Barb's Daily Dose

The Menopause Pot Belly

The Menopause Pot Belly, or Meno Pot Belly as I call it.  I've got it, many of my friends have it, and a few are successfully avoiding it.  For years we thought that this was related to small increases in women's insulin resistance as we age, meaning that we can't metabolize carbohydrates as well and are prone to diabetes.

Data published in the journal Obesity may have found a different explanation. Data from the Study of Women's Health Across the Nation (SWAN), which is a longitudinal, community-based study found that  testosterone is more likely to be the cause in increased abdominal fat that women have around the time of menopause. The same research team also found that metabolic syndrome, which is linked to abdominal fat and risk of diabetes and heart disease was also related to testosterone levels.

Is it Warm in Here?

I was talking to a group of friends recently and they were talking about how warm they get at night. Many thought it was the clothes they were wearing. Sorry to say this, but this is one of the first signs of the fun filled trip on the roller coaster known as: perimenopause.

Yes, all of a sudden, there's sweat on the back of you neck, or maybe your clothes are drenched. Is it the heavy comforter or flannel nightgown?  Probably not.  Unfortunately, if you're 45 or older, when you start feeling warm at night, it's probably some degree of night sweats.

Heavy Periods

"I decided to stay in the shower, because I was bleeding so heavily that it was just easier that way."

Did you know that 1 in 5 women suffer from heavy periods?  That's a lot of pads and tampons. Some women have heavy periods their entire lives and some only experience this particularly feminine challenge with perimenopause.

The quote above is from my friend J. She lives on the east coast and called to say that she was really worried, because her bleeding had become so bad that she couldn't leave the bathroom. 

She said, that she since was the only one at home and was bleeding so heavily that she decided to get into the shower because as she says, "I figured if bled to death in the shower, it would be easier to clean up."

This floored me. Always thinking of others first, putting ourselves last.  Really, she was doing the best she could at the time.  She also said that she was afraid that she couldn't drive to the doctors office 20 minutes away. 

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.

Myths about Urinary Tract Infections

Here are my top 5 myths that I hear all the time about Urinary Tract Infections.

#1 Wiping matters - If only I had wiped myself differently, this wouldn't have happened.  Not true. Studies show that contrary to what your mom told you or you heard way back when, you don't have to wipe front to back or back to front or sideways. It doesn't matter.  

#2 Drink lots of water to flush out the bacteria - Ok, this was a trick. 

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.

Hot Flashes & Yoga

Yoga Breathing

For women who are not interested in hormones to treat their hot flashes and night sweats, there are other alternatives, including slowed, rhythmic breathing.

Several studies have found that women who practice yoga type breathing everyday have fewer hot flashes and night sweats. And if they feel a hot flash starting, taking 6-8 deep breaths can lessen the severity. What happens with a hot flash.

Hot Flashes are particularly insidious. Anything that increases our core temperature by less than 0.5 degrees can bring on the heat. Stress, in the form of neuro-chemical responses to stimuli also trigger hot flashes. It's as if the fight or flight reaction causes nerves to fire that signal the thermal regulation center to bump it up a notch.

The yoga breathing seems to interfere with this pathway to the lava like response. I've tried it myself and it works as the moment begins, and does decrease the intensity and the length of the flash.

First Signs of Menopause

A new study has found that shorter lengths of time between menstrual periods may be a clue of menopause for many women. Researchers have found that between the ages of 42 and 52, women in early menopause had intervals of fewer than 21 days between periods, while longer intervals between periods are more common in late menopause.

I just gave a talk on Menopause at the American Academy of Nurse Practitioners in Washington, DC (please provide a link here). The first stage of menopause is known as the Perimenopause, because there is a lot of variability in the cycles. Many women notice that their periods come more often and are shorter as they enter the 40's. As time goes on, they time between periods does lengthen, and the periods may last longer.

When to be concerned:

• You are bleeding or spotting for more than 10 days
• You are bleeding so heavily that a pad or tampon gets soaked through in less than 1 hour
• You have several days of heavy bleeding each month, where you soak through pads and/or tampons in less than 2 hours
• The time between periods is less than 21 days. Count from the first day of bleeding to the next first day of bleeding.

What your health care provider might suggest:
• Lab tests including:
– TSH (Thyroid Stimulating Hormone) - 10% of women have a thyroid issue, which can cause irregular bleeding
– CBC (Complete Blood Count) to see if you're anemic
– Pregnancy test (still the most common cause of irregular bleeding)
• Ultrasound to look for causes of bleeding
• Sonohysterography - An ultrasound that also uses a small amount of fluid gently inserted into the uterus to better visualize any possible fibroids or polyps that could cause bleeding
• Hysteroscopy - In this procedure, a special lighted camera is inserted into the uterus to have a better look at what might be causing bleeding.

Look for other blogs on treatments and causes of abnormal bleeding. For more information on menopause on my award winning menopause guide, click here.

Hot Flashes: Staying cool this summer

Is it hot in here, or is it just me?

Dr. Robert Freedman has a theory about why our bodies become much more likely to sweat or shiver in Menopause. In perimenopause and menopause, lowered Estrogen levels narrow the Thermoneutral Zone (TNZ), leading to more hot flashes and night sweats. He also found that increases in one of our neurotransmitters, norepinephrine also narrows the TNZ. Some medications will widen the TNZ, including Estrogen, some anti-depressants, and gabapentin.

Some triggers to avoid:

• Alcohol
• Smoking
• Hot drinks
• Stress

Freedman RF. Semin Reprod Med. 2005;23:117-25.

Tips for staying cool this summer with hot flashes and night sweats:

If you're not interested in Hormone treatment or other prescription medications for your hot flashes and night sweats, consider these remedies:

• Cool Showers in the morning and before bed at night
• Have a fan ready when you're putting on your makeup
• Skip the hot coffee or tea and have iced drinks
• Dress in layers
• Bring an extra wrinkle free-blouse if you're sweating through your clothes.
• Got Ice? Passing an ice cube over your wrist can help you cool down fast
• TryCool Sets pajamas
• Put your pillowcase in the freezer before bed

Yoga Breathing:

Dr. Freedman also found that when women feel hot flash coming on, taking slow, deep breaths, like you do with Yoga, helps decrease the intensity of the hot flash. Aim for 6-8 slow, deep breaths per minute.

For more information, see: Your Personal Guide To Menopause.