A new exercise prescription makes it easier than ever to keep your blood pressure under control. And it works better, too, than trying to huff and puff for 30 minutes straight every day. A study of exercise and blood pressure from the Healthy Lifestyles Research Center at Arizona State University showed that walking briskly for 10 minutes 3 times a day was even more effective than one 30-minute session a day at controlling blood pressure. The study volunteers had “prehypertension,” that is higher than normal but not over the hypertension line—but it predisposes people to full-blown hypertension, which can put you at risk of strokes, heart disease, and more. The easy-to accomplish, 10-minute sessions sent the volunteers’ average daily blood pressures down and cut the number of blood pressure spikes above 140/90.

See more on menopause and exercise in our online magazine Menopause Flashes.

Many women use botanical supplements like black cohosh during menopause. In this post, I'm going to briefly summarize research, possible risks, and how to be a smart consumer regarding this herb. Black cohosh (Actaea racemosa, also called Cimicifuga racemosa) is a popular non-drug treatment for menopause symptoms. Evidence about the effectiveness and safety of black cohosh for treatment of hot flashes is mixed: some studies show improvement of menopause symptoms and some show no benefit. There are no long-term safety studies yet, and most are shorter than 6 months. Future black cohosh studies should give us more information about the proper and safe use of this herb.

Meanwhile, there have been over 50 reports of liver damage such as hepatitis and liver failure with use of black cohosh-containing products. Cause and effect is difficult to prove in these situations, but the number of similar reports is concerning. Because black cohosh is harvested from plants grown in the wild, there is a risk of use of the wrong plant species and adulteration with harmful materials from other wild plants. The US Pharmacopeia states that any product containing black cohosh should carry the following statement: "In rare cases, black cohosh has been reported to affect the liver. Discontinue use and consult a healthcare practitioner if you have a liver disorder or develop symptoms of liver trouble, such as abdominal pain, dark urine, or jaundice."

Here at NAMS, we recommend that you buy black cohosh from a reputable company and use it for a short time if it lessens your menopause symptoms. If it is not effective for you, do not use it. The most common side effects of black cohosh are stomach upset and headache.

How can you find the safest source of black cohosh? The US Food and Drug Administration (FDA) is unfortunately not required to inspect supplements. It is up to all of us to look out for our safety when using them. Can seals of approval help? For an interesting discussion of the potential value of seals of approval for supplements, read Kaiser Permanente's message to its members. Additionally, the National Center for Complementary and Alternative Medicine is a wonderful source of accurate information about alternative therapies. I encourage you to check it out. Note that there is an entire section on herbal products entitled "Herbs at a Glance," including specific information about black cohosh. Other excellent resources for consumers are the Office of Dietary Supplements and the FDA's overview of supplements and safety.

A new study about the effect of hypnosis on hot flashes published in the NAMS journal Menopause shows that hypnosis can help cut hot flashes by as much as 74%. One group of women in the study got five weekly sessions of hypnosis where they received hypnotic suggestions for mental images of coolness, a safe place, or relaxation — whatever their preference — and they also got a recording to practice with daily. Their hot flashes were reduced by 74% and their severity was also lessened. 

Another group of women in this study had five sessions with a clinician where they could talk about their symptoms, and they got a CD to listen to daily that had general information about hot flashes. This group reported only a small reduction in hot flashes: 13%.

This study is the best one so far to test the value of hypnosis for hot flashes because it pitted hypnosis against a similar “treatment” thought not to have much effect, similar to the way drugs are tested against dummy placebo pills. We hope to see these results confirmed by other researchers.

Hope you’re not sitting down for this one. Much recent research has explored the harms of too much sitting, at work or at home watching television. Why exactly is it harmful?

When you’re seated, electrical activity in your muscles slows down — especially in the powerful muscles of the legs and lower body. This causes your body’s calorie-burning rate to drop to about one per minute. That’s just a third of the rate you’d reach while walking around.  After just a day, inactivity lowers insulin effectiveness and increases your risk of Type 2 diabetes and obesity. One study of overall sitting time in US adults found that women who sat for more than 6 hours a day had a 40% higher death rate. Another study of television viewing time in Australia concluded that for each additional hour of television a person sat and watched per day their risk of dying rose by 11%. Prolonged sitting was also found to double the risk of diabetes and heart disease — a risk that wasn’t eliminated by regular exercise. Authors of the diabetes study said that the average American adult spends 50% to 70% of their day sitting.

How to fix this? If you have a desk job, get up and take a short, brisk walk every hour. Instead of always emailing, walk around your office to talk to coworkers. Take the stairs and use a restroom on a different floor. If you’re willing to make an investment, there are standing desks for sale (or just pile up books on your desk for a do-it-yourself fix) and even treadmill desks. After work, park a little farther from the store on those errands and enjoy the extra exercise. Rise, shine and start moving!

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.

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.

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. 

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.