Archive for Menopause


Mammograms and Fear: is avoidance an option?

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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!

Categories : breast cancer, Menopause
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Quality Sleep:why we need it and how to get it

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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!


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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.


How Rainbows Relate To Your Health

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Spring is around the corner and so are fresh fruits and vegetables, the farmer’s market; and sunshine!

After spending a week in a cold NYC at the recent Integrative Health Conference, I am ready! I usually go once yearly for my shot of motivation on improving diet and life balance. After many years of going to this conference, it has become ever more clear that a healthy diet, activity and stress reduction are powerful medicines against illness.

It is increasingly talked about in medical and health news, that eating a rainbow color of fresh foods is key for good health. There are nutrients and compounds in whole foods (nuts, legumes, vegetables and fruits) that are capable of controlling how our genetic code is expressed!

If you are genetically predisposed, it is possible that your diet and lifestyle can determine or influence whether you will develop diabetes, heart disease, or even cancer. It is astounding that plants and greens have the power to prevent diabetes in a person from a family where diabetes is rampant.

It is all in your choices and what is most important to you.

This year’s conference was to some degree focused on gut health and how a poor diet can lead to inflammation in your body, triggering eczema, arthritis, migraines to name a few things. It seems that healthy bacteria in our gut helps to create a proper barrier, to prevent inflammation. Additionally, regular elimination gets rid of toxins; including the metabolites of estrogen. Getting rid of these metabilites has been postulated to decrease your risk of breast cancer!

My take home message that I pass to my readers is this:

  • eat a variety of fresh plant foods daily, try to get the rainbow in!
  • eating more greens and fruits and veggies increases fiber in your gut as well as healthy bacteria; increasing regularity and ridding yourself of toxins
  • try to get protein from nuts and legumes and limit animal protein to highest quality you can afford, maybe eat a little less at each serving to afford better quality sources
  • make time to cook, after all, food is important in our lives and shouldn’t be delegated to what is most convenient
  • drink lots of water, not from plastic bottles; to flush out toxins filtered by the kidneys
  • limit sugar and processed foods, start with 1 or 2 small changes and build on it regularly
  • ENJOY YOUR LIFE! You only have one life, work some fun into your day or week, and spend time relaxing!
  • turn off electronics once in a while, set these boundaries for work if needed

In the last 2 weeks, I have managed to do some of this. How much can you do, or do you need to do?

This can be you next action: take some time to decide what your goals are for your health, and what you can do to achieve those goals. Be positive about yourself and your abilities to change. Write down affirmations and take them with you when you leave the house. Read them when you feel temptation to take a short cut that works against your health.

You can do it! Two steps forward and one step back is still forward momentum. Keep going!




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One of the most profound changes you may be experiencing entering and transitioning through menopause is a lack of desire and inability to enjoy sex. While you may still crave intimacy with your partner, having sex may not be high on your list.

This doesn’t help us feel like the woman we want to be, as we are getting older!

So what is going on, and what can you do about it?

Much of the lack of desire can be attributed to lower estrogen levels, AND lower testosterone levels. We all know these hormones are not being produced in the same abundance, but a 90% reduction of estrogen production sure does explain some things!
There are other factors to consider:

  • you may not like how you look if you have gained weight and lost some muscle and support
  • you may be tired if you are not sleeping as well
  • you may have grown apart from your husband through years of working, raising children or tending to family issues
  • it may hurt to have sex, either from a lack of lubrication in the vagina, or arthritis pain in back and hips

Most of these issues can be remedied, and some remedies will help with desire. It may be interesting for you to know that the sexual response does change with menopause.

It is widely recognized by experts the the DESIRE for sex often comes AFTER the activity has started and you are getting warmed up, so to speak. What I mean is, the desire that used to drive you to seek sex isn’t the first feeling any more. This comes after your are started and feeling good, and is normal with menopause.

What a relief to know what you are experiencing is normal, now you just have to learn to work around this in order to have some intimacy fun with your partner.

