You’re 40 and suddenly it seems as if you’re falling apart. You wake in the morning soaked in sweat, despite the ceiling fan above. You can’t lose those last five pounds no matter how hard you try. Your interest in sex has gone the way of…well it’s just gone. And suddenly you’re spending more time browsing the face cream aisle than the ice cream aisle.
Could this be the start of menopause?
Before we try to answer that question, let’s get the nomenclature right. First, there really is no “start” to menopause. Menopause is actually just one day — the day on which you’ve gone twelve consecutive months without menstruating. Normal menopause can occur any time between ages 40 and 58, although the average age is 51.4.
The day after that magical day of menopause, you’re considered postmenopausal. The day before: premenopausal. Then there’s this other phase called perimenopause. And that, my friend, may be the realm you’ve entered.
Perimenopause refers to the transitional time before menopause. It can last a few months or, most likely, a few years. It usually starts in your forties, although it can begin earlier in some women. The primary cause is loss of follicles in the ovaries, leading to slowly declining estrogen levels as your ovaries age. This decline isn’t consistent, however, which is why your symptoms may come and go as often as your college-aged children.
Tests Not Available
Unfortunately, there is no conclusive test that can tell you that you are, indeed, in the menopausal transition. No, not even those over-the-counter tests that purport to pinpoint your hormone levels. That’s because those tests, with names like Estroven, Menocheck and RU25 Plus, are designed to measure levels of a hormone called follicle stimulating hormone, or FSH. Your body releases this hormone when estrogen levels drop, because it signals the ovaries to produce more estrogen. So, the thinking goes, if FSH levels are high, it means estrogen levels are low, ergo you’re approaching menopause.
And indeed, for years gynecologists used this hormonal measurement as an indicator of menopause. But it turns out that estrogen levels fluctuate nearly as much as the stock market — not only day-to-day, but from morning to night. So a single FSH measure, even a couple, is really no indication of menopausal status.
Instead, you’re better off evaluating your status by your symptoms. These include:
Hot flashes and night sweats.
Called vasomotor symptoms, we’re still not sure what causes them. Somehow, it seems, declining estrogen plays havoc with your body’s temperature controls, increasing your core temperature and triggering your body’s cooling attempt — sweating. Hot flashes are the second most common menopause-related symptom, affecting about 75 percent of women. It’s also one of the most bothersome. The bad news: In some women, they continue even after menopause itself.
Irregular periods.
Fluctuating hormone levels mean strange things may be happening to your periods. You may find them coming more often — every 24 days instead of every 28 days, for example — or less often. You can even skip several periods in a row only to have them return on a regular basis. You may also find that your periods are considerably heavier or lighter than they used to be, and that they last longer or shorter than they used to.
Problems sleeping.
We don’t really know if fluctuating hormone levels contribute to the sleep problems women say are so common during this time of life. It could be that the night sweats interfere with sleep, or that the stresses of this time of life, including teenaged children, aging parents and career transitions, keep you awake. Regardless, studies find that more women report insomnia as they move through midlife, primarily the type that involves waking up in the middle of the night.
Headaches.
You may find you’re having more headaches, particularly around your period. And if you’ve always been prone to premenstrual headaches, you may find they’re more severe and last longer. The good news? Once you reach menopause, you should experience far fewer headaches.
Mood swings.
There’s good evidence that perimenopausal women experience more irritability, fatigue and “blue moods,” during the perimenopausal transition than before. Again, this could be related to shifting hormonal levels, but is more likely related to midlife stressors. If these mood swings become so intense they interfere with your normal life, however, you should seek professional help.
Vaginal dryness.
Estrogen plays a key role in maintaining the moistness and flexibility of the vagina. So as levels drop, you may find you feel “drier” down there. You may notice other changes, such as a discharge or odor, and you may even find you have problems with some urine leakage.
