The Hot Years Issue 39

N 39 o

My Menopause Magazine

Lesbian Midlife Health

Food and Menopause

Put Some Fun In Your Food

Special Considerations

Instant Update:

Migraines & Menopause

Reena Jadhav

Do This Exercise

To Bust Belly Fat

Patient Advocate, Menopause Warrior

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Pap Smears When is Enough... Enough?

Social Media and Menopause - Truth or Fiction

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No 39

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In this Issue: Reena Jadhav

Discover how her journey from cancer survivor and early menopause made her a patient advocate menopause warrior Social Media and Menopause Truth or Fiction

Migraines and Menopause

New Position Paper on Estrogen Get the latest facts

Put Some Fun In Your Food

Lesbian Midlife Health Special Considerations

Pap Smears When is Enough...

Enough?

Do This Exercise to Bust Belly Fat

Ask Dr. Mache

Editorial

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The Importance of

Accurate Information

L

et’s face it, we live in a time of alternative truths and fake news. And unfortunately, healthcare information is not exempt from this alternative universe.

According to the website Mediabistro, more than 40% of consumers say that information found via social media affects the way they deal with their health and according to a recent study, 54% of patients are very comfortable with their healthcare providers seeking medical advice from online communities to better treat their conditions. But is social media accurate? Do you vet it?

In this issue of The Hot Years, we’re bringing you accurate, vetted information via interviews with leading authorities at the Annual Meeting of the North American Menopause Society (NAMS).

NAMS president, Dr. Marla Shapiro, discusses social media’s impact on your healthcare.

Executive Director of NAMS, Dr. JoAnn Pinkerton, reveals the new recommendations on hormone replacement therapy (HRT), a much needed bit of accurate reporting since the 2002 WHI study contained so many errors about the safety of HRT.

Dr. Jennifer Blake, CEO of the Society of Obstetricians and Gynaecologists of Canada announces her society’s new nutrition website and guidance on how to improve your diet, and a great recipe to reduce hot flashes from Reena Jadhav.

We discuss with Dr. Patricia Robertson of UCSF important details about the lesbian community’s midlife needs and Dr. Jelena Pavlovic from Albert Einstein College of Medicine reveals much need information about menopause and migraines.

You’ll also discover the latest on who should get a pap smear and learn a great exercise to help you shed some belly fat from champion IFBB fitness pro and women’s health trainer Kimberly Doehnert.

Enjoy this amazing issue of The Hot Years. And be sure to share it with your friends.

Yours in good health, Dr. Mache Dr. Sharon

Editor

Associate Editor

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Reena Jadhav

Patient Advocate, and Menopause Warrior Reena Jadhav is a speaker, startup coach, investor, and five-time entrepreneur with a passion for disruptive ideas that transform the human experience and create meaningful, lasting change. She is a Harvard MBA and summa cum laude from Wharton Business School in Marketing and Accounting.

Mache Seibel MD: Reena Jadhav and I first met when she invited me to do an interview for her HealerPedia podcast. In addition to her remarkable career as an entrepreneur, she has also successfully navigated several serious health issues. Now she is using her lessons learned to positively impact healthcare by raising awareness through education.

Reena, can you tell us about the health challenges you have overcome?

Reena Jadhav: Absolutely. We can begin with my colon cancer at 35.

That was a surprise. I was a very fit, healthy, Asian, skinny woman. I worked out and I thought I ate pretty healthy. So when I self-diagnosed

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myself after seeing blood in my stools, I pushed my way in through my primary care to the GI doc, who did a colonoscopy. He found a polyp that he thought was pre-cancerous, but it came back as full-fledged cancer that was pretty aggressive. So they went back in to remove that specific segment of colon and stitch the rest of the colon back together.

If you’re not feeling right, listen to your body. Don’t let doctors tell you there’s nothing wrong with you.

That was a very interesting experience for a 35-year-old who was in the midst of a very fast growing startup as Chief Marketing Officer, and I really didn’t have time for this, you know?

It’s so funny in hindsight. Where were my priorities?

Dr. Mache: It’s hard to make time for illness.

Reena: It sure is.

Dr. Mache: Facing a potentially life-threatening illness at the ripe old age of 35 is surprising. The fact that

you were able to identify it early gave you a real opportunity to overcome it with the least collateral damage possible. I know it was terrible, but the good thing is you have survived and now are past that window. An important point here is that illness can happen at any age to anyone at any time.

Reena: My one insight that I share with everyone now is, “If you’re not feeling right, listen to your body. Don’t let doctors tell you there’s nothing wrong with you.” Because there were five doctors that said to me I was going crazy, and maybe I had hemorrhoids, and I was imagining things.

Dr. Mache: What were your symptoms?

Reena: I kept seeing dark blood on my stool and I had a couple of hot flashes. When you Google hot flashes at night ... and I didn’t even know if it was a hot flash, so I was Googling sweating at night... If you Google night sweats and dark blood on stool, guess what comes up? Colon cancer. It happened for a good three to four months.

It was a good two months before I decided to call my primary and make an appointment. She said, “You’re crazy.

It’s probably hemorrhoids.” Then she’s like, “Wait, it’s not even that. You have nothing. Go away.”

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Went to another doctor. Same deal.

But she said, “It looks like you’re one of those annoying people that’ll keep coming back, so why don’t you go meet see this very prominent GI guy.”

He looked at me and gave me this very patronizing smile and said, “You don’t have colon cancer. There is nothing wrong with you.” But... “You seem like one of those women that’ll keep calling me and annoying me, so why don’t we just do a colonoscopy?” Keep in mind, insurance didn’t cover colonoscopy if you were below 40, because unfortunately, when they tested my stool for blood the test was negative.

