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Ellen Dolgen

  • Post-Menopausal? Don't Let High Blood Pressure Sneak Up on You

    Posted on Monday, July 28, 2014 few decades ago, we had a totally different definition of "high." Today, as Baby Boomers, we often associate "high" with body temperature (translation: hot flashes), numbers when we step on the scale and, for some of us, blood pressure.

    While it's easy to spot rising body temperatures (red faces and sweat-drenched clothes) and expanding waistlines (busted buttons and zippers and snaps — oh my!), an increase in your blood pressure may not be so apparent.

    Not tonight, dear, I've got a headache

    Take, for example, the recent experience of one of my colleagues. One night, she woke up in the middle of the night with a horrific headache at the base of her skull. So she popped an ibuprofen and managed to go back to sleep. The next night, deja vu. On the third night, she woke up and entered "headache base of skull lying down" in the web search engine.

    Now we all know it's not usually a great idea to self-diagnose based on Internet search findings. My colleague found everything from migraines (she had these before, but told me that this headache felt different) to an abundance of spinal fluid to brain cancer to high blood pressure.

    Hypochondria or hypertension?

    Trying not to panic (after all, it could raise her blood pressure), she called her doctor the next morning and managed to get an appointment the same day, citing her concern over elevated blood pressure. Even though she had low blood pressure her whole life, monitors her salt intake and exercises regularly, high blood pressure was the only diagnosis that seemed plausible.

    Turns out, her self-diagnosis was spot on.

    My colleague is not alone.

    According to the National Institutes of Health, hypertension is by far the most important risk factor that affects women in the early postmenopausal years. About 30 percent to 50 percent of women develop hypertension before the age of 60. While you may experience many of these symptoms from menopause alone, mild to moderate hypertension may cause complaints such as non-specific chest pain, sleep disturbances, headaches, palpitations, hot flushes, anxiety, depression and tiredness.

    The Mayo Clinic concurs, noting that blood pressure generally increases after menopause. This could be attributed to the hormonal changes of menopause or an increase in body mass index (BMI).

    Is HRT the MVP?

    While some types of hormone replacement therapy (HRT) for menopause may contribute to increases in blood pressure, many doctors prescribe transdermal (meaning through a cream or a patch) estradiol HRT for women early in their menopausal journey — under age 60 to help keep cholesterol levels down. Remember, there is no risk of thrombosis (blood clots) with transdermal HRT — it is the oral estrogen with progestin that increases the risk of thrombosis. When started more than 10 years after menopause, oral estrogen is more likely to cause a stroke or heart attack in the first year after starting HRT. According to the National Insititutes of Health, in women with severe menopausal complaints and who are at low risk for cardiovascular heart disease, the use of HRT in the years proximal to menopause may be very helpful.

    It is also important to note that for women who only took oral estrogen, who did not take progestin and were younger than age 60, the risk of heart attack, stroke and death from any cause decreased. A Women's Health Initiative trial showed that women who start HRT before age 60 decreased their overall mortality by 35 percent.

    The Endocrine Society also stated in its 2010 Scientific Statement on HRT: "Menopausal hormone therapy was associated with a 40 percent reduction in mortality in women in trials in which participants had a mean age below 60 years or were within 10 years of menopause onset."

    It is important to note that throughout these studies it is clear that the sooner you start estrogen therapy after menopause, the better.

    Take control

    To control your blood pressure both before and after menopause, the Mayo Clinic recommends:

    • Maintain a healthy weight.

    • Eat heart-healthy foods, such as whole grains, fruits and vegetables.

    • Reduce the amount of processed foods and salt in your diet.

    • Exercise on most days of the week.

    • Limit or avoid alcohol.

    • If you smoke, stop.

    Your doctor will consider prescribing medicines if your blood pressure is 140/90 or higher — the threshold for high blood pressure.However, you may want to opt for beta blockers instead of calcium-channel blockers, as the latter have been linked to an increased risk of breast cancer. A study reported in the Journal of the American Medical Association noted that in women aged 55 to 74, use of calcium-channel blockers for 10 or more years was associated with higher risks of both ductal and lobular breast cancer. (My colleague mentioned this to her doctor, who wasn't even aware of this study. She is now taking a low-dose beta blocker.) Other medications used to treat hypertension include enzyme inhibitors, receptor blockers and diuretics.

