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Ellen Dolgen

  • Happy Menopausal Thanksgiving Travels!

    Posted on Monday, November 23, 2015 time is vacation time. We spend enormous amounts of energy finding the cheapest airline reservations, hotel rooms, and chatting about how excited we are about our vacations. This is all fun!

    Then the dreaded "P" word invades our joy – packing. Packing is not fun. Anyone who thinks it is MAAAAAY be just a little obsessive compulsive.....just saying! We spend hours thinking about it, talking about it, and then finally getting down to doing it! We really need a vacation by the time we zip up that damn bag.

    Now that I am postmenopausal, my packing is quite different. The space the period paraphernalia used to occupy is now filled with my lotions/potions that will enable me to keep my skin young forever- plus lots of space for bras. I remember when I used to go bra-less. In those days, I might throw in one bra for a sheer dress, but I could crinkle it up in the palm of my hand. It didn't need its own department in the suitcase! Whether the bra is strapless, t-strapped, or a plain old two strapper – all perimenopause, menopause and postmenopausal bras require wires and lots of space. Sounds like a drag, I know, but it's a worse drag if you don't wear one (nice joke, right?).

    When finally done packing, I proudly zip up my bag, but am careful to keep my eyes fixed upon it for a moment. My suitcase looks like the way I feel after I have had that second piece of apple pie (plus a pumpkin one) on Thanksgiving. I whisper to my suitcase, "Please don't explode. Once we get there I will unzip you and you will feel better again!"

    Happy Menopausal Thanksgiving!

    My Motto: Suffering in silence is OUT! Reaching out is IN!

    Click here to download my free eBook, MENOPAUSE MONDAYS The Girlfriend's Guide To Surviving and Thriving During Perimenopause and Menopause.

    Shmirshky, Your links have been removed, please consider upgrading to premium membership.

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  • Is Alcohol Stirred with Menopause a Good Elixir?

    Posted on Monday, November 9, 2015 this season offers us a whole new reason to want to reach for our cocktail of choice. Forget work, spouses, kids, and money issues. Those may have been your old reasons for cracking open a bottle of Pinot Noir. Now there's a new one: the extremely frustrating, often debilitating, more-than-maddening symptoms of perimenopause and menopause. We've survived dating, figured out that we can't ever fully figure out our spouse, delivered and raised our children, and now finally it should be OUR TURN. Unfortunately, Mother Nature has other plans for us. Instead of basking in our empty-nester glory, we find ourselves in perimenopause and menopause. UGH!

    Although alcohol may be thought by some in the Community of Menopausal Warriors as the go-to elixir for taking the edge off of seasonal stress and menopausal symptoms, it actually may not be the best choice.

    That glass of wine may enrage some menopausal symptoms, hot flashes being one of them! Remember that alcohol is a refined carbohydrate that acts like sugar in the body. It can cause an epinephrine release, which can trigger a hot flash. Some women say that their symptoms are more triggered by red wine than white.

    Although not based upon specific conclusive research, drinking may trigger hot flashes for some women according to NAMS (North American Menopause Society). Some studies find alcohol increases menopausal hot flashing, whereas others find the opposite. This alone could drive a gal to drink! Unfortunately for many of the Sisterhood, that delicious red (or white!) concoction of fermented fruit can be a double-edged sword. So it is best to determine whether it's a personal trigger for you.

    Let's first define what moderate drinking is. NIAA defines it this way: Moderate (low risk): no more than seven drinks per week and no more than three drinks on any single day. Ladies, if you need to pull out your calculator to add up the number of drinks you consume in a are probably exceeding the moderate zone!

    Before you stop reading, according to NAMS, there may be a "bottoms upside "benefit associated with alcohol consumption! ("I'll toast to that!)

    • Moderate drinkers have a significantly lower risk of coronary heart disease than nondrinkers. The heart benefits of moderate drinking become apparent at menopause when heart disease risk normally goes up, and the heart benefits continue after that. Hormone therapy doesn't affect that benefit.

    • Women who drink moderately have a lower risk of type 2 diabetes.

    • Those who drink moderate amounts of alcohol, especially wine, have a lower risk of dementia than those who don't drink at all.

    • Women who drink lightly or moderately have a lower risk of stroke than nondrinkers.

