Archive for Menopause


Weight Gain is Where is All Starts

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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.

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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.



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I was recently contacted by the NIH regarding my thoughts on the use of HRT for treatment of menopausal symptoms. I was asked to review a brochure from NIH (National Institute of Health), to see if viewers may find some benefit from their information.

Hot flashes can can certainly be a very difficult symptom of the menopausal transition. They can interfere with sleep, affect our confidence at work as well as concentration. They are embarrassing, make us feel old; and can make coping with social situations difficult. Some of us have it bad, others not so much.

Now, according to a recent study, they are costing the companies we work for; in the form of lost time at work.


A recent analysis of data looking at the insurance claims of 500,000 menopausal women, all of whom were insured by Fortune 500 companies. Half suffered from hot flashes, and half did not. This analysis took place over the space of a year.

This analysis revealed a surprising 1.5 million more health care visits in the group with hot flashes compared to the control group. The cost of lost work by this group was estimated to be over 27 million dollars and the cost of this additional health care almost 340 million!

I am not sure that 250,000 hot flashing women could actually rack up this amount of cost to their employers and health insurers; but the point is noted. Hot flashes affect women and affect productivity.

This change has apparently been amplified since the Women’s Health Initiative findings of an increased incidence of stroke and heart attacks to users of HRT; resulting in more women opting not to use hormone replacement.

While hormone replacement therapy may carry an increased risk of breast cancer and cardiovascular events if you are in a high risk category for either of these, it can also be very safe to use for several years. This can be a life saver if you are someone suffering from hot flashes.

For my readers following me for the past few years, you are probably aware that I am a proponent of HRT if you are low risk. I feel they are safe to use for a limited time and can help ease the transition.

The following link to an NIH brochure containing information regarding Hormones and Menopause will allow you to review the position of National Institute of Health regarding the safety of hormone use for many women at low risk for cancer and heart disease. It contains some good information that I basically feel is sound. The brochure can be read online or ordered for free.

So check it out! Don’t be afraid to discuss possible use of hormones to ease your menopausal symptoms if they are interfering with work and social activities. As they did for me, they may help ease the worst of it for a few years, and help you establish some changes in your routine to accommodate the changes that menopause can bring!

ps. There is no financial incentive for me promoting this brochure, I receive nothing from NIH or any other organization; and the brochure is free.

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Habits Can Change Your Life

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What exactly are your habits and why are they important for change? Habits are what we do throughout the day; actions that govern our lives, often without us even thinking about it. Habits are what save our cognitive powers for the more important tasks of the day.

Most people think that focusing and strengthening willpower is what it takes to resist temptation, or to make a life style change. We often concentrate too much on willpower to make the changes we want. How many times have you told yourself in the morning: if I have enough willpower today, I will be able to resist smoking/sugar/sweets/etc; whatever it is you want to change.

Dr Kelly McGonigal states in her book “The Willpower Instinct” , that research has shown that the people who believe they have the strongest will power are the ones most likely to fail at resisting temptation!


They are the least self informed about where, what and why they fail temptation. By not knowing what their triggers are, they expose themselves to situations that will tempt them.

So how can we change our bad habits if willpower will not provide us with the tool we need?

Habits! Our habits are what we do without thinking, without expending energy to make a decision. Establishing firm and consistent habits is not as hard as you may think, and it is the cornerstone of making healthy changes.

As Charles Duhigg discusses in his book, The Power of Habits; habits influence everything we do throughout the day including how we get dressed in the morning, to interacting and working and continuing to whether we reach for food and a beer at the end of a day. We can change our habits repeatedly over time, in order to adjust to what we need at any given time of our lives.

Habits can help you change your life, or can keep you mired in the same routine that is creating the very problems you want to change.

Either way, if change is in your future to become your wanted future self; you must change your habits.

Start with one small change you want to make. Plan for it in your routine and imagine yourself doing this thing. Construct a routine around this habit, or the avoidance of this habit.

