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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Mythbusting The Mask Debate
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Mythbusting The Mask Debate
We asked you for your mask policy this respiratory virus season, and got the above-depicted, below-described, set of responses:
- A little under half of you said you will be masking when practical in indoor public places
- A little over a fifth of you said you will mask only if you have respiratory virus symptoms
- A little under a fifth of you said that you will not mask, because you don’t think it helps
- A much smaller minority of you (7%) said you will go with whatever people around you are doing
- An equally small minority of you said that you will not mask, because you’re not concerned about infections
So, what does the science say?
Wearing a mask reduces the transmission of respiratory viruses: True or False?
True…with limitations. The limitations include:
- The type of mask
- A homemade polyester single-sheet is not the same as an N95 respirator, for instance
- How well it is fitted
- It needs to be a physical barrier, so a loose-fitting “going through the motions” fit won’t help
- The condition of the mask
- And if applicable, the replaceable filter in the mask
- What exactly it has to stop
- What kind of virus, what kind of viral load, what kind of environment, is someone coughing/sneezing, etc
More details on these things can be found in the link at the end of today’s main feature, as it’s more than we could fit here!
Note: We’re talking about respiratory viruses in general in this main feature, but most extant up-to-date research is on COVID, so that’s going to appear quite a lot. Remember though, even COVID is not one beast, but many different variants, each with their own properties.
Nevertheless, the scientific consensus is “it does help, but is not a magical amulet”:
- 2021: Effectiveness of Face Masks in Reducing the Spread of COVID-19: A Model-Based Analysis
- 2022: Why Masks are Important during COVID‐19 Pandemic
- 2023: The mitigating effect of masks on the spread of COVID-19
Wearing a mask is actually unhygienic: True or False?
False, assuming your mask is clean when you put it on.
This (the fear of breathing more of one’s own germs in a cyclic fashion) was a point raised by some of those who expressed mask-unfavorable views in response to our poll.
There have been studies testing this, and they mostly say the same thing, “if it’s clean when you put it on, great, if not, then well yes, that can be a problem”:
❝A longer mask usage significantly increased the fungal colony numbers but not the bacterial colony numbers.
Although most identified microbes were non-pathogenic in humans; Staphylococcus epidermidis, Staphylococcus aureus, and Cladosporium, we found several pathogenic microbes; Bacillus cereus, Staphylococcus saprophyticus, Aspergillus, and Microsporum.
We also found no associations of mask-attached microbes with the transportation methods or gargling.
We propose that immunocompromised people should avoid repeated use of masks to prevent microbial infection.❞
Source: Bacterial and fungal isolation from face masks under the COVID-19 pandemic
Wearing a mask can mean we don’t get enough oxygen: True or False?
False, for any masks made-for-purpose (i.e., are by default “breathable”), under normal conditions:
- COVID‐19 pandemic: do surgical masks impact respiratory nasal functions?
- Performance Comparison of Single and Double Masks: Filtration Efficiencies, Breathing Resistance and CO2 Content
However, wearing a mask while engaging in strenuous best-effort cardiovascular exercise, will reduce VO₂max. To be clear, you will still have more than enough oxygen to function; it’s not considered a health hazard. However, it will reduce peak athletic performance:
…so if you are worrying about whether the mask will impede you breathing, ask yourself: am I engaging in an activity that requires my peak athletic performance?
Also: don’t let it get soaked with water, because…
Writer’s anecdote as an additional caveat: in the earliest days of the COVID pandemic, I had a simple cloth mask on, the one-piece polyester kind that we later learned quite useless. The fit wasn’t perfect either, but one day I was caught in heavy rain (I had left it on while going from one store to another while shopping), and suddenly, it fitted perfectly, as being soaked through caused it to cling beautifully to my face.
However, I was now effectively being waterboarded. I will say, it was not pleasant, but also I did not die. I did buy a new mask in the next store, though.
tl;dr = an exception to “no it won’t impede your breathing” is that a mask may indeed impede your breathing if it is made of cloth and literally soaked with water; that is how waterboarding works!
Want up-to-date information?