    "The risk of developing high blood pressure over a lifetime is extremely high if a person lives long enough," said Dr. Deepak Bhatt, professor of medicine at Harvard Medical School, and director of the Integrated Interventional Cardiovascular Program at Brigham and Women's Hospital. For post-menopausal women, this is particularly true. By the time they reach their 60s and 70s, 70 percent of women have high blood pressure. After age 75, that figure rises to nearly 80 percent, according to the Centers for Disease Control.

    If left untreated, high blood pressure can lead to stroke and heart failure. It also can also contribute to dementia, kidney failure, vision problems (especially for those with diabetes), and sexual dysfunction.

    As patients — and particularly as women patients — we've got to be our own advocates. If you suspect that something's amiss with your health, get professional advice. Politely (but firmly) insist that you need an appointment. In most cases, physicians will work to accommodate you. It's important to be in tune with your own body and in touch with medical updates so that you can make informed decisions when it comes to your health.

    Suffering in silence is OUT! Reaching out is IN!

    0 Replies
  • Low testosterone—not just a “guy” thing!

    Posted on Monday, July 21, 2014 can be such a challenge. There's the whole "fuzzy brain" scenario—you know, that "where is my car/my purse/my mind" experience.

    Or maybe it's your body that's pooping out. You know exercise would help but you just don't have it in you to work out.

    And let's not even talk about your sex drive. Right now, you feel like you have a starring role in "Sexless in the City!" You've lost that lovin' feeling and you don't know where to find it!

    Is this just part-and-parcel of the whole menopause/low estrogen issue or could something else be going on—like a case of low testosterone (Low "T")?

    Dr. Michael Krychman, Executive Director of the Southern California Center for Sexual Health and Survivorship Medicine in Newport Beach California explains, "While estrogen is critical, it is my belief that there is interplay between lowered estrogen and lowered testosterone levels in women as they age."

    What you need to know about testosterone:

    • It's part of our hormonal makeup.Not just a guy thing, the steroid hormone testosterone is produced in smaller amounts by body—one place is our ovaries—and is essential for muscle tone, a healthy libido, and strong bones.

    • Enter menopause abruptly and testosterone can nose-drive.While women can start experiencing low "T" during their menopausal journey, which may begin a decade earlier than when menstrual periods stop, a quick jump into "the change" can send testosterone levels plummeting. According to Dr. Krychman, "Many feel that surgical or abrupt menopause can cause more severe and abrupt symptomology rather than a gradual decline. It seems that when science or disease interferes with Mother Nature, she retaliates by sudden withdrawal and plunging testosterone."

    • Low-T symptoms are wide-ranging. When T levels drop, women can experience depression, fatigue, weight gain, bone and muscle loss, and cognitive dysfunction. Then there is the whole "low libido" issue, which can be dramatically decreased. As for orgasms, if we have them, they can be more "ho-hum" than "woo hoo!" if our "T" level is down, according to a report from The North American Menopause Society.

    • Boosting testosterone levels can help. Supplementing with testosterone can benefit your heart, mood, energy, and bone and muscle health. Additionally, testosterone can sustain skin elasticity and tone, encourage heart health, boost libido, help prevent osteoporosis risks, decrease body fat and increase muscle strength.

    You think you have low "T." Now what?

    • First, rule out other medical problems by scheduling a visit with your health care professional, or menopause specialist. Underactive or overactive thyroid, for example, can also affect your energy level, libido and general physical health or well being.

    • Ask about testing your testosterone level. Typical tests will measure and calculate your total testosterone and "free" testosterone. ("Free" testosterone measures the active portion—the levels of bioavailable testosterone that is not bound by the blood proteins. Ranges vary between post-menopausal and premenopausal women, with a gradual decline as we age, says Dr. Krychman. However, he adds, "I advise treating symptoms, not lab values. A comprehensive assessment with a good differential is the rule. Testosterone supplementation is not the panacea. It is important to remember that this there is also approximately 40% placebo effect!"

    • Discuss treatment options. If your testosterone levels are below norm and you have the symptoms, your health care professional may suggest an "off-label use" of testosterone, with or without estrogen. (Why "off-label? Because the FDA has yet to approve any testosterone drug for women.)