A personal example I will share with you involves my suspicion of  vegetables. I am a health care provider, and I preach all day long about the power of healthy diet. I try to follow the example of my own words, but I admit I find it hard to eat my vegetables every day.

In searching for a habit that would some how allow me to increase vegetables, I came upon green smoothies.  So I tried it for a week or so and realized I could handle raw spinach or Kale as long as it was pulverized and blended with some sweet fruit. To reinforce this habit, I leave the blender on the counter next to the sink and below the cabinet with coffee cups. Can’t miss it. I make myself buy the big tub of baby spinach and because I hate throwing out food; I am compelled to use it up every week.

After 3-4 months of this, it is firmly imbedded in my morning routine. Low and behold, my husband, who hates vegetables even more than I do; drinks them also!

Forming a new habit involves a commitment to this habit, as well as setting triggers and tools in place to help you with your commitment to this habit. With regular practice and focusing on the positives of this change, you just might find yourself sauteing broccoli for dinner!

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Safety of Fibroid Surgery Questioned

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Every year, many women undergo treatment of their uterine fibroids. Many of them are menopausal, as this is the time fibroids can cause problems.

Up to 20% of women have fibroids at some time of their lives. These usually benign growths often occur in pregnancy and shrink after the uterus returns to its normal size. For some women however, they can continue to grow and become quite large. If there is rapid growth, concerns that a sarcoma are raised. A sarcoma is a rare cancer of the muscle cells within the uterine wall.

If you have one or more fibroids, you may experience heavier than normal menses as you approach menopause. This can be a nuisance, but it can also cause anemia. This anemia can impact your health with lack of energy as well as place a strain on your heart if the anemia is significant enough.

There is a wide range of treatments for fibroids, with the final treatment being a hysterectomy. This is usually the coarse of treatment if the anemia is persistent enough, and other treatments have not been successful at lessening the heaviness of the menses.

Many women are happy to have a hysterectomy after months or years of heavy menses and anemia. In the past, a hysterectomy was done exactly has you may be picturing it. An incision in the abdomen, removal and then stitches. A 6 week recovery follows at which you may not be able to work.

A new procedure has been utilized over the past several years that significantly reduces recovery time as it is not as invasive. It is called morcellation. This surgery allows the surgeon to remove the uterus and fibroids through a small incision near the belly button! This has been a tremendous advancement in hysterectomy for women, and the decreased recovery time has helped make the difficult decision of hysterectomy easier.

Your are probably wondering how this enlarge uteruse, sometimes the size of a football; can fit through a tiny opening.

The morcellation procedure involves cutting the removed parts into small peices and removing them as such. A spinning blade is sometimes used, and this is the potential cause of a serious problem.

If your fibroid has a small focus of cancer cells-a sarcoma, within it; this spinning blade can spread this cancer onto other organs within your abdomen. It is very rare that this happens, but it has.

A less lethal but equally serious complication can arise when benign fibroid tissue latches on the other organs, microscopically, and causes problems months and years post operatively.

How can you use this information? If you have fibroids and are considering a hysterectomy, talk to your gynecologist about your concerns regarding this procedure. Ask your surgeon if there have been any patients to experience this adverse outcome and what he or she can do the minimize the chance of post surgical problems. Make sure your surgeon is experienced and qualified to do a morcellation if this is the route you choose.

As with any surgery, there are risks and benefits and it is up to you and your surgeon the discuss and weigh these. This procedure has benefitted many women without any adverse outcomes, and it is still a good procedure in experienced hands.

Categories : Menopause Symptoms
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Your Exercise Prescription

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Many patients ask me what I think the best exercise is.

My answer is ” any exercise you enjoy and will do consistently”. With one caveat: healthy exercising as we age must include aerobic exercise to help the heart, strength exercise to help the muscles and bones, and stretching to help the ligaments and muscles. This triad of exercise maintained balance, strength, flexibility and endurance.

This sounds overwhelming to someone just starting an exercise program, but a good start may be either yoga or Pilates; or both. Which program is better? That depends on what you want to accomplish and which you feel better suited for.