Some simple things you can do to get started feeling sexy again:

  • Spend some time with your partner doing fun things, to get back that feeling of closeness and partnership.
  • Talk to your medical provider about easing the discomfort of intercourse, controlling hot flashes and sweating
  • Work on your energy level by getting sleep, exercising, eating well to avoid bloated feeling
  • Work on weight control so you are happier with how you look

There are many strategies and treatments to help with the many issues contributing to sexual difficulties.

Join me and other experts from Vibrant Nation in an upcoming  Google Hangout about these very issues!

Getting Your Sexy Back  is happening Feb. 19th.; check back in the next few days to sign up and get the details. It’s free, and sure to give you lots of tips!




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What You Should Know About Osteoporosis

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Osteoporosis and osteopenia are the consequences of aging, and all menopausal and post menopausal women are at risk. This is a problem as these conditions place you at risk for breaking a hip or fracturing your back with a significant enough fall. The inactivity these fractures cause, place you at risk for other serious medical conditions.

Bone thinning, which is what both of these conditions are, occur in response to a genetic predisposition, aging, poor nutrition, inactivity as well as other factors associated with some medications and medical conditions. The trigger is often the decrease of estrogen production that happens with the menopausal transition.

It may surprise you to find out bone is not a static calcium filled mold. It is a dynamic, living tissue that is constantly being repaired by being reabsorbed and renewed by the cells within it.

As we age, the bone building cells slow down while the bone resorbing cells continue to dissolve older bone. New bone is formed more slowly as a result. If your diet is low in calcium and Vitamin D, the bone you form may not be very strong. If there is enough bone loss to place you at risk for a fracture from a fall, due to decreased bone strength; you are diagnosed with osteoporosis.

Are you at risk for Osteoporosis? Perhaps if you are part of one of the following groups more at risk for this:

  • older women and men of northern European decent
  • Asians, especially women
  • 45% of postmenopausal women have low bone density.
  • Caucasian women have a 40% risk of a forearm or spinal or hip fracture (usually from a fall) in their lifetime.
  • Caucasian men have a 13% risk.

Interestingly, those of African decent have a decreased incidence of osteoporosis

The risks and causes of Osteoporosis include:

  • Age
  • Race
  • Smoking
  • Excess Alcohol intake
  • Certain Medications like corticosteroids, anti-seizure, anti-organ-transplant-rejection drugs and chemotherapy
  • Obesity
  • Underweight
  • Malabsorption
  • Kidney Disease
  • Liver Disease
  • Spinal Cord injury
  • Diseases of the Bone Marrow
  • Hereditary Bone Development Diseases
  • Endocrine and Metabolic diseases like Hyperthyroidism, Cushing syndrome, Hypogonadism

Although the main causes are 1) Estrogen deficiency and 2) changes of age,1/3 of all men and women with Osteoporosis have another coexisting cause of bone loss!How can you prevent and/or treat Osteoporosis?

Your bones are dynamic and constantly being remodeled.  Providing your body with the raw materials in the form of fresh, organic food is very important. The minerals you need are freshest in these foods.

A diet high in protein and minerals including calcium, phospherous, magnesium and zinc. Bone of comprised of these items, as well as blood, and if you have an insufficient amount of these minerals in your system, the body will remove them from bone to replace what is needed.  There is a balance between minerals so that if one is too low the other is excreted.

Low Vitamin D3 levels can also adversely affect bone density through poor utilization of the calcium you consume.

To prevent osteoporosis and help already weakened bones try these actions:

  • keep protein to a minimum – .8grams per pound of IDEAL body weight (excess protein causes mineral loss through the kidney). T00 much protein is actually detrimental to bone health!
  • eat lots of fresh fruits and vegetables to get important nutrients for bone support
  • do resistance exercises for 30 minutes 3 times a week – as good as estrogen in post-menopausal women. this helps activate bone building cells
  • practice balance exercises – falls are the main cause of fractures
  • learn to fall – take a basic judo course or Akido orientation
  • reduce stress – the stress hormone cortisol kills the bone forming cells called osteoblasts
  • discuss whether estrogen therapy is safe and indicated for you for a short while
  • bisphosphonate drugs can help for a few years but need to be stopped and they can be difficult to tolerate.

