What You Should Have Been Told About The Menopause Beforehand
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What You Should Have Been Told About Menopause Beforehand
This is Dr. Jen Gunter. She’s a gynecologist, specializing in chronic pain and vulvovaginal disorders. She’s also a woman on a mission to demystify things that popular culture, especially in the US, would rather not talk about.
When was the last time you remember the menopause being referenced in a movie or TV show? If you can think of one at all, was it just played for laughs?
And of course, the human body can be funny, so that’s not necessarily the problem, but it sure would be nice if that weren’t all that there is!
So, what does Dr. Gunter want us to know?
It’s a time of changes, not an end
The name “menopause” is misleading. It’s not a “pause”, and those menses aren’t coming back.
And yet, to call it a “menostop” would be differently misleading, because there’s a lot more going on than a simple cessation of menstruation.
Estrogen levels will drop a lot, testosterone levels may rise slightly, mood and sleep and appetite and sex drive will probably be affected (progesterone can improve all these things!) and not to mention but we’re going to mention: vaginal atrophy, which is very normal and very treatable with a topical estrogen cream. Untreated menopause can also bring a whole lot of increased health risks (for example, heart disease, osteoporosis, and, counterintuitively given the lower estrogen levels, breast cancer).
However, with a little awareness and appropriate management, all these things can usually be navigated with minimal adverse health outcomes.
Dr Gunter, for this reason, refers to it interchangeably as “the menopausal transition”. She describes it as being less like a cliff edge we fall off, and more like a bridge we cross.
Bridges can be dangerous to cross! But they can also get us safely where we’re going.
Ok, so how do we manage those things?
Dr. Gunter is a big fan of evidence-based medicine, so we’ll not be seeing any yonic crystals or jade eggs. Or “goop”.
See also: Meet Goop’s Number One Enemy
For most people, she recommends Menopausal Hormone Therapy (MHT), which falls under the more general category of Hormone Replacement Therapy (HRT).
This is the most well-evidenced, science-based way to avoid most of the risks associated with menopause.
Nevertheless, there are scare-stories out there, ranging from painful recommencement of bleeding, to (once again) increased risk of breast cancer. However, most of these are either misunderstandings, or unrelated to menopause and MHT, and are rather signs of other problems that should not be ignored.
To get a good grounding in this, you might want to read her Hormone Therapy Guide, freely available as a standalone section on her website. This series of posts is dedicated to hormone therapy. It starts with some basics and builds on that knowledge with each post:
Dr. Gunter’s Guide To The Hormone Menoverse
What about natural therapies?
There are some non-hormonal things that work, but these are mostly things that:
- give a statistically significant reduction in symptoms
- give the same statistically significant reduction in symptoms as placebo
As Dr. Gunter puts it:
❝While most of the studies of prescription medications for hot flashes have an appropriate placebo arm, this is rarely the case with so-called alternative therapies.
In fact, the studies here are almost always low quality, so it’s often not possible to conclude much.
Many reviews that look at these studies often end with a line that goes something like, “Randomized trials with a placebo arm, a low risk of bias, and adequate sample sizes are urgently needed.”
You should interpret this kind of conclusion as the polite way of saying, “We need studies that aren’t BS to say something constructive.”❞
However, if it works, it works, whatever its mechanism. It’s just good, when making medical decisions, to do so with the full facts!
For that matter, even Dr. Gunter acknowledges that while MHT can be lifechanging (in a positive way) for many, it’s not for everyone:
Informed Decisions: When Menopause Hormone Therapy Isn’t Recommended
Want to know more?
Dr. Gunter also has an assortment of books available, including The Menopause Manifesto (which we’ve reviewed previously), and some others that we haven’t, such as “Blood” and “The Vagina Bible”.
Enjoy!
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Coconut vs Avocado – Which is Healthier?
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Our Verdict
When comparing coconut to avocado, we picked the avocado.
Why?
In terms of macros, avocado is lower in carbs and also in net carbs—coconut’s a little higher in fiber, but not enough to make up for the difference in carbs nor, when it comes to glycemic index and insulin index, the impact of coconut’s much higher fat content on insulin responses too. On which note, while coconut’s fats are broadly considered healthy (its impressive saturated fat content is formed of medium-chain triglycerides which, in moderation, are heart-healthy), avocado’s fats are even healthier, being mostly monounsaturated fat with some polyunsaturated (and about 15x less saturated fat). All in all, a fair win for avocado on the macros front, but coconut isn’t bad in moderation.