      According to WebMD, oral testosterone (taken by mouth) is processed by the liver—which can result in a change of cholesterol levels. But that same effect doesn't occur when testosterone is administered by skin patch, gel or cream (aka transdermal) or in pellet form (the size of a grain of rice) inserted under the skin. "What form to use depends on many facets including patient tolerability, patient price, side effects and clinician preference," says Dr. Krychman.

    • Weigh the risks vs benefits with your health professional or menopause specialist. Dr. Krychman has a frank and candid conversation with his patients about the benefit versus the risk – safety and efficacy are always balanced, he states. Make sure you understand the pros and cons of the treatment options, and, once you start therapy, have regular blood work to keep track of your levels. It is important to monitor your blood count and lipid panel, coupled with testosterone levels.

    Bottom line? Don't blame Mama Estrogen for all your menopause miseries. Papa Testosterone could be partly responsible for your brain fog, exhaustion and crashing libido! Get the info you need to take charge of dealing with your symptoms. Evaluate the risks and benefits, to determine what is best for your body and your quality of life.

    Suffering in silence is OUT. Reaching out is IN.

    0 Replies
  • Menopause Just Got Easier: Chocolate for Your Heart and Soul

    Posted on Monday, July 7, 2014 you're looking for any excuse to indulge in chocolate without feeling post-pleasure guilt: you're in luck! July 7th is National Chocolate Day and studies show this sweet indulgence is loaded with flavonoids and anti-oxidants known to open clogged arteries, keep heart disease at bay and even improve your mental acuity. What's not to like?

    Columbus Discovered America...and Chocolate!

    When Christopher Columbus was offered a sip of chocolate drink or 'xocoatl' by the Aztecs, he didn't like the taste, but" target="_blank">Spanish conquistador Don Hernan Cortes not only loved the drink, he knew he had a valuable commodity on his hands and loaded his return ship with cacao beans. He was right: people loved the chocolate drink, but it was a pleasure afforded only the very rich. Eventually, the secret recipe got out and before long chocolate was all the rage in Europe and America.

    Popular Food with Healthy Benefits

    The popularity of chocolate has prompted hundreds of medical studies to examine the effects on the human body. Dark chocolate, containing at least 70% cacao, possesses seemingly magical powers in opening arteries, minimizing insulin resistance and reducing morbidity. And that's just for starters.

    For menopausal women facing the double whammy of increased cardiovascular risk and runaway diabetes, there are encouraging results. In one study the test subjects strictly adhered to the program—a clever way of saying they didn't mind eating chocolate every day of the testing period! The results showed that flavonoids, the active ingredient in chocolate, reduced insulin resistance while minimizing the risk of heart disease in post-menopausal diabetic women, actually prolonging their lives over the next 10 years of daily consumption. How much better can it get? As it turns out—a lot!

    The bioactive-mechanistic properties of chocolate and nitric oxides assist in vascular dilation, which is a fancy way of saying that chocolate helps reduces LDL or 'lousy' cholesterol, particularly in overweight older adults. A sweet morsel not loaded with post-consumption guilt. Sign me up!

    My personal favorite involves 'cocoa intervention' as a means to fight heart disease. In this study there were two control groups: one given skim milk and cocoa and the other just skim milk. Surprise! The group given the chocolate milk showed that the 39 compounds linked to the intake of cocoa minimizes free radicals, known to cause cancer and raise the risk of heart disease.

    Just Plain Fun!

    Laughing is good for the soul...and body. Chocolate has a tendency to bring on the fun. We channeled our inner Lucille Ball in Menopause Mondays with a clip of Lucy and Ethel stuffing chocolates in their mouths when they get behind at the factory! Who hasn't had a chuckle at that?

    But Wait—There's More!

    There are additional mental benefits! Plagued by losing that thought before it finds it way from your brain to your mouth? Chocolate's absorbed flavonoids impact the parts of your brain connected with learning and memory. When these flavonoids interact with brain cells, neuroprotective and neuromodulatory proteins kick into high gear to assisting with brain connectivity through increased blood flow. This reaction has been shown to slow aging, dementia and disease-related cognitive decline.