Dr. Mache: You had bleeding for months on and off and told yourself, “I gotta have a colonoscopy,” and you persevered to get it done even though you were young and healthy. You had hot flashes, but menopause was pretty far from your thinking, I imagine.

We think of menopauseas something that hits women in their mid50s. It’s certainly not something you think about at 35 or even 40

Reena: Absolutely. We think of menopause as something that hits women in their mid-50s, right? It’s certainly not something that you think about when you wake up at 35 or even 40 or even 45. It didn’t occur to me.

The night sweats went away and fortunately, I caught the colon cancer when it was stage one. One of the reasons why I become so spiritual is because post everything, the docs came back and said, “There’s no way you would have had any bleeding because it was stage one.” With that said, when I came out of the surgery, I did realize that I couldn’t keep working at the pace that I was working, sleeping maybe four hours a night. And I had a one year old and a three year old at that time. There’s work outside the home and work inside the home that needs to get done.

I also couldn’t digest food as well. I suddenly couldn’t eat chips or chickpeas. I was eating a lot of junk food and that caused me a lot of gas and bloating. I went back to the GI doctors and they said, “Take some time off. It’s pretty normal.” They gave me some acid blockers.

That went on from age thirty-six and a half, a year after my colon surgery.

I continued to have gut dysbiosis as I now understand. I had gone through

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that big surgery and my gut got pretty messed up and nothing was recommended to get it back in shape. Then I started getting sleeplessness and I had no idea it was connected to perimenopause. My sleeping rhythm got all messed up around 37.

puffed shut and my face got bright red. I itched. When I went to the doctor they said, “Oh, you’re allergic to makeup.” A week later I had the same symptoms. So they said, “Maybe it’s something you’re eating. Let’s do some allergy tests.”

Dr. Mache: Did you talk with your doctors about these symptoms and the possibility of menopause.

A week later, same thing, but now, it started to become whelps. There were over 19 symptoms. The worst symptom was weight loss. I got down to 90 pounds. I’m 5’7”. That was the only symptom people took seriously because my allergy tests came back negative.

Reena: I did.

That actually happened when I hit 45 and I had my second huge health crisis. I went on vacation and came back with food poisoning. I had to take pills to stop the food poisoning because we were on a plane six hours later.

I started getting sleeplessness and I had no idea it was connected to perimenopause.

When you have food poisoning, let your body do its thing. Don’t take pills to stop the diarrhea. Allow the body to let the toxins out.

I was told, “Oh, you’ve got food poisoning. Take an anti-diarrhea pill.”

A week later is what I call the beginning of the end or the end of the beginning. I had my first experience of what I now understand as severe histamine intolerance. My eyes

Dr. Mache: That could be a sign of cancer.

Reena: Bingo. I had another colonoscopy, which was clear. Then an endoscopy (of the upper GI tract), which was also clear. And then a gazillion other tests for all kinds of rare diseases and cancers. Finally, they said, “You are healthy. There’s nothing wrong with you. You’re probably depressed, anorexic and looking for attention.”

In fact, I am very happy, settled in life, financially secure, with a loving husband

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and two great kids. And I’m being told that I’m depressed and anorexic and I’m not tracking my food diary correctly.

Dr. Mache: Nothing wrong and nothing found are two different things.

Reena: I think the medical system is trained in how to diagnose what’s wrong with someone. If all this comes clear, you’re at the end of your line.

Dr. Mache: I’ve always believed if it is not where you’re looking, look somewhere else.

Reena: If I had cancer, an autoimmune or thyroid disease, they would have found it, right? I then began my journey to figure out what the heck was wrong with me.

I went to my gynecologist. I said, check me out. Do you think any of this could be menopause? She said, “No, you have your period.” They actually stopped about two months later.

Dr. Mache: You’re 45 now?

Reena: I was 45 and having very regular periods. She did an exam, took a pap smear, and checked my estrogen and progesterone levels. She said, “You’re fine.” A few months later, I went back and insisted she do an FSH and it was at hundreds and she looked

at me, shocked. “I can’t believe you are in menopause.”

Dr. Mache: You had colon cancer and that was dismissed and you persisted. You thought you might be in menopause and you persisted to get an FSH test, which is typically the first test to check for the transition into menopause. You’ve had two significant things happen and neither one was diagnosed and both at ages that are not unheard of but uncommon. Were they tying menopause to your weight loss?

You could have had malabsorption.

Reena: It turned out I did have a severe case of SIBO (Small Intestinal Bacterial Overgrowth), which probably came from the gut surgery, leading to a whole bunch of other stuff.

More people have it than they realize.

If you have belching, gas or bloating, those are signs. If you have malabsorption, that’s a sign. I also had a severe leaky gut, which came from all the sugar in my diet.

I’ve always been skinny and fit, working out five to six days a week since I was 18. For me, it’s fun. I enjoy it.

I equated working out with health, right? The fact is, I was having two Starbucks mocha with muffins a day as my snack, and I could gobble up an entire bar of Twix without putting on weight, because I worked out.

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Dr. Mache: You ate enough sugar to throw the bacteria in your intestines out of whack, so they couldn’t help you with your digestion. Basically, you had eaten yourself into starvation.

Reena: That’s exactly it. I was nutritionally dying, even though I did eat lentils and rice and healthy foods. I had also deprived my gut of fermented food, green vegetables, probiotics, and things that allow the gut to digest food. Menopause uncovered the crap that was already brewing. That’s why we see women having the highest number of autoimmune reactions.

Dr. Mache: The amount of sugar you ate along with the hormonal imbalance also imbalanced your body’s normal microbiome (the bacteria of your intestine). Estrogen also has an impact on serotonin and other hormones in your intestine that affect gut motility. So you lost weight. You were probably a 120 to 130 pounds or so originally.

