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Menopausal Weight Gain NOT Inevitable

Thursday, May 8th, 2014

It may seem like weight gain is an inevitable effect of menopause. It is indeed common, and there are several reasons why, including:

  • Levels of estrogen, which appears to have a weight-regulating effect, drop significantly during menopause.
  • Older women are less likely to get enough exercise than younger women.
  • Muscle mass declines, and this has a slowing effect on your metabolism. This means that you may need fewer calories, but if you adjust your food intake accordingly, creeping weight gain will likely be the result.
  • Older women are more likely to have jobs that demand very little in the way of physical labor; they may also eat out more with the kids out of the house.

And weight gain isn’t just a cosmetic issue – it also increases your risk of many health problems, including diabetes, heart disease, high blood pressure, and several types of cancer.

However, you still have plenty of control over your weight during and after menopause, so don’t fall for the notion that weight gain is natural or that there’s nothing you can do about it. Even though weight control may be more of a challenge because of physiological and lifestyle changes that take place during menopause, it still boils down to taking in no more energy than you expend.

If you find the pounds adding up, your first line of defense is to eat less. In your fifties, you probably need a couple hundred calories a day less than you did when you were younger. Make your food choices more carefully. No one needs empty calories, but menopausal women should be especially careful to choose mostly vegetables, fruits, lean meats, whole grains, and low-fat or non-fat dairy products.

Exercise is another key step to beating menopause weight gain. Exercise gives you more energy and burns fat, while building muscle. And maintain or increasing your muscle mass is important because the more muscle you have, the faster you burn calories all day long. Adults up to 65 years old need at least 30 minutes of moderate-intensity exercise five days a week, such as brisk walking, and at least two muscle-strengthening workouts a week. You may need to add even more if your goal is to lose weight.

A good support system is also important. Enlist the support of your family and friends, or better yet, find a partner to work out with who can help encourage you and keep you motivated – and do the same for him or her.

The answer to menopause weight gain isn’t glamorous or easy, and there is no secret formula. But with concentrated effort to control your diet and exercise habits, you can absolutely maintain or even improve your weight at any stage of life. For more information on menopause, see my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H

Postmenopausal Bleeding

Thursday, April 17th, 2014

Once you have gone through menopause (and it has been a year since you’ve had a period), you should not be bleeding. More conservative doctors consider bleeding after six months of not bleeding to be a potentially worrisome sign. Not even spotting is considered normal after menopause, and should be evaluated by your doctor as soon as possible. Some of the conditions that can be responsible for postmenopausal bleeding include:

Polyps: These typically benign growths can develop on the cervix or in the uterus and can cause bleeding.

Endometrial atrophy: This is the thinning of the tissue lining the uterus, the endometrium. After menopause, lower estrogen levels are responsible for this condition, which can be a cause of unexpected bleeding.

Endometrial hyperplasia: Sometimes, when too much estrogen and too little progesterone are present, the endometrium can thicken, and this can cause bleeding.

Endometrial cancer: Endometrial or uterine cancer can cause bleeding. This is most common between the ages of 65 and 75.

Other potential causes for postmenopausal bleeding include infection, hormone therapy, certain medications (blood thinners, for example), and other types of cancer besides endometrial.

In order to find the reason for your bleeding, your doctor will want to take your medical history, perform a physical examination, and perform some tests. These tests may include a transvaginal ultrasound, a biopsy, a hysteroscopy (in which the inside of your uterus is examined with a small camera), a sonohysterogram (which is a transvaginal sonogram with saline solution instilled into the uterine cavity) or a D&C (dilation and curettage; during this test, uterine tissue is removed and sent to a lab to be analyzed).

Which treatment your doctor recommends will depend on the cause of the bleeding. If you have polyps, surgery may be necessary to remove them. Medication is typically used for endometrial atrophy; endometrial hyperplasia may call for both medication and surgery aimed at the removal of the thickened endometrial tissue.

What If It’s Cancer?

If it is determined that you have endometrial cancer, your doctor will probably want to perform a total hysterectomy, a surgical procedure in which your uterus and cervix are removed. Other parts that might need to be removed include the ovaries, fallopian tubes, part of the vagina, or nearby lymph nodes. You may also need radiation, chemotherapy, or hormone therapy.

Just keep in mind that while irregular bleeding during perimenopause can be normal, bleeding after menopause isn’t. Even if it’s very light, postmenopausal bleeding warrants an immediate call to your doctor to have it checked out. Chances are good that the bleeding is being caused by a minor problem, but there is always the chance that it could be something more serious. And if it is cancer, the earlier it is treated, the better, so don’t ignore even very light postmenopausal bleeding.

