What are the most common symptoms of menopause? And which can hormone therapy treat?

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Despite decades of research, navigating menopause seems to have become harder – with conflicting information on the internet, in the media, and from health care providers and researchers.

Adding to the uncertainty, a recent series in the Lancet medical journal challenged some beliefs about the symptoms of menopause and which ones menopausal hormone therapy (also known as hormone replacement therapy) can realistically alleviate.

So what symptoms reliably indicate the start of perimenopause or menopause? And which symptoms can menopause hormone therapy help with? Here’s what the evidence says.

Remind me, what exactly is menopause?

Menopause, simply put, is complete loss of female fertility.

Menopause is traditionally defined as the final menstrual period of a woman (or person female at birth) who previously menstruated. Menopause is diagnosed after 12 months of no further bleeding (unless you’ve had your ovaries removed, which is surgically induced menopause).

Perimenopause starts when menstrual cycles first vary in length by seven or more days, and ends when there has been no bleeding for 12 months.

Both perimenopause and menopause are hard to identify if a person has had a hysterectomy but their ovaries remain, or if natural menstruation is suppressed by a treatment (such as hormonal contraception) or a health condition (such as an eating disorder).

What are the most common symptoms of menopause?

Our study of the highest quality menopause-care guidelines found the internationally recognised symptoms of the perimenopause and menopause are:

  • hot flushes and night sweats (known as vasomotor symptoms)
  • disturbed sleep
  • musculoskeletal pain
  • decreased sexual function or desire
  • vaginal dryness and irritation
  • mood disturbance (low mood, mood changes or depressive symptoms) but not clinical depression.

However, none of these symptoms are menopause-specific, meaning they could have other causes.

In our study of Australian women, 38% of pre-menopausal women, 67% of perimenopausal women and 74% of post-menopausal women aged under 55 experienced hot flushes and/or night sweats.

But the severity of these symptoms varies greatly. Only 2.8% of pre-menopausal women reported moderate to severely bothersome hot flushes and night sweats symptoms, compared with 17.1% of perimenopausal women and 28.5% of post-menopausal women aged under 55.

So bothersome hot flushes and night sweats appear a reliable indicator of perimenopause and menopause – but they’re not the only symptoms. Nor are hot flushes and night sweats a western society phenomenon, as has been suggested. Women in Asian countries are similarly affected.

Woman sits on chair, looking deflated
You don’t need to have night sweats or hot flushes to be menopausal.
Maridav/Shutterstock

Depressive symptoms and anxiety are also often linked to menopause but they’re less menopause-specific than hot flushes and night sweats, as they’re common across the entire adult life span.

The most robust guidelines do not stipulate women must have hot flushes or night sweats to be considered as having perimenopausal or post-menopausal symptoms. They acknowledge that new mood disturbances may be a primary manifestation of menopausal hormonal changes.

The extent to which menopausal hormone changes impact memory, concentration and problem solving (frequently talked about as “brain fog”) is uncertain. Some studies suggest perimenopause may impair verbal memory and resolve as women transition through menopause. But strategic thinking and planning (executive brain function) have not been shown to change.

Who might benefit from hormone therapy?

The Lancet papers suggest menopause hormone therapy alleviates hot flushes and night sweats, but the likelihood of it improving sleep, mood or “brain fog” is limited to those bothered by vasomotor symptoms (hot flushes and night sweats).

In contrast, the highest quality clinical guidelines consistently identify both vasomotor symptoms and mood disturbances associated with menopause as reasons for menopause hormone therapy. In other words, you don’t need to have hot flushes or night sweats to be prescribed menopause hormone therapy.

Often, menopause hormone therapy is prescribed alongside a topical vaginal oestrogen to treat vaginal symptoms (dryness, irritation or urinary frequency).

Doctor talks to woman
You don’t need to experience hot flushes and night sweats to take hormone therapy.
Monkey Business Images/Shutterstock

However, none of these guidelines recommend menopause hormone therapy for cognitive symptoms often talked about as “brain fog”.

Despite musculoskeletal pain being the most common menopausal symptom in some populations, the effectiveness of menopause hormone therapy for this specific symptoms still needs to be studied.

Some guidelines, such as an Australian endorsed guideline, support menopause hormone therapy for the prevention of osteoporosis and fracture, but not for the prevention of any other disease.

