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Menopause education is my mission. Spurred by my own experience struggling with the symptoms of menopause, I have devoted the last ten years of my life to helping other women during this often difficult time. I am not a doctor or scientist, but I have "talked the talk" with countless menopause experts, so that I can "walk the menopause walk" with you and share the keys to this menopause kingdom.
Together with my son, Jack, we have created a FREE eBook, MENOPAUSE MONDAYS The Girlfriend's Guide to Surviving and Thriving During Perimenopause and Menopause, a comprehensive guide to all things menopause—the symptoms, treatments, and long-range effects on a woman's health.
Presented in an entertaining and informative way, we share information and expertise from numerous specialists, replacing the confusion and embarrassment so often experienced with medically sound solutions. You'll find detailed descriptions and treatments for the symptoms you or your loved one may experience, from hot flashes and mood swings to mental fogginess and loss of libido, and lots more in between.
In addition to sharing the latest research and proven treatments, you will find tips on how to find a menopause specialist who's right for you, and a clear explanation of what tests to ask for. You'll also learn about the latest studies on hormone replacement as well as alternative therapies and remedies. Finally, we share the real-life experiences of women—and those who love them—as they traverse the crazy ups and downs of perimenopause and menopause.
The FREE eBook format will allow us to periodically do updates with the latest studies and information. In that sense, it will be a living text that grows as the information grows.
Help me with my mission! Spread the word!
Suffering in silence is OUT! Reaching out is IN!
Before I tell you all about this fabulous new eBook I'm releasing
for FREE I want to take a moment to reflect on what the Menopause Mondays blog, and all my work in educating women and men on perimenopause and menopause, has meant to me, and to thank YOU for everything you've given me.
As I walked down the stairs to my computer this morning, I began reminiscing about these past years of writing and blogging about perimenopause and menopause.
My morning usually begins at 7AM. I love the quiet of the house and the sunlight peaking in as I raise the blinds. I yearn for my morning coffee, but these days it is a few steps behind my probiotic (who knew we need to balance the good and bad bacteria?!!) and a large glass of ice water.
I try to do my morning 20-minute meditation, but frankly my need to check my emails resulting from my weekly blog posts usually wins out. What if someone is suffering in another time zone? I don't want them to wait too long to get support. I remember how alone I felt when my perimenopausal symptoms were running my life. More like ruining my life.
Some of the emails contain just one line: "Help, I am depressed!" or "I can't sleep anymore. Am I in perimenopause?" Others are very long journals of very trying, difficult emotional highs and lows, severe depression, insomnia, or shockingly severe issues with sex and libido that are causing marriages to fall apart.
Most of the time, I can direct people to the various blogs in which I interview specialists on the topic to help answer their questions. But, sometimes I just know that they need to talk to someone who cares. So, I send them my cell phone number. Then immediately my cell phone rings.
I know that just being able to verbalize what is bothering you can be very calming. Funny, though, as I speak to women from all over the world, I find my way back to my own inner peace. Each and every time, I hang up the phone with a full heart and a smile on my face. Helping others seems to be very healing and nourishing to me. When I started out, I had no idea this would happen.
When I have a spare moment, I try to follow up with everyone who has contacted me to see how they are doing.
My follow-up emails are sometimes frustrating, as some women try so hard to be "fine" that they may not take the steps needed to feel better. For example, I may have called a menopause specialist in NYC to squeeze in a patient who was truly at her wits' end, only to find out she cancelled the appointment! I don't give up. Instead, I keep nagging until they go to the specialist! I know my role is to be their health advocate until they learn to advocate for themselves. I take my role seriously.
There are days when David has to peel my butt off of my chair to eat lunch or dinner or get on my bike! Thank goodness he does! Otherwise, I might be completely glued to my chair by now.
My husband and children have consistently rallied around me, encouraging me and pushing me to continue on my mission, even when I had self-doubts and frustrations. I know it's a bit cheesy, but I like cheese! They truly are the wind beneath my wings. I love it that my husband and children are proud of me. They have no idea how much that means to me.
When I allow myself to step back and review my journey, and let go of my Virgo-ism and the self-critical chatter that harps on the things that I could have done better, I truly feel I have accomplished something that I am proud of. I have helped lots of women and the people who love them. This is the most rewarding thing of all.