I finally had to recognize that I had to completely change my lifestyle. I made hundreds of little changes.

Reena: That’s right. I went from 125 down to 90 pounds.

Dr. Mache: That’s a 35-40 pound weight loss, or over a quarter of your weight.

Reena: It was frightening. I looked like a bag of bones. I saw the freak out in my husband’s eyes.

Dr. Mache: What was happening with your menopause symptoms?

Reena: I felt extreme heat where I thought I was burning alive. Then I had the histamine intolerance with massive hives on my face, which drove me crazy because it prevented me from going out and doing regular work. It actually was debilitating in terms of keeping me locked up in the house.

My eyes would be swollen shut. Tripled in size. I couldn’t breathe. I couldn’t shower with hot water or walk too fast, I would hive out. The histamine tolerance was extreme. It became hard to eat food when even water would make me breakout. Then I couldn’t sleep at night.

There was no magic pill. I finally had to recognize that I was going to have to completely change my lifestyle. I made hundreds of little changes.

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You can’t solve all your problems by taking pills. I started getting my body back in balance. I started going to sleep really early, getting up in the morning and walking in the sun. It’s called grounding in the sun. We are no different than plants and flowers.

I don’t think I’d seen sun in decades by choice.

Dr. Mache: Your work kept you inside to the point that you wanted to go into the sun to get the benefits for vitamin D and other things.

eaten immediately once done. I didn’t eat a single left over for the entire 16 months I was healing. I got rid of all processed foods. For a sugar addict, you can imagine how traumatic that was.

Dr. Mache: You reeducated your body to good nutrition.

Reena: Yes, but the biggest issue was my gut wasn’t tolerating anything. I did take some shortcuts, in the form of Vivonex. I asked a lot of my doctors, “Look, what would you feed to really sick people when you think they might be dying to help them get better?”

I went to three meals a day and ate fresh, whole foods cooked at home and eaten immediately once done

Reena: Exactly. I was extremely deficient in vitamin D. Taking vitamin D is great, but it doesn’t replicate the thousands of things that your body does when you’re sitting in the sun.

My diet changed completely. I stopped snacking, which is what I’d done for decades. Instead of a big meal, I used to eat six small snacks a day because I had read that was best. Well, that’s not true at all. It ruins your gut’s motility and makes it impossible for your gut to clean its cells. Your gut needs a four to six hour break, especially if you’re going to eat protein.

I went to three meals a day and ate fresh, whole foods cooked at home and

I learned about Vivonex. It’s a pre-digested drink that’s ingested to give dying people the nutrition they need if they’re not eating. I had also read that it helped SIBO. It tastes awful.

Dr. Mache: It contains amino acids and vitamins and things that are essential for your body and easy to absorb because it is pre-digested.

Reena: Exactly, but it’s different from popping a vitamin pill because the vitamin pill needs to be digested. My

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Own your health and work hard to protect it. Go back to the way your grandparents ate and lived. Slow down. Think of life as a joyous, fun ride. family would run away from me because they said I stunk when I drank it.

But within an hour of drinking it I could actually open my eyes.

Dr. Mache: At some point you had to make a choice about estrogen. How did you come to that decision and what did you decide to do?

Reena: Great question. I was put on the pill after it was discovered that I had ovarian cysts. I’d never been on the pill during the first 10 years of my marriage, but here I was on the pill, because I had ovarian cysts. It made me very sick. I saw Ayurvedic doctors, Chinese doctors, an acupuncture therapist, functional medicine doctors and they said to me, “Get off the pill now. It’s killing all your good bacteria.” I got off the pill. Then we figured out that I had a very high FSH and I was actually in menopause.

Then I went to see four different gynecologists who gave me four different recommendations on what I should do for hormonal therapy. I tried a number of different types of estrogen.

Now I am on the patch. My goal is to get to the lowest dose and then eventually wean off to maybe just a little lotion that I apply occasionally. But it absolutely helped.

Dr. Mache: Thank you for sharing your journey to health with us. Are there any additional words of wisdom you’d like to impart before we stop?

Reena: I think the most important thing is you have to own your health and work hard to protect it. Go back to the way your grandparents ate and lived. Slow down. Think of life as a joyous, fun ride. Don’t take it so seriously.

We don’t even realize how stressed we are. Take back your calm. Take back your peace. Take back your joy.

Enjoy life and things will fall into place.

Find out more about Reena Jadhav on HealerPedia.com. You’ll also learn about her workshops and Heal Circle, a monthly group to help people heal.

Get it NOW!

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Put Some Fun In Your Food

Food Menopause Best Choices for

During menopause your body changes.

Your diet needs to change too.

V

irginia Woolf once said, “One cannot think well, love well, sleep well, if one has not dined well.” It’s true, and the challenge as midlife women is to understand what “dining well” means, especially in and around menopause.

Dr. Jennifer Blake, the CEO of the Society of Obstetricians and Gynaecologists of Canada, shared her perspective on nutrition for midlife women

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with Dr. Mache Seibel at the North American Menopause Society’s annual meeting in Philadelphia.

Like Dr. Mache, whose philosophy is to “take care of the sum of you, not just some of you,” Dr Blake also takes a holistic approach. She sees this “as a much bigger conversation than just what to eat. It’s stopping and thinking about food and how we’re approaching food in our daily lives.”

According to Dr. Blake, “What we know is that we can get ourselves really off track if we focus on this nutrient or that nutrient or think that there’s a magic recipe.” Instead, we tend to get it right if we “step back and think about the role that food is playing - why we’re eating, who we’re eating with, how we’re preparing our food, who’s preparing our food.” That means really looking at food as nourishing not just our bodies, but playing a very constructive and enjoyable part of our daily lives.”

shop for locally grown food and then leisurely cooked a meal with a friend?