    • At and after menopause (ages 50-62), women who drink moderately have stronger bones than nondrinkers.

    • Midlife and older women who drink moderately have a lower risk of becoming obese than nondrinkers.

     Before you pour that second glass of wine, here is the list of why alcohol is not so great for us:

    • Any amount of alcohol increases the risk of breast cancer. The increase in risk is there, but small, for women who drink one drink a day. Women who drink two to five drinks a day have about 1.5 times the risk of nondrinkers. (The increased risk doesn't seem to have anything to do with alcohol's effect on estrogen levels.)

    • Drinking may trigger hot flashes for some women, although that isn't based in research. So determine whether it's a personal trigger for you. (As for a general risk of experiencing hot flashes and night sweats, some studies find alcohol increases it, whereas others find the opposite.)

    • Drinking alcohol increases the risk of many other cancers. The risk rises with the amount of alcohol consumed. (And the risk rises higher if you smoke as well.)

    • Alcohol has harmful interactions with many medications, such as medicines for arthritis, indigestion or heartburn, high cholesterol, high blood pressure, and more. Check out which ones [Link Removed].

    • More than moderate drinking increases the risk of cardiovascular disease. Among heavy drinkers, women are more susceptible to alcohol-related heart disease than men.

    • Women who drink heavily are prone to central obesity—the apple shape that is a big risk for cardiovascular disease.

    • Heavy drinking can lead to osteoporosis that cannot be reversed. It's also a risk for fractures.

    • Binge drinking increases the risk of developing type 2 diabetes.

    • Women at menopause are especially vulnerable to depression, and heavy drinking can just make that worse. Heavy drinking itself can lead to depression, and women who show signs of alcoholism are two to seven times more at risk of developing depression than men.

    • Alcoholic women are more susceptible than men to key organ system damage, including heart muscle damage, nerve damage, cirrhosis, and possibly brain damage as well.

     Moderation is the key word here, ladies! Too much of a good thing is, well, too much! Cocktails anyone?

    Remember: Suffering in silence is OUT! Reaching out is IN!

    Click [Link Removed]to download my free eBook, MENOPAUSE MONDAYS The Girlfriend's Guide To Surviving and Thriving During Perimenopause and Menopause.

    Shmirshky, Your links have been removed, please consider upgrading to premium membership.

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  • Understanding Hypoactive Sexual Desire Disorder (HSDD) - Low Libido

    Posted on Monday, October 26, 2015 August 2015, Sprout Pharmaceuticals received FDA approval for ADDYI™, known generically as Flibanserin. It is a once-daily, non-hormonal pill. The FDA had twice previously declined to approve this pill, repeatedly requesting further studies. The pill will be used for the treatment of the most common form of sexual dysfunction in premenopausal women, generalized acquired hypoactive (low) sexual desire disorder (HSDD). It is estimated that 8 to 14 percent of women ages 20 to 49 have the condition, which is about 5.5 to 8.6 million U.S. women.

    Low libido is a commonly known term. HSDD (Hypoactive Sexual Desire Disorder) was a new one for me, so I reached out to two doctors to get the scoop in layperson speak.

    Dr. Michael Krychman*, the Executive Director of the Southern California Center for Sexual Health and Survivorship Medicine Inc. in Newport Beach CA. explained HSDD this way, "Distressing lowered sexual interest- loss of sexual thoughts, fantasies or general interest in the pursuit of sex. Many women report a loss of a sexual interest – something they definitely miss, a loss of something internal or sensual femininity. It's lost and they want it back!"

    So you're saying we finally got our "pink pill"!!???

    Dr. Josh Trutt*, a healthy aging expert at Evolved Science in New York City, adds, "Because of the frequent comparisons to Viagra, it's worth noting that HSDD is not really analogous to erectile dysfunction. Viagra treats cases of erectile dysfunction that are primarily caused by a vascular (blood flow) problem. It improves blood flow to the penis, enabling erections, but it does not improve "desire." HSDD is a problem of diminished desire, and Flibanserin is intended to restore that person's diminished desire to their prior baseline."

    Ok, so calling Flibanserin our "pink pill" is misleading. This pill works on modulating key brain chemicals to restore a balance between inhibition and excitation. In contrast, as Trutt explained, Viagra doesn't address libido. It doesn't work on your brain, but rather on your blood vessels. Flibanserin is not indicated to enhance sexual performance.

