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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Surgery won’t fix my chronic back pain, so what will?
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This week’s ABC Four Corners episode Pain Factory highlighted that our health system is failing Australians with chronic pain. Patients are receiving costly, ineffective and risky care instead of effective, low-risk treatments for chronic pain.
The challenge is considering how we might reimagine health-care delivery so the effective and safe treatments for chronic pain are available to millions of Australians who suffer from chronic pain.
One in five Australians aged 45 and over have chronic pain (pain lasting three or more months). This costs an estimated A$139 billion a year, including $12 billion in direct health-care costs.
The most common complaint among people with chronic pain is low back pain. So what treatments do – and don’t – work?
Opioids and invasive procedures
Treatments offered to people with chronic pain include strong pain medicines such as opioids and invasive procedures such as spinal cord stimulators or spinal fusion surgery. Unfortunately, these treatments have little if any benefit and are associated with a risk of significant harm.
Spinal fusion surgery and spinal cord stimulators are also extremely costly procedures, costing tens of thousands of dollars each to the health system as well as incurring costs to the individual.
Addressing the contributors to pain
Recommendations from the latest Australian and World Health Organization clinical guidelines for low back pain focus on alternatives to drug and surgical treatments such as:
- education
- advice
- structured exercise programs
- physical, psychological or multidisciplinary interventions that address the physical or psychological contributors to ongoing pain.
Pain education is central. Monkey Business Images/Shutterstock Two recent Australian trials support these recommendations and have found that interventions that address each person’s physical and psychological contributors to pain produce large and sustained improvements in pain and function in people with chronic low back pain.
The interventions have minimal side effects and are cost-effective.
In the RESOLVE trial, the intervention consists of pain education and graded sensory and movement “retraining” aimed to help people understand that it’s safe to move.
In the RESTORE trial, the intervention (cognitive functional therapy) involves assisting the person to understand the range of physical and psychological contributing factors related to their condition. It guides patients to relearn how to move and to build confidence in their back, without over-protecting it.
Why isn’t everyone with chronic pain getting this care?
While these trials provide new hope for people with chronic low back pain, and effective alternatives to spinal surgery and opioids, a barrier for implementation is the out-of-pocket costs. The interventions take up to 12 sessions, lasting up to 26 weeks. One physiotherapy session can cost $90–$150.
In contrast, Medicare provides rebates for just five allied health visits (such as physiotherapists or exercise physiologists) for eligible patients per year, to be used for all chronic conditions.
Private health insurers also limit access to reimbursement for these services by typically only covering a proportion of the cost and providing a cap on annual benefits. So even those with private health insurance would usually have substantial out-of-pocket costs.
Access to trained clinicians is another barrier. This problem is particularly evident in regional and rural Australia, where access to allied health services, pain specialists and multidisciplinary pain clinics is limited.
Higher costs and lack of access are associated with the increased use of available and subsidised treatments, such as pain medicines, even if they are ineffective and harmful. The rate of opioid use, for example, is higher in regional Australia and in areas of socioeconomic disadvantage than metropolitan centres and affluent areas.
So what can we do about it?
We need to reform Australia’s health system, private and public, to improve access to effective treatments for chronic pain, while removing access to ineffective, costly and high-risk treatments.
Better training of the clinical workforce, and using technology such as telehealth and artificial intelligence to train clinicians or deliver treatment may also improve access to effective treatments. A recent Australian trial, for example, found telehealth delivered via video conferencing was as effective as in-person physiotherapy consultations for improving pain and function in people with chronic knee pain.
Advocacy and improving the public’s understanding of effective treatments for chronic pain may also be helpful. Our hope is that coordinated efforts will promote the uptake of effective treatments and improve the care of patients with chronic pain.
Christine Lin, Professor, University of Sydney; Christopher Maher, Professor, Sydney School of Public Health, University of Sydney; Fiona Blyth, Professor, University of Sydney; James Mcauley, Professor of Psychology, UNSW Sydney, and Mark Hancock, Professor of Physiotherapy, Macquarie University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Radishes vs Carrots – Which is Healthier?
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Our Verdict
When comparing radishes to carrots, we picked the carrots.
Why?
In terms of macros, carrots have more fiber and carbs; the two root vegetables both have comparable (low) glycemic indices, so we’re saying that the one with more fiber wins, and that’s carrots.
In the category of vitamins, radishes have more of vitamins B9 and C, while carrots have more of vitamins A, B1, B2, B3, B5, B6, E, K, and choline. An easy win for carrots.
When it comes to minerals, radishes have more selenium, while carrots have more calcium, magnesium, manganese, phosphorus, and potassium. Another clear win for carrots.
In terms of polyphenols, radishes do have some, but carrots have more, and thus win this category too.