    From a psychological standpoint, another study looked at people who took the time to savor chocolate and actually tied in ritualistic behavior with goal-oriented benefits. In other words—relaxing and enjoying said chocolate works about as well as anything else!

    So, after the barbeques and fireworks are over, take heart—just three more days until National Chocolate Day! Give yourself permission to indulge and enjoy that luxurious treat. It's really all good!

    Suffering in Silence is Out! Reaching Out is In!

    0 Replies
  • Free At Last!

    Posted on Monday, June 30, 2014, the Constitution gave us freedom of speech, freedom of religion, the right to bear arms (or, in our menopausal state, the right to bare arms).

    But think about it. Are you emotionally free? Do you have freedom from a negative self-image? From a lowered sense of worth? Freedom from the word "can't"?

    If not, it's time to free yourself from the negative chatter (both internal and external) that holds you back from doing what you want to do or simply being who you want to be.

    You know what I mean. As women in the throes of perimenopause and menopause, we constantly have to filter out those subliminal messages that make us feel less than fabulous.

    I am reminded of the record album (yes, that dates me and I'm proud of it!) and book titled Free to Be... You and Me by Marlo Thomas and Friends back in '72. Although the overriding theme was gender neutrality — promoting individuality, tolerance, and comfort with one's identity — a major message was that anyone can achieve anything. That's a concept we can take to heart as women truly in the prime of our lives.

    Our knee-jerk reaction is to blame the media, the entertainment industry and advertising campaigns that — while perhaps not blatantly disparaging older women — glorify youth and, by association, cast a negative light on the natural process of aging.

    One company's efforts

    Restorsea™, a natural skincare brand, is making an effort to "reverse the negative stigma associated with aging, encouraging women to embrace it instead." Its first digital advertising campaign, featuring new brand ambassador Gwyneth Paltrow, is centered on the idea that "Your Best is Yet to Come." Restorsea™ Founder and CEO Patti Pao started her company at age 50. "Proof that 'Your best IS yet to come,'" she said.

    While I commend Restorsea™ for its efforts, I must question its selection of Paltrow as brand ambassador. At 41, she's a mere youngster compared to many of us.

    Restorsea™ wasn't the first brand to look at women in a new light via its advertising campaign. The 2004 Dove® Campaign for Real Beauty ad campaign featured real women whose appearances were outside the stereotypical norms of beauty. The ads asked viewers to judge the women's looks (oversized or outstanding? and wrinkled or wonderful?), and invited them to cast their votes online.

    Dove ad campaign takes flight

    In 2007, the Dove® global study, "Beauty Comes of Age," revealed that 91 percent of women ages 50-64 believed it was time for society to change its views about women and aging. The campaign celebrated the essence of women 50-plus — wrinkles, age spots, gray hair and all. Internationally renowned photographer Annie Leibovitz captured images that celebrated what, until then, were viewed as "flaws" in aging women.

    The Restorsea™ and Dove campaigns are admirable, but what we need to do is not look outward, but look inward. It's those pesky little voices in our head that we need to turn off, to drown out with positive reinforcement.

    Avoid these thinking traps

    According to the National Association of Social Workers, negative thinking leads to negative self-talk, which can affect self-esteem and even physical health. Positive self-talk, however, boosts a woman's confidence. Here are a few thinking traps we should avoid:

    • All-or-nothing.Black or white/good or bad thinking takes into account only extremes and does not look at the whole picture. Sure, I may have a few more wrinkles, but that's not all. I also have a lot more wisdom and moxie.

    • Crystal ball. While we may wish we could read other people's minds, it just ain't so. Thinking that others are viewing you as old and irrelevant will only lead you to project those thoughts onto yourself.

    • The blame game. Similar to personalizing, this is when you think in terms of "poor me" or "it's all [fill in the blank's] fault." Blame game thinking puts you at risk to behave as either a victim or a blamer. Instead of blame and shame, train yourself to think not as a victim, but as a victor over aging.

    • "Should-ing." A spin on shoulda/woulda/coulda, this type of thinking assumes (and you know what they say about assuming!) that you and other people should think and/or act in certain ways. If you think that you're old, out of touch, and should take a back seat in life, you'll tend to act that way. If you think that you're vibrant and can contribute to society, look out, world!