Although all the symptoms listed above are representative of perimenopause, they can also be caused by numerous medical issues. So regardless of whether you think your symptoms are from this midlife transition, it’s important to see your health care professional for a complete medical and psychological evaluation. He or she can rule out any other medical conditions and confirm whether you are or aren’t in the menopausal transition.
For more information on the health topics mentioned in this article visit
Mayo Clinic is now recruiting patients for both a “virtual registry” with retrospective and prospective components and development of a DNA biobank of SCAD patients and first degree relatives. If you are a woman who survived a spontaneous coronary artery dissection (SCAD) and are interested in applying to be accepted to a study being conducted at Mayo Clinic by Dr. Sharonne Hayes,access the preliminary information here.
Protocol entails diagnosis confirmation and angiographic review to determine eligibility prior to enrollment in either of the studies. Women with SCAD can access the documents from this link or can request them to be emailed or mailed via the MayoSCAD@mayo.eduemail address.
In a recent American Heart Association survey of Hispanic Americans, 45 percent thought they were at ideal heart health. However, 66 percent of those surveyed said a health professional told them they had a risk factor for heart disease and/or needed to make a lifestyle change to improve their heart health. These findings indicate that most people don’t associate important risk factors such as poor diet and physical inactivity with heart disease.
Further survey findings show that whites (83 percent) are more likely than Hispanics (71 percent) to have visited a doctor within the past year. Hispanics are also further behind whites in knowing their blood pressure, cholesterol and glucose levels.
Heart Disease, Stroke and Diabetes are the leading causes of death among Hispanics. The majority of Hispanics are not aware that these can be prevented with simple lifestyle changes.
This book can help teach Hispanic families how to identify their risk factors as well as steps to lower their risk. “Tomo contol de su salud” is a step by step guide which is easy to understand and includes many pictures and charts.
Heart disease, diabetes and stroke are the leading causes of death among Hispanics, but you CAN prevent them. One out of four Hispanics die from heart disease or stroke. Hispanic people are twice as likely to develop diabetes compared to non-Hispanics. Hispanics develop heart disease risk factors ten years younger than non-Hispanics. This book will teach you and your family how to prevent a heart attack, stroke and diabetes.
If your doctor just started you on insulin therapy, you’ve likely had diabetes for a while and you know the importance of following a healthy diet, exercising regularly and monitoring your blood sugar levels. Nothing changes in terms of these requirements now that you’re on insulin. Hopefully, you’ll find it easier to keep fasting blood sugar levels in your target range and to reach an A1C of less than 7 percent.
You may be wondering about the effect of insulin on other aspects of your life. Here’s what we know:
Your sex life. You may have noticed changes in your libido and sexual life since your diagnosis of diabetes. High blood sugar can reduce vaginal lubrication, leading to dryness and pain during intercourse. It can also increase the risk of vaginal infections, which can make sex more painful. Long-term damage to small blood vessels can occur when diabetes isn’t well controlled, resulting in decreased arousal. Since insulin should provide better control of your blood sugar, with fewer episodes of high blood sugar levels (hyperglycemia), you may see these symptoms improve.
Pregnancy. Having diabetes during pregnancy can increase the risk of miscarriage, early labor and delivery, as well as preeclampsia and congenital defects in the baby. However, the best thing you can do to prevent these issues is to control your blood sugar levels before and during your pregnancy. In fact, all guidelines regarding pregnancy and diabetes recommend starting insulin therapy before getting pregnant so women can achieve target blood sugar (glucose) levels before conceiving. Taking insulin during your pregnancy is perfectly safe. One study that reviewed 10 years of pregnancy outcomes in women with type 2 diabetes found those taking insulin during pregnancy had significantly lower rates of complications. If you use oral medications for blood sugar control, talk to your health care provider about whether they are approved for use during pregnancy.