Osteoporosis is often over looked as a healthy concern, but can have a serious negative impact on your life by reducing mobility, strength and balance. Your bones are as important as the rest of you, they are part of the vehicle that allows you to do the things you like to do!

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I know, as you stand in front of the calcium supplements your medical provider has urged you to start taking; your mind goes blank and confusion sets in.

It sounds so easy, “start taking calcium supplements daily”. “Ok” you say, that is one health action that seems easy for you to initiate. Until you stand before the mind boggling array of supplements available.

This post will hopefully make your decision easier.

The first thing to do is acquaint yourself with how to determine the amount of calcium you may be getting in your foods and beverages. This is easy if you are consuming something with a nutritional label on the container. Reading the nutrition label, you will see on the very bottom a percentage of calcium provided. This percentage is based on 1000 mg recommended by the FDA daily. Take that number and multiply by 10; that is the mg provided in that serving. For example, the yogurt I eat at lunch, Fage, lists 15% in the one serving container. So that provides 150 mg.

We menopausal women need between 1200-1500 mg a day. It is hard to get all that in the diet. For instance, milk provides a whopping 300 mg per 8 oz glass, but you would have to consume4-5 glasses a day to get the total recommended amount. That is a lot of calories, and most weight conscious women are not going to consume so many calories in milk.

Cheeses, especially the harder ones, provide a good amount of calcium. Greens also have calcium and this is harder to quantify. My ballpark estimate is a cup of cooked greens probably has 75 mg of calcium. Many foods and juices are now fortified with calcium, so this can be an easy way to get a good bone building serving of calcium(and Vitamin D). The NIH has a decent list of calcium content of foods for you to tally.

You get the picture, look at what you consume, add it up. The difference between what you get and what you need can be made up with supplements.

Ok, which supplement?

The most common forms are calcium carbonate, and calcium citrate.

Calcium Carbonate is the most common form of supplement, and the form used to supplement foods and juices that do not contain dairy or calcium naturally. It has the highest amount of elemental calcium, but is the hardest to digest. It requires more stomach acid to absorb, something that can be difficult as we age as stomach acid production can decrease for some people with aging. Additionally, if you take a heart burn medicine, you also may not absorb this form of calcium as readily.

Calcium Citrate is the second most common form. It is easier to absorb, but you do have to take more tablets as it has a lower percentage of calcium. You can take it on an empty stomach; and many supplements have the bonus of adding Vitamin D to it.

Calcium Phosphate has a high percentage of calcium but is not as easily absorbed as the above two. It is not as common and may produce more gas and constipation as other forms.

Many people like the idea of Coral Calcium, as it seem natural. It is basically a form of calcium carbonate derived from fossilized coral reefs. The manufacturers have made many health claims that have never been proven. Additionally, I have issues with using a resource that is endangered, as living coral reefs are.

Oyster shell calcium can also be a favorite as it is derived from a natural source. These forms have been found in some cases to contain high levels of lead and other toxic metals.

A new form of calcium supplement, KoAct, has had some mention in the medical press. It is a branded calcium collagen supplement that in a small study, showed improved reduction of bone loss as compared to an equivalent dose of calcium carbonate and vitamin D.  Call me a sucker, but my recent bone density revealing osteopenia has me taking action. I am giving this supplement a try and have found it to be tolerable and not causing the common problems of gas and constipation.

