Barb's Daily Dose

The Hormone Guide

Women Will Understand This! 
Men Should Memorize It!

Every woman knows that there are days when all a man has to do is open his mouth and he takes his life in his hands! This is a handy guide that should be carried like a driver's license in the wallet of every husband, boyfriend, co-worker or significant other!

DANGEROUS	SAFER	SAFEST	ULTRA  SAFE
What's for  dinner?	Can I help you  with dinner?	Where would you like  to go for dinner?	Here, have some wine.
Are you  wearing that?	You sure  look good in brown!	WOW! Look at you!	Here, have some wine
What are you  so worked up about?	Could we be  overreacting?	Here's my paycheck.	Here, have some wine.
Should you be  eating that?	You know, there are  a lot of apples left.	Can I get you a piece  of chocolate with that?	Here, have some wine.
What did you  DO all day?	I hope you didn't  over-do it today.	I've always loved you  in that robe!	Here, have some wine.

No Periods?

Yes, that's right, women who are on birth control do not need to have a period every month. 

How is this possible, you wonder? Well, as long as there is balance in hormones, then there is no risk of problems. I'll explain a little further.

The menstrual cycle 

If you click on the link above you can learn more about the menstrual cycle, which will make this easier to understand.

Help, I forgot my Birth Control Pill

If I had a nickel for every time that I heard that!  This is a very scary experience, but don't fear, the answers are right here:

If you forgot 1 pill:  

Take it as soon as you remember, and use a back up method of birth control for 3 days to be safe.  You may notice some breakthrough bleeding or spotting for a few days.

If you forgot 2 pills in a row

Take 2 pills as soon as you can, and 2 more the next day to catch up. Use a back up method of birth control for 3 days to be safe. You may notice some breakthrough bleeding or spotting for a few days.

If you're always forgetting pills

Consider switching to another method of birth control.  Stay tuned, we'll talk about the options in the next few weeks.  There's:

NuvaRing

Mirena

Depo-Provera

Implanon

And my favorite, a girl's best friend, Condoms.

  

Night sweats

A friend called me the other day and wanted to get together to talk about what she could do to get more sleep at night. She's in her early 50's and is still having regular periods, so wasn't aware of the hidden and insidious hormonal roller coaster otherwise known as Peri - Menopause.

Peri-Menopause

I'm giving a talk on this at a local community group soon, and am busy finding photos of burning buildings to add to the slides. That's what it feels like. Or maybe a steam factory.  Night sweats are particularly vexing because it could just be that you've got too many covers on, or that you're just warm.

PCOS & Weight Control

I have written many posts on PCOS. Here's Part 1, Part 2, Part 3 and Part 4.  

Today, let's talk about Metformin.  I'm preparing a talk I'm giving in at the annual conference of the California Association of Nurse Practitioners. So I've been reading lots of up to the minute research. 

Weight control is more difficult

As you know from previous posts, PCOS is a complex condition that causes Insulin resistance, difficulty losing weight and increased appetite. Recently the FDA has approved the use of a medication used for people with Type 2 diabetes to help women with PCOS lose weight to help prevent them from developing Type 2 diabetes. 

Metformin

This is not a diet drug, but helps manage blood glucose levels and in several studies helped teenagers

Breast Cancer, Exercise & Diet

For a long time, we've known that by increasing exercise, in general women could decrease the likelihood that they would have breast cancer.  We didn't know why, but there was an association.  

My mom had breast cancer

I knew I was at higher risk for developing breast cancer and I had read enough of the studies to know that the more I exercised, the more I'd decrease my chance of hearing that the mammogram was worrisome or that the biopsy was not good. So, I dragged myself out to jog, or to spin class or to the gym.  

The Va Jay Jay is Dry Dry

Vaginal Dryness 

When you buy your ticket on the hormonal roller coaster, affectionately known as menopause, sorry, but there probably isn’t a stop at splash mountain. Nope, menopause brings lots of unexpected twists and turns and one big secret, your Va Jay Jay will be a lot dryer. 