    • "What if" and "if only." Thinking like is likely to reinforce resentment, fears and anxiety. You can't turn back the clock, so there's no use in thinking "What if I were 10 years younger?" or "If only I didn't have these wrinkles ...." Change "what if" to "what about" — as in "What about I smile at my reflection in the mirror?" Change "if only" to "if I want to" — as in "If I want to, I can [fill in the blank]."

    Are you guilty of falling into any of the thinking traps listed above? If so, free yourself from those traps now. When you do, you'll be amazed at what you can accomplish.

    Let freedom ring!

    0 Replies
  • Vive la différence! Men and Women Not Created Equally (at Least When It Comes to Food)

    Posted on Monday, June 23, 2014 probably told you to act like a lady, but did she ever tell you to eat like a lady? This breakthrough book does.

    Men and women are different. Period. (We get periods; they don't.)

    So it makes sense that we gain — and lose — weight differently from men. That's exactly what author Staness Jonekos emphasizes in her latest book, Eat Like a Woman.

    Jonekos is not only an author, but also a women's health and empowerment advocate and one of the original executive producers who launched Oprah Winfrey's first network, Oxygen Media. She spent time researching these gender differences and pulled all this fabulous info together for us in Eat Like a Woman.

    She teamed up with Dr. Marjorie Jenkins to medically review the Eat Like a Woman 3-Week 3-Step program. Dr. Jenkins refers to herself as a "womanologist" and is a 2013 Texas SuperDoc. She is a professor of medicine and associate dean for women in Health and Science at Texas Tech University Health Science Center, where she holds the J Avery "Janie" Rush Endowed Chair for Excellence in Women's Health.She created the Laura W. Bush Institute for Women's Health at Texas Tech.

    If you're like me, over your lifetime you've been on every diet in the book! I wish I had a dime for every pound I've lost and gained since puberty! It only took me close to 60 years to realize that dieting is OUT! Eating healthy is IN!

    This is why Staness' book jumped out at me! I like the way she thinks! No more diets. Focus on a different eating lifestyle. Rather than grabbing a milk chocolate candy bar, grab a yummy 70% cocoa dark chocolate bar.

    Week One of the program focuses on breakfast — the most often skipped meal for women but most essential meal of the day. When I eat breakfast, I think more clearly! I'm loving the book's mouth-watering recipes. (The book includes 50 recipes, by famous chefs and celebrities. Many of the recipes feature ingredients vital to women's health, such as calcium, iron, zinc, folate and omega-3 fatty acids.)

    Week Two moves onto lunch and dinner and why the "European" concept of making lunch your biggest meal benefits women. Week Three introduces the important life-changing concept SWEAT: Smart Women Exercise All the Time (love this!), teaching us how to eat before and after exercise and how to continue on the path to obtaining and maintaining a healthy weight for life.

    I find there is a direct correlation between how I feel about myself and what I put in my mouth! Let's stop eating to assuage our emotions and start eating to feel good! Without really dieting, you'll see the pounds melt away and you'll learn to understand the relationship between stress and your health, interpret the messages your body is sending you, and how to eat to support hormone balance and emotional health. The results?

    • Drop those stubborn pounds

    • Effortlessly maintain a healthy weight

    • Change your relationship with food

    • Reduce your risk of disease

    • Slow the aging process

    • Exercise smarter

    The authors encourage women to rethink how they think about food, incorporating the latest science on sex-differences as motivation to practice a healthy lifestyle for each life stage. Here are a few of their tips:

    • Eat healthy carbs, which are digested slowly and make you feel fuller: whole grains, sweet potatoes, yams, brown rice, beans, fruits, and vegetables. If you eat a "bad" carb, add some protein to balance the glycemic load.

    • Add cinnamon to your diet; it has anti-inflammatory benefits and helps fight fat storage. (I add a teaspoon each morning over my half a piece of toast – yum!)

    • Include high-protein foods in your "Menopause Makeover®": turkey, protein shakes, Greek yogurt, tofu, eggs, edamame, nut butter, nuts and lentils.