When it comes to vitamins, avocados are higher in vitamins A, B1, B2, B3, B5, B6, B9, C, E, K, and choline. Most of those differences are by very large margins. Coconuts are not higher in any vitamins. A huge, easy, “perfect score” win for avocados.
In the category of minerals, however, it’s coconut’s turn to sweep with more calcium, copper, iron, magnesium, manganese, phosphorus, zinc, and selenium—though the margins are mostly not nearly as impressive as avocado’s vitamin margins. Speaking of avocados, they do have more potassium than coconuts do, but the margin isn’t very large. A compelling win for coconut’s mineral content.
Adding up the sections, we get to a very credible win for avocados, but coconuts are also very respectable. So, as ever, enjoy both (although we do recommend exercising moderation in the case of coconuts, mainly because of the saturated fat content), and if you’re choosing between them for some purpose, then avocado will generally be the best option.
Want to learn more?
You might like to read:
- Can Saturated Fats Be Healthy? ← defying Betteridge’s Law here!
- Avocado, Coconut & Lime Crumble Pots ← if you do want to enjoy both, here’s a fabulous way to do so in style
Take care!
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How much does your phone’s blue light really delay your sleep? Relax, it’s just 2.7 minutes
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It’s one of the most pervasive messages about technology and sleep. We’re told bright, blue light from screens prevents us falling asleep easily. We’re told to avoid scrolling on our phones before bedtime or while in bed. We’re sold glasses to help filter out blue light. We put our phones on “night mode” to minimise exposure to blue light.
But what does the science actually tell us about the impact of bright, blue light and sleep? When our group of sleep experts from Sweden, Australia and Israel compared scientific studies that directly tested this, we found the overall impact was close to meaningless. Sleep was disrupted, on average, by less than three minutes.
We showed the message that blue light from screens stops you from falling asleep is essentially a myth, albeit a very convincing one.
Instead, we found a more nuanced picture about technology and sleep.
Mangostar/Shutterstock What we did
We gathered evidence from 73 independent studies with a total of 113,370 participants of all ages examining various factors that connect technology use and sleep.
We did indeed find a link between technology use and sleep, but not necessarily what you’d think.
We found that sometimes technology use can lead to poor sleep and sometimes poor sleep can lead to more technology use. In other words, the relationship between technology and sleep is complex and can go both ways.
How is technology supposed to harm sleep?
Technology is proposed to harm our sleep in a number of ways. But here’s what we found when we looked at the evidence:
- bright screen light – across 11 experimental studies, people who used a bright screen emitting blue light before bedtime fell asleep an average of only 2.7 minutes later. In some studies, people slept better after using a bright screen. When we were invited to write about this evidence further, we showed there is still no meaningful impact of bright screen light on other sleep characteristics including the total amount or quality of sleep
- arousal is a measure of whether people become more alert depending on what they’re doing on their device. Across seven studies, people who engaged in more alerting or “exciting” content (for example, video games) lost an average of only about 3.5 minutes of sleep compared to those who engaged in something less exciting (for example, TV). This tells us the content of technology alone doesn’t affect sleep as much as we think
- we found sleep disruption at night (for example, being awoken by text messages) and sleep displacement (using technology past the time that we could be sleeping) can lead to sleep loss. So while technology use was linked to less sleep in these instances, this was unrelated to being exposed to bright, blue light from screens before bedtime.
Which factors encourage more technology use?
Research we reviewed suggests people tend to use more technology at bedtime for two main reasons:
- to “fill the time” when they’re not yet sleepy. This is common for teenagers, who have a biological shift in their sleep patterns that leads to later sleep times, independent of technology use.
- to calm down negative emotions and thoughts at bedtime, for apparent stress reduction and to provide comfort.
There are also a few things that might make people more vulnerable to using technology late into the night and losing sleep.
We found people who are risk-takers or who lose track of time easily may turn off devices later and sacrifice sleep. Fear of missing out and social pressures can also encourage young people in particular to stay up later on technology.
What helps us use technology sensibly?
Last of all, we looked at protective factors, ones that can help people use technology more sensibly before bed.
The two main things we found that helped were self-control, which helps resist the short-term rewards of clicking and scrolling, and having a parent or loved one to help set bedtimes.
We found having a parent or loved one to help set bedtimes encourages sensible use of technology. fast-stock/Shutterstock Why do we blame blue light?
