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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Tribulus Terrestris For Testosterone?
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(Clinical) Trials and Tribul-ations
In the category of supplements that have enjoyed use as aphrodisiacs, Tribulus terrestris (also called caltrop, goat’s head, gokshura, or puncture vine) has a long history, having seen wide use in both Traditional Chinese Medicine and in Ayurveda.
It’s been used for other purposes too, and has been considered a “general wellness” plant.
So, what does the science say?
Good news: very conclusive evidence!
Bad news: the conclusion is not favorable…
Scientists are known for their careful use of clinical language, and it’s very rare for a study/review to claim something as proven (scientists leave journalists to do that part), and in this case, when it comes to Tribulus’s usefulness as a testosterone-enhancing libido-boosting supplement…
❝analysis of empirical evidence from a comprehensive review of available literature proved this hypothesis wrong❞
Strong words! You can read it in full here; they do make some concessions along the way (e.g. mentioning unclear or contradictory findings, suggesting that it may have some effect, but by an as-yet unknown mechanism if it does—although some potential effect on nitric oxide levels has been hypothesized, which is reasonable if so, as NO does feature in arousal-signalling), but the general conclusion is “no, this doesn’t have androgen-enhancing properties”:
Pro-sexual and androgen enhancing effects of Tribulus terrestris L.: Fact or Fiction
That’s a review though, what about taking a look at a representative RCT? Here we go:
❝Tribulus terrestris was not more effective than placebo on improving symptoms of erectile dysfunction or serum total testosterone❞
As a performance-enhancer in sport
We’ll be brief here: it doesn’t seem to work and it may not be safe:
Insights into Supplements with Tribulus Terrestris used by Athletes
From sport, into general wellness?
Finally, a study that finds it may be useful for something!
❝Overall, participants supplemented with TT displayed significant improvements in lipid profile. Inflammatory and hematological biomarkers showed moderate beneficial effects with no significant changes on renal biomarkers. No positive effects were observed on the immune system response. Additionally, no TT-induced toxicity was reported.
In conclusion, there was no clear evidence of the beneficial effects of TT supplementation on muscle damage markers and hormonal behavior.❞
About those lipids…
Animal studies have shown that it may not only improve lipid profiles, but also may partially repair the endothelial dysfunction resulting from hyperlipidemia:
Want to try some?
In the unlikely event that today’s research review has inspired you with an urge to try Tribulus terrestris, here’s an example product on Amazon
If on the other hand you’d like to actually increase testosterone levels, then we suggest:
Topping Up Testosterone? ← a previous main feature did earlier this year
Take care!
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Nonverbal Epiphany – by Dr. Stephen Furlich
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The subtitle of this book, “Steps To Improve Your Nonverbal Communication” suggests that this is principally an instructional book—it’s not. Rather, it’s mostly informational, and it is left to the reader to interpret what to do with that information.
But, what a lot of information!
And well-sourced, too: this book has scientific paper citations at a rate of one or two per page, with many diagrams and infographics too. It is, in effect, a treasure trove of physiological, psychological, and sociological data when it comes to nonverbal communication and the various factors that influence it.
So, what can you hope to gain from this book? A lot of sorting out of science vs suppositions, mostly.
From digit ratios to crossed arms, from eye-contact to attire, do things really mean what we’ve been told they mean?
And if they don’t, will people perceive them that way anyway, or will textbook rules go out the window in a real conversation? How about in real nonverbal interactions?
(What’s a nonverbal interaction? It’s the behavior exhibited between strangers in the street, it’s the impression given and received by your profile picture, things like that).
Bottom line is that this book is data, data, and more data. If ever you wanted to sort the psychology from the pseudoscience, this is the book for you.
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The Inflammation Spectrum – by Dr. Will Cole
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We’ve previously reviewed Dr. Cole’s other book “Gut Feelings”, and now he’s back, this time to tackle inflammation.