    Many women complain about a loss of libido. So, I asked Dr. Trutt how a woman would know if she was a candidate for this new pill. He said, "Anyone can have temporarily diminished libido due to life circumstances, or prolonged diminished libido due to medications, drug use, an abusive relationship, and other causes. The HSDD diagnosis tries to separate those situations out by specifying that, even within the context of the person's age and culture, she is dealing with diminished desire lasting more than six months which is causing significant personal/ relationship distress, in the context of a stable/ healthy relationship, and these symptoms are not explained by medications, drug use or some other disease process."

    Sometimes dry vagina and loss of libido go hand in hand. It is important to note that Flibanserin is not a treatment for vaginal dryness. If a woman has a healthy libido and yet is nevertheless not lubricating adequately, that issue needs to be addressed separately with your healthcare provider.

    Dr. Krychman stressed the importance of speaking with your health care professional. He further added that the DSDS (decreased sexual desire screener) can help with the diagnosis. HSDD may be caused by other conditions, psychiatric/medical or psychological or even a destructive relationship- these issues are not HSDD.

    I was curious as to why this is approved for premenopausal women only. Dr. Krychman, responded, "Right now it has been studied in over 11,000 women (both pre and post-menopausal). However, the drug is FDA approved for premenopausal women, only. The drug has been studied in both populations and has been shown to be effective and safe. Providers may choose to use this medication in women over 50 who have HSDD, however, it would be considered off-label use!"

    Doctors must rule out many issues before diagnosing the condition such as; relationship issues, medical problems, depression and mood disorders. I wondered if there are similar requirements on doctors before they prescribe Viagra, Cialis and other drugs used to treat erectile dysfunction. Dr. Krychman explained, "Not really- but good sexual medicine physicians will look at the balance of both medical and psychological causes of sexual problems and rule in or out confounding issues and treat or offer interventions accordingly."

    According to Even the Score (an advocacy group sponsored by Sprout Pharmaceutical), the FDA has been exhibiting gender bias in approving 26 medicines for sexually-related disorders in men and zero or few for women.

    There is still plenty of controversy over this drug. Flibanserin regulates two neurotransmitters -- dopamine and serotonin – brain imagining studies of women with and without HSDD implicate the brain's frontal cortex, which many think control hormones related to sexual desire. However, there are many skeptical physicians who aren't sure what role these neurotransmitters actually play in causing HSDD. Some say it is not actually clear as to how the drug actually boosts libido in women who are helped by the drug.

    Dr. Trutt commented, "There has been a lot of talk about the FDA being biased against women, such that Flibanserin is the first approved drug to treat women with low sex drive. But it seems to me that this may be a bit misleading: there are no FDA-approved drugs for men with low sex drive either. Viagra does not treat low sex drive; it treats a physical inability to perform. In that sense, Viagra is more similar to Premarin or Vagifem, which have been approved for vaginal dryness-- and Premarin was FDA-approved for that purpose many years before Viagra came along! Testosterone has been used off-label for low libido in men, but that is not an FDA-approved use. (Testosterone is FDA-approved specifically for the treatment of low testosterone levels combined with an associated medical condition. If a man has low libido but normal testosterone levels, testosterone is not FDA-approved for the treatment of his low libido.)

    Trutt went on to say, "It is very common for libido to decrease around menopause, when testosterone levels drop. Many studies have definitively shown the benefit of testosterone on women's libido and sexual response. A 2014 review paper on the use of testosterone for women with HSDD stated:

    "On the basis of our analysis of 20 randomized, placebo-controlled trials, we can conclude that testosterone has a positive effect on sexual response [in women], having been reported to increase pleasure from masturbation, sexual desire, the frequency of sexual activity, sexual satisfaction, and orgasm. These findings are consistent with those of other studies showing increases in sexual desire, the frequency of sexual activity, and sexual satisfaction in women receiving androgen therapy."

    Trutt further explained, "Testosterone improves libido in women-- and testosterone has been available for women for decades. Estratest came on the market in 1964 and was originally marketed for hot flashes, but has been used off-label for low libido since at least 2003. While Estratest was not FDA-approved for low libido, it is available (and so is compounded testosterone), so the fault probably does not lie with the FDA so much as with our doctors, who have been reluctant to prescribe testosterone for women. Many of my patients see dramatic improvements in libido when their testosterone is replaced. Given the added benefits of preventing the muscle loss (sarcopenia) of aging, and improved bone density, certainly in my practice I would check testosterone levels before turning to a medication that affects dopamine and serotonin receptors."

