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Posts Tagged ‘women’s health’

The American Cancer Society has released new guidelines for Mammogram Screenings. We know you’ve likely read a lot about it. I thought I’d hand it over to our old friend and writer Julie, a longtime MiddlesexMD blogging pal, who has breasts of her own and some thoughts to share on what to do when new guidelines hit the airwaves.

Guideline Headlines!!! Okay girls! Grab them and run! But which way! When? Where? But wait!!! No!

No! These guidelines are saying to maybe squish less often? For some of us? Really? To not start so soon? Who are these people?

I’m confused.

With the latest release of Breast Cancer screening guidelines from the American Cancer Society, it’s easy to feel a little—entangled—in questions of when and whether to handle our screenings. And no wonder. The discussions are very much in the air, and the experts are agreeing to disagree. Very politely.

It wasn’t the intention of the committee to create this confusion, of course.

They truly wanted to offer up more leeway in guidelines, particularly for women with average risk of developing breast cancer—and that’s most of us. But leeway is very hard for most of us to interpret. Most of us just want very clear direction. We want safety and assurance. We want to avoid unnecessary exposure to radiation and unnecessary medical procedures. That’s not too much to ask, is it?

Well, we can’t have absolute assurances from medical guidelines. It would be so nice if we could. We can only get the best advice from smart committees working from what data they have to keep the greatest number of us safe most of the time.

So the new guidelines ease up on the youngest women, aged 40-45, saying they don’t need to start screening if they have average to low risk of breast cancer. Of course we women in menopause are already screening our breasts, have already been at it for years by now. Now we are wondering what to tell our daughters. And we will be getting different advice from at least three of the six breast-cancer-guideline-writing organizations in the US alone.

In fact all of those concurrent guidelines exist out there already, in our doctors’ heads. And online. And in our restless heads and hearts. So what do we do with all of this various information?

First… We breathe.

Then…  We remember, that we are each in charge of our own bodies. Guidelines are there just as a framework of reference. In practice, we each are working on our particular realities, which must be dealt with in the particular, with a plan that takes in all of the unique, unusual, specific aspects of our own bodies, or our daughter’s, their daughter’s.

So, I’ll take me, for example.

Those guidelines would suggest, since my breasts have been around for 55 years (well, one of them. The other seems much, much older), and in my family there is no history of breast cancer at all, and I have no current cancer markers, good and good. But… I’ve had so many surgeries and lung problems my chest as been radiated enough in my lifetime to light up Tokyo on a moonless night, which is not so good, and I’ve had to have a few lumps biopsied here and there, which have markers they like to peek at now and again, so….. Yeah I’m signed up for annual scans. Am I worried? Not really. But I’m committed. My sister, with the same family history, may logically choose to scan less often. Because she’s been much healthier throughout her life.

A young relative in my family? Just turned 40. Did she need to go for her first exam? Not really, but she and her friends made a party of it at the local breast exam clinic. Wine and bites and breast squashing in paper robes. She could have put it off another 5 years, but she prefers to get this ball rolling. Preference plays a roll here. She is being cautious.

You see how this rolls. Family history + conference with your physician over your own medical history + your own ideas and feelings about medical tests at this time in your life, taken together with a careful review of the recommendations = your best plan for screening. That plan for screening? It changes year over year as you age. That’s how you do this. Review your plan each year for you. Discuss it with the women in your family. And your friends. Like. Discuss it. Out loud. Over coffee or tea.  Like, “What’s your breast scan plan, Mom?”

Like that.

It’s not rude.

No. It’s not.

Happy deciding, everyone.

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So my medical journals are telling me, again, that I need I need to eat better and keep moving. Gee, folks, thanks for the news!

But I rarely receive such specific advice as I have these past few weeks. They have handed me very, very clear directions:

  • Eat a Mediterranean Diet including extra-virgin olive oil.
  • Exercise 300 minutes a week.

Wait… Really?

Specifically….  for menopausal women… my medical journals are suggesting we do this to avoid breast cancer.

Well! That’s pretty specific! And pretty awesome when scientists are paying special attention to my favorite people!

So let’s look at these studies suggesting ways we just might, through diet and exercise, provide our bodies an optimal environment for fighting off breast cancer.

The PREDIMED study, published in JAMA, September, 2015, was conducted in Spain from 2003 to 2009, wherein more than 4,000 women at high cardiovascular risk, aged 60 to 80, were randomly placed on three diets: the Mediterranean diet, supplemented with extra-virgin olive oil (first cold-pressed), The Mediterranean Diet supplemented with mixed nuts, or a Low-Fat diet.

The results of this study have been coming out for some time, and have been fascinating. This latest release shows that those on the olive-oil-supplemented diet had a 68-percent lower risk of developing breast cancer than the other participants in the study. It’s one study, of course, and needs to be repeated, but it’s rather fascinating. Earlier outcomes of the PREDIMED study suggested the same diet resulted in a delay in cognitive decline for the same population. There will be more news from this cohort. We will stay tuned.

By the way, when shopping for olive oil, it is best to stick with first-cold-pressed, extra-virgin olive oil for your good health. It costs a little more, but that’s the healthy choice that this study is based upon. Cheaper oils have been heat-treated or chemically treated, and are no longer a healthy choice for your body.

The exercise link is a the Breast Cancer and Exercise Trial in Alberta, Canada, published in JAMA Oncology in 2015. The study followed 400 women. Half of them worked out for a half an hour a day, 5 days a week. The other half worked out for an hour a day, 5 days a week. They worked out at 65 to 75 percent heart rate for at least half of their workouts. All without changing their usual diets. The women were overweight, disease-free non-smokers, and they were followed for three years. Subcutaneous and abdominal fat and waist-to-hip ratio decreased significantly more in the high-exercise-volume group.