The focus here is on understanding what things trigger inflammation in your body—personally yours, not someone else’s—by something close to the usual elimination process yes, but he offers a way of sliding into it gently instead of simply quitting all the things and gradually adding everything back in.
The next step he takes the reader through is eating not just to avoid triggering inflammation, but to actively combat it. From there, it should be possible for the reader to build an anti-inflammatory cookbook, that’s not only one’s own personal repertoire of cooking, but also specifically tailored to one’s own personal responses to different ingredients.
The style of this book is very pop-science, helpful, walking-the-reader-by-the-hand through the processes involved. Dr. Cole wants to make everything as easy as possible.
Bottom line: if your diet could use an anti-inflammatory revamp, this is a top-tier guidebook for doing just that.
Click here to check out The Inflammation Spectrum, find your food triggers and reset your system!
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Break the Cycle – by Dr. Mariel Buqué
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Intergenerational trauma comes in two main varieties: epigenetic, and behavioral.
This book covers both. There’s a lot more we can do about the behavioral side than the epigenetic, but that’s not to say that Dr. Buqué doesn’t have useful input in the latter kind too.
If you’ve read other books on epigenetic trauma, then there’s nothing new here—though the refresher is always welcome.
On the behavioral side, Dr. Buqué gives a strong focus on practical techniques, such as specific methods of journaling to isolate trauma-generated beliefs and resultant behaviors, with a view to creating one’s own trauma-informed care, cutting through the cycle, and stopping it there.
Which, of course, will not only be better for you, but also for anyone who will be affected by how you are (e.g. now/soon, hopefully better).
As a bonus, if you see the mistakes your parents made and are pretty sure you didn’t pass them on, this book can help you troubleshoot for things you missed, and also to improve your relationship with your own childhood.
Bottom line: if you lament how things were, and do wish/hope to do better in terms of mental health for yourself now and generations down the line, this book is a great starting point.
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Three Daily Servings of Beans?
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝Not crazy about the Dr.s food advice. Beans 3X a day?❞
For reference, this is in response to our recent article on the topic of 12 things to aim to get a certain amount of each day:
So, there are a couple of things to look at here:
Firstly, don’t worry, it’s a guideline and an aim. If you don’t hit it on a given day, there is always tomorrow. It’s just good to know what one is aiming for, because without knowing that, achieving it will be a lot less likely!
Secondly, the beans/legumes/pulses category says three servings, but the example serving sizes are quite small, e.g. ½ cup cooked beans, or ¼ cup hummus. And also as you notice, dips/pastes/sauces made from beans count too. So given the portion sizes, you could easily get two servings in by breakfast (and two servings of whole grains, too) if you enjoy frijoles refritos, for example. Many of the recipes we share on this site have “stealth” beans/legumes/pulses in this fashion
Take care!
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Flexible Dieting – by Alan Aragon
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This is the book from which we were working, for the most part, in our recent Expert Insights feature with Alan Aragon. We’ll re-iterate here: despite not being a Dr. Aragon, he’s a well-published research scientist with decades in the field of nutritional science, as well as being a personal trainer and fitness educator.
As you may gather from our other article, there’s a lot more to this book than “eat what you like”. Specifically, as the title suggests, there’s a lot of science—decades of it, and while we had room to cite a few studies in our article, he cites many many more; several citations per page of a 288-page book.
So, that sets the book apart from a lot of its genre; instead of just “here’s what some gym-bro thinks”, it’s “here’s what decades of data says”.
Another strength of this book is how clearly he explains such a lot of science—he explains terms as they come up, as well as having a generous glossary. He also explains things clearly and simply without undue dumbing down—just clarity of communication.
The style is to-the-point and instructional; it’s neither full of fitness-enthusiast hype nor dry academia, and keeps a light and friendly conversational tone throughout.
Bottom line: if you’d like to get your diet in order and you want to do it right while also knowing which things still need attention (and why) and which you can relax about (and why), then this book will get you there.
Click here to check out Flexible Dieting, and take an easy, relaxed control of yours!
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