Archive for November, 2012

Perimenopause, also called menopause transition, starts with variation in menstrual cycle length. Cycles can go from every 28 to 30 days to every 21 to 24 days—or 21-40 days. Cycles that are closer, further apart, longer, shorter, heavier, or lighter are all considered normal for perimenopause. Rarely, women go from having regular periods to having none, skipping the “transition.”

98 percent of women experience a natural menopause—one year without menstruating—between ages 40 to 58. I have seen one or two women at age 60 still menstruating—but somebody has to be that 1 to 2 percent! We really are unable to predict the age of menopause for any given woman. Again, for most women the symptoms of perimenopause last for four to eight years, but, again, there are a few stragglers who have them longer than most.

Any bleeding after menopause deserves investigation and evaluation, so it is important to differentiate post-menopausal bleeding from a few lingering periods.

I sense from the question that you’re ready for a “change”! Hang in there. It’s coming.

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Breast cancer doesn’t really have much in common with sex. But I know it’s hard to be very interested in sex when you have cancer or are recovering from cancer treatments or are working to feel good about your body again after having had cancer.

However, anyone interested in staying vibrant and healthy (not to mention sexy) should be interested in the breakthrough research on breast cancer just announced in the journal Nature.

Turns out, genetic mutations caused by cancer and the unique genetic “fingerprint” they leave may be the new frontier for cancer treatment and could suggest treatments targeted to specific genetic mutations.

This research, which is the scientific equivalent of putting a man on the moon, is an outcome of the Cancer Genome Atlas, a federally funded study to map genetic changes caused by common cancers. Breast cancer is the third (after colon and lung cancer) to come under intense analysis, with several hundred researchers tracking the genetic changes caused by unmetastized tumors from 825 women.

As a result, four new subtypes of breast cancer based on 30 to 50 genetic mutation have been identified, which suggest new approaches to treatment and also explains why some one-size-fits-all treatments may not work.

“When treating breast cancer, we offer specific therapies that have been tested on large populations of cancer patients,” said Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City in an article for HealthDay News. “…This research helps move us to the point where we will look at a tumor’s genetic makeup and tailor a specific treatment that will attack the tumor cells based on the tumor’s genetic fingerprint.”

This research may alter cancer treatments by

  • Basing treatment on the genetic signature of the cancer rather than its location in the body. For example, one of the less common but most deadly breast cancers is genetically very different from other breast cancers but very similar to ovarian cancer, suggesting that treatment for this breast cancer could also be similar to that for ovarian cancer.
  • Avoiding unnecessary, ineffective, and potentially harmful treatment. For example, one of the most common cancers, whose growth is fueled by estrogen, was routinely treated by an estrogen-blocking drug. The genetic study identified two different types of this common cancer, which suggests more targeted treatments. So, besides receiving appropriate treatment, cancer patients may also be able to avoid potentially harmful treatment. “Targeted therapies allow for more effective treatment of tumors, while minimizing the treatment of tumors with less effective therapies and their subsequent side effects,” said Dr.Bernik.
  • Suggesting new avenues for research. When these subtle genetic differences are identified, new research and treatments can begin. For example, some women with the same HER2-enriched gene respond to treatment by the drug Herceptin, and other women don’t. Now, ongoing clinical trials will try to identify the differences in the genetic makeup of the HER2 tumor that may explain the different responses to treatment.

While this research may be seismic for oncologists, it will be years before the laborious process of testing and approvals are complete and we begin to see the results on the ground and in our doctors’ offices.

Still, this affirms the need for informed, individual health decisions, weighing all factors, instead of applying one-size-fits-all thinking. And, taking the long view, this is great news for our daughters and granddaughters.

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Hypothyroidism, which is a low-functioning thyroid gland, is quite common in women; about one in eight will have thyroid disease in her lifetime. Interestingly, there’s been little research in understanding how thyroid function may affect sexual function.

The good news is that treatment for hypothyroidism—supplementation of thyroid hormone—is straightforward, and women receiving treatment seem to have little or no increase in sexual issues. Those who are not treated seem to have more issues with desire, lubrication, and orgasm.

As women get older, their risk of having thyroid disease increases. There are both physical symptoms (like weight gain, dry and yellowish skin, hair loss, fatigue, muscle or joint aches and pains) and cognitive symptoms (like slower thinking or speech, memory issues), but at age 50 and thereafter I recommend a screening—simple blood tests—at regular intervals.

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What I’m Thankful for

Feeling gratitude and not expressing it is like wrapping a present and not giving it. —William Arthur Ward

The good thing about holidays is that they give us an opportunity to reflect (if we’re not too busy preparing for them) and to cultivate good old virtues, like generosity and gratitude. Holidays encourage us to express things, like love and appreciation, that we don’t get around to in the normal course of daily life.

Thanksgiving, of course, is a time for gratitude.

So this holiday gives me a great opportunity to tell you that I’m really grateful for the many people who support and value the work we do here at MiddlesexMD. This work wouldn’t be possible without all you supportive people.

Six years ago I refocused my clinical practice to serve the sexual health needs of women in midlife because I discovered that so many of us were struggling with the physical and sexual changes brought on by menopause. Women, I learned, needed advice and guidance but didn’t know where to look for it.

Now, MiddlesexMD has its own website, newsletter, and blog. We have an online boutique with an array of tasteful, helpful, and woman-tested products to help keep the sexual flame alight. In fact, we’ve become one of the go-to resources nationally for information about sex at midlife.

That’s pretty impressive, if you ask me.