Can you say Sahara? 

Yes, there will be more wrinkles, but you knew that. What many of my patients are surprised by is how dry their skin is, especially in the vagina. Gosh darn it! Sorry, I was just channeling Tina Fey, imitating a certain governor. Now that you don’t have to worry about pregnancy, all of a sudden, your ability to lubricate recedes like a middle-aged man’s hairline. 

Infections are more common 

Sorry to say, that when the vagina is dry, it means that the pH is off balance allowing less of the good health bacteria (lactobacillus) to grow and more of the bad bacteria that cause vaginal and bladder infections to grow. 

What to do? 

Think about talking to your health care provider about treatments. There’s good news. Even if you’re not interested in hormones to treat hot flashes and night sweats, a minimal amount of vaginal estrogen used regularly will help restore the balance and help you avoid infections. 

Interested in more information about sex during menopause?  Get my Menopause Download.

My Grandmother Shrunk

I remember when I noticed that my grandmother was shrinking. This tall, imposing figure from my childhood, who never baked a cookie in her life, and kept her brood grandchildren in line, with one raised eyebrow and a look that said, "You're not measuring up to my impossibly high standards."  How did she go from 5' 7" to 5' 1" ?  

I'll tell you, it was osteoporosis!  Aha. Every time I try to explain this to patients without a picture, I lose them, so these 2 might help. 

As the bones become less thick and less dense, the vertebrae develop tiny little crush fractures and flatten more and more like a pancake. leading to loss of height.

Birth Control and lowered Libido

I prescribe a lot of birth control pills and many NuvaRings for my patients. As you might imagine most women like their method and have few side effects. Women love the convenience of the NuvaRing and find it easy to use. Many providers, (myself included) like the fact that it has the lowest circulating dose of estradiol (15 mcg). The NuvaRing is a great option for women with menstrual migraines, acne, headaches, & with PMS. 

Within the last month, I have received 3 separate calls from women who wanted to stop using the NuvaRing because of much lower sex drive. One said, that she knows why it's such great contraception, because she has absolutely no interest in sex. Another found that her moods were depressed and she was much more fatigued. Another experienced hot flashes and night sweats on it. 

I searched the literature and the package insert and sure enough lowered libido is one of the side effects. This can happen with any form of hormonal birth control, not just the NuvaRing. Yet, I suspect that the lowered estrogen dose may make this more common in some women. 

The longer I practice, the more I notice individual variation among women. We can all take the exact same dose and yet, each will have a different experience.

Bottom line, if you are having side effects from any medication, give your provider a call and find a better alternative.

PCOS & Weight Control

A while back I started a series on PCOS. You can read parts 1,  2 &  3 and the post on treatment if you'd like. Today we'll talk about weight control, which is a challenge for many women with PCOS.

Quick Review

Most women with PCOS also have difficulty losing weight and keeping weight off, which is not their fault and completely unfair. Because of the imbalance of hormones, they also have an underlying Insulin Resistance, in simplified terms means that they are more likely to gain weight.

How this happens:

• Eating starches and carbohydrates makes blood sugar.
• Insulin helps transport blood sugar into muscle, fat and liver cells.
• With Insulin Resistance, there are lots of roadblocks to this transport.
• This leads to higher blood sugar levels.
• It also causes more fat to develop, especially around the waist area.
• This can lead to Type 2 Diabetes.

Nutrition recommendations

It's a good idea to ask your provider to check your fasting glucose level and cholesterol & triglycerides in a Lipid panel. If you can see a nutritionist, that's even better.

Most women with PCOS will be able to lose and maintain their weight if they restrict their carbohydrates with a diet much like South Beach. Some start from the beginning if they want to lose weight, others use the 2nd phase or maintenance plans to control their weight. 

My patients have found that limiting carbohydrates not only helps with their weight loss, but also improves their triglyceride & cholesterol levels.