    As in most medications, there is a big list of contraindications with Flibanserin. One that particularly stood out for me was: alcohol. These FDA's concerns over Flibanserin's side effects may still restrict the number of doctors and pharmacists who are willing to offer it to patients. Common side effects of Flibanserin include dizziness and sleepiness. A few patients who took a too-high dose or consumed alcohol with the medicine in clinical trials also experienced a drop in blood pressure that caused them to faint.

    We often joke about low libido, but for many women HSDD is a serious condition. It is up to you and your healthcare professional to determine which protocol is best for your personal health needs. Staying on top of the latest information will help you be your own "best" healthcare advocate.

    My Motto: Suffering in silence is OUT! Reaching out is IN!

    Click here to download my free eBook, MENOPAUSE MONDAYS The Girlfriend's Guide To Surviving and Thriving During Perimenopause and Menopause.


    Dr. Krychman reports: Consultant/Advisory Board: Palatin, Pfizer, Shionogi, Sprout, Noven, Viveve Medical Materna.

    Dr. Trutt reports: none

    Shmirshky, Your links have been removed, please consider upgrading to premium membership.

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  • SIGN THE PETITION in Support of NAMS Proposal for a Label Change On the Boxed Warning for Lower-Dose Vaginal Estrogen

    Posted on Friday, October 23, 2015 all vagina owners!

    On November 10, 2015, the US Food and Drug Administration (FDA) is holding a workshop in Silver Spring, Maryland on the subject of the product labeling of lower-dose vaginal estrogen. This workshop will also provide public comments and testimonials on this subject.

    I am happy to hear that The North American Menopause Society (NAMS) is spearheading the need for the box labeling for low dose vaginal estrogen to be changed. Right now the box labeling overstates the potential risks, and frankly it inhibits many doctors from prescribing this treatment. When women read the box label they are scared half to death to use this very successful treatment option.

    Lower dose vaginal estrogen, commonly referred to as LET (local estrogen therapy) is used for women who are experiencing the following symptoms:

    • Vaginal dryness

    • Vaginal burning

    • Vaginal discharge

    • Genital itching

    • Burning with urination

    • Urgency with urination

    • More urinary tract infections

    • Urinary incontinence

    • Light bleeding after intercourse

    • Discomfort with intercourse

    • Decreased vaginal lubrication during sexual activity

    • Shortening and tightening of the vaginal canal

     The medical community has many names for this condition: dyspareunia, vulvar and vaginal atrophy or Genitourinary (Don't worry, I can't pronounce that either.) Syndrome of Menopause. For our purposes, let's call it dry vagina!

    Dry vagina occurs when there's a drop in levels of estrogens, produced by the ovaries. Estrogens maintain the structure and function of the vaginal wall, the elasticity of the tissues around the vagina, and production of vaginal fluid. When it comes to the vagina, thin is out!

    As if graying hair, sagging tatas and expanding waists weren't enough, we now find out that our vaginas are aging too! If you feel you're left high and dry, you're not alone. Vaginal dryness affects as many as 75 percent of postmenopausal women. Between 17 and 45 percent of postmenopausal women say they find sex painful, according to[Link Removed]. Deadline for signatures is November 10th!

    It's been about 10 years since my vagina was found stranded on a desert island and took my sex drive with it! Since rescuing it, my life is full, happy and satisfied. Remember: Your symptoms are treatable. You can have a happy vagina again!

    Please share with the sisterhood!

    Shmirshky, Your links have been removed, please consider upgrading to premium membership.

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  • Breast Cancer, Mammograms & Menopause

    Posted on Monday, October 19, 2015 news media has lots to say about breast cancer, mammograms, and menopause. At times, I find myself a bit confused over all the conflicting opinions of doctors over the new data. We all want to keep our breast friends healthy, so let's go over the information together.

    As the number of candles on our birthday cakes increases, so does our risk of developing breast cancer. While a 30-year-old woman's risk of developing breast cancer in the next 10 years is one in 227, that of a 60-year-old woman is one in 28, according to the National Cancer Institute. Hit 70 and the risk increases to one in 26.