What are the risks?

The greatest concerns about menopause hormone therapy have been about breast cancer and an increased risk of a deep vein clot which might cause a lung clot.

Oestrogen-only menopause hormone therapy is consistently considered to cause little or no change in breast cancer risk.

Oestrogen taken with a progestogen, which is required for women who have not had a hysterectomy, has been associated with a small increase in the risk of breast cancer, although any risk appears to vary according to the type of therapy used, the dose and duration of use.

Oestrogen taken orally has also been associated with an increased risk of a deep vein clot, although the risk varies according to the formulation used. This risk is avoided by using estrogen patches or gels prescribed at standard doses

What if I don’t want hormone therapy?

If you can’t or don’t want to take menopause hormone therapy, there are also effective non-hormonal prescription therapies available for troublesome hot flushes and night sweats.

In Australia, most of these options are “off-label”, although the new medication fezolinetant has just been approved in Australia for postmenopausal hot flushes and night sweats, and is expected to be available by mid-year. Fezolinetant, taken as a tablet, acts in the brain to stop the chemical neurokinin 3 triggering an inappropriate body heat response (flush and/or sweat).

Unfortunately, most over-the-counter treatments promoted for menopause are either ineffective or unproven. However, cognitive behaviour therapy and hypnosis may provide symptom relief.

The Australasian Menopause Society has useful menopause fact sheets and a find-a-doctor page. The Practitioner Toolkit for Managing Menopause is also freely available.The Conversation

Susan Davis, Chair of Women’s Health, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Four Ways To Upgrade The Mediterranean Diet

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    Four Ways To Upgrade The Mediterranean Diet

    The Mediterranean Diet is considered by many to be the current “gold standard” of healthy eating, and with good reason. With 10,000+ studies underpinning it and counting, it has a pretty hefty weight of evidence.

    (For contrast, the Ketogenic Diet for example has under 5,000 studies at time of writing, and many of those include mentioning the problems with it. That’s not to say the Keto is without its merits! It certainly can help achieve some short term goals, but that’s a topic for another day)

    Wondering what the Mediterranean Diet consists of? We outlined it in a previous main feature, so here it is for your convenience 😎

    To get us started today, we’ll quickly drop some links to a few of those Mediterranean Diet studies from the top:

    The short version is: it glows, in a good way.

    The anti-inflammatory upgrade

    One thing about the traditional Mediterranean Diet is… where are the spices?!

    A diet focusing on fruits and non-starchy vegetables, healthy oils and minimal refined carbs, can be boosted by adding uses of spices such as chili, turmeric, cumin, fenugreek, and coriander:

    Why and How the Indo-Mediterranean Diet May Be Superior to Other Diets: The Role of Antioxidants in the Diet

    The gut-healthy upgrade:

    The Mediterranean Diet already gives for having a small amount of dairy, mostly in the form of cheeses, but this can be tweaked:

    Mediterranean diet with extra dairy could be a gut gamechanger

    The heart-healthy upgrade

    The Mediterranean Diet is already highly recommended for heart health, and it offers different benefits to different parts of cardiovascular health:

    The Mediterranean Diet: its definition and evaluation of a priori dietary indexes in primary cardiovascular prevention

    The DASH (Dietary Approaches to Stop Hypertension) diet can boost it further, specifically in the category of, as the name suggests, lowering blood pressure.

    It’s basically the Mediterranean Diet with a few tweaks. Most notably, red meat no longer features (the Mediterranean Diet allows for a small amount of red meat), and fish has gone up in the list:

    Description of the DASH Eating Plan

    The brain-healthy upgrade:

    The MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet combines several elements from the above, as the name suggests. It also adds extra portions of specific brain-foods, that already exist in the above diets, but get a more substantial weighting in this one:

    MIND and Mediterranean diets linked to fewer signs of Alzheimer’s brain pathology

    See also: The cognitive effects of the MIND diet

    Enjoy!

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  • Early Bird Or Night Owl? Genes vs Environment

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    A Sliding Slope?

