There are now new guidelines regarding the frequency of mammogram screening, and yes, this debate continues to go on!
These recommendations however, are backed by most professional medical organizations. The American Cancer Society agrees, and that carries a lot of weight.
These newest recommendation apply to women of low risk, and include starting age 45 instead of 40; and having a mammogram yearly until 55 yrs of age. At this point, women are recommended to have a mammogram every other year until within 10 yrs of life expectancy (when the average woman dies); then they can stop. The new recommendations recommend against monthly self breast exams, and against your medical provider doing breast exams.
If you are at high risk, ie have a family history of breast cancer or a personal history of cancer as well as some unhealthy life style practices; you are recommended to discuss your screening with your provider.
- In other words, if you have had a sister, mother, daughter with breast cancer; you are at higher risk and need to be screened more regularly and start a little earlier.
- If you have had any other cancer, you are considered at risk for future cancers from other sites; so you are at higher risk.
- If you smoke, drink more that 10-14 alcoholic drinks a week (ie 12 oz beer, 5 oz wine, 1-1.5 oz liquor), are in the obese weight category, and are not active; you should get regular screening.
Many providers, myself included, do not agree with the lack of provider breast exams. I personally, will not give that up in my clinical practice. A lump is a lump and how are you going to know it is not cancer unless it is found and evaluated?
The reason for this shift in recommendations involve trying to minimize aggressive and fear inducing procedures and treatments for abnormalities that ultimately are benign or so slow growing they will not impact longevity. Cancer occurring in the 40′s and early 50′s are felt to be more aggressive and faster moving.
One major and important organization, the American Congress of Obstetricians and Gynecologists do not agree with these new recommendations.
They feel screening should begin at age 40 and continue yearly, no end point specified. They still approve of self breast exams and yearly provider exams.
What do I, as a provider, recommend? Somewhere in the middle.
I do agree with yearly exams in the 40′s and 50′s. As stated above, if I see a woman for a yearly female exam, she is getting a breast exam. Self breast exams are fine every other month or so. It is probably ok to skip a year here and there with mammograms if someone is low risk. If a woman has no family history or personal history of cancer, but her healthy habits are not good; I will recommend yearly mammograms. I feel it is likely safe to stop screening in the late 70′s for most healthy women who expect to live well into their 80′s.
This is my take on the new recommendations. Let me know what your experiences, questions and thoughts are!
What do you consider most important health factor that will enable you to continue to live life the way you want?
For some of us, it is to have a sharp mind to continue with the creative pursuits we want to engage. Our brains and creative process are the most part to us. We then hope our bodies are healthy enough to carry those minds around for a while.
For others it is to have the energy and strength to be as physically active as we want.
There is no doubt however, a healthy heart is needed for both types ways of living. It turns out that quite possibly striving for a healthy cholesterol profile may not be enough for menopausal women!
A recent study out of the Univ. of Pittsburgh School of Public Health reveals that having a high HDL cholesterol can cause cholesterol plaque, just as the bad LDL can. This study followed 225 women in their mid to late 40′s for 9 yrs. They were determined to be clear of cardiovascular disease at the beginning of the study. It was noted that the women with higher HDL levels as they transitioned through menopause had a greater number of cholesterol plaques formed that the other participants. The researchers theorize that the changing levels of estrogen affects cholesterol metabolism, but they admit they do not know more than that.
We have been taught for years that having a high HDL, or “good cholesterol”, is protective against heart disease. We do not know all there is about cholesterol and how it is metabolized, but this small study would indicate that a lot more has to be determined before we have a clear picture or the final word on cholesterol and aging.
What can we women do in the meantime to protect our hearts?
We can improve all the other potential risk factors we may have for heart disease.
- Consume a diet low in animal fats, trans fats and saturated fats. Increase healthy plant based fats
- Decrease and eliminate processed starches, sweets and packaged foods. Studies have suggested that when saturated fat is consumed with processed starch (think chicken biscuit, pastries, fast food meals) more harm is done than consuming saturated fat by itself. Having said that, you still need to LIMIT the saturated fat you consume.
- Stop smoking or using nicotine products. Nicotine basically inflames the walls of blood vessels, allowing cholesterol particles to adhere and gather.
- Exercise in any way that is enjoyable and tolerable for you. Moving helps metabolize food energy so it is used, not floating around looking where is will live.