My whole being is so wrapped around this mission that I seem to know when someone needs help no matter where I am: on an airplane, at the grocery check-out line, in the carwash waiting room, or at a social event. I zero in on the women who are suffering in silence. David has nicknamed me the "Vagina Whisperer." He gets that look that says, "And...there she goes!" As I try to engage with the woman, he watches with pride and great patience.
It's shocking that while there are ever increasing numbers of women in the workplace, in corporate executive positions, and other vital roles in our society, so many women are still suffering in silence. My mission is to replace the confusion and embarrassment about the symptoms millions of women go through before, during, and after menopause with medically sound solutions presented with lots of love and laughter.
So in that spirit, I will be releasing a new eBook, available for FREE to all women and the people who love them. The book will be an amalgamation of what I've learned from interviewing experts, from my own experiences, and from the personal stories that the sisterhood has shared with me. The book will be called, Menopause Mondays: A Girlfriend's Guide to Surviving and Thriving During Perimenopause and Menopause. The eBook format will allow me to periodically do updates with the latest studies and information. In that sense, it will be a living text that grows as we grow.
That's why we're here. So we can grow together.
As I work on this eBook, you may be hearing from me more sporadically. I have re-organized EllenDolgen.com and updated our blog information, making it even easier for you to find the answers you need. Think of EllenDolgen.com as a resource library. You can easily access my Menopause Symptoms Chart, Menopause Specialist Directory, Blogs, Health News Flashes, Top Symptoms, and FAQs. As we go through this new chapter together, please continue to communicate with me directly at firstname.lastname@example.org.
Your energy and appreciation has empowered and motivated me to continue our good work together and elevate Menopause Mondays into the next chapter of its life: Menopause Mondays: A Girlfriend's Guide to Surviving and Thriving During Perimenopause and Menopause.
In today's over-prescribed, oversized yet undernourished society, we often find ourselves plagued with inexplicable ailments. I'm not talking about the hot-flash-weight-gain-tender-breast-migraine symptoms of perimenopause and menopause. I'm talking about more chronic, everyday symptoms.
As with menopause symptoms, many people are seeking out alternative treatments to prescription drugs. Interestingly, while people often look to eliminate troublesome foods from their diet, it's less common for them to add certain foods to help alleviate symptoms.
For those who suffer from histamine intolerance, many have found relief through a combination of physical and mental "treatments." By regulating diet and using the brain to heal, many sufferers have alleviated their symptoms.
Although histamine intolerance may affect only about 1 percent of the population, its symptoms are often confused with other maladies, such as food allergies. The majority of those diagnosed with histamine intolerance is women in their 40s. Guess what? Hormonal imbalance can trigger histamine intolerance in women who previously did not suffer from it prior to menopause.
So what are the symptoms of histamine intolerance? Here they are... and many are eerily similar to menopausal symptoms:
What foods can trigger histamine reactions? The following foods have the highest levels of histamine:
OK, so what foods are considered anti-histamine? Yasmina Ykelenstam, who bills herself as The Low Histamine Chef, eats the following foods to counteract when she has had a food-related histamine overload:
Ykelenstam follows a low-histamine diet to ease her own symptoms (plus meditation, not medication) and is the author of several cookbooks. She calls upon the power of the brain, using mindfulness meditation and visualization as healing tools.
Healing involves both the body and the mind, as I noted in my cousin's brave battle with breast cancer. Studies have confirmed this direct correlation. The Western world has been turning increasingly to alternative therapies, many derived from Eastern practice and medicine.
"Meditation may be an important adjunct strategy in the treatment of chronic illness," says Ykelenstam, but she says its benefits are often grossly underestimated or overstated. While meditation certainly isn't a cure-all, she says its impact on self-healing should not be discounted.
In an article in Psychology Today, mind-body-spirit pioneer Dr. Henry Grayson says we've got it all wrong. " Well, the common way of thinking is upside down. We think that our purpose is to heal the body. But the body is really just empty space. It's 99.999% empty space. It's consciousness that rules. ... If we're trying to heal the body without healing the mind, using the mind to heal the body, we missed the basic healing that's necessary for us."
In short, while I've focused a great deal on histamine intolerance here, my point is that first you need to find out whether your symptoms are menopause related or due to an underlying condition. See your menopause specialist.