All in all, enjoy either or both, but carrots deliver the most nutrients by far!
Want to learn more?
You might like to read:
What Do The Different Kinds Of Fiber Do? 30 Foods That Rank Highest
Enjoy!
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Trout vs Carp – Which is Healthier?
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Our Verdict
When comparing trout to carp, we picked the trout.
Why?
Both have their strong points!
In terms of macros, trout has slightly more protein and fat, and/but also has less cholesterol than carp. So, we pick the trout in the macros category.
In the category of vitamins, trout has much more of vitamins A, B1, B2, B3, B5, B6, B7, B12, C, D, E, K, and choline, while carp has slightly more vitamin B9. In other words, an easy win for trout here.
When it comes to minerals, however, trout has more potassium and selenium, while carp has more calcium, copper, iron, magnesium, manganese, phosphorus, and zinc. A fair win for carp this time.
You may be wondering about heavy metals: this will vary depending on location, as well as the age of the fish (younger fish have had less time to accumulate heavy metals than old ones, so if you’re visiting the fishmonger, choose the smaller ones) and the lives they have led (e.g. wild vs farmed), however, as a general rule of thumb, trout will generally have lower heavy metals levels than carp, all other things (e.g. location, age, etc) being equal.
In short, enjoy either or both in moderation, but trout wins on 3/4 categories today.
Want to learn more?
You might like to read:
Farmed Fish vs Wild Caught: Antibiotics, Mercury, & More
Take care!
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Delicious Quinoa Avocado Bread
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They’re gluten-free, full of protein and healthy fats, generous with the fiber, easy to make, and tasty too! What’s not to love? Keep this recipe (and its ingredients) handy for next time you want healthy burger buns or similar:
You will need
- 2½ cups quinoa flour
- 2 cups almond flour (if allergic, just substitute more quinoa flour)
- 1 avocado, peeled, pitted, and mashed
- zest and juice of 1 lime
- 2 tbsp ground flaxseed
- 1 tsp baking powder
- ½ tsp MSG or 1 tsp low-sodium salt
- Optional: seeds, oats, or similar for topping the buns
Method
(we suggest you read everything at least once before doing anything)
1) Preheat the oven to 350℉/175℃.
2) Mix the flaxseed with ⅓ cup warm water and set aside.
3) Mix, in a large bowl, the quinoa flour and almond flour with the baking powder and the MSG or salt.
4) Mix, in a separate smaller bowl, the avocado and lime.
5) Add the wet ingredients to the dry, slowly, adding an extra ½ cup water as you do, and knead into a dough.
6) Divide the dough into 4 equal portions, each shaped into a ball and then slightly flattened, to create a burger bun shape. If you’re going to add any seeds or similar as a topping, add those now.
7) Bake them in the oven (on a baking sheet lined with baking paper) for 20–25 minutes. You can check whether they’re done the same way you would a cake, by piercing them to the center with a toothpick and seeing whether it comes out clean.
8) Serve when sufficiently cooled.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Gluten: What’s The Truth?
- Why You Should Diversify Your Nuts!
- Monosodium Glutamate: Sinless Flavor-Enhancer Or Terrible Health Risk?
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I lost weight and my period stopped. How are weight and menstruation linked?
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You may have noticed that changes in weight are sometimes accompanied by changes in your period.
But what does one really have to do with the other?
Maintaining a healthy weight is key to regular menstruation. Here’s why – and when to talk to your doctor.
The role of hormones
The menstrual cycle – including when you bleed and ovulate – is regulated by a balance of hormones, particularly oestrogen.
The ovaries are connected to the brain through a hormonal signalling system. This acts as a kind of “chain of command” of hormones controlling the menstrual cycle.
The brain produces a key hormone, called the gonadotropin-releasing hormone, in the hypothalamus. It stimulates the release of other hormones which tell the ovaries to produce oestrogen and release a mature egg (ovulation).
But the release of the gonadotropin-releasing hormone depends on oestrogen levels and how much energy is available to the body. Both of these are closely related to body weight.
Oestrogen is primarily produced in the ovaries, but fat cells also produce oestrogen. This is why weight – and more specifically body fat – can affect menstruation.
Fat cells produce oestrogen, a hormone with a key role in the menstrual cycle. Halfpoint/Shutterstock Can being underweight affect my period?
The body prioritises conserving energy. When reserves are low it stops anything non-essential, such as reproduction.
This can happen when you are underweight, or suddenly lose weight. It can also happen to people who undertake intense exercise or have inadequate nutrition.
The stress sends the hypothalamus into survival mode. As a result, the body lowers its production of the hormones important to ovulation, including oestrogen, and stops menstruation.