    Dr. Ricki Pollycove, M.D., a women's health expert agrees, "Age, or getting older, is the single greatest risk for getting diagnosed with breast cancer. There are many likely reasons for this, and many are related to what are called epigenetic factors. In simple words, our lifestyles influence our genes. We can become educated and actively change our behaviors to lower individual risks as we get older."

    Many women are suffering from the various symptoms of perimenopause and menopause, and in spite of the data, remain afraid of hormone therapy (HT). They are convinced it will increase their risk of breast cancer. I asked Dr. Pollycove to tell us how hormone therapy can affect the risk of breast cancer.

    "Estrogen use over the long term actually lowers a woman's risk for breast cancer! It decreased rates of breast cancer by 23 percent in the largest clinical trial out of the U.S., which was re-analyzed after 11 years of conjugated estrogen (estrogen only) use and published in 2011. In fact, a 33 percent lowered rate of breast cancer was seen in women who took more than 80 percent of their study pills! 2015 updates show a continued decrease in breast cancer rates even 5 years after stopping estrogen therapy. However, headlines often read differently and scare women out of the HT they need."

    For example, Dr. Pollycove said that there is a 2013 large mammogram review study in the Journal of the National Cancer Institute that found HT's effect on breast cancer risk varies somewhat by ethnicity, body mass index, and breast density. Dr. Pollycove further noted that the HT used in this study was MPA (Medroxyprogesterone Acetate), a synthetic progestin (not a bioidentical HT). This form of HT had a small but negative impact - an additional 8 cases of breast cancer in 10,000 women-years of use. It is frustrating that the press often does not mention the different types of HT (bioidentical/natural vs non-bioidentical/synthetic) in their news reports.

    Pollycove added, "Most diseases we see on the rapid rise (heart disease, diabetes, osteoporosis, fracture, frailty, dementia and dependency) are all associated with not taking estrogen after menopause. These worse outcomes with aging have appeared in recent population data involving millions of women around the globe."

    Dr. Josh Trutt, MD, a healthy aging expert at Evolved Science in New York City, agrees. Although he prescribes bioidentical hormones, he points out that both bioidentical and non-bioidentical estrogen decrease breast cancer risk, however, when combined with non-bioidentical/synthetic progestins like Medroxyprogesterone acetate or norethisterone, there is a small increased breast cancer risk."

    Dr. Trutt said, "The pervasive fear of breast cancer is causing women to avoid estrogen therapy—which is a tragedy because avoiding estrogen therapy is killing women by the tens of thousands. That's because each year, heart disease kills 20 times as many women as breast cancer-- and taking estrogen cuts your risk of heart disease in half. Because of estrogen's tremendous benefit in heart disease prevention, if a woman starts estrogen replacement within ten years of menopause, it lowers her risk of death by 40% for as long as she takes it (at least for up to 16 years, which is as long as the randomized prospective studies have followed women on hormones."

    Dr. Pollycove adds, "Observational studies of estrogen users have shown significantly reduced rates of heart disease and diabetes for over 30 years; the more years of use the better the health in menopause."

    "Which hormone regimen is right for you," says Dr. Trutt, "Depends on how many years it has been since menopause, and what other risk factors you may have. But some form of hormone therapy is appropriate -and, in fact, should be standard of care for prevention of heart disease and osteoporosis- for all menopausal women."

    I was curious if having a hysterectomy affects a women's risk of breast cancer. Here is the silver lining according to Dr. Pollycove, "Surgical menopause with the removal of ovaries actually slightly lowers a woman's risk for breast cancer. The basis for this lowered risk is not well understood, but it is one of the good-news aspects of the upsetting situation many women feel when they have to give up their uterus due to pain, diseases like severe endometriosis, or abnormal precancerous or cancerous growths. A 2011 multi-center study from the University of Southern California, Los Angeles, shows that removal of one or both ovaries is associated with a decreased risk of breast cancer."

    On a related matter, mammograms are quite a hot topic! There was a large study published June 2015 which demonstrates, "that routine mammography screening frequently results in overdiagnosis because it identifies invasive breast cancers that would either have regressed on their own or never developed to clinical significance. Overdiagnosis may account for 30%-50% of cancers identified by mammography screening. The absolute number of overdiagnoses may exceed 70,000 women in the U.S. each year."