As you try different supplements for tolerability, try to add some calcium in your diet. I usually suggest to my patients that they take a supplement containing 400-500 mg of calcium morning and evening. Then eat something with calcium mid day, like yogurt or cheese stick. If you eat cereal in the morning, use 8 oz of milk and drink it all. Then take your supplement at lunch and after dinner. You can easily switch it around, but you cannot take it all at once. Your gut can only absorb up to 500 mg of calcium at a time, so it has to be spaced out. When someone wants a specific recommendation, I will often suggest Caltrate twice daily. Its a good supplement of calcium citrate with vitamin D, is easily tolerated and affordable.

We need calcium for many functions within the body, including heart, blood vessel, and muscle function. What we don’t get in our diet, our body will take from the bones to fulfill this need. As we age, our bone making cells within the bone slow down. So you can see how a deficit can occur.

Take your calcium, and remain strong and mobile as you move through menopause and beyond!


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I was recently contacted by the International Osteoporosis Foundation regarding a new social forum they have developed. Their aim is to increase conversations between women and professionals regarding the serious health consequences of osteoporosis; as well as to discuss available therapy and life style changes to help improve bone density.

Seeing first hand the devastating impact immobility can place on women as they age, I eagerly support such a great resource for us. Here’s what they have to say:

OsteoLink is a direct response to unmet needs in osteoporosis communications. In 2009, the International Osteoporosis Foundation commissioned a survey of over 1,600 people with osteoporosis and health professionals in 12 countries in Europe and Australia that found significant gaps in communication and understanding about living with osteoporosis.

An increasing number of people are seeking health information online and ‘Silver surfers’ are on the rise — in Europe people aged over 55 are the fastest growing group of internet users. Health-care social networking is beginning to harness the power of the internet to bring networks of people together to improve personal management of health conditions and create widespread advocacy.

OsteoLink provides a platform for conversations and aims to improve communication between people who live with osteoporosis and their health-care providers, in the hope that this leads to better disease management. It gives patients from around the world, their friends and families the opportunity to pose questions to those going through a similar situation and address any concerns directly. Through the exchange of knowledge and providing support for one another the ambition is to help improve health outcomes. Osteolink is a growing online community with 1’100 members to date, and is accessible in English, German, Greek and Swedish.

By connecting and exchanging experiences with other osteoporosis patients and interacting with health-care professionals about daily troubles, Osteolink strives to bring comfort and reassurance to people. It’s ultimate goal being to improve the bone, muscle and joint health of our communities. [Some recently discussed topics were osteoporosis treatment, exercise, bone-healthy diets, useful tips and recipes. Questions addressed included: “I just tried this recipe this weekend which was fantastically delicious but also is a good source of calcium”; “Does anyone who is in the 30's have Osteoporosis? What treatment has been given you?”].

Join the conversation:

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Ways to Reduce Your Risk of Cancer-Naturally

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October is Breast Cancer Awareness month; a time we women can think about our risks for breast cancer and how we can reduce them. A time to share our thoughts, knowledge and experiences with friends and loved ones.

According to experts, breast cancer is lower in countries with more of a plant based diet. The same experts state that diet is responsible for 30-40% of all cancers!

Researchers here in the US have not yet been able to link a higher fat diet with a higher rate of breast cancer. A study is ongoing however, the WHEL -Women’s Healthy Eating and Living study, looking at the effect of lifestyle and eating on the risk of breast cancer. This study will not be finished for a few more years. A similar study is ongoing in Europe, called EPIC-European Prospective Investigation into Cancer. It is involving over 500,000 people in 10 countries; and looking at the link between lifestyle and cancer.

We do know however, that being overweight and drinking alcohol heavily, and maybe even moderately; are 2 lifestyle habits that are associated with an increase risk of breast cancer. This HAS been shown in studies.

It is all about the immune system, and that IS how you can take control. Eating a healthy diet full of important nutrients, such as you get from fresh fruits and vegetables, gives your body what it needs to support a healthy immune system. A diet low in foods with added chemicals or pesticides, reduces the chance of unhealthy cell changes that may promote cancer. And maintaining a healthy weight with reduced fat, also reduces the amount of estrogen that fat cells are known to emit.