Menopause. Once you are menopausal, your body’s production of insulin drops even further, increasing insulin resistance. The fact that you’re already taking insulin is a good thing, but be sure to monitor your blood sugar for changes in your insulin requirements after menopause. As for hormone therapy, the decision is up to you and your health care professional. Replacement estrogen and/or progesterone therapy is recommended only for short-term use to address symptoms such as hot flashes and vaginal dryness in perimenopausal and postmenopausal women, but not for long-term use. The same recommendations apply if you have diabetes. An analysis of 107 studies found that hormone therapy reduces insulin resistance and fasting blood sugar levels in women with type 2 diabetes. However, if you have any significant risk factors for heart disease, talk with your doctor about whether hormone therapy is right for you and about other steps you can take to reduce your risks.
Other medications. People with diabetes often need other medications, such as a statin to control cholesterol and blood pressure-lowering drugs. Some drugs can increase your response to insulin; others can reduce it. Those that may increase the blood sugar-lowering effects of insulin include ACE inhibitors, fibrates, certain antidepressants, most oral anti-diabetes medications, some anti-arrhythmia drugs, certain pain relievers, hormones and antibiotics. Drugs that can reduce the blood sugar-lowering effects of insulin include certain steroids, niacin, diuretics, albuterol, certain hormone medications like thyroid hormones and estrogen and progesterones in oral contraceptives, as well as some psychiatric medications such as olanzapine and clozapine. Beta blockers, clonidine and lithium can make you more susceptible to hypoglycemia, while pentamidine can cause hypoglycemia, sometimes followed by hyperglycemia. Remind every health care professional who prescribes any drug for you that you take insulin, and ask if the drug will affect your blood sugar levels. Taking insulin for your diabetes doesn’t have to change your life. In fact, given the evidence regarding the benefits of insulin therapy in diabetes, it will help you have a longer, healthier life.
This content was developed with the support of sanofi aventis. For more information on the health topics mentioned in this article visit the HealthyWomen.org areas below.
Diabetes Health Center : http://www.healthywomen.org/healthcenter/diabetes Healthy Living Center : http://www.healthywomen.org/ages-and-stages/healthy-living Midlife & Beyond: http://www.healthywomen.org/ages-and-stages/midlife-and-beyond Pregnancy Center : http://www.healthywomen.org/healthcenter/pregnancy Menopause Center: http://www.healthywomen.org/healthcenter/menopause References American Diabetes Association. Standards of me dical care in diabetes–2010. Diabetes Care. 2010;33(Suppl 1):S11-61. Ekpebegh CO , Coetzee EJ, Merwe Lvd, et al. A 10-year retrospective analysis of pregnancy outco me in pregestational Type 2 diabetes: comparison of insulin and oral glucose-lowering agents. Diabetic Medicine. 2007;24(3):253-258. Giraldi A, Kristensen E. Sexual dysfunction in women with diabetes mellitus. J Sex Res. 2010;47(2):199-211. Lantus [product information]. Bridgewater , NJ : Sanofi Aventis; 2007. Mahmud M, Mazza D. Preconception care of women with diabetes: a review of current guideline recommendations. BMC Womens Health. 2010;10:5. Wedisinghe L, Perera M. Diabetes and the menopause. Maturitas. 2009;63(3):200-203.
Heart disease is the #1 killer of Hispanic men and women in the U.S. Hispanics are at a higher risk to develop diabetes which is a strong risk factor for heart problems. Heart disease and diabetes risk factors specific to the Hispanic/Latino population will be discussed and strategies to reduce risk.
On July 29, the British Medical Journal published a meta-analysis on the effects of calcium supplements on the risk of heart disease. The results were reported in the general media. The study’s conclusion suggested that calcium supplements may increase the risk of a heart attack.
In response to the story, Daniel Fabricant, Ph.D., vice president of Global Government and Scientific Affairs for the Natural Products Association notes the following:
“There are thousands of studies on calcium, but the authors selected only eight to do this meta-analysis. None of the selected studies had cardiovascular outcomes as the primary end-points, and data on cardiovascular events were not gathered in a standardized manner, so it would appear much more of a predetermined outcome versus one of great scientific rigor.”