Being chronically underweight means not having enough energy available to support reproduction, which can lead to menstrual irregularities including amenorrhea (no periods at all).
This results in very low oestrogen levels and can cause potentially serious health risks, including infertility and bone loss.
Missing periods is not always a cause for concern. But a chronic lack of energy availability can be, if not addressed. The two are linked, meaning understanding your period and being aware of any prolonged changes is important.
How about being overweight?
Higher body fat can elevate oestrogen levels.
When you’re overweight your body stores extra energy in fat cells, which produce oestrogen and other hormones and can cause inflammation in the body. So, if you have a lot of fat cells, your body produces an excess of these hormones. This can affect normal functioning of the uterus lining (endometrium).
Excess oestrogen and inflammation can interfere in the feedback system to the brain and stop ovulation. As a result, you may have irregular or missed periods.
It can also lead to pain (dysmenorrhea) and heavier bleeding (menorrhagia).
Being overweight can sometimes worsen premenstrual syndrome as well. One study found for every 1 kg increase in height (m²) in body mass index (BMI), the risk of premenstrual syndrome went up by 3%. Women with a BMI over 27.5 kg/m² had a much higher risk than those with a BMI under 20 kg/m².
What else might be going on?
Sometimes weight changes are linked to hormonal balances that indicate an underlying condition.
For example, people with polycystic ovary syndrome may gain weight or find it hard to lose weight because they have a hormonal imbalance, including higher levels of testosterone.
The syndrome is also associated with irregular periods and heavy bleeding. So, if you notice these symptoms, it’s a good idea to talk to your doctor.
Similarly, weight changes and irregular periods in midlife might signal the start of perimenopause, the period before menopause (when your periods stop altogether).
Changes in weight and your period could be a sign of menopause approaching. Sabrina Bracher/Shutterstock When should I worry?
Small changes in when your period comes or how long it lasts are usually harmless.
Similarly, slight fluctuations in weight won’t usually have a significant impact on your period – or the changes may be so subtle you don’t notice them.
But regular menstruation is an important marker of female health. Sometimes changes in flow, regularity or the pain you experience can indicate there’s something else going on.
If you notice changes and they don’t feel right to you, speak to a health care provider.
Mia Schaumberg, Associate Professor in Physiology, School of Health, University of the Sunshine Coast and Laura Pernoud, PhD Candidate in Women’s Health, School of Health, University of the Sunshine Coast
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Blood-Brain Barrier Breach Blamed For Brain-Fog
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Move Over, Leaky Gut. Now It’s A Leaky Brain.
…which is not a headline that promises good news, and indeed, the only good news about this currently is “now we know another thing that’s happening, and thus can work towards a treatment for it”.
Back in February (most popular media outlets did not rush to publish this, as it rather goes against the narrative of “remember when COVID was a thing?” as though the numbers haven’t risen since the state of emergency was declared over), a team of Irish researchers made a discovery:
❝For the first time, we have been able to show that leaky blood vessels in the human brain, in tandem with a hyperactive immune system may be the key drivers of brain fog associated with long covid❞
~ Dr. Matthew Campbell (one of the researchers)
Let’s break that down a little, borrowing some context from the paper itself:
- the leaky blood vessels are breaching the blood-brain-barrier
- that’s a big deal, because that barrier is our only filter between our brain and Things That Definitely Should Not Go In The Brain™
- a hyperactive immune system can also be described as chronic inflammation
- in this case, that includes chronic neuroinflammation which, yes, is also a major driver of dementia
You may be wondering what COVID has to do with this, and well:
- these blood-brain-barrier breaches were very significantly associated (in lay terms: correlated, but correlated is only really used as an absolute in write-ups) with either acute COVID infection, or Long Covid.
- checking this in vitro, exposure of brain endothelial cells to serum from patients with Long Covid induced the same expression of inflammatory markers.
How important is this?
As another researcher (not to mention: professor of neurology and head of the school of medicine at Trinity) put it:
❝The findings will now likely change the landscape of how we understand and treat post-viral neurological conditions.
It also confirms that the neurological symptoms of long covid are measurable with real and demonstrable metabolic and vascular changes in the brain.❞
~ Dr. Colin Doherty (see mini-bio above)
You can read a pop-science article about this here:
Irish researchers discover underlying cause of “brain fog” linked with long covid
…and you can read the paper in full here:
Want to stay safe?
Beyond the obvious “get protected when offered boosters/updates” (see also: The Truth About Vaccines), other good practices include the same things most people were doing when the pandemic was big news, especially avoiding enclosed densely-populated places, washing hands frequently, and looking after your immune system. For that latter, see also:
Beyond Supplements: The Real Immune-Boosters!
Take care!
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- the leaky blood vessels are breaching the blood-brain-barrier