    Dr. Pollycove feels that the mammogram controversy mostly revolves around Ductal or Lobular Carcinoma in Situ, DCIS or LCIS. These are the presence of abnormal cells inside a potential milk-transporting duct or a milk-producing lobule in the breast.

    In the September 2015 issue of the New York Times, there is an interview with Dr. Laura Esserman, a well-recognized breast surgeon and researcher at the University of California, San Francisco. Esserman is one of the most vocal proponents of the idea that breast cancer screening brings with it overdiagnosis and treatment. She is advocating for more "watchful waiting" rather than biopsy-diagnosing these "indolent precancerous lesions." Her approach was given a boost in a long-term study published in JAMA Oncology. After 20 years of analysis, this study made the case for a less aggressive approach for DCIS.

    Pollycove acknowledges that clinical trials are in progress, but she feels that at present, it takes a lot of courage for some women to wait and repeat imaging in a year or so. How completely a woman and her doctor need to explore such mammogram findings, undergo biopsy diagnosis, is a matter of personal opinion.

    The study suggests that the more mammograms you do, the more non-dangerous tumors you find, which are then removed, and, therefore, the "mortality rate" is artificially lowered. The study reports that "Overdiagnosis also distorts mortality rate calculations; because the mortality rate is defined as the number of women who died divided by the number diagnosed with cancer. Increasing the number of "diagnosed" women by 30–50% in the screened group lowers the apparent mortality rate. This causes women to believe that mammograms lower mortality much more than they actually do."

    The study authors concluded that, given the impact to the patient of overdiagnosis, together with the lack of evidence that mammography actually lowers mortality rates; informed consent to asymptomatic women should include these results and consideration of the benefits of avoiding mammograms.

    Dr. Trutt helped to clarify this for me. He said, "About 40% of "positive" mammograms are not actually dangerous cancers-- yet women still go around thinking that they have/had cancer. They undergo more repeat studies, biopsies, often unnecessary surgery. Then they are "cured," which makes people think "wow, look how many lives we are saving by screening with mammograms"-- but these are not women who actually had dangerous cancers, so it is misleading. The mammograms didn't help at all."

    Dr. Pollycove currently serves on the Board of Trustees of the NCoBC, which includes the society that was formerly known as the American Society of Breast Diseases. Her colleague, Dr. Daniel B. Kopans, Professor, Radiology, Harvard Medical School, Director, Breast Imaging at Massachusetts General Hospital takes great issue with simple statements about overdiagnosis and death rate declines. Dr. Kopans feels that the statement, "mammograms save lives" is not an empty phrase and that primary care clinicians see the enormous difference in the quality of life when breast cancers are detected early and treatments for a cure are much simpler. He and Dr. Pollycove both feel that MRI's have their place in conjunction with mammography. Seeing "all of the elements in a haystack" makes MRI more difficult to interpret when not guided by mammograms.

    In contrast, Dr. Eric Topol, Director of the Scripps Translational Science Institute in La Jolla, California- Chief Academic Officer for Scripps Health, professor of Genomics at The Scripps Research Institute, and Editor and Chief of Medscape states in his commentary on Medscape, "It is time to reboot how we screen for breast cancer. Until now, the use of mass screening suggests that we are unable to differentiate the risk in any given individual. So instead of a smart approach that uses family history and genetics, we have dumbed it down and treated all women the same. As a result, we have come to rely on a test that is notoriously inaccurate but has become a fixed part of American medical practice since it was introduced almost 50 years ago. With the tens of millions of low-risk women unnecessarily undergoing screening each year, any test would be vulnerable to a high rate of false positives. That applies to higher-resolution scans, too, such as magnetic resonance, digital mammography, and ultrasound. Indeed, there is a better path forward."