Read more about the menopause and other natural changes in your body in my health book, “Inside information for Women”.

– Yvonne S. Thornton, M. D., M. P. H

Dealing with Painful Intercourse

Thursday, March 27th, 2014

Pain felt during sex is known as dyspareunia, and it can cause a number of problems for you and your relationship. Besides the physical discomfort, painful intercourse can have emotional side effects as well, so this problem should be dealt with as soon as you become aware of it.

Causes of Painful Intercourse

Sometimes the reason for pain during intercourse is as simple as insufficient vaginal lubrication. Taking more time with foreplay or using a water-based lubricant will often solve the problem. However, sometimes there is a condition responsible for the discomfort that needs to be addressed. Conditions that may cause dyspareunia include:

  • Vaginal infections, such as a yeast infection or bacterial vaginosis
  • Menopause, which can cause a significant reduction in natural lubrication, as well as thinning of the vaginal tissues which can lead to discomfort
  • Vaginal dryness not caused by menopause – this can also be triggered by breastfeeding and certain medications
  • Injury to the vagina or vulva, such as a tear or episiotomy from childbirth, or
  • A sexually transmitted infection (STI)
  • Vaginismus, a condition in which the vaginal muscles contract involuntarily
  • Endometriosis, in which the tissues that normally line the inside of the uterus grow elsewhere
  • Problems involving the uterus, such as myoma (fibroid tumors)
  • Problems involving the ovaries, such as cysts
  • Problems involving the cervix, such as infection
  • Ectopic pregnancy

Treatment for Painful Intercourse

If you aren’t sure why you are experiencing pain during intercourse, a visit to your gynecologist is in order. For example, in the case of dryness caused by menopause, your doctor can prescribe estrogen creams or other medications. Most infections and endometriosis can be treated by your doctor as well.

When no apparent cause is found, therapy might be helpful. Sexual activity is deeply intertwined with emotion; therefore any type of negative emotion such as anxiety, depression, fear, or feelings of low self-esteem can play a role in painful intercourse. Issues such as guilt, negative emotions regarding past abuse, or conflicting feelings about sex can also cause physical reactions that make sex unpleasant. It can be difficult to tell whether pain has psychological or physical causes (or a combination), so a conversation with your doctor about all possible issues is the best course of action.

When you see your doctor, be sure to mention additional symptoms that you may be having in addition to pain, such as bleeding, irregular periods, genital lesions, unusual discharge, or involuntary contractions of the vaginal muscles, that may give him or her the clues needed to diagnose and treat your problem effectively.

– Yvonne S. Thornton, M. D., M. P. H

Just How Important Is Calcium?

Monday, February 24th, 2014

Through every stage of life, calcium is an important component of a woman’s diet. Calcium is involved in many aspects of overall health. It is believed to be important for bone health, prevention of cardiovascular disease, blood pressure regulation, weight management, and prevention of some types of cancer.

How Much Calcium Do You Need?

The recommended daily allowance of calcium for women between 19 and 50 years of age is 1,000 mg. That recommendation does not change when you are pregnant, but meeting it does become even more important, because you are providing nutrition for your baby as well, and his or her bones and teeth need calcium for proper development. In addition, when you don’t get enough calcium for a long period of time, you are at risk for developing osteopenia, which can lead to osteoporosis.  What’s the difference? Osteoporosis is a disease that breaks down the tissue in our bones, making them fragile and more likely to break. Osteopenia is not a disease, but a term that describes low bone density. Both can lead to painful fractures.  While osteopenia is not considered a disease, being diagnosed with osteopenia requires further monitoring. Preventive measures should be taken since osteoporosis may develop if bone density loss increases.

Actually, the real protection against osteoporosis begins when one is a teenager, because porousness of the bones is the end stage of a long process. Continuing to drink milk after childhood through the teenage years is like putting calcium in the bank to be drawn on later. Unfortunately, teenagers favor sodas over milk and not many drink the two glasses of milk a day that would allow them to meet more than half their daily calcium needs.

Which food has more calcium?  A cup of collard greens or a cup of whole milk?  The answer is collard greens!  Eight ounces of skim milk contains almost 300 mg – even more than whole milk, and in a healthier, fat-free package. Yogurt and cheese are good sources of calcium too, but remember that dairy products are just one of many ways to get the calcium you need. Salmon, kale, broccoli, and calcium-fortified orange juice are just a few of the other many places to find calcium.  I don’t believe that my orange juice should be calcium-fortified, but the manufacturers are offering the option.  Just drink milk!