The blue light theory involves melatonin, a hormone that regulates sleep. During the day, we are exposed to bright, natural light that contains a high amount of blue light. This bright, blue light activates certain cells at the back of our eyes, which send signals to our brain that it’s time to be alert. But as light decreases at night, our brain starts to produce melatonin, making us feel sleepy.
It’s logical to think that artificial light from devices could interfere with the production of melatonin and so affect our sleep. But studies show it would require light levels of about 1,000-2,000 lux (a measure of the intensity of light) to have a significant impact.
Device screens emit only about 80-100 lux. At the other end of the scale, natural sunlight on a sunny day provides about 100,000 lux.
What’s the take-home message?
We know that bright light does affect sleep and alertness. However our research indicates the light from devices such as smartphones and laptops is nowhere near bright or blue enough to disrupt sleep.
There are many factors that can affect sleep, and bright, blue screen light likely isn’t one of them.
The take-home message is to understand your own sleep needs and how technology affects you. Maybe reading an e-book or scrolling on socials is fine for you, or maybe you’re too often putting the phone down way too late. Listen to your body and when you feel sleepy, turn off your device.
Chelsea Reynolds, Casual Academic/Clinical Educator and Clinical Psychologist, College of Education, Psychology and Social Work, Flinders University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Imposter Syndrome (and why almost everyone has it)
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Imposter Syndrome (and why almost everyone has it)
Imposter syndrome is the pervasive idea that we’re not actually good enough, people think we are better than we are, and at any moment we’re going to get found out and disappoint everyone.
Beyond the workplace
Imposter syndrome is most associated with professionals. It can range from a medical professional who feels like they’ve been projecting an image of confidence too much, to a writer or musician who is sure that their next piece will never live up to the acclaim of previous pieces and everyone will suddenly realize they don’t know what they’re doing, to a middle-manager who feels like nobody above or below them realizes how little they know how to do.
But! Less talked-about (but no less prevalent) is imposter syndrome in other areas of life. New parents tend to feel this strongly, as can the “elders” of a family that everyone looks to for advice and strength and support. Perhaps worst is when the person most responsible for the finances of a household feels like everyone just trusts them to keep everything running smoothly, and maybe they shouldn’t because it could all come crashing down at any moment and everyone will see them for the hopeless shambles of a human being that they really are.
Feelings are not facts
And yet (while everyone makes mistakes sometimes) the reality is that we’re all doing our best. Given that imposter syndrome affects up to 82% of people, let’s remember to have some perspective. Everyone feels like they’re winging it sometimes. Everyone feels the pressure.
Well, perhaps not everyone. There’s that other 18%. Some people are sure they’re the best thing ever. Then again, there’s probably some in that 18% that actually feel worse than the 82%—they just couldn’t admit it, even in an anonymized study.
But one thing’s for sure: it’s very, very common. Especially in high-performing women, by the way, and people of color. In other words, people who typically “have to do twice as much to get recognized as half as good”.
That said, the flipside of this is that people who are not in any of those categories may feel “everything is in my favor, so I really have no excuse to not achieve the most”, and can sometimes take very extreme actions to try to avoid perceived failure, and it can be their family that pays the price.
Things to remember
If you find imposter syndrome nagging at you, remember these things:
- There are people far less competent than you, doing the same thing
- Nobody knows how to do everything themselves, especially at first
- If you don’t know how to do something, you can usually find out
- There is always someone to ask for help, or at least advice, or at least support
At the end of the day, we evolved to eat fruit and enjoy the sun. None of us are fully equipped for all the challenges of the modern world, but if we do our reasonable best, and look after each other (and that means that you too, dear reader, deserve looking after as well), we can all do ok.
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Smart Sex – by Dr. Emily Morse
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First, what this isn’t: this isn’t a mere book of sex positions and party tricks, nor is it a book of Cosmo-style “drive your man wild by using hot sauce as lube” advice.
What it offers instead, is a refreshingly mature take on sex, free from the “teehee” titillations and blushes that many books of the genre go for.
Dr. Emily Morse outlines five pillars of sex:
- Embodiment
- Health
- Collaboration
- Self-knowledge
- Self-acceptance
…and talks about each of them in detail, and how we can bring them together. And, of course, how we or our partner(s) could accidentally sabotage ourselves or each other, and the conversations we can (and should!) have, to work past that.
She also, critically, and this is a big source of value in the book, looks at “pleasure thieves”: stress, trauma, and shame. The advice for overcoming these is not “don’t worry; be happy” but rather is actual practical steps one can take.