Once you've determined what's causing your symptoms, you can either choose to live with them or decide the best course of treatment for yourself.
Suffering in silence is OUT! Reaching out is IN!
Think back to your PRE-menopause days. If someone told you they could trigger menopause for you, you'd hardly have jumped at the chance, right? But that's exactly what many cancer survivors younger than 50 – or even younger than 40 – experience.
Each year in the U.S., almost 50,000 women younger than 50 are diagnosed with invasive breast cancer. Nearly 10,000 of them are younger than 40. During chemotherapy, women may have irregular menstrual cycles, amenorrhea (disappearance of menstrual periods), menopausal symptoms or be thrown into actual menopause. Menopause may be immediate or delayed, permanent or temporary when triggered by chemotherapy.
I reached out to the Yale Cancer Center and spoke to Dr. Erin W. Hofstatter, Assistant Professor of Medicine (Medical Oncology); Co-Director, Genetic Counseling Program, and Dr. Elena Ratner, Assistant Professor of Obstetrics, Gynecology, and Reproductive Sciences, to shed some light on issues of concern to my readers. They graciously provided me with philanthropy of their knowledge!
Dr. Hofstatter flatly responded, "I am a huge fan." More and more data shows that this 3-D mammography cuts false-positives and call-back rates, and is picking up a few extra cancers per 1,000 women screened. It is a small amount of extra radiation compared to the usual 2-D mammogram, but is well worth it since it reduces call-backs and need for diagnostic mammograms (which are a lot more radiation than a screening 2-D mammo).
Genetic Testing For BRCA1 and BRCA2
Dr. Hofstatter noted that about 5 percent of breast cancer patients test positive for the BRCA1 and BRCA2 genes associated with the disease. However, the likelihood of testing positive for a woman with breast cancer depends on how old she is, if she is of Ashkenazi Jewish heritage, and what type of breast cancer she has. All these women have a slightly higher chance of testing positive. Here are some stats on the chances of women with breast cancer testing positive:
I asked Dr. Ratner what her thoughts were on the new research on Ashkenazi Jews and BRCA1 and BRCA2. The study recommends routine screening for the BRCA1 and BRCA2 genes for all women of Ashkenazi Jewish descent – even without a family history. Her research actually deals in gene mutation. She said she thinks it is very reasonable for women of Ashkenazi descent to be tested. Knowing your genetic mutations and what predisposes us to cancers is beneficial so that we can actually be proactive about it.
Dr. Ratner explained that the standard care options for women who carry the gene vary depending on the medical history of each patient. However, it is recommended that you add an MRI and sonogram – alternating at six-month intervals for breast cancer screening. For ovarian cancer screening, usually it is a pelvic (vaginal) ultrasound done every 12 months and a blood test CA-125 done every 6-12 months.
Breast Cancer Treatment Options
Research is also continuing on surgical treatment of breast cancer. Dr. Hofstatter shared her analysis of a recent JAMA study on the survival benefit of a double mastectomy in treating unilateral breast cancer. "Many women diagnosed with a breast cancer believe that getting a bilateral mastectomy will help them to improve their chances of curing the cancer and will make them live longer," she said.
"The truth is, once the cancer has developed, the long-term risk of the cancer to someone's health is the same no matter what surgery they choose. In other words, the chances that their cancer will recur at a later time are the same regardless of the surgery they choose. If a woman chooses bilateral mastectomy, she should understand that the purpose of that type of surgery is to prevent a second, new breast cancer in the future. For most women, the chances of developing another new breast cancer is .5 - 1 percent per year. I completely understand why a woman might want to be aggressive about her surgical options, and I always think it should be a patient's choice. However, I fear women are 'going under the knife' without truly understanding the risks and benefits of the procedure. If anything, this JAMA study supports the idea that breast conservation is a safe option both in the short term and long term for most women."
Breast Cancer After-Care Protocol
I was wondering what the "best practice" is now for breast cancer survivors and the length of time they will need to take drugs like Aromasin/Exemestane. Many women email me that they were originally told five years; however, it seems that the protocol is changing to 10 years.