What about calcium supplements? Their safety is often called into question, although for now they appear to be harmless. The real issue is that supplements are not a stand-in for natural foods that contain calcium, because they lack the protein, vitamins, and minerals that you, and your growing baby if you are pregnant, both need. With just a little effort you can get all the calcium you need easily through a healthy diet.

Calcium need during menopause is 1200 milligrams per day. After menopause, it increases to 1500 milligrams per day.  We once thought that calcium and Vitamin D supplementation should be taken to prevent bone fractures in postmenopausal women.  However, the United States Preventive Services Task Force, an independent panel of experts in prevention and primary care, recently issued a draft statement in June, 2012, recommending that healthy postmenopausal women should NOT take low doses of calcium or Vitamin D supplements to prevent fractures.  Why?  Because the supplements were found NOT to prevent fractures and only increased the risk of other problems, such as kidney stones.  So the risks outweighed the benefits and taking these supplements may actually be harming you.


Lactose Intolerance

Lactose intolerance is a common condition in which unpleasant symptoms such as bloating or diarrhea occur after consuming lactose, milk’s natural sugar. This happens when an individual does not produce enough of the enzyme lactase to properly break down the lactose. Lactose intolerance can unsurprisingly make it more of a challenge to consume enough calcium. However, some individuals can consume a small amount of milk without issue. Yogurt is often a good alternative.  However, there are many products today designed for lactose-intolerant individuals. In addition, there are many non-dairy sources of calcium available such as kale, broccoli, collards, and foods fortified with calcium.

Can You Get Too Much Calcium?

Like anything other good thing, too much calcium can present potential problems. Hypercalcemia can cause renal and vascular problems, as well as kidney stones. It can also cause constipation. However, it’s important to realize that you would have to consume more than three times the recommended daily allowance of calcium for problems to begin to occur. Given the average American diet, this is just not a real concern. So drink plenty of skim milk and enjoy lots of other calcium-rich foods as part of your balanced nutritious diet, especially while you are pregnant, lactating or postmenopausal.

For more information about the risk factors associated with postmenopausal osteoporosis, I refer you to my health book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.

Diagnosing Menopause

Thursday, December 12th, 2013

Thousands of women enter menopause each day. With average life expectancy increasing, the average woman will live out a third of her life after menopause. Menopause begins anywhere between 48 and 55 years old, but the average is 52. What does it mean to enter menopause, though, and what changes lead up to the official beginning of menopause?

Estimating when menopause will begin is more important than simply predicting the final menstrual period (FMP). In the year leading up to this, bone loss accelerates and cardiovascular risk factors increase. Until fairly recently, there was no reliable way to predict when the FMP would occur. Now, we are beginning to learn ways to estimate whether a woman is within a year or two of her FMP. These models are not used in clinical settings yet, but work in this area is promising.

Perimenopause begins several years (four, on average) before menopause. This is a transitional stage that includes several physiologic changes, including:

1. Irregular menstrual periods. A woman’s menstrual cycle undergoes marked changes in the years leading up to menopause. Typically this is a gradual lightening and spacing out of periods, but it can include heavier, more frequent periods, or sporadic combination of both.  

2. Hot flashes. Hot flashes are an extremely common symptoms of menopause, occurring in up to 80 percent of women.  These generally last several minutes and are characterized by a sudden sensation of heat that spreads out from the chest and face. Sweating and heart palpitations can accompany hot flashes, which are sometimes followed by feeling cold and shivering. Hot flashes may occur less often than daily, or they may occur several times in one day. They happen particularly often at night.

3. Sleep disturbances. Sometimes, hot flashes cause sleep problems, but often, sleep problems occur even without hot flashes. Feelings of anxiety or depression may contribute to sleep disturbances.

4. Vaginal dryness. As estrogen decreases, the vaginal lining thins, resulting in atrophic vaginitis, which can cause vaginal dryness, itching, and dyspareunia (painful intercourse) due to insufficient natural lubrication. A water-based lubricant can easily solve this problem.

5. Depression. Perimenopausal women are more likely to experience depression than premenopausal women, and sometimes this is new-onset depression. Then, in early postmenopause, the risk decreases.