And then sat down in a relaxed way, nourished by the conversation as well as the food? Sounds wonderfully fulfilling, doesn’t it?

And while you’re at the farmer’s market, be sure to stock up on extra veggies. According to Dr. Blake, “every woman should think about increasing the number of vegetables that she’s eating in her diet, and preferably, getting those vegetables as fresh as you can so that you’re getting all the nutrients that they have. We know that simply increasing the amount of vegetables on your plate will have a positive impact on your health.”

This last quote

by Dr Blake deserves to be repeated… “We know that simply increasing the amount of vegetables on your plate will have a positive impact on your health.” According to a recent article in the New England Journal of Medicine, exchanging one saturated fat meal such as a steak per week for one vegetarian meal can increase your lifespan by years - even if you don’t begin doing that until you are

Every woman should think about increasing the number of vegetables she’s eating

And this makes a lot of sense. Think about it, when was the last time you enjoyed going to a farmer’s market to

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age 65 or older. So don’t be afraid of a squash and pile on the zucchini, carrots and peppers!

In addition to increasing veggies, Dr. Blake noted that many women don’t realize that as they approach and enter middle age, they need to increase the amount of protein they’re eating. “We don’t think about that. We think that protein is for the kids who are bodybuilding in the gym. That’s something different.”

As explained in HerNutrition.ca, the newly launched website Dr. Blake helped create, menopausal women need extra protein to maintain muscle mass and strength, preserve bone mass, and prevent skeletal degeneration. And according to Dr. Blake, “it’s best to get the protein from the food that nature packed it in, rather than from powders.”

“We have to understand,” Dr. Blake noted, “that our protein needs increase as we get older. This goes for men as well as women, because our body is less able to absorb the protein, so we do need to increase our protein and it gets absorbed best when we divide it up over three meals a day.”

Dr. Blake explained that if we typically have our heavy protein at dinner, we’re not actually getting the maximum value from the protein and we’re probably not sleeping terribly well either.

“The rule of thumb for daily protein intake is a gram of protein per kilogram of body weight. So if you weigh 60 kilograms, you need 60 grams per day of protein. That’s a lot protein; so think about what am I having at breakfast and where’s my protein coming from?’” And it can come from meat, chicken, fish, beans, cottage cheese,

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nuts, or greek yogurt. If you know your protein requirements, you can plan your meals accordingly.

What about simple carbohydrates? According to Dr. Blake, “We handle sugar less well as we get older so sugar is not your friend.

Limit sweetener, sweetened foods and sweetened beverages. We tend to do much better with the low glycemic index foods.” Just limit sweets to occasional treats.

some supplements that women in and around menopause may need to take. Dr. Blake said that, “vitamin D for those of us who live in the northern parts of the continent is really important, especially over age 50.”

We handle sugar less well as we get older so sugar is not your friend.

Even when we eat a well balanced diet rich in nutrients, there are still

“Calcium is another very important mineral that many women do not get enough of in their diet. Supplement your diet to make sure you get ~1,200 milligrams of calcium daily. If you need more than one calcium supplement, divide the doses for better absorption.”

Bon appetite!

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The Impact of

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Social Media onMenopause Mache Seibel, Md

Marla Shapiro, MD

President of the North American Menopause Society

Social media has great influence, but how do you know if it’s accurate

S

ure you’re on social media. But how much time do you spend vetting the source of the information you read?

Considering what’s going on in the news, you may be pondering this issue more than usual. But we often accept what we read at face value, especially medical news that gets wide coverage.

Here to give an insider’s view on social media is Dr. Marla Shapiro, the President of the North American Menopause Society and medical consultant for a major network in Canada. Dr. Shapiro shared interesting insights with Dr. Mache Seibel at the North American Menopause Society’s annual meeting.

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Dr. Mache: If you’re a woman in midlife, how do you go about understanding social media?

Dr. Shapiro: Firstly, women have to understand that social media is an echo chamber. Nothing is really vetted on social media and you can say whatever you want. If it’s Twitter, it’s 140 characters. It is what it is. It’s out there, it’s social, and as we call it, it’s socialnomics. It has a lot of value because it’s shared. But just because it’s shared and just because it’s on social media does not necessarily mean that it’s either evidence-based or accurate, or even has anything to do with you as an individual.

Dr. Mache: Social media’s a reflection of society, not an image of society.

Dr. Shapiro: Yeah, but it’s only a reflection of a certain segment of society. It doesn’t necessarily reflect all of society. We see that, for example, when we look at simple studies like uptake of flu vaccine. If you’re in an area where there’s a lot of anti-flu vaccination in social media, you’ll see that it’s quite viral. Even though it’s not validated or evidence-based, you’ll find pockets of communities that don’t partake of the flu vaccine.

One of the most prominent cases that I can think of in terms of women’s health and social media was Natalie

Women have to understand that social media is an echo chamber. Nothing is really vetted there and you can say whatever you want Morton, a 14-year-old girl who got an HPV vaccine and then died. The whole program was stopped. The headlines were both true and related. She got the vaccine. She died after the vaccine. As it turned out, an autopsy performed within 48 hours showed that in fact she had an underlying congenital cardiac defect and her death had nothing to do with the vaccine. In that case, social media was very effective in quickly opening up chat rooms and having discussions about what happened in response to the event. In that case, social media pretty much put out a fire, if you will, of stopping a program dead in its tracks.

In Japan, on the other hand, where there was an epidemic of fainting after the HPV vaccine, it became viral throughout the country. It was cause and effect and it essentially has stopped their vaccination program.

Social media can be quite dangerous.

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It can be all consuming. You have to be quite cautious about social media.

Dr. Mache: Social media often follows the headline. So when people see a headline, what’s the next thing that they should do to vet what they see on social media?