Most of the studies we cited today were from 2022 or 2023, but you can get up-to-date information and guidance from the World Health Organization, who really do not have any agenda besides actual world health, here:
Coronavirus disease (COVID-19): Masks | Frequently Asked Questions
At the time of writing this newsletter, the above information was last updated yesterday.
Take care!
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Stop Checking Your Likes – by Susie Moore
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You might think this one’s advice is summed up sufficiently by the title, that there’s no need for a book! But…
There’s a lot more to this than “stop comparing the worst out-takes of your life to someone else’s highlight reel”, and there’s a lot more to this than “just unplug”.
Instead, Susie Moore discusses the serious underlying real emotional considerations of the need for approval (and even just acceptance) by our community, as well the fear of missing out.
It’s not just about how social media is designed to hijack various parts of our brain, or how The Alogorithm™ is out to personally drag your soul through Hell for a few more clicks; it’s also about the human element that would exist even without that. Who remembers MySpace? No algorithm in those days, but oh the drama potential for those “top 8 friends” places. And if you think that kind of problem is just for young people 20 years ago, you have mercifully missed the drama that older generations can get into on Facebook.
Along with the litany of evil, though, Moore also gives practical advice on how to overcome those things, how to “see the world through comedy-colored glasses”, how to ask “what’s missing, really?”, and how to make your social media experience work for you, rather than it merely using you as fuel. ← link is to our own related article!
Bottom line: if social media sucks a lot of your time, there may be more to it than just “social media sucks in general”, and there are ways to meet your emotional needs without playing by corporations’ rules to do so.
Click here to check out Stop Checking Your Likes, and breathe easy!
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Pistachios vs Cashews – Which is Healthier?
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Our Verdict
When comparing pistachios to cashews, we picked the pistachios.
Why?
In terms of macros, both are great sources of protein and healthy fats, and considered head-to-head:
- pistachios have slightly more protein, but it’s close
- pistachios have slightly more (health) fat, but it’s close
- cashews have slightly more carbs, but it’s close
- pistachios have a lot more fiber (more than 3x more!)
All in all, both have a good macro balance, but pistachios win easily on account of the fiber, as well as the slight edge for protein and fats.
When it comes to vitamins, pistachios have more of vitamins A, B1, B2, B3, B6, B9, C, & E.
Cashews do have more vitamin B5, also called pantothenic acid, pantothenic literally meaning “from everywhere”. Guess what’s not a common deficiency to have!
So pistachios win easily on vitamins, too.
In the category of minerals, things are more balanced, though cashews have a slight edge. Pistachios have more notably more calcium and potassium, while cashews have notably more selenium, zinc, and magnesium.
Both of these nuts have anti-inflammatory, anti-diabetic, and anti-cancer benefits, often from different phytochemicals, but with similar levels of usefulness.
Taking everything into account, however, one nut comes out in the clear lead, mostly due to its much higher fiber content and better vitamin profile, and that’s the pistachios.
Want to learn more?
Check out:
Why You Should Diversify Your Nuts
Enjoy!
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Rainbow Roasted Potato Salad
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This salad has potatoes in it, but it’s not a potato salad as most people know it. The potatoes are roasted, but in a non-oily-dressing, that nevertheless leaves them with an amazing texture—healthy and delicious; the best of both worlds. And the rest? We’ve got colorful vegetables, we’ve got protein, we’ve got seasonings full of healthy spices, and more.
You will need
- 1½ lbs new potatoes (or any waxy potatoes; sweet potato is also a great option; don’t peel them, whichever you choose) cut into 1″ chunks
- 1 can / 1 cup cooked cannellini beans (or your preferred salad beans)
- 1 carrot, grated
- 2 celery stalks, finely chopped
- 3 spring onions, finely chopped
- ½ small red onion, finely sliced
- 2 tbsp white wine vinegar
- 1 tbsp balsamic vinegar
- 1 tbsp lemon juice
- 1 tbsp nutritional yeast
- 1 tsp garlic powder
- 1 tsp black pepper
- ½ tsp red chili powder
- We didn’t forget salt; it’s just that with the natural sodium content of the potatoes plus the savory flavor-enhancing properties of the nutritional yeast, it’s really not needed here. Add if you feel strongly about it, opting for low-sodium salt, or MSG (which has even less sodium).