Talk with your medical provider about your cholesterol profile and how it may impact your health. There is a relatively new way of analyzing cholesterol called the NMR lipoprotein. This technology looks at the particle size and count of both good and bad cholesterol. We all make different sized cholesterol particles, and the more yours are large, the less likely they can stick to the walls or arteries and create plaques.
Until we know more about cholesterol, do what you can with your habits. This way you can be more active, creative, influential, involved, thought provoking and connected for many more years!
Like many of us, I am constantly trying to tweak my health habits to improve health, weight, and energy. As I look at ways to improve my diet, one thing has become clear to me.
The importance of preparing your own meals.
Luckily, many stores can provide us with healthy alternatives in the form of organic produce, eggs and meats from animals raised humanely and feed quality nutrition.
When looking at nutrition that is optimal, the safety and quality of many commercially prepared version of foods is often questionable and inferior to what we can prepare at home. We put a lot of trust into food manufacturers and regulatory powers overseeing the health of additives used by large food corporations. In many instances, they have done a good job, but there may be a myriad of ways that these chemicals may affect us that have not adequately been looked at.
Take the example of high fructose corn syrup.
This was felt at one time to be a healthy additive that improved commercially prepared foods. We now understand how this item has contributed to obesity. The chemical makeup of HFCS causes it to be metabolized differently in the body, contributing to diabetes, liver disease. The shear volume of sugar hidden in foods with HFCS adds calories that our brain does not necessarily acknowledge, preventing us from feeling full. Contrary to industry claims that sugar is sugar; this form of sugar does not act like regular table sugar. If you are interested in reading more about this, Mark Hyman is a well recognized leader in nutrition and integrative health.
While organic foods may be more expensive, you may find that you can eat less and still afford the better quality food. Plan some time over the weekend or your off days, to prepare some meals and dishes. You will be happier knowing what has gone into your food and may even notice a change on the scales!
How comfortable can we really be handing over control of the quality of our meals to total strangers?
You may have heard in the new recently, that a recent study on Vitamin D did not show any benefit for bone health in post menopausal women.
I want to point a few things out however, before you stop your supplement, thinking it is not doing any thing.
- This study was done in a small group of women.
- It only last 1 year.
- It compared women taking 800 IUs of Vitamin D3, and those taking 50,000 IUs of Vitamin D3, and women taking a placebo.
The study did show there was greater absorption of calcium in the high dose supplement group, but it did not show any increase of bone density or muscle mass. Additionally, the sit-to-stand test was also unchanged.
It is important to understand that this study was only done for a year, and this may very well not be long enough to see a change of bone density. And it was done on a small sampling of women.
It is also important to understand that levels of Vitamin D above 30 ng/ml is felt to have benefit for muscles, brain, colon. You may not need 50,000 IUs, but I still adhere to a daily 2,000 IU tablet.
It does seem that small studies are released regularly with conflicting information. What is important to remember, is that we need strong bones that won’t break when we fall. We need strong muscles to give us strength, stability and balance; to help prevent us from falling.
We can accomplish this with a diet high in calcium and Vitamin D, supplement when our diet is lacking these important nutrients. And we can further help ourselves by exercising both aerobically for our hearts, and strength training for our strength and balance.
We likely enjoy the actions that cause our weight gain, eating tasty food and lots of it. Or maybe it feels like the only way to get in nutrition; we are busy so we reach for fast food, convenient food or even quality restaurant food. It all tastes good. Of course, that is the point of the food industry. Keep us coming back for more.
The problem is that most of our health issues start with weight gain. And stress, with the associated behavior changes that come with stress. Smoking, eating, drinking, not sleeping, and probably not exercising.
So the question is how do you want to live your life? And what are you willing to do to achieve this?
You may not feel empowered to make the changes needed to avoid illness and disease that your genes may predispose you to. Or you feel it is inevitable. You may not feel you have the time and energy, or deep down, deserve the time and energy to devote to yourself. It could be a combination of all or none of these reasons. Granted there are many exceptions to this, diseases that a life style change will not prevent or treat. Or it feels too late and medications are needed to improve and prolong life.
Most likely your medical professional has not devoted the time to talk with you in depth about diet; they may not even be very well trained in this themselves. Add to this, the confusing internet barrage of diets promising a quick fix. This is why the drug industry has become “big pharma”.
But most of it starts with weight gain.