Since body fat increases postmenopausal breast cancer risk, this suggests this higher dose is a better dose of exercise for us to keep the weight off, the body fat down. Lower body fat is a better environment for lower breast cancer risk.

So I’m going to take a brisk walk to the grocery store, buy two big bottles of my favorite extra-virgin oil, and do biceps curls with them on the way home. Or maybe I’ll just stay a little longer on my treadmill and have a nice salad with dinner.

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You say you’ve been using Replens regularly, and have noticed that hydrogenated palm oil is among the ingredients. You’ve heard that hydrogenated fats are unhealthy, and wonder whether you should be concerned.

You’re right to be concerned about ingesting hydrogenated palm oil in food products, especially if you have elevated cholesterol and triglycerides. As an ingredient for a topical product, though, like a vaginal moisturizer, the oil is safe and won’t affect your lipids. Applied to the surface of your skin or tissues, the moisturizer is not absorbed into your bloodstream.

Keep using that moisturizer! Keeping tissues health goes a long way toward comfort and enjoyment.

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I started MiddlesexMD because I wanted to help women to stay as sexually active as they choose for as long as they choose. I’d heard from too many women in my medical practice who assumed that they were “over” that part of their lives, whether or not they liked the assumption. Discomfort, downright pain, less pleasure, and diminished libido appeared to be barriers they just couldn’t see past.

I thought I was in a unique position to help: I’d practiced obstetrics and gynecology for a couple of decades, had become qualified as a menopause care specialist, and had myself reached what we call “a certain age.” I could explain the medical realities from the perspective of a woman who shared experiences and day-to-day impact.

And I hoped to contribute to breaking the silence about midlife sexual health, since so few of us have talked to our friends, our doctors, and even our partners about what’s changing and what we might want to change.

It’s been rewarding. An unexpected benefit for me—and in some ways for you, too—is all of the people I’ve met who share the vision: of women taking control of their health and wellness, including their sexuality, as they move through midlife.

The MiddlesexMD team first met Rebecca Posten, CEO of PrevaLeaf, at a conference for nurse practitioners in Savannah. We were struck by the similarity in our missions and values. PrevaLeaf’s purpose is to “provide women with gentle and natural products to maintain their intimate wellness.” When Rebecca says she’s all about “helping women stay in control and stay well,” she’s speaking my language.

She and I have other things in common, too: We’ve both had medical training specializing in ob/gyn; we’ve both networked with women entrepreneurs who had practical experience in bringing a vision to life; she shares my interest in spreading the word about women’s health; we both have daughters who know much more than their peers about women’s anatomy and sex.

None of those, though, are the reasons I feel good about offering PrevaLeaf™ products. As a physician, I share PrevaLeaf’s bias toward prevention and wellness, and the intensity of their focus on women’s health. I like how seriously they take natural ingredients; they’re a member of the Natural Products Association and follow their guidelines for ingredients and manufacturing processes.

But the proof is in the products, so I invite you to check them out. PrevaLeaf Oasis is a water-based vaginal moisturizer for daily use. PrevaLeaf Soothe is for those occasions when discomfort calls for some additional relief.

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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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Birthdays are a useful thing—although it’s increasingly easier to celebrate them for our children (or grandchildren) than for ourselves. Here at MiddlesexMD, we’re celebrating a milestone: It was five years ago this month that we launched our website. While I’ve been practicing medicine for much longer (did I say it’s not easy to celebrate every milestone?), this marks five years of encouraging women to learn about and take charge of their sexual health throughout their lives.

Celebrating Five YearsThere are a number of ways to measure how far we’ve come, like marking our children’s height on a chart. The first that comes to mind is the number of women who’ve been in touch. We’ve been in contact with hundreds of thousands of women (and men who love them) from 209 countries. Many have thanked us for solving a specific problem, or for simply providing some hope and a path to follow. We’ve talked to hundreds of women in person, too, at medical conferences. Nurse practitioners and other health care providers have said how grateful they are to have a resource for patients and, because many of them are women, have shared personal stories, too. As a physician, I have more options available to me than I did five years ago. Osphena comes to mind as a treatment for vaginal and vulvar pain. And while localized estrogen products have been on the market for a while, I’ve noticed more advertisements for them. While too much advertising—especially of pharmaceuticals—can sometimes just be noise, I see the ads as an increase in conversation about women’s sexual health. And that’s a good thing. I’m hopeful about increased conversation at the FDA, too. Last fall I attended meetings to discuss how the agency reviewed and set priorities for drugs to treat women’s sexual health challenges. It’s been rewarding to join with colleagues in Even the Score, a campaign for women’s sexual health equity. In March, eleven members of Congress signed a letter to the commissioner of the FDA, expressing the firm belief that “equitable access to health care should be a fundamental right” and noting the disparity between the number of FDA-approved drugs for male sexual dysfunction (26) and female sexual dysfunction (0). It will take some time for new treatments to make their way through development, testing, and FDA approval. In the meantime, I’m also happy to note more books (including my own) and websites offering information, encouragement, and community to women as they navigate midlife and beyond. I hope you’re talking, too—to your partner, your friends, your sisters, and your health care provider. When we share our experiences, we feel less alone. And we can also learn from each other about what’s happening and what works to keep us vital and engaged. Because we know that even at—especially at—midlife and beyond, we’ve still got it! (Through the end of April, celebrate with us by using the code PARTYFIVE to take 20 percent off your purchase from our website.)

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