    I asked Dr. Trutt to tell us about the breast screening protocol he recommends for his patients. He replied, "Not surprisingly, this recent paper demonstrates that for the vast majority of women, irradiating their breasts while applying 50 lbs. per square inch of pressure is more likely to be harmful than beneficial. For higher risk women or women who insist on imaging, I now refer them to Alpha 3T MRI in NYC. Drs. Newatia and Hussman are able to offer what is essentially the Ferrari of breast MRIs because they have optimized their equipment and the technique used. Specifically, they have 16-channel breast coils and a 3 Tesla magnet, and they use "multiparametric" imaging with dynamic (rather than static) contrast enhancement (DCE), diffusion imaging, and spectroscopy. Multiparametric MRI optimizes the accuracy of breast MRI screening for all patients of any age, even the 40% of women with dense breasts. No test is perfect, but they are able to distinguish dangerous from benign lesions better than a mammogram can, which cuts down the stress and expense of having to repeat the study, and reduces unnecessary biopsies."

    Trutt explained, "If insurance doesn't approve the screening, they charge about $600 cash. Not everyone can afford that, but hopefully insurance will start paying for it when they realize how much cheaper and more accurate a quality MRI is than a mammogram, the results of which are more often "indeterminate" (which leads to more mammograms and then biopsies that could be avoided)."

    In contrast, Dr. Pollycove expressed that, "The logic of this is not obvious, but imaging experts disagree with Dr.Topol and Dr.Trutt. The most important thing women can do to lower their chance of having their quality of life or lifespan affected by breast cancer is to get regular mammograms and at least an annual clinical breast exam by a provider. The reassuring news is that the older a woman is when diagnosed, the less likely she is to have a life-threatening cell type of breast cancer. Women with non-invasive cancers of the breast (which are the most common in women who undergo regular screenings) have a disease-free survival rate of 93 percent. Women with non-invasive breast cancer or invasive tumors that are less than a centimeter in diameter often have a lumpectomy in which the cancerous tumor is removed while leaving the rest of the healthy breast tissue intact; called breast conservation. The key here, however, is early detection. Virtually no one dies of in-situ abnormalities. The problem is that without proper removal of some aggressive types of in-situ abnormalities, tumor progression does in fact occur. Using the simple label, 'Overdiagnosis,' is vague and can be falsely reassuring."

    Pollycove went on to explain, "The National Consortium of Breast Centers (NCoBC) and internationally respected as the premier multidisciplinary breast care society, recommend annual screening for women 40 and older. To confuse things, however, in 2009, the U.S. Preventive Services Task Force issued new guidelines stating that women younger than 50 didn't need routine annual mammograms and those ages 50 to 74 should only get screened every two years. Before that, the recommendation was that all women aged 40 and older get mammograms every one to two years—a recommendation the American Cancer Society, NCoBC, ASBD, ASPRS, many physicians, and, according to a study from Brigham and Women's Hospital, about half of women, still follow."

    In their latest statement, the U.S. Preventative Services Task Force states the following: "The Task Force recognizes that a mammography is an important tool in reducing breast cancer deaths. The science shows that screening is most beneficial for women ages 50 -74. The decision to start screening before age 50 should be an individual one and should be made by a woman in partnership with her doctor. The draft recommendation on breast cancer screening will not affect insurance coverage. Mammography is a screening service generally covered by all public and private insurance plans without co-pays or cost sharing for the patient."

    Dr. Pollycove feels that the task force is based on cost-effective benefit (dollars spent per cancer detected) not on what is always best for the patient. Sadly, the more lethal cancers are more often found in the women aged 40-50. Her hope is that the USPSTF draft recommendation on breast cancer screening will not be endorsed by the US Congress and adversely affect insurance coverage. The PALS Act (Patient Access to Lifesaving Screening Act) has been introduced in both the House (H.R. 3339) and the Senate (S. 1926). The sponsors are Senators Barbara Mikulski (D-MD) and Kelly Ayotte (R-NH) and Representatives Renee Ellmers (R-NC), Debbie Wasserman Schultz (D-FL), and Marsha Blackburn (R-TN). If passed, this would ensure that women who want to get regular mammograms retain insurance coverage with no copay and avert thousands of unnecessary deaths resulting from implementation of draft United States Preventive Services Task Force (USPSTF) breast cancer screening recommendations.