Weight gain causes inflammation and a host of hormonal responses that makes it extremely difficult for the body to maintain its balance. As a result, systems start to malfunction, causing production of other substances that more profoundly affect the balance within our body. This can even set us up for cancer.
If you want to avoid all this, it is not too late. But you do have to change, and maybe change big-time; but not necessarily all at once.
Some simple rules to live by:
- Eat 3 meals daily, starting with a lot of protein at breakfast. Eat enough to space meals 5 hrs apart at least; and do not snack. If you must snack, make it healthy.
- NO SUGAR, or anything that acts like sugar when you eat it. This includes processed foods with any sort of fructose corn syrup or any syrup, agave, honey, sugar. No white rice, white potatoes, white pasta, white bread, white tortillas, snacks like pretzels, chips, cookies, cakes, pies, candy etc. No biscuits, donuts, bagels. They are all compressed white flour and are the equivalent to sugar in your body and brain.
- Get 7-8 hours of sleep at night. I cannot stress how important this is. The hormones that regulate your appetite and food metabolism are actually to some degree, secreted and regulated at night. Not sleeping interferes with this.
- Do not eat after dinner. Your liver needs a rest from all of this food metabolism and giving your body a 12 hr fast during the night helps it to work at producing the right hormones at the right time. This is also why not snacking helps.
- Get rid of as much stress as possible. I know this can be a hard one. You have one life to live and your life would be so much better if stress were reduced. Some things we cannot get rid of, but we can change how we react. Look into meditation, even 5 minutes a day is beneficial. Exercise helps to reduce the stress hormone cortisol, which contributes to the unhealthy cascade that aging can bring. And sleep of course, helps reduce stress as it places parts of your brain in standby mode, helping to reset certain functions.
Ok, this all seems overwhelming perhaps.
Pick one item on the list above and work on it for a month or so. Figure out what will work for you. Then start on the next thing. You do not have to do it all at once, but you may notice a curious affect. When we change one habit for the better; sometimes other habits change without us really making an effort.
It is up to you, but I am here to help. Trust me, I have seen it, done it, lived it; and to some degree successfully changed it. Contact me with questions, and consider contracting for some coaching time if you are stuck and need help.
All this change may seem hard, but it is really not hard once you start taking steps.
Last week I gave you all some links sent to me by the NIH to help women come to terms with the possibility of heart disease. What is it you need to know about to determine if you need to be worried?
Here are some of the basics.
1. What is your blood pressure, glucose, and cholesterol? These 3 things are the early warning signs of potential harm to your heart and blood vessels.
An elevated blood pressure occurs for a variety of reasons but basically the blood vessels are too narrow and the heart has to work harder as a pump to get the blood to flow through and make it to the organs. The heart over time can enlarge, and not work as effectively.
An elevated glucose causes problems with the walls of the blood vessels, making them less healthy, inflamed and eventually not effective as conduits for the blood flowing through.
Elevated bad forms of cholesterol can infiltrate into the lining of the blood vessels, causing blockages. These can eventually rupture, causing a complete blockage. When this happens in the brain, it is a stroke; in the coronary blood vessels it is a heart attack.
2. What are your genetics for heart disease? In other words, have many family members had early heart attacks and strokes?
Having a strong family history of heart disease indicates there is a tendency to inflammation in your blood vessels that contributes to poor health of arteries. This genetic predisposition may include diabetes, high cholesterol, high blood pressure.
Having a family history does not mean you are fated to have an MI or stroke, but it does mean you need to be very careful what you do in terms of lifestyle and habits. You can avoid the fate of your genes with careful living.
3. What are your health habits? Yes, yes; this is what we medical people preach about day in and day out!
It is the one most important modifiable action you can take however, which is why we stress healthy habits so much. You have the power to change the fate of your genes!
Exercise helps the heart get a good work out, it exercises the muscle and gets the blood flowing all over your body. It uses up the excess calories you may have eaten. It lowers cortisol levels that are elevated in most of us due to the stress of our lives. This lower cortisol following exercise causes the muscle layer around the outside of the blood vessel to relax a little, making the tube a little wider and easing the heart from having to pump so hard. The idea is for your heart to work hard during exercise, and not all the time. Additionally, exercise helps your liver make more of the good cholesterol which then helps the body get rid of the bad cholesterol.
A healthy diet low in animal fats, trans fats, and saturated fats that come from fried foods, packaged and processed baked foods; helps to keep cholesterol lower and inflammation in the blood vessels lower. Then the cholesterol flowing through your blood stream doesn’t have as much inflammation to latch onto, creating a plaque or potential blockage.