According to Dr. Hofstatter, just how long women must be on these drugs is up for debate. She said she feels that the new standard will likely be 10 years. For pre-menopausal women, she said, 10 years of Tamoxifen has been proven to be better than five years. No data yet definitively says that 10 years of an aromatase inhibitor is best, but the guidelines are saying to "consider it" in all patients who have completed five years.
"The BCI Index is designed to help doctors and patients decide the length of treatment. This test takes the original tissue from the cancer and sends it to the company, which studies gene expression of several different genes in the particular woman's tumor. Based on these results, a statistical report is produced that estimates the possible benefit from extended therapy."
Dr. Hofstatter predicts that the clinical use of the BCI will increase over the coming years, and will likely become a new standard.
Treatment for DCIS
I asked Dr. Hofstatter what the recommended protocols are for women with ductal carcinoma in situ (DCIS). She said DCIS is still officially considered a breast cancer, but is non-invasive. This means, by definition, it cannot spread outside the breast, and therefore cannot be life-threatening. Women are typically treated for DCIS-type cancer with radiation and surgery, and oftentimes anti-hormonal agents that carry side effects. But some people are suggesting that this is "overkill" and that the treatment is worse than the disease. Some suggest that we should leave DCIS alone, not call it a cancer, and instead consider it a "high-risk lesion." This debate will go on for years.
What we do know, she said, is that, while many DCIS lesions lie dormant and harmless for many, many years, there are others that do invade and become dangerous. We do not fully understand which DCIS lesions are which, so it becomes hard to pick and choose which patients need everything and which don't. The bottom line is that women should talk with their doctors about their particular DCIS lesion, and decide which therapies are best for them. Sometimes, surgery with either radiation or anti-hormone pills is acceptable.
Treatment of Menopausal Symptoms
At Yale, Dr. Hofstatter is studying the use of Remifemin (estrogen-free black cohosh) in early-stage breast cancer, specifically DCIS, to see if a few weeks of Remifemin taken before surgery can reduce cell proliferation in areas of DCIS.
For breast cancer survivor Vicky, Remifemin was just what the doctor ordered. "I am 48 now and was treated at 35 for stage 1b breast cancer with surgery, chemo, radiation and Tamoxifen," she said. "Hot flashes started full on for me ... and I immediately went on Remifemin.... The hot flashes are about 98 percent gone."
Dr. Elena Ratner said that women like Vicky, whose menopause was triggered by treatment for breast cancer, are the hardest to help. Their tumors have hormonal receptors, and even a minuscule amount of estrogen could grow their tumors.
Ironically, estrogen therapy is often prescribed to relieve menopausal symptoms in non-breast cancer patients. For example, local estrogen therapy (LET) is often used to treat vaginal atrophy (dry vagina). While Dr. Ratner acknowledges that LET has a very low systemic absorption, she said many oncologists discourage its use in breast cancer patients. She further recommends vaginal moisturizers as a viable option for these women. She noted that even testosterone can convert to estrogen in the body, so this is not an option for women with breast cancer.
And, while estrogen protects bone health, for breast cancer patients Dr. Ratner prescribes two 600mg doses of calcium twice a day with vitamin D, plus cardio and low weight-bearing exercise.
Many of these young breast cancer patients also hope to start a family, but toxic treatments such as chemo can adversely affect their fertility. Dr. Ratner stresses the importance for women and their providers to discuss fertility prior to their treatment. Some chemotherapy will not affect fertility in the long fun but others may.
I am so grateful for the generosity of these wonderful experts at the Yale Cancer Center. Knowledge is power!
Suffering in silence is OUT! Reaching out is IN!
When menopausal symptoms plague your every waking hour during the day...and night...it's likely time to investigate whether hormone therapy (HT – formerly referred to as HRT) is the right decision for you. However, there are so many options not only in what kind of hormones you should take, but also which type of pharmacy—traditional or compounding—you want to frequent to get those meds that keep you feeling like your new and improved self.
Maybe you've already gone to your regular doctor to ask about how to keep your hot flashes, flashpoint temper, and insomnia at bay, but you might still be confused about the different forms of HT- bioidentical vs. non bioidentical options.
Conversely, you might be wondering if you should just 'go it alone' and use a combination of what you know makes you feel better, such as diet and meditation. No wonder you're confused about what to do!