Dr. Shapiro: It’s a good question because sometimes even when you read the original article, someone’s vetting it for you. If it’s something that’s of great interest, you have to do your due diligence. Find an expert that you trust who can help you go through it. Women say to me, “You doctors change your mind,” and it’s no, not at all, I don’t think that we’re changing our mind. As science evolves and information evolves

in a very complex field, we have more information to make recommendations that may seem as if we’ve changed our mind, but it’s not a question of changing our mind as much as it’s incorporating the new data and going forward. Many articles are written based on an abstract or on the press release, as opposed to really reading the article.

Dr. Mache: A summary of a summary.

Dr. Shapiro: A summary of a summary of a summary. For example, I think our downfall with the Women’s Health Initiative (a 2002 study that incorrectly stated that estrogen increased the risk of breast cancer and other diseases), is that when the data was reported, we did not emphasize at that time

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that it was across all age spectrums and that the results were for the entire group together. If I’m a 50-yearold woman in the study, and there’s a 70-year-old woman in the study, just by virtue of age alone, our risks for breast cancer and heart disease are completely different.

We needed to look at the outcomes by at least decades, to see if it makes a difference, because age makes a difference. The biggest risk factor for breast cancer after being female is age. The biggest risk for heart disease is age.

We know that heart disease risk for women increases a decade later than for men, and then we lose our estrogen protection and we catch up very quickly. It’s not one shoe fits all sizes. When

that study first came out, those headlines, Hormone Therapy Harms, Hormone Therapy Causes Heart Disease, had no context. That’s also the problem with social media - it’s information without context. Without the context, you really can’t make a decision.

I think as women, menopause is very confusing. There are a lot of changes in our body, and it’s very difficult to tease out. Is this menopause? Is this aging? Is this a combination of the two? I would tell women that education is your most powerful tool, but where you get that education is critical. Before you start getting educated, get educated about where you should get educated, and then go from there!

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New Position Paper on

Estrogen

North American Menopause Society The latest recommendations on estrogen is a must read…

D

r. Mache Seibel: I’m talking with Doctor JoAnn Pinkerton, the Executive Director for the North American Menopause Society (NAMS), about their new position paper on hormone therapy (HT).

Can you tell us about it?

JoAnn Pinkerton, MD: After about 18 months, and 23 experts, we really looked at all the data about hormone therapy.

The good news is that for women who are at menopause, symptomatic, having hot flashes or night sweats, under 60 or within 10 years of menopause, hormone therapy is safe.

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Forget what you learned in 2002 (from the WHI study) about how scary hormone therapy is.

Instead, think, “Do I need it? If so, I can use it!

For these women, hormone therapy is effective, and it works. It relieves hot flashes. It relieves night sweats. It improves sleep. And for those who are at risk for bone loss, it prevents bone loss.

The really exciting news is, forget what you learned in 2002 (from the Women’s Health Initiative or WHI study) about how scary hormone therapy is. Instead, think, “Do I need it? If so, I can use it.”

There’s new lower doses, transdermal (through the skin) doses, and lots of different ways to give hormone therapy if you have symptoms.

Dr. Mache: Wow, that’s a major reevaluation of some of the most scary and confusing information ever published.

Dr. Pinkerton: So many people are afraid to use hormones, systemically, vaginally, because of that initial WHI study that came out. What we really did was said, “You know what? It doesn’t apply to women who are at the beginning of menopause.” For women who are at the beginning of menopause, it is safe, and effective, and it works!

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Lesbians and the LGBT community have special considerations in menopause

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idlife poses lots of challenges for all women. And lesbian and bisexual women versus heterosexual women face even more challenges. Dr. Patricia Robertson from the University of California, San Francisco, is on a mission to make sure those extra challenges are recognized and treated.

According to Dr. Robertson, lesbian health is “an emerging field with

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very little research. However, there are some significant issues that have come to the surface.” And it’s important that both patients and healthcare providers become aware of these issues so that the approximately 9% of women who have had same sex partner relationships during their lifetime can get appropriate care.

Approximately 90 percent of LGBT persons want their healthcare provider to know their sexual orientation. And yet 80 percent of providers believe that patients would refuse to disclose their sexual orientation if asked. This creates a real disconnect.

Breast cancer risk is one area that needs heightened awareness. During an interview with Dr. Mache Seibel at the North American Menopause Society’s annual meeting, Dr. Robertson explained that lesbian women “need to think about how they’re going to approach menopause and look at their individual risk for breast cancer.

There’s probably a slight increase risk of breast cancer for lesbians versus heterosexual women.”

There appears to be both a social and physical component to this increased risk. According to Dr. Robertson, “the mammogram-screening rate is about the same but there are

risk factors in the community such as increased alcohol use, especially up into the age of 40. Also, most lesbian women have not had biological children and therefore have not had the chance to breast feed, which can be protective if started earlier.”

There are other areas of concern as well. Dr. Robertson noted, “there’s an increased body mass index for many lesbians compared to heterosexual women. As lesbians age this can manifest itself as knee and back problems, social isolation, and mobility issues.”

The impact of community engagement on health and well-being was underscored, Dr. Robertson stated.

Approximately 90 percent of LGBT persons want their healthcare provider to know their sexual orientation “The Office of Women’s Health recently sponsored four studies focused on midlife lesbians and found that during this time of life lesbians were interested in talking about healthy eating. Not loss of weight per se but social connections with each other.”

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She explained, “a lot of times LGBT Whether it be through online commupeople are estranged from their faminities, welcoming religious organizalies of origin betions, or other cause of the difvenues, Dr. Robficult judgments ertson stressed It’s not unusual for that happen that, “as lesbilesbians to have a family when they have ans and bisexual of choice rather than have women age, they come out to their families. It’s not strong relationship with need to connect unusual for lesto help stay well.” their family of origin bians to have a Here again, like family of choice in the interview rather than have with Dr. Blake on strong relationship with their family of nutrition, we’re finding that health is origin. So there’s a strong need for about “taking care of the sum of you, them to be in a community.” not just some of you.”