    In Tuesday’s newsletter, we asked you how much control you believe we have over our sleep schedule, and got the above-depicted, below-described, set of responses:

    • 45% said “most people can control it; some people with sleep disorders cannot
    • 35% said “our genes predispose us to early/late, but we can slide it a bit
    • 15% said: “going against our hardwired sleep schedules is a road to ruin”
    • 5% said “anyone can adjust their sleep schedule with enough willpower”

    You may be wondering: what’s with those single-digit numbers in the graph there? And the answer is: Tuesday’s email didn’t go out at the usual time due to a scheduling mistake (sorry!), which is probably what affected the number of responses (poll response levels vary, but are usually a lot higher than this).

    Note: yes, this does mean most people who read our newsletter don’t vote. So, not to sound like a politician on the campaign trail, but… Your vote counts! We always love reading your comments when you add those, too—often they provide context that allow us to tailor what we focus on in our articles

    However, those are the responses we got, so here we are!

    What does the science say?

    Anyone can adjust their sleep with enough willpower: True or False?

    False, simply. It’s difficult for most people, but for many people with sleep disorders, it is outright impossible.

    In a battle of narcolepsy vs willpower, for example, no amount of willpower will stop the brain from switching to sleep mode when it thinks it’s time to sleep:

    ❝Narcolepsy is the most common neurological cause of chronic sleepiness. The discovery about 20 years ago that narcolepsy is caused by selective loss of the neurons producing orexins sparked great advances in the field

    [There is also] developing evidence that narcolepsy is an autoimmune disorder that may be caused by a T cell-mediated attack on the orexin neurons and explain how these new perspectives can inform better therapeutic approaches.❞

    ~ Dr. Carrie Mahoney et al. (lightly edited for brevity)

    Source: The neurobiological basis of narcolepsy

    For further reading, especially if this applies to you or a loved one:

    Living with Narcolepsy: Current Management Strategies, Future Prospects, and Overlooked Real-Life Concerns

    Our genes predispose us to early/late, but we can slide it a bit: True or False?

    True! First, about our genes predisposing us:

    Genome-wide association analysis of 89,283 individuals identifies genetic variants associated with self-reporting of being a morning person

    …and also:

    Gene distinguishes early birds from night owls and helps predict time of death

    Now, as for the “can slide it a bit”, this is really just a function of the general categories of “early bird” and “night owl” spanning periods of time that allow for a few hours’ wiggle-room at either side.

    However, it is recommended to make any actual changes more gradually, with the Sleep Foundation going so far as to recommend 30 minutes, or even just 15 minutes, of change per day:

    Sleep Foundation | How to Fix Your Sleep Schedule

    Going against our hardwired sleep schedule is a road to ruin: True or False?

    False, contextually. By this we mean: our “hardwired” sleep schedule is (for most of us), genetically predisposed but not predetermined.

    Also, genetic predispositions are not necessarily always good for us; one would not argue, for example, for avoiding going against a genetic predisposition to addiction.

    Some genetic predispositions are just plain bad for us, and genes can be a bit of a lottery.

    That said, we do recommend getting some insider knowledge (literally), by getting personal genomics tests done, if that’s a viable option for you, so you know what’s really a genetic trait (and what to do with that information) and what’s probably caused by something else (and what to do with that information):

    Genetic Testing: Health Benefits & Methods

    Take care!

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  • These Signs Often Mean These Nutrient Deficiencies (Do You Have Any?)

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    These are not a necessary “if this then this” equation, but rather a “if this, then probably this”, and it’s a cue to try upping that thing in your diet, and if that doesn’t quickly fix it, get some tests done:

    • White bumps on the skin: vitamin A, omega 3
    • Craving sour foods: vitamin C
    • Restless leg syndrome: iron, magnesium
    • Cracked lips: vitamin B2
    • Tingling hands and feet: vitamin B12
    • Easy bruising: vitamin K and vitamin C
    • Canker sores: vitamin B9 (folate), vitamin B12, iron
    • Brittle or misshapen nails: vitamin B7 (biotin)
    • Craving salty foods: sodium, potassium
    • Prematurely gray hair: copper, vitamin B9 (folate), vitamin B12
    • Dandruff: omega 3, zinc, vitamin B6
    • Craving ice: iron

    Dr. LeGrand Peterson has more to say about these though, as well as a visual guide to symptoms, so do check out the video:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to know more?

    You might like this previous main feature about supplements vs nutrients from food

    Do We Need Supplements, And Do They Work?

    Enjoy!

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  • What’s Keeping the US From Allowing Better Sunscreens?