    To further expand the conversation of breast cancer, many of us want to understand the risk factors. Dr. Pollycove explained, "Divide the risk factors for breast cancer into two buckets: the risks about which you can do something and those that are out of your control as you enter menopause. While it's frustrating and often upsetting if you have a family history of breast cancer or mutated BRCA1 and BRCA2 genes, knowing—and communicating to your doctor—your inherited, "not-going-to-change," risk factors is important in determining the right prevention plan for you. After childbearing is completed, some oncologists recommend considering oophorectomy in BRCA 1 and 2 gene carriers. Some other risk factors include dense breast tissues and previous benign breast conditions such as hyperplasia with atypia of ductal or lobular tissue, cysts, and papillomas. What's more, if you've never been pregnant or had your first pregnancy after age 30, your risk for breast cancer increases slightly, according to the American Cancer Society. Pregnancy and breastfeeding reduce breast cancer risk likely because they help mature breast tissue and reduce the total number of menstrual cycles that a woman has throughout the course of her life; this may influence cancer risk by altering hormone exposure to the breast tissues."

    Whether to get the BRCA testing done is a decision that you and your physician should make together. Information is power. My cousin, Karen, had breast cancer and being that I am of Ashkenazi Jewish descent, I decided I wanted the BRCA test. The more baseline information available for my doctors and me to consider, the better. I wanted to have this information for me, my children, grandchildren and the many generations to follow so that it can be incorporated into our ongoing heath care decisions.

    Pollycove went on to expand on the risk factors that we can control. She put it quite simply, "Basically, anything that's bad for your overall health is bad for your breasts. Some examples: smoking, being overweight or gaining weight at mid-life, living a sedentary or stressful lifestyle, eating a diet high in saturated fat, drinking more than seven to 10 alcoholic drinks per week, and eating few fruits and vegetables."

    Dr. Pollycove, "beats the lifestyle drums" every day in caring for her patients. Her prevention prescription: Perform aerobic exercise for at least 20 minutes a day. She maintains that this alone can cut your risk of breast cancer in half. I shall remember that when I am having a hard time peeling myself out of my desk chair to go exercise!

    Women have critical decisions to make regarding their breast health. As confusing as it may be, it is important to be aware of the latest information and science so that you can be a full partner at the table and discuss the pros and cons of these important health care decisions which affect your quality of life and lifespan.

    This is a lot to digest for me, too! But, I wanted to give you a well-rounded and uplifting (pun intended) version of both sides of the story. Now, I think I need to take my breast friends out for a drink!

    My Motto: Suffering in silence is OUT! Reaching out is IN!

    Click here to download my free eBook, MENOPAUSE MONDAYS The Girlfriend's Guide To Surviving and Thriving During Perimenopause and Menopause.

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  • A Singing Uterus Stars in Crazy Ex-Girlfriend!

    Posted on Monday, October 5, 2015 64,000 of you know Rachel Bloom as the singing uterus in my "A Singing Uterus Explains Perimenopause and Menopause" video.

    Now hold on to your ovaries, just one week from today, Rachel will sing & dance onto Monday night TV in the new musical comedy series, Crazy Ex-Girlfriend premiering on the CW, October 12th! Check your local listing for the time.

    Crazy Ex-Girlfriend is a romantic comedy that explores the psyche of a woman who abandons her phenomenal job at a law firm in New York, to find her high school-era ex-boyfriend in West Covina, CA – not exactly paradise!

    Rachel is not only starring in the show, she created the show along with Aline Brosh McKenna. You may have heard of Aline, she was the screenwriter of The Devil Wears Prada. I loved that movie!

    I fell in love with Rachel in 2010 when I saw her music video (WARNING this video is NOT PG) about Ray Bradbury. Of course, we all know Ray Bradbury who was the recipient of the 2000 National Book Foundation Medal for Distinguished Contribution to American Letters, the 2004 National Medal of Arts, and the 2007 Pulitzer Prize Special Citation. Apparently, Ray Bradbury fell in love with the video too (so did almost 3 Million other people!), and subsequently asked to meet Rachel!Rachel Bloom

    I know that everyone does stuff, but not like Rachel does stuff.

    Regardless of the topic, from menopause to obsessive young love, Rachel never fails to deliver gifted and creative tongue-in-cheek, hysterical comedy. As I watch Rachel's career soar, I will always remember and deeply appreciate, how she helped tens of thousands of women, both young and not so young, understand and prepare themselves for perimenopause and lives of self-empowerment.

    Thanks, Rachel! Next time I visit West Covina, I will be looking for you!

    Shmirshky, Your links have been removed, please consider upgrading to premium membership.

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