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Migraines & Menopause

Hormones play an important role in causing and treating migraines.

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o you suffer from rinse and repeat migraines? Are you wondering if and when they will ever stop?

If you answered, “Yes,” you are not alone. Dr. Jelena Pavlovic, a neurologist at the Albert Einstein College of Medicine and Montpelier Medical Center who specializes in treating women with

migraines, explained that at any given time, 18 percent of women in the United States will suffer from a migraine. And forty percent of women will experience a migraine at some time in their life.

Read on to get the latest 411 on migraines and menopause…

What are the symptoms of migraine?

Dr. Pavlovic described the typical migraine as a moderate to severe headache that often starts unilaterally, often around the eye or the side of the face and then may spread throughout or may switch sides. It can be all over the face. And it will

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often be associated with other symptoms such as nausea with or without vomiting. Interestingly, as women age they tend to vomit less frequently.

There’s sensitivity to light or sound.

Some women can experience other symptoms like neck pain, fatigue, weakness, increase or decrease of appetite, or occasional mood changes. But the typical story of migraine is, “I feel like going to lay down in a dark room and not talk to anyone. ”From Dr. Pavlovic’s experience, “If you feel like that you probably have a migraine.”

As you can see, migraines can be quite debilitating. There is some good news, though. Although migraines are common in perimenopause, migraines decrease during menopause, and especially post-menopause. Dr. Pavlovic said, “Generally, the good news is that we can tell our patients when they come and they’re quite unhappy with their headaches, that they’re going to get better post-menopause.”

But the bad part of that news is that prior to getting through menopause, they’re going to go through perimenopausal changes that are associated with increase in headache frequency.

So women who have had an average of one or two migraine attacks a month, will often have worsening of their headache during the perimenopause transition and increase to 10-15

or sometimes even more than 20 migraines a month. “In my practice I see a lot of women who have 30 days of headache a month, which is a really a horrific burden of headache.”

Why do migraines increase during perimenopause?

Dr. Pavlovic explained that since migraines are hormonally regulated, it is thought there’s an increased migraine frequency at this time because of rapidly occurring hormonal changes. And it’s not just headache that’s increased.

The Women’s Health Initiative (WHI) study showed that women with migraine tend to also have moderate to severe vasomotor symptoms like night sweats and hot flashes. Even if their headaches are well controlled, these women have a genetic predisposition to migraines, and seem to experience increased frequency or increased severity of other menopausal symptoms as well. The good news is that hormone therapy can be used to improve migraine in that setting as well as to treat other menopausal symptoms that women with migraine experience.

Menopausal Hormone Therapy versus Oral Contraceptive Use Using hormone therapy in menopause is not the same as using oral contraceptives in women with migraine with aura. According to Dr. Pavlovic, “For women who have migraine with

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aura, use of oral contraceptives is contraindicated.” But it’s different for women who have migraine with aura during menopause and need hormone treatment, even though they are often told early on in their life that hormones are not for them.

“So as they’re going through perimenopause, they might have had two or three headache attacks every month for years, and they were never on contraceptives because they were not supposed to be. Now they’re going through perimenopause in their 40s or early 50s and they’re having lots of headaches. Sometimes 15 or more headache attacks a month.”

When they come to headache specialists like Dr. Pavlovic, her response is, “Perhaps you should try hormone therapy.” They often say, “But I was told I can’t.” However, there’s no data to support not using hormone therapy with migraines in menopause. Women with migraines with or without an aura can continue to use hormone therapy.

Talk with your doctor and see what’s right for you.

For more information visit the American Migraine Foundation, which is sponsored by the American Headache Society.

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Abdominal Crunch H

ere is a great upgrade to a popular machine women use in the gym. But there can be a problem engaging your abs if you have a weak core. So here’s how to make the belly flab work its way off...

How to do the exercise: Add a balance ball to get more core engagement 1

Place a balance ball under the feet

2 Draw in the navel.

3 Pull down the machine to crunch 4 Hold for a 2 count 5 Return to start 6 Complete 10-15 reps, 3 sets Did you like this exercise? Sign up for Kimberly’s emails and you can get 7 FREE CIRCUITS that can be done at home or in the gym.

Get it now

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When To Stop

Getting Pap Smears The rules for getting a pap smear have changed. Discover when to start, when to stop and when there are exceptions to those rules

C

onfused about when to get a pap smear or how often to get one? A lot of people are. It’s changing and it’s kind of complicated.

So here’s a pap quiz for you.

How often do you need a pap smear?

Every year?

Every 3 years?

Every 5 years?

Never after age 65?

All are correct and all are incorrect.

Read on…

Told you it was confusing.

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First of all, what is a pap smear?

According to the American College of Obstetricians and Gynecologists (ACOG), it’s “a sample of cells taken from the cervix to look for changes that could lead to cancer; this test may be combined with testing for human papillomavirus (HPV) in women aged 30 years and older (co-testing).

When do start getting a pap smear?

According to ACOG, start getting tested at age 21.

How often do you need a pap smear?

After age 21, typically every 3 to 5 years. It depends on whether or not you get the pap smear alone or combined as a co-test with the HPV

A pap smear is a sample of cells taken from the cervix to look for changes that could lead to cancer screening. It turns out certain strains of HPV (16 and 18) are thought to be responsible for most cases of cervical cancer. If either the pap smear or the HPV test is positive, you may need to get additional testing and come back for the co-test yearly.

