressant formula, so be sure to discuss all treatment options with your healthcare provider to determine if it is right for you.

    This is a milestone year. For decades, hormone therapy has been the only medication approved for menopausal symptoms. Now there are choices. We hope this encourages others to conduct research in the field of menopause.
    4 Comments
  • 7 tips for better sex after 50

    by Margery Gass | Aug 01, 2013
    I recently compiled some tips for better sex after age 50 for the Cleveland Clinic—here’s the quickie version of the list:

    1. Practice, practice, practice. Remaining sexually active preserves the physical functioning of your vagina.
    2. Lubricate and moisturize if you’re experiencing dryness.
    3. Don’t be shy—talk to your healthcare provider about any sexual problems you are experiencing.
    4. No libido? Therapy may help. Relationship issues may be related to a lack of desire.
    5. Think your sex life could be better? Talk it through and share your feelings with your partner.
    6. Talk a walk—and do it regularly. Exercise will make you feel and look better.
    7. Try something different. Different sexual positions can make intercourse more comfortable and more interesting.
                    
    For more detailed sexual problems and solutions, read the full article and visit our Sexual Health & Menopause module.

    Go comment!
  • Calcium and vitamin D help hormones help bones

    by Margery Gass | Jul 15, 2013
    Really? The answer keeps changing, but a new analysis from the major Women’s Health Initiative (WHI) trial supports the use of supplements—at least for women taking hormones after menopause.

    The supplements and hormones in the WHI study had a synergistic effect. Women using both therapies had much greater protection against hip fractures than with either therapy alone. These results suggest that women taking postmenopausal hormone therapy should also take supplemental calcium and vitamin D. Although they couldn’t specify how much, authors noted that the benefits seem to increase with increasing total intake of calcium and vitamin D. The dose will depend on keeping side effects, such as constipation from too much calcium, to a minimum.

    That differs from the recommendation of the US Preventive Services Task Force (USPSTF), made earlier this year. USPSTF stated there was no basis for recommending calcium and vitamin D supplements to prevent fractures. But now, with a study this large, there may well be.

    Go comment!
  • FDA approves first nonhormonal hot flash treatment

    by Margery Gass | Jul 03, 2013
    Good news for women who have been waiting for an effective nonhormonal treatment for hot flashes: the FDA has just approved the very first nonhormonal therapy in the history of menopause. We have known for awhile that some antidepressants provide relief from hot flashes, but not one was officially approved for that purpose. The newly approved product will be a lower dose of an antidepressant first approved 20 years ago (paroxetine, brand name Paxil). The lower dose approved for hot flashes is called Brisdelle and will probably be available in November. Women who have not found sufficient relief for their moderate or severe hot flashes from lifestyle measures will now have one more option to discuss with their healthcare provider.

    Until now, hormone therapy was the only FDA-approved treatment for moderate to severe hot flashes. Some women cannot use hormone therapy for medical reasons or simply prefer not to use it. Brisdelle provides another choice. Although it may not reduce hot flashes as effectively as hormone therapy, it will decrease flashes for most women. Like other drugs, it will not meet the needs of every woman.

    Every drug comes with risks and side effects: In clinical trials studying how the drug affected menopausal women, side effects included headache, fatigue, and nausea/vomiting, most commonly occurring in the first week. The label also carries the warning of all antidepressants in this class, that of potentially increasing suicidal thoughts or behavior in the first few months. There is also a possible reduction in the effectiveness of the breast cancer drug tamoxifen if the drugs are used together.

    3 Comments
  • In younger women, HT does not harm cognitive function

    by Margery Gass | Jul 03, 2013
    The WHIMSY trial released somewhat reassuring data last week:  for women ages 50 to 55, using hormone therapy (HT) will neither harm nor benefit their cognitive function.  WHIMSY examined 1,272 Women’s Health Initiative (WHI) participants who were ages 50 to 55 when they began taking HT or placebo and reported on their cognitive health about 7.2 years after they stopped the medication.

    In some ways, this data was disappointing, as it did not support the “window of opportunity” theory that taking HT close to menopause maintains and benefits health. However, this theory does have evidence of benefit regarding women’s risk of cardiovascular disease, coronary heart disease, heart attack, and atherosclerosis.

    Here at NAMS, we counsel that the decision of whether to take HT must be individualized for each woman, considering her overall health, severity of symptoms, quality-of-life priorities, and personal risk factors. We know that the risks of HT use in healthy women ages 50 to 59 are low. In older women, however, HT is associated with greater risks: A related WHI trial (WHIMS) found that HT use in women ages 65 to 79 caused a near doubling of rates of dementia, higher rates of cognitive decline over time, and decreased brain volume.

    The bottom line of the new WHIMSY results is that younger women can be reassured that, if they choose to take HT for their symptoms, it will not harm their cognitive function or cause dementia.