Both yoga and Pilates strengthen muscles and help with stretching; yoga perhaps helping stretching a little more. They appear very similar to the uninitiated. I believe the biggest difference is in the mental aspect of yoga. There is much concentration on breathing and maintaining a pose that becomes increasingly hard, and breathing slowly and focusing your mind on controlling the discomfort. This skill can be very helpful in other areas of life!

Pilates lovers will site the efficiency and strength of the workout, with some of the same mental benefits of yoga. Holding a difficult pose in Pilates takes focus and concentration, just as in Yoga. Pilates concentrates mostly on the body, where Yoga focuses on aligning your spiritual center through rigorous physical poses. Pilates focuses on control of movements, strength of core muscles, centering and concentration as you move through precise movements. With this, there is focus and controlled breathing. So on the outside, Pilates and yoga seen very similar.

A big difference is the philosophical and spiritual component of yoga, compared to the physical strengthening of Pilates. Both are very adaptable to any level, and can be done to some extent without equipment. Most communities have classes available without needing to belong to a workout facility.

I admit that I prefer Yoga over Pilates primarily to help me learn to still my mind. It does not always work, but there are still the benefits of strengthening and flexibility I have achieved. Either way, both exercise programs can be done for strength and flexibility and are known to be beneficial for posture; as well as achieving health benefits for heart!


Menopause can be confusing, and it can make you feel as if you are falling apart or losing your mind!

For most of us, we have the irregularity of our menstrual cycle to clue us into a possible cause for the slew of new symptoms we are experiencing! This can become a very confusing time for women who do not have a menstrual cycle any more because of having had a hysterectomy.

When a woman has a hysterectomy, usually the ovaries are left in. This means that a women will still be getting estrogen that the ovaries produce. That is until the ovaries sputter out and stop functioning. When this sputtering is occurring, the symptoms of menopause occur and can be continuous or come and go.

Women with a uterus with have irregular periods during this peri menopausal time. This menstrual irregularity is sometimes, but not always, accompanied by some or all of the symptoms of menopause: hot flashes, sleep disturbance, fatigue, joint and muscle pain to name a few. If you do not have a uterus, you can still experience these symptoms but you may not get clued into menopause as a cause!

It can be mystifying and sometimes scary if you are experiencing these symptoms and do not realize it is menopause.

You may think you are sick from an infection if you are tired and achy, feeling hot and cold. You may wonder if you have diabetes with some of these symptoms. The heart palpitations that come with menopause can cause concern over your heart health. The brain fog of menopause can make you wonder if you are developing dementia.

Before you become frightened about what your health is doing, see your medical provider. A few easy tests can tell you the answer. Your provider can do a test looking at the hormones that control ovarian function to see if you are in menopause. This is called the FSH and LH hormone test. An estrogen level can also be tested but this hormone fluctuates so much, it is not always diagnostic. At the same time, a thyroid test can be done to check for this as a cause. A check for anemia is a good idea, as this can help determine if anemia is contributing to your fatigue.

If you have not had a physical in over a year, the onset of menopause is an excellent time to get a health check. You may think you do not need a female exam following a hysterectomy, but you do! A breast exam and an ovarian exam are two important exams to participate in. Additionally,  blood work to check for diabetes and elevated cholesterol, as well as blood pressure measurement are all important yearly measurements.

Whether or not you have had a hysterectomy, discussing your concerns with your medical provider can allay your fears and concerns regarding your health. Having had a hysterectomy can confuse the picture for you, but your provider has tools at his or her disposal that can be used to clear up any confusion!

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This One Big Easy Change Can Improve Your Life!

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OK, so you just came back from your yearly physical and your provider told you that  your blood pressure and cholesterol are too high, your are in the obese category, and you need to lose 30 lbs.

On top of all this, you are menopausal, hot all the time, tired all the time and can’t think straight. Your head is screaming WHERE DO I START?

Oh, and did I mention you did not get any advise on how to accomplish all this!