- To serve: 1 cup basil pesto (we’ll do a recipe one of these days; meanwhile, store-bought is fine, or you can use the chermoula we made the other day, ignoring the rest of that day’s recipe and just making the chermoula component)
Method
(we suggest you read everything at least once before doing anything)
1) Preheat the oven as hot as it goes!
2) Combine the potatoes, white wine vinegar, nutritional yeast, garlic powder, black pepper, and red chili powder, mixing thoroughly (but gently!) to coat.
3) Spread the potatoes on a baking tray, and roast in the middle of the oven (for best evenness of cooking); because of the small size of the potato chunks, this should only take about 25 minutes (±5mins depending on your oven); it’s good to turn them halfway through, or at least jiggle them if you don’t want to do all that turning.
4) Allow to cool while still on the baking tray (this allows the steam to escape immediately, rather than the steam steaming the other potatoes, as it would if you put them in a bowl).
5) Now put them in a serving bowl, and mix in the beans, vegetables, balsamic vinegar, and lemon juice, mixing thoroughly but gently
6) Add generous lashings of the pesto to serve; it should be gently mixed a little too, so that it’s not all on top.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- White Potato vs Sweet Potato – Which is Healthier?
- Eat More (Of This) For Lower Blood Pressure
- Our Top 5 Spices: How Much Is Enough For Benefits?
Take care!
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The Easiest Way To Take Up Journaling
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Dear Diary…
It’s well-established that journaling is generally good for mental health. It’s not a magical panacea, as evidenced by The Diaries of Franz Kafka for example (that man was not in good mental health). But for most of us, putting our thoughts and feelings down on paper (or the digital equivalent) is a good step for tidying our mind.
And as it can be said: mental health is also just health.
But…
What to write about?
It’s about self-expression (even if only you will read it), and…
❝Writing about traumatic, stressful or emotional events has been found to result in improvements in both physical and psychological health, in non-clinical and clinical populations.
In the expressive writing paradigm, participants are asked to write about such events for 15–20 minutes on 3–5 occasions.
Those who do so generally have significantly better physical and psychological outcomes compared with those who write about neutral topics.❞
Source: Emotional and physical health benefits of expressive writing
In other words, write about whatever moves you.
Working from prompts
If you read the advice above and thought “but I don’t know what moves me”, then fear not. It’s perfectly respectable to work from prompts, such as:
- What last made you cry?
- What last made you laugh?
- What was a recent meaningful moment with family?
- What is a serious mistake that you made and learned from?
- If you could be remembered for just one thing, what would you want it to be?
In fact, sometimes working from prompts has extra benefits, precisely because it challenges us to examine things we might not otherwise think about.
If a prompt asks “What tends to bring you most joy recently?” and the question stumps you, then a) you now are prompted to look at what you can change to find more joy b) you probably wouldn’t have thought of this question—most depressed people don’t, and if you cannot remember recent joy, then well, we’re not here to diagnose, but let’s just say that’s a symptom.
A quick aside: if you or a loved oneare prone to depressive episodes, here’s a good resource, by the way:
The Mental Health First-Aid That You’ll Hopefully Never Need
And in the event of the mental health worst case scenario:
The six prompts we gave earlier are just ideas that came to this writer’s mind, but they’re (ok, some bias here) very good ones. If you’d like more though, here’s a good resource:
550+ Journal Prompts: The Ultimate List
The Good, The Bad, and The Ugly
While it’s not good to get stuck in ruminative negative thought spirals, it is good to have a safe outlet to express one’s negative thoughts/feelings:
Remember, your journal is (or ideally, should be) a place without censure. If you fear social consequences should your journal be read, then using an app with a good security policy and encryption options can be a good idea for journaling
Finch App is a good free option if it’s not too cutesy for your taste, because in terms of security:
- It can’t leak your data because your data never leaves your phone (unless you manually back up your data and then you choose to put it somewhere unsafe)
- It has an option to require passcode/biometrics etc to open the app
As a bonus, it also has very many optional journaling prompts, and also (optional) behavioral activation prompts, amongst more other offerings that we don’t have room to list here.
Take care!
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Calculate (And Enjoy) The Perfect Night’s Sleep
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This is Dr. Michael Breus, a clinical psychologist and sleep specialist, and he wants you to get a good night’s sleep, every night.
