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Archive for September, 2015

My car’s license plate reads “HOTFLAS.” I take it for granted, until someone rolls down his window to talk to me at a stop sign.

“Hey, I like your license plate,” he says. “You must be about 50. Wow, my wife is going through that. It’s really tough. It’s been a real challenge.”

Only a few days later, I was meeting with a colleague from a nonprofit for whom I volunteer. “Remind me what you do,” he said. It took about half a sentence from me (“I’m a doctor specializing in menopause care…”) to strike a nerve with him. “It’s like a stranger is living in my house,” he said, of his wife’s journey through menopause.

It’s Menopause Awareness Month. These men—among so many others who regularly cross my path—are aware of menopause. Now. I think it’s safe to say that the experience has taken them—and their wives—somewhat by surprise. I can’t think of another medical condition that affects so many of us—directly and indirectly—yet about which we have so little advance education.

Six thousand American women become menopausal every day (defined as not having menstruated for a year). In the U.S., the average age of menopause is 51; that’s the age the youngest of the Baby Boomers are now. We have the highest proportion of menopausal women in our population we’ve ever had—and may ever have again.

And yet, women I meet in all areas of my life—and the men who are living with them—are surprised by the range of effects from the change in estrogen in their systems. While lots of jokes (and T-shirts) circulate about hot flashes, women don’t realize that they may also have

  • Difficulty with memory and cognition
  • Increased joint pain
  • Urinary urgency and frequency, including susceptibility to bladder infections

About half of women have pain with intercourse five years after menopause. For whatever reason, many women don’t associate that symptom with menopause. Too many of us think it’s just “what happens.” Too many of our doctors don’t ask about our sex lives, so women don’t tell about their experiences. While there are a range of treatments—both over the counter and prescription—that would help, too many of us are unaware of them.

Avoiding the topic doesn’t make menopause go away. I’ll keep talking—to patients, to colleagues, to men and women on the street. I encourage you to learn everything you can, pay attention to your own health, and to join the conversation! We midlife women are indispensible resources to our families, our companies, our communities. We deserve to have this natural phase of our lives understood!

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We’re always trying to give you food for thought; this time we want to encourage you to think about the relationship between food and sex. It’s pretty straightforward: Eating healthy foods leads to feeling healthy and feeling healthy both increases the likelihood that you’ll be interested in sex—not to mention that you’ll enjoy it.

There’s no easier time to eat healthfully that than harvest season, when fresh fruits and vegetables are plentiful. If you plan ahead, you can turn your quest for healthy eating into a fun activity that brings the two of you closer.

Take some time to choose a menu together, or, if your partner isn’t interested in that step, at least get buy-in for the menu that you’ve chosen. As you and your beloved stroll through the farmer’s market (or grocery store), talk about the associations you each have with fresh foods. In learning why your partner hates blueberries or loves Brussels sprouts, you might hear a childhood story that gives you new insight.

While any fresh fruit or vegetable is good for you, you may want to seek out specific ones. The folic acid in asparagus, for example, increases histamines, which are important to sex drive. Meanwhile, watermelon contains L-citrulline, an amino acid that increases blood flow to sex organs. Peaches do the same thing. And cold-water fish like salmon, anchovies, and oysters are high in omega-3, which improves everything from mood to memory. The avocado has two things going for it: its suggestive shape and the folic acid it contains.

When you have all the ingredients and have found your way home, the real fun begins: You cook together—in more ways than one.

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I’m an optimist by nature.

And that’s a good thing. I saw an article this week headlined “Women are not getting treated for menopausal symptoms.” It outlines the research behind the statement, research done in Australia but believed to be indicative of the reality elsewhere, including the U.S. and the U.K.

The researchers surveyed nearly 1,500 women who were 40 to 65 years old. Some of the results:

  • Up to half experience “vasomotor symptoms,” which include hot flashes and night sweats.
  • Seventeen percent said their vasomotor symptoms were moderate to severe.
  • Eighteen percent reported moderate to severe sexual symptoms.
  • Only 11 percent of respondents said they were using any hormone therapy.
  • Less than one percent were using non-hormone therapy.

This is, sadly, in line with other research I’ve seen over the past few years. Too many of us are taken by surprise by menopause symptoms. Too many of us expect the symptoms to pass in a month or two, when in actuality they may last for years. Too many of us suffer in silence (in one study, only 14 percent of men and women over age 40 had talked to their doctors about sexual health). And too many of our doctors lack either the information or the confidence to help us navigate these years.

And there are options available. The initial “alarming” findings from the Women’s Health Initiative regarding systemic hormone therapy have been largely disproved, put into a broader context of the trade-offs between quality of life and symptom management. The North American Menopause Society points out that breast cancer risk associated with systemic hormones doesn’t usually rise until “after 5 years with estrogen-progestogen therapy or after 7 years with estrogen alone”—which is likely long enough to weather the worst of menopause symptoms.

Localized hormones are an option for some symptoms; because they’re applied directly in the vagina, very little is circulated throughout the body. That limits or eliminates the risk of side effects, while still offering benefits in maintaining or restoring vaginal tissues.

New nonhormonal options for menopausal symptoms are also available, approved by the FDA. Osphena is a “selective estrogen receptor modulator” (SERM) that targets the vagina and uterine lining. Duavee is another medication in the SERM category that can be effective for hot flashes, with potential benefits for bone density. Brisdelle is an antidepressant that’s been prepared at a dosage that can help with hot flashes while minimizing its occasional side effects of weight gain and loss of libido.

Those are all prescription options, and there are plenty of steps women can take on their own, as well. That’s really our entire message, but if you’re looking for a place to start, these are the products women find most immediately helpful:

  • Lubricants make uncomfortable sex immediately more comfortable.
  • Moisturizers have longer-lasting effects, and can be used with lubricants to counter vaginal dryness.
  • Vibrators, as I tell women in my practice, are the reading glasses for diminished genital sensation.
  • And Kegel exercise tools help women keep their pelvic floors in shape, which is good not only for sexual response but for managing incontinence.

See how many things we can do? We don’t need to “grin and bear it,” as researcher Dr. Susan R. Davis, from the Monash University in Melbourne, fears we think. Step one is to believe—share some of my optimism!—that something can be done.

And then learn what you can, talk to your health care provider about your history, symptoms, preferences, and risks. Feel free to experiment until you find some options that make you smile.

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