Don’t give up and throw in the towel, letting it all go. You can start with changes, one at a time. It will be slow, but steady progress with a result in a lower blood pressure, cholesterol and weight. Oh, and you may get rid of those troubling menopausal symptoms as a side benefit!

OK, lets get started.

First is diet. Throw out the sugar and go just 3 days, only 3 days without sugar. This means no sodas, no sweet tea, no candy, desserts. It ALSO means no dairy as this has lactose which is a type of sugar, and yes that includes cheese. No fruit, as this has sugar. No starches as these cause spikes of blood sugar and fuel cravings for sugar. REMEMBER, this is only 3 days.

What good will this do you may wonder? It gives you control over your blood glucose, it detoxifies your system, and it lessens food cravings. And it may just make you feel better! Exercise is important, but diet needs to come first. Food is like a medicine, it profoundly affects your body system and can heal you, or kill you.

Sugar and refined packaged foods are the most destructive things to our health, other than cigarettes. Choose these 3 days of no sugar to eat as much natural food as you can. Go for salads, fresh cooked vegetables, and water…lots of water. You can eat small amounts of nuts, this will give you some healthy fats which will help you feel full. You can eat protein, pick leaner cuts of meat not hot dogs or sausages as these are processed and very high in fat. You can have a few eggs. Try an omelet with veggies for breakfast, salad with some meat and a light salad dressing for lunch, a lean meat and 2 cooked vegetables for dinner. Snack on nuts, raw veggies and humus. Drink water, water, water; you can squeeze some lemon in it for flavor.

Ok, so you have detoxed from sugar for 3 days. What’s next?

You may be surprised what the scale has done and hopefully this will motivate you to continue with some diet changes. For the next few weeks, slowly add in some cheese, then other dairy and some fruit. Not all at once, but 1-2 things every day. As you do this, you should continue to notice a benefit in how you feel. It is still important to avoid processed foods and sweets.

Some strategies to avoid complete deprivation of the foods you like is to pick one day a week, and allow yourself some foods that you enjoy. Don’t go overboard, and get right back on track the next day. If you feel yourself really craving these foods, you may need to avoid doing this and pick only one day a month. You may actually find though, that your stomach does not like these fatty processed foods after you haven’t eaten them for a while. This is progress!

This is a start, it will not solve all of your problems but it is a significant help. Blood glucose spikes fuel cravings making us eat more. Eating more causes weight gain which makes the heart work harder, and what isn’t used for energy is stored as fat or cholesterol. Blood glucose spikes can also trigger hot flashes and make them more powerful. A higher plant based diet can provide you with the plant version of estrogen called phytoestrogens; which can help lessen menopausal symptoms.

Coming home from your medical providers office needn’t make you feel dome and gloom. Make this one small change to start and see what happens. Check in with me later to see other changes that can help you reverse any negative biological process going on!



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If you are a woman reading this post, chances are you have experienced a urinary tract infection at some point in your life.  Burning with urination, frequency, and discomfort in the pelvic and genital region are all familiar symptoms to many of us by the time we reach menopause.

Having these symptoms and seeing a medical provider for antibiotics may seem like an automatic “no brainer” therapy. It would certainly be a surprise to be told there is no infection present. Your next questions would most likely involve what could be causing your symptoms.

All that burns is not a UTI! There is a condition that many women suffer from called Vestibulitis. The vestibula is the region inside the vulvar tissues and the entrance to the vagina. This area is loaded with nerves, and can easily become irritated by vaginal or urinary infections. For some women however, this irritation becomes cyclic and persistent, never seeming to completely go away with the standard UTI or vaginitis treatment.

Vestibulitis can be uncomfortable or downright painful. It can affect sexual relations, and it can affect the ability to exercise or even sit for long periods of time.  This pain is often felt as burning, stinging, raw or an irritated sensation. Surprisingly it affects white women between ages 20-60 almost exclusively; researchers are unsure why this demographic is most affected.