First, let’s assume you know a lot of good advice about how to do that already in terms of environment and preparation, etc. If you want a recap before proceeding, then we recommend:
Get Better Sleep: Beyond The Basics
Now, what does he want to add?
Wake up refreshed
Of course, how obtainable this is will depend on the previous night’s sleep, but there is something important we can do here regardless, and it’s: beat sleep inertia.
Sleep inertia is what happens when we wake up groggy (for reasons other than being ill, drugged, etc) rather than refreshed. It’s not actually related to how much sleep we have, though!
Rather, it pertains to whether we woke up during a sleep cycle, or between cycles:
- If we wake up between sleep cycles, we’ll avoid sleep inertia.
- If we wake up during a sleep cycle, we’ll be groggy.
Deep sleep generally occurs in 90-minute blocks, albeit secretly that is generally 3× 20 minute blocks in a trenchcoat, with transition periods between, during which the brainwaves change frequency.
REM sleep generally occurs in 20 minute blocks, and will usually arrive in series towards the end of our natural sleep period, to fit neatly into the last 90-minute cycle.
Sometimes these will appear a little out of order, because we are complicated organic beings, but those are the general trends.
In any case, the take-away here is: interrupt them at your peril. You need to wake up between cycles. There are two ways you can do this:
- Carefully calculate everything, and set a very precise alarm clock (this will work so long as you are correct in guessing how long it will take you to fall asleep)
- Use a “sunrise” lamp alarm clock, that in the hour approaching your set alarm time, will gradually increase the light. Because the body will not naturally wake up during a cycle unless a threat is perceived (loud noise, physical rousing, etc), the sunrise lamp method means that you will wake up between sleep cycles at some point during that hour (towards the beginning or end, depending on what your sleep balance/debt is like).
Do not sleep in (even if you have a sleep debt); it will throw everything out.
Caffeine will not help much in the morning
Assuming you got a reasonable night’s sleep, your brain has been cleansed of adenosine (a sleepy chemical), and if you are suffering from sleep inertia, the grogginess is due to melatonin (a different sleepy chemical).
Caffeine is an adenosine receptor blocker, so that will do nothing to mitigate the effects of melatonin in your brain that doesn’t have any meaningful quantity of adenosine in it in the morning.
Adenosine gradually accumulates in the brain over the course of the day (and then gets washed out while we sleep), so if you’re sleepy in the afternoon (for reasons other than: you just had a nap and now have sleep inertia again), then caffeine can block that adenosine in the afternoon.
Of course, caffeine is also a stimulant (it increases adrenaline levels and promotes vasoconstriction), but its effects at healthily small doses are modest for most people, and you’d do better by splashing cold water on your face and/or listening to some upbeat music.
Learn more: The Two Sides Of Caffeine
Time your naps correctly (if you take naps)
Dr. Breus has a lot to say about this, based on a lot of clinical research, but as it’s entirely consistent with what we’ve written before (based on the exact same research), to save space we’ll link to that here:
How To Be An Expert Nap-Artist (With No “Sleep-Hangovers”)
Calculate your bedtime correctly
Remember what we said about sleep cycles? This means that that famous “7–9 hours sleep” is actually “either 7½ or 9 hours sleep”—because those are multiples of 90 minutes, whereas 8 hours (for example) is not.
So, consider the time you want to get up (ideally, this should be relatively early, and the same time every day), and then count backwards either 7½ or 9 hours sleep (you choose), add 20–30 minutes to fall asleep, and that’s your bedtime.
So for example: if you want to have 7½ hours sleep and get up at 6am, then your bedtime is anywhere between 10pm and 10:10pm.
Remember how we said not to sleep in, even if you have a sleep debt? Now is the time to pay it off, if you have one. If you normally sleep 7½ hours, then make tonight a 9-hour sleep (plus 20–30 minutes to fall asleep). This means you’ll still get up at 6am, but your bedtime is now anywhere between 8:30pm and 8:40pm.
Want to know more from Dr. Breus?
You might like this excellent book of his that we reviewed a while back:
The Power of When – by Dr. Michael Breus
Enjoy!
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