A recent study has suggested that women with healthy diets and weights prior to a diagnosis of ovarian cancer, had a better success rate with treatment and lower mortality in the years following diagnosis. This information was collated from data of the Women’s Health Initiative. It is felt this is related to a more vibrant immune system in women with healthier diets.

There are several simple steps you can take to improve your diet:

  • Buy one new vegetable every week you grocery shop, and experiment with different way to prepare, cooked or raw.
  • Add chopped vegetables to soups or spaghetti sauces, either home prepared or jarred.
  • Eat your fruits, don’t drink them. This gives you valuable fiber and reduces chance of unhealthy additives.
  • Trim fat and remove skin from meats and poultry to reduce unhealthy fats
  • Use less salad dressing. Even try some of the yoghurt bases salad dressing now in markets. I have tried several and they are very good, usually located in the produce part of the market, no the usual salad dressing isle.
  • Think of your plate divided into 1/3 section. Meat or protein on 1/3, vegetables on 1/3 and whole grains or beans on a third. Or, 2/3 s veggies, 1/3 protein.
  • Reduce your portion sizes of protein to total of 6 oz a day
  • Limit your alcohol. Alcohol is basically a sugar. Healthy limits are no more than 7 beverages a week for women, with a serving size of 4-5 oz of wine, or 1 0z of liquor, or one 12 oz beer (not IPA as the alcohol content is higher in many IPA beers) So MEASURE your wine glasses to know how much you are actually getting when you pour! A huge goblet filled to the top is not 1 serving.

Take this month of October to decide if you are serious about improving your immune system and sustaining your health for years and decades to come.

Start with one suggestion above and work on it. When you have integrated this into your routine, and you no longer need to think about it because it is automatic; start on the next item you feel you can, and need to change.

Making long lasting and important changes need not be done overnight. If you can, great!

Most of us however, have to start slowly and deliberately. I know you can change, I have seen it daily in my work in medicine. When the motivation is there, the power is there, and the will is there.

Find your power and motivation to make needed changes, and work to escape the risk of cancer.

Categories : breast cancer
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Is It Safe to Mix Your Drugs?

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Having many medications available OTC (over the counter) is helpful for treating minor illness and maladies. We trust that what is available OTC is safe, and taken alone, they usually are. It is when we get into mixing things that trouble arises. And mixing certain medications both OTC and prescription, with alcohol can be very dangerous.

The FDA and medical community are working on raising awareness about combining seemingly innocent medications. Now that we can to the store to get our own remedies for pulled muscles, cold symptoms and allergies, even sleep; the possibility of an interaction is increasing. Most all of these medications are processed through the liver, and when this pathway gets clogged with too many drugs, the liver gets overloaded and inflamed. Blood levels of these drugs can become higher than intentioned, amplifying their affect.

Ibuprofen and Aleve both, in the NSAID category,and Tylenol; are some of the major causes of liver and kidney overload. There are many cold and sleep preparations containing both NSAIDS and Tylenol, and when taken during the same period of time, you can end up getting a large dose of pain relievers.

When you add alcohol to certain other medications such as antidepressants, anti-anxiety agents, sleep agents and ADD medication, prescription narcotic pain medications; this can be a toxic mix to the nervous system. I have had many people report to me unusual and mostly unremembered activity after having a few drinks and taking a sleep aid such as Ambien. It is frightening to think about getting on the internet and emailing people, or being on a hotel balcony and not remember any of it!

In most instances of receiving medications from a medical provider, they will be alerted to any potential interactions of prescription drugs. That is, if they know everything you are taking. It is not unusual for people to see more than one provider. It is important for you to inform all your providers about all the drugs you are taking. Do not assume they will know this from receiving notes from each other.

Ask your provider if any new medication can be safely taken with any OTC meds you routinely or even occasionally take. Ask them if you can take these medications with alcohol if you drink.

Being honest with your medical practitioner about what you do and take that is not prescribed, will keep you healthy and just may prevent a trip to the ER!

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