Whether it's a patch, gel, drops or pills, hormones are available in all varieties and forms. In addition to the manufactured meds that maybe your mom took, bio-identical hormones are popular because women want something to mimic the hormones made in their own bodies, such as estradiol that naturally decreases as you go through menopause
Now throw the idea of a compounding pharmacy in the mix vs. the conventional corner drug store and you might wonder if you should go back to 'eeny, meeny, miny moe' game to make the final decision.
What Is A Compounding Pharmacy?
Christine Givant, RPH and Deb Hubers from the La Vita Compounding Pharmacy in San Diego offer this explanation: compounding pharmacies prepare medications by mixing raw ingredients to custom formulate a medication that results in an exact dosage and strength for each individual patient. These medications are compounded based on a doctor's prescription.
The two add that no pharmacy, conventional or compounding is regulated by the FDA, but rather by individual state board of pharmacies and each state has different requirements. However, they point out that reputable compounding pharmacies use ingredients sourced from an FDA-approved chemical house. That's why it's critical to select a compounding pharmacy that is approved by the Pharmacy Compounding Accreditation Board or PCAB. Pharmacies accredited by the PCAB not only comply with quality standards, but have also demonstrated that they've undergone strict evaluations by inspectors.
Because there have been instances of problems with compounding pharmacies, the US Congress recently reviewed additional methods of oversight. That resulted in the legislative body passing a law for increased oversight of drug compounding and President Obama signing the Drug Quality and Security Act into law just last fall.
So, Is A Compounding Pharmacy for You?
Well, first and most importantly, choose your doctor with care and discuss with them whether you want to go the compounding route. Each doctor will likely have a different view.
There are a growing number of specialists solely dedicated to helping menopausal women. If you're not certain if one practices in your area, the North American Menopause Society can help you locate one near you.
A new study at Case Western Reserve University states that many women, leery of taking conventional hormones and tired of their regular doctors not taking them seriously are even seeking anti-aging physicians for hormonal therapy routes. Sometimes hormonal therapy will utilize bio-identical hormones and that's the subject of another study showing some women prefer using an anti-aging specialist to distinguish between manufactured and bio-identical hormones, as it relates to their individual health.
Additionally, you might want to consider an Institute for Functional Medicine (IFM) certified practitioner. This means that they are experienced in functional medicine, which utilizes each patient's environment, lifestyle and genetic information to address health issues including chronic disease. This approach, recommended by Deb Hubers of La Vita Compounding Pharmacy, takes into account your diet, how you live your life, what diseases you suffered from in early childhood and current stressors in your life. Based on that information, the practitioner orders tests that might uncover things you hadn't considered, such as leaky gut syndrome or sensitivities to certain foods. The IFM certified practitioner then pulls all of this 'new' information together, along with any genetic mutations and how they affect your metabolic pathways, especially during menopause, to determine a very specific course of treatment. Researchers now understand that those pathways provide critical information as to what is going on in your body at the cellular level and that is instrumental in treating disease, fighting obesity and even determining what nutrition your body requires, so that you remain healthy throughout menopause.
If you'd like to locate an IFM certified practitioner in your area, click here and then key in your zip code first; then, check the box indicating that you want your search to show only 'IFM certified practitioners.' You can limit your search to the distance you're willing to drive to visit one.
It's critical for you to do your homework and investigate which type of menopause specialist will work the best for you, as you consider undergoing hormone therapy.
So, after finding the right specialist, should you go manufactured or compounded bio-identical hormones? First and foremost, educate yourself, but also pay attention to which entity is publishing the research, as in this recommendation against bio-identical compounding. A different study gives an entirely different view, based on a study of women with an average age of 52 taking bio-identical compounded hormones and who actually realized a significant decrease in irritability and emotional liability.
There is a fierce competition for your dollars, especially now as thousands of baby boomers seek relief from menopausal symptoms.
Lab Tests are Critical
Lab testing provides baseline markers, according to Deb, and leads to the best treatment protocols for each patient. Then, ongoing testing helps the doctor evaluate if the treatment is working.
"The laboratory tests are actually used as a precautionary or safety measure for many patients' treatment plan. This standard testing often does not evaluate many of the markers doctors that specialize in hormone therapy utilize to evaluate a patient, such as thyroid tests," says Deb.