The style throughout is direct and unpatronizing. Since the advice within pertains to everyone who has and/or wants an active sex life, very little is divided by gender etc.
There is some attention given to anatomy and physiology, complete with clear diagrams. Honestly, most people could benefit from these, because most people’s knowledge of the relevant anatomy stopped with a very basic high school text book diagram that missed a lot out.
Bottom line: this book spends more time on what’s between your ears than what’s between your legs, and yet is very comprehensive in all areas. Everyone has something to gain from this one.
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Cupping: How It Works (And How It Doesn’t)
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Good Health By The Cup?
In Tuesday’s newsletter, we asked you for your opinion of cupping (the medical practice), and got the above-depicted, below-described, set of responses:
- About 40% said “It may help by improving circulation and stimulating the immune system”
- About 26% said “I have never heard of the medical practice of cupping before this”
- About 19% said “It is pseudoscience and/or placebo at best, but probably not harmful
- About 9% said “It is a good, evidence-based practice that removes toxins and stimulates health”
- About 6% said “It is a dangerous practice that often causes harm to people who need medical help”
So what does the science say?
First, a quick note for those unfamiliar with cupping: it is the practice of placing a warmed cup on the skin (open side of the cup against the skin). As the warm air inside cools, it reduces the interior air pressure, which means the cup is now (quite literally) a suction cup. This pulls the skin up into the cup a little. The end result is visually, and physiologically, the same process as what happens if someone places the nozzle of a vacuum cleaner against their skin. For that matter, there are alternative versions that simply use a pump-based suction system, instead of heated cups—but the heated cups are most traditional and seem to be most popular. See also:
National Center for Complementary and Integrative Health | Cupping
It is a dangerous practice that often causes harm to people who need medical help: True or False?
False, for any practical purposes.
- Directly, it can (and usually does) cause minor superficial harm, much like many medical treatments, wherein the benefits are considered to outweigh the harm, justifying the treatment. In the case of cupping, the minor harm is usually a little bruising, but there are other risks; see the link we gave just above.
- Indirectly, it could cause harm by emboldening a person to neglect a more impactful treatment for their ailment.
But, there’s nothing for cupping akin to the “the most common cause of death is when someone gets a vertebral artery fatally severed” of chiropractic, for example.
It is a good, evidence-based practice that removes toxins and stimulates health: True or False?
True and False in different parts. This one’s on us; we included four claims in one short line. But let’s look at them individually:
- Is it good? Well, those who like it, like it. It legitimately has some mild health benefits, and its potential for harm is quite small. We’d call this a modest good, but good nonetheless.
- Is it evidence-based? Somewhat, albeit weakly; there are some papers supporting its modest health claims, although the research is mostly only published in journals of alternative medicine, and any we found were in journals that have been described by scientists as pseudoscientific.
- Does it remove toxins? Not directly, at least. There is also a version that involves making a small hole in the skin before applying the cup, the better to draw out the toxins (called “wet cupping”). This might seem a little medieval, but this is because it is from early medieval times (wet cupping’s first recorded use being in the early 7th century). However, the body’s response to being poked, pierced, sucked, etc is to produce antibodies, and they will do their best to remove toxins. So, indirectly, there’s an argument.
- Does it stimulate health? Yes! We’ll come to that shortly. But first…
It is pseudoscience and/or placebo at best, but probably not harmful: True or False?
True in that its traditionally-proposed mechanism of action is a pseudoscience and placebo almost certainly plays a strong part, and also in that it’s generally not harmful.
On it being a pseudoscience: we’ve talked about this before, but it bears repeating; just because something’s proposed mechanism of action is pseudoscience, doesn’t necessarily mean it doesn’t work by some other mechanism of action. If you tell a small child that “eating the rainbow” will improve their health, and they believe this is some sort of magical rainbow power imbuing them with health, then the mechanism of action that they believe in is a pseudoscience, but eating a variety of colorful fruit and vegetables will still be healthy.
In the case of cupping, its proposed mechanism of action has to do withbalancing qi, yin and yang, etc (for which scientific evidence does not exist), in combination with acupuncture lore (for which some limited weak scientific evidence exists). On balancing qi, yin and yang etc, this is a lot like Europe’s historically popular humorism, which was based on the idea of balancing the four humors (blood, yellow bile, black bile, phlegm). Needless to say, humorism was not only a pseudoscience, but also eventually actively disproved with the advent of germ theory and modern medicine. Cupping therapy is not more scientifically based than humorism.