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  • Hot flashes and night sweats before menopause

    by Margery Gass | Jun 17, 2013
    Hear “hot flash” and most of us think of menopause. But reproductive-aged women have them too. How many healthy premenopausal women have vasomotor symptoms (hot flashes and night sweats), and why?

    In women ages 45 to 56 with regular menstrual cycles, about 55% have experienced vasomotor symptoms at some point, shows new research in Menopause. The cross-sectional study examined 1,513 women in the Pacific Northwest. Native American women were most likely to report vasomotor symptoms (66.7%), followed by black women (61.4%), and white women (58.3%).  Asian and Hispanic women in the study were least likely to report ever having vasomotor symptoms (about 8% and 37%, respectively), similar to the patterns during the menopausal transition and early postmenopause.

    Why would premenopausal women have hot flashes? As levels of estrogen go down in the body, numbers of hot flashes go up. Estrogen naturally declines as a woman gets older, especially at menopause. But estrogen levels can fluctuate enough to cause hot flashes years before menopause. Some women have hot flashes right after giving birth. Some may get them from intense exercise or from illness.

    The relationship between reproductive status, general health, hormone levels, age, and vasomotor symptoms is complex and needs further investigation. But rest assured that it is perfectly normal to have hot flashes in the years before menopause. If you are still having regular cycles, these vasomotor symptoms do not necessarily mean menopause is beginning.

    1 Comment
  • It’s not your imagination: menopause memory struggles are real

    by Margery Gass | May 30, 2013
    Memory struggles at menopause are real, showed a study published in our journal Menopause. The study really struck a chord. News stories followed quickly, including two segments on The Today Show. One reason the study got so much attention is that it validated women’s experience. In the first segment on Today, co-anchor Savannah Guthrie interviewed Pauline Maki, PhD, from the University of Illinois at Chicago, who is one of the study authors and a member of the NAMS Board. The message for women, Dr. Maki said, is “You’re a very good judge of how good or how poor your memory is. It’s important that women recognize what they feel can be validated by scientific research, that it's not all in their head.” In the second segment Guthrie interviewed NAMS member Rebecca Brightman, MD, from Mount Sinai School of Medicine, who seconded that message, saying “You’re not crazy. This is real.”

    Dr. Brightman also offered reassurance—this isn’t something you’ll have to live with forever. Other studies have shown that women’s former memory levels usually return after the menopause transition is over, she pointed out.

    While you’re struggling with the problem, try to get enough sleep, because that can play a major role in helping you stay sharp. Use little tricks to help you perform better, such as making notes and lists. And have faith—it’s going to get better.

    The study, “Objective cognitive performance is related to subjective memory complaints in midlife women with moderate to severe vasomotor symptoms,” was published online in May and will be published in the December 2013 print edition of Menopause.
    Go comment!
  • Don’t worry, be (heart) happy

    by Margery Gass | May 21, 2013
    Here’s a pleasant way to lessen your risk of cardiovascular disease: Get happier.

    A 2007 study found that emotional vitality (a sense of enthusiasm, of hopefulness, of engagement in life, and the ability to face life’s stresses with emotional balance) appears to reduce the risk of coronary heart disease.

    If only it were that easy! you say. Are there ways to feel more happiness as an adult woman, fully-formed and set in your ways? The science says yes. It’s never too late to cultivate good mental health, emotional and social competence, and resilience. Tried and true methods include psychotherapy, meditation, faith-based activities, sports, and spending time with friends. Anxiety and depression (as well as happiness and optimism) are forged by both nature and nurture and are only 40% to 50% heritable.

    Finding a way to be in the moment, whether through playing music, practicing a sport, or engaging in any favorite pastime that allows you to lose yourself in the activity can help reduce stress and restore happiness.

    Other ways to be happier:
    • Optimism
    • Creating a supportive network of family and friends
    • Being good at self-regulation (bouncing back from troubles by staying physically active, eating well, avoiding risky behaviors, and knowing things will eventually look up again)
    • Training your brain: buy an attractive little notebook or journal and list the positive things that happen each day. Focus on those as you are drifting off to sleep. We can practice focusing on the positive and get better at it.

    And even if you try to cultivate more happiness in your life and find it’s not helping much, don’t fret, just wait a while: Happiness levels in the human lifespan have a U-shaped curve—people decline in happiness through their 40s and 50s (with the lowest point around age 46) then increase in happiness thereafter. It’s nice to know that scientific research shows that women in their 40s and 50s are going to feel happier as they grow older. Cheers!
    Go comment!

MenoPause: the blog!

Posts to our Blog are written by NAMS staff members and Dr. Margery Gass. All posts are reviewed and edited by Dr. Gass. 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. 

Margery L.S. Gass, MD, NCMP
NAMS Executive Director

An internationally recognized leader in the field of menopause, Dr. Gass became Executive Director of The North American Menopause Society in 2010. Dr. Gass has been an investigator on numerous research projects, including serving as a principal investigator for the Women’s Health Initiative, and has published and presented on a wide range of topics related to menopause, including osteoporosis, sexual dysfunction, and hormone therapy.

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