The two main types of vestibulitis are cyclic and vulvar. Cyclic vestibulitis occurs mainly with triggers such as intercourse, bike riding for extended periods; and tends to be more intermittent. It is felt to be a reaction to a prolonged mild or undetected yeast infection. It is treated with an extended course of antifungal medications such as Diflucan.

Vulvar vestibulitis is more constant and unremitting. It too can be from an undetected yeast infection but can also be from atrophic tissues  experienced in menopausal or peri-menopausal years. This type of vestibulitis is most likely to occur with menopause when it does occur. It can be treated with topical estrogen cream, sometimes with steroid creams for short periods of time.

Vestibulitis can become chronic primarily due to irritated nerves that release chemicals which further inflame the vestibular tissues, creating a vicious cycle. Because of the potential chronicity of this problems, treatment is usually carried out for many weeks. Along with medication to relieve the symptoms, dietary changes are often helpful. Taking calcium and consuming a low oxalate diet is felt to neutralize the urine and reduce irritation to vulvar tissues.

This problem can have a major impact on a woman’s life and it is important to get to a professional that specializes in vestibulitis if your symptoms are ongoing for months or years. Many medical centers and university hospitals have specialist within their gynecology divisions that specialize in vestibulitis. A specialist is often required for treatment as many gynecologist and family practice providers are not trained to treat this condition; as well as that surgery is sometimes required.

If you are experiencing vaginal or vulvar burning, first see your regular provider to get an exam. Your provider can examine you for a urinary tract infection, vaginal infection, atrophic changes, or other skin conditions that can cause your symptoms. A simple short therapy may take care of your symptoms. If it does not however, I suggest asking your provider for a referral to a specialist.

You may feel your symptoms are too embarrassing to discuss with a specialist, but pain that affects your life should be  evaluated and treated. This will give you quality of life.

Categories : Menopause Symptoms
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Heart disease claims the lives of 1 in 4 women. It continues to be a significant issue for women and unfortunately, often presents in different ways as compared to men. For this reason, it is often overlooked as a potential problem for menopausal women.

The factors that contribute to heart disease for women are still unknown. It is felt that lack of natural estrogen somehow potentiates plaque formation in the large and small arteries supplying heart muscle.

Recent analysis of date from a nurses study has also highlighted the increased degree of heart disease in depressed women. Again, the mechanisms for this are not yet fully understood. There has long been observation and knowledge that depression can occur after a heart attack or heart surgery. The question remains, which came first and is this a coincidental association or is there a link?

It is not new that menopause can be a challenging time! With sleep deprivation, fatigue, problems with concentration; it is no surprise that women feel over whelmed and at times moody and depressed. Not every women however, becomes clinically depressed.

The unknown however, is whether the estrogen fluctuations of menopause can cause someone to experience depression for the first time. And if experiencing depression for the first time, do you have an increased risk of heart disease? There is 2 fold increase in the rates of depression known to occur during menopause; and depression has been shown to increase rate of cardiovascular disease.

There is currently a study undergoing at UNC called the PERT study, the Peri menopausal Estrogen Replacement Trial; to look at this issue further. This study is evaluating the (hopefully) beneficial effect of the use of estrogen in treating a new, or newly recurrent depression in perimenopausal women. They will be evaluating the incidence of heart disease for women being treated for depression with estrogen, to determine the efficacy of this treatment for both depression and heart disease in depressed women.

If you are interested in participating in this trial, or would like to know more; click on this link: UNC PERT study.

Knowing the potential cause of a woman’s depression can help tailor treatment, as well as determine what sort of pharmacological treatment may be most beneficial in alleviating symptoms. Knowing the link between depression and heart disease may help dictate surveillance testing for heart disease as you transition through menopause.

Because this is a major cause of illness and death in post menopausal women, it is important to educate yourself regarding your risk factors for heart disease. Many factors are known to contribute to heart disease, such as diabetes, elevated cholesterol, smoking, obesity and family history. It important for women to now understand that  depression is now added to the list of risk factors.

Know your risks, know the symptoms of heart disease; and change what you can!

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