Other symptoms can be present during the menopausal transition, including problems with sexual function, cognitive changes such as memory loss or difficulty concentrating, joint aches and pains, breast tenderness, headaches, and long-term issues such as bone loss and the increased risk of cardiovascular disease. A woman may experience only one or two menopausal symptoms or she may get every symptom in the book.

After several years of menstrual irregularity, menses eventually ceases altogether. Clinical menopause is defined as the absence of menstrual periods for at least six months. All of the symptoms of menopause can be treated and quality of life improved. Talk to your doctor about treatments for individual symptoms, or the possibility of hormone replacement therapy. You can also find more information on this topic in my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.

Myomas – Also (Wrongly) Known as Fibroids

Thursday, November 7th, 2013

As widely used as the term “fibroids” is, it is, in fact, a misnomer. “Myoma or myomas”  is the proper name for these tumors of the uterine muscle.

Myomas can be many different sizes and are typically hard and rubbery. They grow slowly and can occur at any time in any woman. 25 percent of all women have myomas, while 50 percent of black women do. Fortunately, many of these myomas are small and require no treatment. There can be just one or dozens in one uterus, and each one can be smaller than a pea or as large as a cantaloupe – or anywhere in between.

If your doctor tells you that you have a myoma, there are some questions you should be prepared to ask. You’ll want to know how big it is, how many of them there are, and where in the uterus they are located. Furthermore, you’ll want to discuss any symptoms it may be causing. A diagnosis of myomas often leads to hysterectomy, but sometimes this is an unnecessary overreaction, so talk to your doctor about possible other treatments, or whether treatment is needed at all.

For example, at menopause, myomas often shrink. This is because they are largely dependent on estrogen, so when estrogen output dwindles, myomas shrivel. They may not disappear completely, but if they are small enough and not causing symptoms, then there is often no reason to treat them.

However, some myomas can cause troublesome symptoms such as pain, irregular heavy bleeding, frequent urination, or problems with defecation caused by pressure on the colon. Another problem with myomas is that they can be hard to distinguish from ovarian cysts and tumors. Because they are slow-growing, though, it’s usually fine to monitor their growth through repeated examinations. If they stay the same size over time, this is a good sign. However, a growing myoma is a concern that requires some type of follow-up, usually exploratory surgery.

If a myoma needs to be removed, there are still different options for women and their doctors to explore. A myomectomy isolates and removes each myoma, while a hysterectomy removes the entire uterus. A woman who wants to preserve her ability to have children may opt for a myomectomy, but she should realize that this operation is difficult and complications are likely, so if she is older or certain that she does not want to have more children, then a hysterectomy is a much safer, simpler option.

There are new alternative treatments for myomas that are not recommended for women who still want to have children, because their newness calls into question the wisdom of recommending them; you can find more information about these treatments in my book, Inside Information for Women. But the fact remains that hysterectomy is the safe, rational course of action for myomas in women who do not want any more kids. Therefore, if you are symptomatic, menopausal and/or have completed your family, your  gynecologist may offer the definitive treatment of hysterectomy.

– Yvonne S. Thornton, M. D., M. P. H.

Working Through Menopause a Problem For Many Women

Thursday, September 26th, 2013

The prevalence of older women in the workplace is greater now than it has ever been before, but evidence collected through a survey of women in the United Kingdom has recently suggested that women of menopausal age feel that their workplace performance has been hindered by the changes in their body during this time. That is no surprise. Menopausal symptoms can range from irregular menstruation starting in the perimenopausal stage to hot flashes, agitation, and even joint soreness or pain.

Many women report that they feel they do not perform as well, and that changes in their body due to menopause affects their productivity and the quality of the work that they produce. However, most express an unwillingness to discuss these problems with their employers, in large part due to the fact that – for the most part – their employers are younger men. While this study took place in the UK, it is applicable to the United States as well.

While all aging employees will likely see some decrease in their workplace abilities as they grow older, the predicament of women going through menopause is a sensitive subject—however, it is one that must be touched on in order to find a solution that works for these women and that does not make them feel as if they are “rocking the boat”, so to speak.

The study in question found four areas of concern that needed to be addressed. The first was a greater awareness of menopause and menopausal symptoms among employers. Along with that was a need for a more flexible schedule and a more comfortable workplace. However, one of the more important areas that this study advised should be broadened was the amount of support that menopausal women in the workforce should be able to receive as they go through this transition.

While not every workplace will have these resources available for women, it is a good reminder of how important it is for any woman to have a good source of support on hand as she progresses through this stage of her life.