    • Say goodbye to belly fat: Limit intake of saturated and trans fat and cholesterol; adjust portion sizes; minimize consumption of beverages with alcohol, sugars and caffeine; limit salt and processed foods; quit smoking; take half home when dining out.

    • Get more fiber in your diet: apples, strawberries, blueberries, pears, cucumbers, celery, tomatoes, oatmeal, oat bran, lentils, beans, zucchini, brown rice, barley, Brussels sprouts, cauliflower, beets, couscous, whole-wheat breads and cereals, seeds.

    • Stave off fatigue with small, frequent meals throughout the day (and, of course, get enough sleep!).

    • Be sure to drink plenty of water — about 9 cups a day, depending on your activity level.

    We don't talk like men, dress like men, or think like men.Vive la différence! So when it comes to eating, why would we eat like men?????

    Eat Like a Woman is designed for busy women... it's easy to incorporate these healthy eating tips into your lifestyle. I encourage you to check it out. After all, what have you got to lose... except a few extra pounds?

    Suffering in silence is OUT! Reaching out is IN!

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  • ‘Finding Yourself’ in Need of Therapy During Menopause

    Posted on Monday, June 16, 2014 now know that women are 70% more likely to suffer from depression than man and menopause's hormonal roller coaster can aggravate the problem. Experts say it's time to slow down and realize that the mind-body connection is a powerful one. And, much as we hate to admit it—we're not in charge of the universe—even though sometimes we like to think so!

    Taking care of parents and kids while simultaneously chasing a paycheck wears you down. Stir in a few menopausal hormones and you can easily find yourself overwhelmed, stressed and depressed. However, psychiatrist" target="_blank">Dr. Harry Croft, principal researcher at Clinical Trials of Texas, says learning to put yourself at the top of the list is critical to restoring a healthy balance.

    "Women suffering from depression outnumber men by a two to one ratio and menopause can be the tipping point for seeking the help you need," says Dr. Croft.

    "Stress and menopause can make for an endless anxiety-riddled loop, requiring women to examine whether their current approach to managing their health is really working. For example, low estrogen can make you feel crummy and you won't function as well. Throw in lack of sleep due to insomnia or waking in the middle of the night and boom—you're super stressed," explains Dr. Croft.

    "Because of that stress women may recognize depression, anxiety and turn to self-medicating through the consumption of alcohol. There is a huge rise of alcohol abuse in older folks because they don't have to get a prescription to drink. Many women closet drink and tell themselves it helps them relax, but might not recognize that they're drinking because of stress. Also, women build up a tolerance to the effects of liquor and then have to drink more to feel good. Combine that with a prescription sleeping pill and you've got real trouble."

    Dr. Croft says a much smarter approach is to have a menopausal specialist run a hormonal panel. Balancing menopausal hormones is an important first step to feeling better. Often, women find that hormone replacement therapy as recommended by their specialist is enough to get them in top shape. If there is a need for further evaluation by a psychiatrist who might prescribe antidepressants, those meds work more effectively once hormonal levels are closer to normal, especially estrogen

    "These two specialists are critical at this stage of life," explains Dr. Croft. "A women's gynecologist might just prescribe a hormone pill and not consider that there could be deeper mental health issues involved. Studies now show that depression is twice as high in women of all ages and hormonal stuff and extra life expectations can be unrealistic, immobilizing women who need to take action," says Dr. Croft.

    There are some simple, positive steps you can take right now to improve your quality of life. We hear it time and again, but exercise is a critical component of a good, healthy lifestyle. Many of us complain here about lack of time, but scientists have published new studies that show short bursts of intensive exercise, taking 10 minutes or less, are enough to get the job done by dramatically increasing oxygen consumption. If you feel the need for something a little less dramatic, yoga is always an excellent alternative and can be modified to comply with any fitness level. Even better news: yoga actually improves sleep efficiency, as shown in a recent study.

    "The biggest thing to control is sleep," says Dr. Croft. "Not just getting to sleep, but maintaining uninterrupted sleep. If women keep waking up, they won't feel rested and stress will pop up again."

    So, ladies take off your superwoman cape and pause to reflect on implementing positive change in your menopausal life—no pun intended! Really, the only thing you're in control yourself!

    Suffering in Silence is Out! Reaching Out is In!

    2 Replies