The preferred testing method now is co-testing (Pap test plus HPV test) every

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5 years. But you may also receive the pap test alone. Since it’s less sensitive, you’ll have to come back every 3 years.

What if I’m age 65 or older?

It’s safe to stop having cervical cancer screening after age 65 if you do not have a history of moderate or severe cervical dysplasia (precancerous changes) or cervical cancer, and if you have had either three negative Pap test results in a row, or two negative co-test results in a row within the past 10 years, with the most recent test performed within the last 5 years.

Why do I have to come back after 65 because of a positive co-test?

Watch this video of a recent study

The preferred testing method now is cotesting (Pap test plus HPV test) every 5 years from New York University School of Medicine and Bellevue Hospital that was presented at the annual meeting of the North American Menopause Society. If you don’t keep coming until all is negative for a number of years, you are putting yourself at risk of cancer.

Watch the video below. You’ll see the importance of paps in just 2 minutes.

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Ask Dr. Mache!

THE resource to get your questions answered about “changes during the change.” Join us every Thursday at 9 pm EST on Facebook LIVE when Dr. Mache answers your most pressing questions about menopause or visit AskDrMache.com and submit your questions in advance.

Here are some Q & A that women have been asking...

I am 61 years old and have been taking bioidentical EPT since I was 50, after having hot flashes, moodiness and sleepless nights. Is it safe to continue taking a lesser dose of this indefinitely or should I stop after this 11 year window? Please help.

Cathy Cathy, that’s an important question. How long to continue taking EPT (Estrogen, Progesterone Therapy) is a very important question that has to be individualized. There is a possibility that risks may increase slightly as you get into your 60s and 70s, but there are not hard and fast rules against hormones after age 60. The North American Menopause Society (NAMS) recommends that a woman over 65 use the lowest dose of hormones needed to control her symptoms and work closely with her healthcare provider. Some insurance companies and Medicare plans may not cover hormones because of safety concerns that have turned out not to be true. It’s called the “Beer’s list.” I’ve explained how these weren’t true in my book The Estrogen Fix. You can read the official statement from NAMS about continuing hormones after age 65 here.

What exactly is menopause? How many eggs is a woman born with and what happens to them leading up to menopause?

Beth Menopause is defined as one year after a woman’s final menstrual period.

If you have both ovaries out while still menstruating, that is called surgical menopause, even if your uterus was not removed.

Women are born with about 400,000 eggs.

Groups of eggs begin to mature each month between puberty and menopause. Typically, one will ovulate each month and the rest are absorbed by the body. At menopause, there are usually no remaining eggs.

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How do you know when you’re experiencing hot flashes? I’m clueless.

Maureen

A hot flash is a sensation of intense heat, sweating that is often accompanied by a rapid heartbeat.

They typically begin in the head and neck or chest and eventually spread to the rest of the body. The intense heat causes the woman to look flushed.

Some are barely noticeable and last less than 5 minutes, but they can also be intense episodes of profuse sweating, cold chills, and dizziness that force women to seek immediate relief. About 75% of women approaching menopause develop hot flashes. If you do experience hot flashes and want some relief, visit HotFlashRescueKit.com.

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Got Questions?

Ask Dr. Mache!

Join the weekly Facebook LIVE HouseCall® Every Thursday 9pm Eastern Ask Questions • Get Answers • Bring Friends Go to AskDrMache.com to submit questions in advance and join me at www.facebook.com/MyMenopauseMagazine

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The Estate Sale

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Click here to hear Dr. Mache narrate this over a bed of his original music performed by Ben Schwendener

I

didn’t know her well. She was an elderly woman whose spine bent to the side so she walked with a cane, more and more slowly as the years went by. I occasionally saw her walking her dog around the block I live on, and though she seemed pleasant as she passed by, her small white bichon never failed to bark and growl as we walked past each other on our opposite routes.

I hadn’t seen her in a while and on this day as I walked past her house on my daily walk, I saw a sign on her front lawn – Estate Sale. A woman exiting the house told me the woman had recently died, had no heirs, and her belongings were being sold off.

I walked up the 5 front stairs into a final snapshot of her life. The house was very tidy. Most of the belongings were functional. Dishes, furniture, a few religious items. There was one exception…

Her walls were lined with lovely paintings. A few were pieces of art she had acquired. But most were paintings she had done. And there were boxes of

other paintings that had no place to be hung. Separate stacks of large ones, small ones, still lifes and portraits. All beautiful, and each being sold to different people from many backgrounds and locations.

I watched for a while as the different people searched through the rooms she used to occupy. Asian, Italian, Jewish, Hispanic, African American; each sifting through the belongings that once held special meaning to her.

I watched as the different people walked out with a small piece of her life’s DNA. And like the cellular DNA of a person who mates with someone from another culture, a small fragment of her essence will mingle and mix and influence in some small degree the new environment it inhabits.

Since I didn’t know her well, I never used to think of her. And now, each time I view the fragment of her estate that I purchased, she surfaces in my mind, living on in some small way.

Mache Seibel, MD

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Get Rid of Hot Flashes with this Flash Freeze

Almond Saffron Smoothie

By Reena A Jadhav Hot flashes are a huge moment of crisis during menopause.

I got miserable enough with my hot flashes every hour on the hour that I decided to do something about them.

I did countless hours on researching various cooling ingredients (according to Ayurveda) and how to concoct them into something edible to COOL ME OFF! Well, all those hours of research and experimenting paid off.

Today, I am unveiling my Flash Freeze Almond Smoothie to help you get rid of your hot flashes. It’s easy to make despite a few exotic ingredients, all of which can be bought on Amazon. I

recommend you splurge on buying all organic ingredients if they are available as your body really doesn’t need more toxins during this time of distress.