Unfortunately this happens all to often a new study comes out and the media headlines saturate the public with only half the story. You never hear all the facts of the study. Surprisingly many studies I hear quoted on the news are inaccurate or incomplete. In order to find out the truth you should either read the study yourself or ask your healthcare provider for all the facts.
Bottom Line: Do NOT stop taking your calcium supplements without first discussing your risk with your healthcare provider.
Sleep apnea is a common disorder in which you have pauses in breathing (actually stop breathing) or shallow breaths while you sleep. Breathing pauses can last from a few seconds to minutes. They often occur 5 to 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound. The most common type of sleep apnea is obstructive sleep apnea. This most often means that the airway has collapsed or is blocked during sleep.
When I lecture about sleep apnea and heart disease I often ask people to take a deep breath and hold it for about 20 to 30 seconds (why not try it now)…
Okay after the 30 seconds let the breath out. That is how long many people with sleep apnea stop breathing while they sleep, often several times every hour.
Take a look at this short PSA on Sleep Apnea:
Untreated sleep apnea can:
Increase the risk for high blood pressure, heart attacks and strokes!
Increase the risk for or worsen heart failure
Lead to irregular heartbeats
Increase the chance of having work-related or driving accidents
Common symptoms of sleep apnea include:
Excessive daytime sleepiness/fatigue
Loud snoring
Observed episodes of breathing cessation during sleep
Abrupt awakenings at night sometimes accompanied by shortness of breath
Awakening with a dry mouth or sore throat
Morning headaches
Difficulty staying asleep (insomnia)
Sleep apnea can be treated once it is diagnosed. By treating your sleep apnea you can actually also protect your heart from future problems.
For more info about risk factors for heart disease, stroke and diabetes visit www.heart-strong.com
We are nurses practitioners who have spent years taking care of people with heart disease and our mission now is to help people PREVENT heart attacks and strokes. We have written two books that may help you learn about your individual risk factors and what you can do to prevent heart problems, strokes and diabetes. “Take Charge: A Woman’s Guide to a Healthier Heart” and “Take Charge: A Man’s Roadmap to a Healthy Heart – So simple you will not even have to stop and ask for directions” – our books offer realistic steps to help you develop a healthier lifestyle, all of the information in the books comes from the latest medical guidelines available and is written in an easy to follow and understand format.
During this final installment of our 3 part series about women and heart disease we will be focusing on heart problems older women are more likely to experience. Some of the things we will discuss are heart failure, diastolic dysfunction, atrial fibrillation, aortic valve disease and sudden cardiac death.
A recent study in the June issue of the American Journal of Public Health evaluated a possible link between depression and extra inches around the waist. Researchers at the University of Alabama at Birmingham examined data from the CARDIA study, a 20 year longitudinal study with over 5,100 men and women.
They discovered that over a 15 year period everyone had put on some weight, but the depressed people gained weight faster. People reporting high levels of depression gained weight fast. The interesting finding is that being overweight initially did not lead to changes in level of depression. The stress hormone cortisol plays a role in both depression and abdominal obesity, so increased levels of this hormone may be the reason why the depressed people gained the belly fat faster.
This study shows the importance of recognizing and treating depression not only for its psychological consequences, but also for physical reasons. In order to control obesity and obesity related diseases, it is important to also make sure depression is appropriately recognized treated.
Depression is a modifiable risk factor – prompt treatment can prevent permanent health problems. To find out more information about risk factors you can control to prevent heart disease, stroke and diabetes visit www.heart-strong.com
During this show we will discuss heart problems women may start to experience around menopause. “The Menopause Triple Threat” – weight gain, high blood pressure & cholesterol problems. Heart attack & stroke risk factors, “Broken Heart Syndrome”
Posted by heartstrong 
Healthy Hearts & Bodies with Heartstrong 