Whether her support is a sister, a close group of friends, or even anonymous strangers through an Internet forum – one of the greater benefits of living in the virtual age – these resources can not only help a woman approaching menopause know what to expect from the changes in her body, but the experience of others can be a great resource to help women uncover ways in which they can broach the subject of menopause with employers and adapt to the changes in her body. By determining what to expect as her body changes a woman will know what to ask for and the concessions that may need to be made in order to keep her active, healthy, and – most importantly – happy in the workplace.

– Yvonne S. Thornton, M. D., M. P. H.

Sex and Menopause

Monday, September 16th, 2013

Many women fear that aging and menopause will affect their sex lives negatively. The truth is that sexual satisfaction can and should last a lifetime. Menopause does present a few new challenges, but they can be easily overcome with the right information and a little patience.

First of all, if you are having sexual problems related to menopause, talk to your doctor about it. It may feel awkward, but your doctor can help you find effective solutions. Your doctor should take your concerns seriously. Your sexuality is an extremely important part of your life, and the basic human need for sexual contact does not diminish or go away just because we get older.

One of the problems women experience during menopause is painful intercourse. This is a symptom of atrophic vaginitis, which is characterized by dryness and painful intercourse as well as other related symptoms. If left untreated, atrophic vaginitis can lead to long-term sexual dysfunction and accompanying emotional distress. This condition is easily treatable with a 2-3 week course of estrogen cream applied to the vagina. Studies such as this one also show that continued, regular sexual activity encourages vaginal elasticity and lubrication.

Besides atrophic vaginitis, some of the other menopausal changes in a woman’s body can negatively affect her sex life if not addressed. The vaginal tissues naturally become thinner and drier, and vaginal secretions and lubrication often decrease. In addition, a menopausal woman is likely to take longer to achieve natural vaginal lubrication – several minutes, as opposed to the 30 seconds or so that younger women need.

These problems can be overcome simply by using a water-based lubricant such as Astroglide, and by being patient with yourself as well as expecting patience from your partner. Your thinner vaginal lining may also become more sensitive, so you should avoid products containing warming agents, flavors, artificial colors, or other chemicals that might cause irritation.

Waning energy is another issue menopausal women sometimes face. The sleep problems experienced during menopause can exacerbate the problem of diminished energy. Take steps to reduce stress and improve sleep, such as staying away from the computer for a couple of hours before bedtime, avoiding exercise late in the evening, and making your bedroom a relaxing (and sensual) sanctuary using soothing music, colors, or scents. Improving the amount and quality of your sleep will give you more energy all day long.

The bottom line is that sexual fulfillment can last the entire span of a woman’s life, and the more sexually active she is through the years, the fewer problems she is likely to experience in the bedroom later. In fact, nonexistent fears of pregnancy, more free time, and fewer inhibitions than younger women often have can make sex even better as you age. For more information on this topic, see my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.

Sleep Disruption in Postmenopausal Women

Thursday, July 18th, 2013

Do you experience difficulty sleeping? If so, then you are not alone. More than a third of individuals report that they face some difficulty sleeping that leaves them tired throughout the day, whether that is insomnia, discomfort during sleep, or patterns of sleeping and waking in the middle of the night. An individual might have difficulty sleeping for any number of reasons, whether it is simply the fact that they are too busy to get the rest that they need or whether it is the result of some more severe issue related to emotional distress or anxiety. However, a new study suggests that sleep difficulties might be heightened in postmenopausal women.   A person should receive between 71/2 and 8 hours of uninterrupted sleep a day.

In this study, both premenopausal women and postmenopausal women were asked to keep a diary tracking their typical sleep patterns across a two-week period. The results showed that postmenopausal women did show a lessened ability to get the recommended amount of sleep throughout the night. When compared to these women’s workday and leisure day schedules, it also showed that postmenopausal women were more likely to lose sleep related to the stresses of their workday.  Consequently, postmenopausal women had less than 7 hours of sleep compared to their premenopausal counterparts who slept about seven and one-half hours.

It can be easy to brush off studies like these, or to think that you’ll simply make up the sleep later if you are one of those that regularly experiences sleep problems. However, there is more than enough evidence available to suggest that losing sleep could lead toward much bigger problems down the line. Despite the potential risks of going without sleep, insomnia and related issues are still one of the most underreported medical problems that many people, and especially women, face. Be sure that if you are experiencing sleep difficulties, you speak to your doctor about them—especially if these sleep difficulties are concurrent with any other life changes, whether they are medical or emotional.

– Yvonne S. Thornton, M. D., M. P. H.