INGREDIENTS for 1+ SERVING Water: 10-12 ounces Almonds: 15 Saffron: 10 strands Cardamom: 1 green pod or 1/8th of a teaspoon of it’s black kernels Rose Water: 1 tablespoon or 2 tablespoon depending on how you like it’s taste Protein Powder: 1 scoop/tablespoon Stevia: Optional to taste if your protein powder doesn’t have any Exotic Ingredient - Gond Katira or Tragacanth gum: 2 tablespoons after soaking OPTIONAL: Benefiber: 1 tablespoon (to give you some all important fiber) Dried Rose Petals: 1 tablespoon Ghee or MCT oil: 1/2 teaspoon DIRECTIONS: 1. Soak the almonds overnight in hot water or for at least 6 hours so you can peal off the skin. Yes we only use soaked pealed almonds as they are “cooling and easy to digest”. Almonds with peal are considered “heating” in Ayurveda and harder to digest. Which means our body can’t absorb all that delicious nutrition!

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So take the time to soak and peal, do not skip this step :) Tip: I soak a whole batch of almonds, peel and keep them in the fridge for daily use.

2. Soak saffron in 1/2 cup of warm water for 10 minutes or so to get the threads gooey. A beautiful shade of orange will emerge in the water.

3. Soak a quarter size piece of Gond Katira overnight in 2 cups of hot water and a large bowl (think large cereal bowl). In the morning you’ll see the little piece has grown into a clear gummy substance and has filled your bowl up!

4. Now that the soaking is done, it’s time to blend!

Gather your 15 peeled almonds, 2 tablespoons of soaked Gond Katira, soaked saffron with the water, cardamom seeds (peel and throw away the green pods if you bought whole pods), protein powder, rose essence water, 12 ounces of water and the optional ingredients and blend away on high for a minute.

Then taste a little (I always have to do this!) add whatever is needed to make it perfect for YOU - maybe add more rose essence or a dash of stevia or toss in some more water if it’s too thick, or more protein powder and

Gond Katira if it’s too watery for your taste. Blend again till all the little pieces are smooth as silk.

5. Pour into a tall frosted glass and enjoy!

Track your hot flashes for the rest of the day and see if you feel calmer, cooler and a lot happier.

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Key Benefits of Key Ingredients: GOND KATIRA • Prevents Heat strokes: I think a hot flash is a heat stroke from internal heat, which I why I tried it the first time! If Indians have been taking this for centuries during crazy hot summers, maybe it could help us in our crazy hot menopause.

• Prevents Constipation and Diarrhea: So, either way you’re good!

• Small Breasts: Yup, apparently it does that too. Not sure if it lifts saggy breasts, you’ll have to share if you notice a difference.

• Urinary Incontinence: Apparently great results against the tinkle from the giggle or jiggle or Zumba • Tumor suppression: That’s just gravy!

• Immune System Boost: We all need that one, all year round.

SAFFRON Proven benefits for women in menopause: Calmness, reduce mood swings, and lessen irritability.

Of course it was used traditionally for thousands of years for coughs, colds, stomach ailments, insomnia, uterine bleeding, scarlet fever, heart trouble, and flatulence. More recently, scientists have concluded that saffron has “neuroprotective potential under toxicity,” which means it may also help your body if your bones leach heavy metals from silver fillings, or other metals your bones have been holding on to!

ROSE WATER: Historically used to curb infections, ulcers, heart disease, and diarrhea, rose water is well known in ancient texts for its calming effect on the nervous sys-

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tem. Mildly sedating, it works as a natural anti-depressant and simply smelling its vapors can soothe anxiety. It is also thought to balance the endocrine system, and help control the unpleasant symptoms of peri-menopause and menopause including mood swings.

CARDAMOM Cardamom is considered an excellent digestive aid, helping reduce bloating and intestinal gas. It is also excellent for balancing Kapha (so if you’re carrying extra weight this could help).

It is also useful for pacifying Vata, so if you’re anxious and agitated, cardamom will calm you down.

ALMONDS Almonds are nutritious and packed with essential vitamins and minerals like vitamin E, zinc, calcium, magnesium and omega-3 fatty acids. Best of all, they help with memory, which turns quite foggy starting in our 40s!

According to MAPI, to best absorb all those nutrients, the almonds should be soaked in water overnight. Otherwise, the enzyme-inhabiting compound in their brown, rough skin that protects the seed until it has the perfect conditions for germination prevents our body from absorbing its nutrients.

WHAT’S YOUR MENOPAUSE SCORE?

use Take the Menopa t Now! Quiz and Find Ou

Discover how much your menopause symptoms impact your • Health • Happiness • Hormone Balance This quiz is for you!

It’s FREE and only takes 2-minutes.

Get instant access to a summary of your results and valuable suggestions to help you navigate “the change” for a healthy, happy life.

Retake the Menopause Quiz in three to six months and find Out how much your symptoms have changed!

Visit MenopauseQuiz.com now

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You may be disappointed if you fail, but you are doomed if you don’t try.

Beverly Sills

CLICK HERE to hear the Song of The Month. I wrote Red Hot Mama to celebrate menopause.

Visit www.DoctorSeibel.com/store/cds for additional songs and CDs. Every effort has been made to ensure that the information contained in this magazine is complete and accurate. However, neither the publisher nor the author(s) is engaged in rendering professional advice or services to the individual reader. The ideas, procedures, and suggestions contained in this magazine are educational and not intended as a substitute for consulting with your physician. All matters regarding health require medical supervision. Neither the authors nor the publisher shall be liable or responsible for any loss, injury, or damage allegedly arising from any information or suggestion in this magazine. The opinions expressed in this magazine represent personal views of the author(s) and are not a substitute for medical care.

All content in this magazine is Copyright Š HealthRock, LLC

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