There are only two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle. —Albert Einstein

As I see it, MiddlesexMD is sort of a miracle. The amazing thing is that so many people are involved, interested, and in so doing, have contributed to its success. We have a small army of people who spread the word about what we’re doing, and give us support, encouragement, help, and advice along the way.

We turn to members of our MiddlesexMD advisory board frequently on this blog. We have a fabulous board whose members represent some of the leaders in the field of female sexual health. Despite their own busy practices, they’re always willing to share their expertise with MiddlesexMD readers. So—members of our great MiddlesexMD advisory board—thank you!

We also have a creative and hardworking internal team that plans, organizes, and runs all the disparate parts of this venture and helps to keep me sane and focused. I’m incredibly grateful to the amazing team that operates behind the scenes. MiddlesexMD wouldn’t be here without you.

Gratitude can transform common days into thanksgivings, turn routine jobs into joy, and change ordinary opportunities into blessings. —William Arthur Ward

Finally, no foray into social media is successful unless people spread the word. MiddlesexMD is successful because other practitioners tell their patients about our site and because readers “like,” tweet, “share,” and tell their friends about us.

To all of you who spread the word—thank you so much. And don’t stop!

Gratitude is a vaccine, an antitoxin, and an antiseptic. —John Henry Jowett

Finally, let me leave you with a little Thanksgiving Day doctor-ish prescription. (You knew this was coming.)

Studies repeatedly link gratitude with higher levels of satisfaction with life. Grateful people are happy people. They pay attention to the positive stuff. They focus on the good and deal with the bad, sad, or difficult when it comes along. This isn’t denial or wishful thinking. It’s a choice that gradually becomes a habit.

So, along with a healthy diet and regular exercise, I’m prescribing a dose of gratitude every day before breakfast. It’s cheaper than pharmaceuticals, and who knows, it might even make sex better, too.

What are you grateful for right now? Who makes your life joyful? Have you told that person how you feel? 

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We know about muscles. We use them; maybe we tone them; maybe we watch them get saggy over the years.

But the vagina?

Yep. That too.

Our pelvic floor is encased in muscle. And just like all the rest of our muscles, it needs regular exercise, especially as we grow older. Age, childbirth, and loss of estrogen take their toll on all that musculature. Like everything else in our anatomy, it ain’t what it used to be.

We’ve talked about the importance of vaginal exercise before—in the form of kegels. That clenching-and-holding of the pelvic floor muscles helps keep our pelvic floor muscles toned, which in turn keeps us continent, keeps our abdominal organs in place, and creates a firm “vaginal embrace” that our partners ought to find very, um, invigorating.

What many of us don’t know is that a handy exercise tool exists to help us tone our pelvic floor. We call them vaginal weights. (A similar version is called ben wa balls, which is an ancient Eastern sex toy that uses weighted balls of various materials. These are said to be mildly stimulating.)

Ana of Fifty Shades renown tucked these little numbers into her vagina for a hot date with Christian and “wore” them throughout the evening. This is a tricky maneuver, requiring good muscle tone and constant attention. Stand up without clenching those pelvic muscles, and you’ll lose your balls, so to speak.

I’m thinking that, by the end of the evening, Ana may have experienced some fatigue “downtown,” but, what with rocks in her sock, she surely was reminded at every turn about where the evening was headed.

In the MiddlesexMD store you’ll find our Luna Beads—four interchangeable balls that allow you to increase the weight you’re carrying. You could try to imitate Ana’s trick on your next date night, but I’d suggest trying them out at home until you’re confident you can keep the things where they belong. Your muscles will thank you, and your partner may, too.

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I once knew a crusty old farmer who refused to acknowledge the existence of daylight savings time. Ask him the time during spring or summer, and he’d respond, “Do you want the real time?” To Robert, daylight savings time was just some misguided newfangled invention.

This weekend, we return to “real” time.

While we gain an hour of sleep early on Sunday morning, we give up an hour of evening sunlight for a whole season. There’s something primeval about these fall and winter twilights. Something that makes you want to draw near the fire. Huddle together for warmth and protection. Share tall tales and drink something bracing.

We can ignore this ancient urge. We can fill the evening hours with activity. We can turn on lights, and stay up late.

But we may be ignoring something important in this seasonal cycle. Perhaps the shortening days and waning light are also reminders. I know they are for me. Our own time is becoming short as well. It’s a bittersweet truth that can’t be altered no matter how busy we keep ourselves.

Rather than avoiding this natural cycle, wouldn’t it be better to savor these twilit evenings, this waning light, with awareness and gratitude—in the same way we ought to experience this season of our lives? Wouldn’t this time be the richer for living it with greater compassion and attention? And doesn’t it make sense to begin with those closest to us?

This year, why not celebrate the return of real time? Why not set aside that hour or two of fading light to reaffirm love and life with the person you share it with now? This can be a quiet thing—the spirit of this season isn’t bombastic or overblown. Its colors are muted—ochre rather than fuchsia; the tone is subdued—Bach rather than Wagner.

Maybe walk together as evening falls. Crunch the leaves; smell the musty crispness. Hold hands.

Maybe sit together in the twilight. Drink mulled wine. Light candles.

Watch a special movie that moves you both. Read aloud—poetry or a book you love.

Mostly, experience this transition with your spiritual senses. Life is moving on. You are acknowledging the passing of time with someone you love. That’s something to be done with care and attention.

When he was 81, my friend Robert moved out of the farmhouse he had shared for his entire life with his bachelor-farmer brother. He moved out to marry Paula, who had outlived three husbands. This was his first marriage. I was the “flower girl” for the marriage of two octogenarians.

Robert wept as he said his vows. When he kissed the bride, it may have been for the first time. You can bet he rejoices in every moment of real time he has with his love.

We should do no less.

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