Lowering sugar in the diet also helps reduce inflammation, avoid diabetes with its’ destructive actions; and helps with weight.
Sodium is a major contributor to high blood vessel for many people through retention of fluid and tightening to the blood vessel walls, making them more narrow.
Maintaining a health weight reduces the amount of blood vessels your heart has to pump blood too, as fat needs blood vessels also. There is less mileage that the heart has to pump blood through. The actions that it takes to maintain a healthy weight also helps the heart, and is described above.
Do you smoke cigarettes or use nicotine products? Nicotine contributes to heart disease mostly through the inflammation and disease to blood vessel walls. Nicotine also contributes to tightening of the blood vessels, making them more narrow. The inflammation and narrowing then helps cholesterol do its’ bad thing with blockages.
Do you get enough good quality sleep? Hey, everything has to rest! Sleep helps aid in repair of the body, lowering of inflammation, mobilizing excess fluid.
OK, quick tips:
- Instead of frying foods, saute in a little olive oil or other healthy oil
- Add very little salt to food, use other seasons like pepper and herbs, spices
- Get out and move every day, figure out a way this will work for you
- Get a good nights sleep, work on sleep habits to aid this occuring
- ditch the sodium, nicotine products, fast foods, fried foods, fatty meats. Make them a rare occurrence
- decrease sugar, white starches like bread, pasta, potatoes, rice; as they basically act like a big dose of sugar in the body
- limit alcohol and caffeine products to a healthy consumption
- have your glucose, cholesterol and blood pressure monitored regularly and talk to your provider about what to do to reduce them if they are elevated.
Think about it, the only rest your heart gets is between each beat. Not to scare you, but that muscle keeps going, all the time. Why would you not be kind to it, protect it, pay attention to it?
We never really thought about our hearts when we were younger, did we?
Aside from the issue of love and relationships, we have pretty much taken our hearts for granted all these years. Until it starts palpitating, jumping wildly around in our chest for no reason.
Now we are paying attention.
We may feel like someone who never remembers to have the oil changed in their car until is starts stalling or hesitating.
The good news is, it is likely not too late-depending on how much you have abused your body with bad habits. It is certainly never too late to improve a few things.
We have to realize that we are at risk for a heart attack or a stroke at this age of menopause, just like all the men we know, care about and love.
Take some time at your next medical appointment and talk about your heart health and how you can preserve or improve it. Along with some helpful tips and information from the NIH included in these brochures, you can think about ways to start the conversation with your provider.
Both of these links have pdf forms you can down load and print, give it to a woman you care about who may still be ignoring their heart. Help spread the word that we women are at much at risk for heart disease, stroke or heart attack as men. This is one area we have equality, whether we want it or not!
Breast cancer is scary, no getting around it. It is especially scary when we know someone who has struggled with it.
Mammograms are painful, more painful for some of us than for others. Add pain to fear, and it is no surprise many of us avoid the ordeal all together.
The most current recommendations for mammogram screening recently published by the USPSTF call for women to have screenings begin at age 50 and occur every other year. Beginning screening at 40 is at the discretion of the individual, taking into account their concerns and risk factors. These recommendations are contrary to the American Cancer Society, and the American College of Obstreticians and Gynecologists(ACOG).
One in six women with develop breast cancer in their 40′s, and there has been a 35% drop in breast cancer death since the mid 1980′s. This coincides with the regular use of mammograms for breast cancer screening. It is no wonder the two most learned medical societies on the subject do not agree with these recent recommendations.
When you are at higher risk for breast cancer, avoiding your mammogram is not really a good option. Sure, it is your choice to not get a mammogram. If you are at risk though, and you cannot change that risk; doesn’t it make sense to be proactive? To catch something before it is a big problem?
Avoiding the problem will not make it go away, but it may make the problem more profound when it lands on your doorstep.
Sure, there is a lot of confusing information about the benefit of mammograms. Many screening tests can bring up abnormalities that need to be evaluated, and are found to be benign. So now we have pain, fear, and extended fear over a false positive mammogram finding. I understand the desire to avoid testing all together.
There are steps you can take however, to help avoid some of the pain and some of the fear.
1. If you are at high risk for breast cancer, talk to your provider about having an MRI performed instead of mammography. It is more accurate, and less painful; but unfortunately not always covered by insurance.