"For example, to totally evaluate a patients' thyroid function, you need more than just a TSH level. Hormones are only one part of the biochemistry pathway and true functional medicine providers need to evaluate genomics like MTHF mutations and micronutrient levels of a patient in addition to hormone levels. Modifying hormone levels of a patient should be taken seriously and understanding the endocrine pathways is a sophisticated science. Laboratory testing is a critically important tool in treating patients and assuring the patient's treatment is properly monitored."
"Compounding pharmacies formulate medications based on a physician's prescription for an individual patient and are not in the business of making medical claims that any formulations are safer than commercial alternatives. Therefore, a physician and patient MUST be allowed to have the invaluable option of choice in their medical care," finished Deb.
In other words, pay attention, ask questions, get your lab work done when the doctor requests it and stay on top of the results to determine if the HT course you've decided upon with you physician is working—for you.
D.o. and Insurance
On January 1, 2012, a new policy called D.o. went into effect that changes the way compounded medications are reimbursed, forcing pharmacies to reject some insurance claims. Now, there is new reason to read the fine print very carefully, when it comes to your insurance carrier covering medications from compounding pharmacies.
In fact, it was announced recently that three compounding pharmacies have joined forces to file a lawsuit against Express Scripts, the country's largest pharmacy benefit manager. That's because Express Scripts said, 'No,' to covering more than 1,000 active ingredients used by compounding pharmacies to produce creams, ointments and other medications, essentially meaning that if it's not covered by insurance, then you'll end up paying more.
In the fog of menopause, it's difficult to wade through all of the information associated with HT and the pharmacies that dispense the meds. But—you'll be glad you did, because if given just the right medication and dosage, the difference between how you feel now and you will feel is...well, the difference between night and day. So, research and discover what the best options are for you and soon you'll be smiling during the day and sleeping like a baby at night; just like you used to!
If you haven't made a resolution yet to keep your weight in check, there's still time! Jan. 19-25 is Healthy Weight Week, celebrating healthy lifestyles for life. This annual celebration is a time for everyone to be active, eat well and feel good.
Menopausal women may be more cognizant of their weight than other age groups. Our reduced metabolism is tipping the scales — and not in our favor! Women don't have a monopoly on this; middle-aged men also suffer from the shrinking-pants syndrome.
Expanding middles are more than about appearances. They are about your health, and can put you at greater risk for heart disease, diabetes and other conditions.
Francie Berg, MS, is chair of Healthy Weight Week. She is a licensed nutritionist and adjunct professor at the University of North Dakota School of Medicine. In 1986 she created the Healthy Weight Network, which sponsors Healthy Weight Week.
As national coordinator of the Task Force on Weight Loss Abuse for the National Council Against Health Fraud, she maintains an extensive collection of questionable products and bizarre gadgets that Americans use in their battle of the bulge.
Tuesday of Healthy Weight Week marks Rid the World of Fad Diets and Gimmicks Day. That's when the Slim Chance Awards are given for the worst diet products of the year. Last year, the Cotton Ball Diet (I'm not kidding!) was dubbed Most Outrageous Diet. On this plan, dieters dip cotton balls in juice and ingest them. The objective is to feel full without actually consuming real food. Risks include a blockage in the digestive system, which could necessitate surgery.
The Tongue Patch Diet won the award for Worst Gimmick. This reversible procedure fits a plastic mesh patch to the patient's tongue. The result? Chewing is extremely painful, thus limiting the dieter to only liquid.
While these awards may be rather tongue in cheek (pun intended), the concept of Healthy Weight Week is a serious one. The Healthy Weight Network links research and practical application. Berg said the network is committed to compiling scientific information from many sources and reporting controversial issues in a clear, objective manner. The network is also committed to exposing deception, reshaping detrimental social attitudes and promoting health at any size.
Following are a few of the things to beware of when evaluating a diet program:
Berg has been a guest on national television, including Oprah, Leeza and Inside Edition. Her books on weight and eating include Women Afraid to Eat, Children and Teens Afraid to Eat and Underage and Overweight: Our Childhood Obesity Crisis—What Every Family Needs to Know.
If you really want to lose weight (and not just money), stick with the tried-and-true method: diet and exercise. Otherwise, you could negatively impact your health. Go with your gut, and use common sense. Before starting
Suffering in silence is OUT! Reaching out is IN!