On the placebo side of things, there probably is a little more to it than that; much like with acupuncture, a lot of it may be a combination of placebo and using counter-irritation, a nerve-tricking method to use pain to reduce pain (much like pressing with one’s nail next to an insect bite).
Here’s one of the few studies we found that’s in what looks, at a glance, to be a reputable journal:
Cupping therapy and chronic back pain: systematic review and meta-analysis
It may help by improving circulation and stimulating the immune system: True or False?
True! It will improve local circulation by forcing blood into the area, and stimulate the immune system by giving it a perceived threat to fight.
Again, this can be achieved by many other means; acupuncture (or just “dry needling”, which is similar but without the traditional lore), a cold shower, and/or exercise (and for that matter, sex—which combines exercise, physiological arousal, and usually also foreign bodies to respond to) are all options that can improve circulation and stimulate the immune system.
You can read more about using some of these sorts of tricks for improving health in very well-evidenced, robustly scientific ways here:
The Stress Prescription (Against Aging!)
Take care!
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Six Ways To Eat For Healthier Skin
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Sadia Badiei, the nutritionist-chef of “Pick Up Limes” fame, has advice:
More than skin-deep:
We’ll not keep them a mystery; here are the six points of focus:
1. Collagen and skin elasticity
Collagen is the structural protein that provides firmness and elasticity to the skin, but its production decreases with age, resulting in about a 1% annual loss starting at age 20. To support collagen, a diet rich in protein is essential, including foods like beans, lentils, tofu, tempeh, nuts, and seeds. They can’t do their work alone though; vitamins C and E play a critical role in collagen production and repair, protecting against damage from sun exposure, pollution, and free radicals. Vitamin E can be found in almonds, sunflower seeds, leafy greens, peanuts, and avocados, while vitamin C is abundant in citrus fruits, bell peppers, and broccoli.
2. Skin healing and zinc
Zinc is critical for wound healing and reducing inflammation, making it particularly helpful in managing skin conditions such as acne, eczema, psoriasis, and rosacea. Great dietary sources of zinc include nutritional yeast, pumpkin, sesame, and hemp seeds, as well as legumes and whole grains. However, zinc absorption can be hindered by phytate levels in some foods. Soaking, sprouting, or fermenting foods where possible can correct for that and improve zinc absorption.
3. Dry skin and hydration
Dry skin can result from many things, including dry air, hot water, abrasive soaps, and certain medications. While moisturizers provide external hydration, dietary omega-3 fats are essential for improving the skin’s barrier function, helping it retain moisture. Plant-based sources of omega-3s include walnuts, hemp seeds, chia seeds, flax seeds, and algae-based supplements. Staying adequately hydrated also supports overall health of course (everything runs on water in one way or another, after all), which indirectly benefits skin hydration, although drinking additional water only helps if dehydration is present.
4. Sebum regulation
Sebum, an oily substance that lubricates the skin, can cause issues like acne and blackheads when overproduced. Hormonal fluctuations and diet both influence sebum levels (in either direction). High glycemic index foods, such as sweetened beverages, refined grains, and sugary snacks, can lead to spikes in insulin, which in turn stimulates excess sebum production. In contrast, low glycemic index foods like vegetables, whole grains, tofu, nuts, and seeds regulate blood sugar and help manage sebum production, promoting clearer skin without an excess or a shortage of sebum.
5. Gut health and skin
The gut-skin connection means that imbalances in gut bacteria can contribute to skin issues like acne, eczema, and psoriasis. Supporting gut health involves increasing the diversity of beneficial bacteria through probiotic-rich foods. Fermented options like plant-based yogurts, kimchi, miso, sauerkraut, and kombucha not only improve gut microbiome health but also positively impact skin health by reducing inflammation and improving overall skin conditions.
6. Inflammation and skin health
Chronic inflammation is associated with so many health issues, and when it comes to skin, that includes acne, rosacea, and even wrinkles. Anti-inflammatory foods, especially those rich in antioxidants, can mitigate these effects and improve skin elasticity, smoothness, and color. Diets centered around fruits, vegetables, and other plant-based foods provide the necessary nutrients to combat inflammation, showcasing the significant role of nutrition in promoting radiant, healthy skin.
For more on each of these, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Undo The Sun’s Damage To Your Skin
Take care!
Don’t Forget…
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