2. If you have dense breast tissue but do not qualify for MRI, get a 3D mammogram. It is more accurate in looking at abnormal appearing dense breast tissue.
3. Bring a friend to your screening test to give you emotional support.
4. Decrease your risk factors: cut down on alcohol, exercise and optimize your weight, stop smoking, reduce the consumption of toxins in your water and food.
It is often women with several family members with breast cancer that are most fearful, for good reason. If you know someone like this who avoids screening altogether, lend them your support. Encouraged them to get a mammogram, it could ultimately ease their minds!
How can we get back to the days where we got in bed, fell asleep, and didn’t wake up until morning?
I bet for many of us, this is a distant memory. As we get older, many of us will do whatever we can to fall asleep. The National Sleep Foundation recently revised the recommended hours of sleep we all need at the different stages of our lives. Adults are recommended to get 7-9 hrs, nightly!
There is a lot we can do to improve our sleep without taking medications. First though, you have to decide that your sleep is a priority; not something to fit in at the end of the day!
We are all busy, and our modern conveniences has made us even busier. Add to that the constant connectivity that some of us want, others of us are expected to have. Many a job does not allow a 9-5 mentality, we are expected to answer emails late into the night. For some of us working for a company that is world wide, we have to be available late into the night for time zones behind us, then early in the morning for time zones ahead of us. Or is it the other way around! This hardly seems sustainable.
Constant sleep deprivation can be harmful to our health. A lot of repair to our body occurs while we sleep, sort of like a computer going to standby, scrubbing out unnecessary bits of broken information. In addition, good sleep is essential for healthy weight control through a series of hormones that are secreted while we sleep. None of us want to gain weight much less acquire the inflammatory conditions and diseases that obesity and insulin resistance place us at risk for.
So it comes down to making choices and setting boundaries as best we can.
- Your may not be able to be on many committees or groups as you would like, limit them to what you can reasonably do
- With a job that requires out of office email answering, talk to your supervisor about setting time limits. You can “on” 24/7 more when you are young, but it takes so much more out of you after 40 or so. It wears you down
- Set a plan for relaxation at night an hour before you want to fall asleep. This hour should be void of ALL electronics. Read an old fashioned book, or listen to music and daydream.
- Do the obvious dietary things: avoid caffeine after noon, don’t eat late at night, limit alcohol as this causes a rebound awakening when the alcohol wears off, sugar and big desserts can undermine sleep with the glucose rush
- Exercise helps tremendously with sleep, done any time of day except within a few hours of bedtime for some people
- Keep lights low and sound low to help the sleep center of your brain secrete melatonin, which quiets the awake center
Medications can certainly be helpful with sleep, but many of them do not mimic the normal sleep cycle. You may be asleep, but it may not restore you like a natural sleep does. Many of these medications are also habit forming and addictive. There is some rebound insomnia next night after use, and sometimes some depression the next day after using Ambien, Lunesta, or Sonata. These meds can be helpful for those rare instances when you must ensure a quick sleep induction, but regular use can be a slippery slope.
Certain times of our lives can contribute to sleep problems, but working on healthy sleep habits and limited use of sleep medications can get you through these years without undue deprivation or overuse of medications.
Follow the tips I have listed above and let me know how it works out. Better yet, send me some of your own tips.
I personally find taking a relaxing shower and getting in bed with light reading and a cup of decaf tea, 30-45 minutes before I feel I need to fall asleep; works 75-85% of the time. Having gone through menopause and sleep deprivation rivaling having a newborn, that is good enough for me!
We women deal with many physical and emotional changes during and after menopause. Some of these changes can take a real toll
on our relationships, including our sex life.
To complicate matters, it’s often difficult to find straightforward,
trustworthy information about how to deal with issues like changes in our
libido, pain during sexual intercourse.
That’s why I’m excited to share with you that Vibrant Nation, the leading
online community for women 45+, is having its first ever Live webcast
discussion, Sex After Menopause. On March 31, 2015 at 1:00pm EST,
Vibrant Nation sexual health expert and blogger Dr. Barb DePree will lead
a panel of women in sharing their stories and advice for getting that spark
back in the bedroom.
Disclosure: I am participating in a Vibrant Influencer Network campaign. I
am receiving a fee for posting; however, the opinions expressed in this
post are my own. I am in no way affiliated with Pfizer and do not earn a commission or percent of sales.