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    When dermatologist Adewole “Ade” Adamson sees people spritzing sunscreen as if it’s cologne at the pool where he lives in Austin, Texas, he wants to intervene. “My wife says I shouldn’t,” he said, “even though most people rarely use enough sunscreen.”

    At issue is not just whether people are using enough sunscreen, but what ingredients are in it.

    The Food and Drug Administration’s ability to approve the chemical filters in sunscreens that are sold in countries such as Japan, South Korea, and France is hamstrung by a 1938 U.S. law that has required sunscreens to be tested on animals and classified as drugs, rather than as cosmetics as they are in much of the world. So Americans are not likely to get those better sunscreens — which block the ultraviolet rays that can cause skin cancer and lead to wrinkles — in time for this summer, or even the next.

    Sunscreen makers say that requirement is unfair because companies including BASF Corp. and L’Oréal, which make the newer sunscreen chemicals, submitted safety data on sunscreen chemicals to the European Union authorities some 20 years ago.

    Steven Goldberg, a retired vice president of BASF, said companies are wary of the FDA process because of the cost and their fear that additional animal testing could ignite a consumer backlash in the European Union, which bans animal testing of cosmetics, including sunscreen. The companies are asking Congress to change the testing requirements before they take steps to enter the U.S. marketplace.

    In a rare example of bipartisanship last summer, Sen. Mike Lee (R-Utah) thanked Rep. Alexandria Ocasio-Cortez (D-N.Y.) for urging the FDA to speed up approvals of new, more effective sunscreen ingredients. Now a bipartisan bill is pending in the House that would require the FDA to allow non-animal testing.

    “It goes back to sunscreens being classified as over-the-counter drugs,” said Carl D’Ruiz, a senior manager at DSM-Firmenich, a Switzerland-based maker of sunscreen chemicals. “It’s really about giving the U.S. consumer something that the rest of the world has. People aren’t dying from using sunscreen. They’re dying from melanoma.”

    Every hour, at least two people die of skin cancer in the United States. Skin cancer is the most common cancer in America, and 6.1 million adults are treated each year for basal cell and squamous cell carcinomas, according to the Centers for Disease Control and Prevention. The nation’s second-most-common cancer, breast cancer, is diagnosed about 300,000 times annually, though it is far more deadly.

    Dermatologists Offer Tips on Keeping Skin Safe and Healthy

    – Stay in the shade during peak sunlight hours, 10 a.m. to 4 p.m. daylight time.– Wear hats and sunglasses.– Use UV-blocking sun umbrellas and clothing.– Reapply sunscreen every two hours.You can order overseas versions of sunscreens from online pharmacies such as Cocooncenter in France. Keep in mind that the same brands may have different ingredients if sold in U.S. stores. But importing your sunscreen may not be affordable or practical. “The best sunscreen is the one that you will use over and over again,” said Jane Yoo, a New York City dermatologist.

    Though skin cancer treatment success rates are excellent, 1 in 5 Americans will develop skin cancer by age 70. The disease costs the health care system $8.9 billion a year, according to CDC researchers. One study found that the annual cost of treating skin cancer in the United States more than doubled from 2002 to 2011, while the average annual cost for all other cancers increased by just 25%. And unlike many other cancers, most forms of skin cancer can largely be prevented — by using sunscreens and taking other precautions.

    But a heavy dose of misinformation has permeated the sunscreen debate, and some people question the safety of sunscreens sold in the United States, which they deride as “chemical” sunscreens. These sunscreen opponents prefer “physical” or “mineral” sunscreens, such as zinc oxide, even though all sunscreen ingredients are chemicals.

    “It’s an artificial categorization,” said E. Dennis Bashaw, a retired FDA official who ran the agency’s clinical pharmacology division that studies sunscreens.

    Still, such concerns were partly fed by the FDA itself after it published a study that said some sunscreen ingredients had been found in trace amounts in human bloodstreams. When the FDA said in 2019, and then again two years later, that older sunscreen ingredients needed to be studied more to see if they were safe, sunscreen opponents saw an opening, said Nadim Shaath, president of Alpha Research & Development, which imports chemicals used in cosmetics.

    “That’s why we have extreme groups and people who aren’t well informed thinking that something penetrating the skin is the end of the world,” Shaath said. “Anything you put on your skin or eat is absorbed.”

    Adamson, the Austin dermatologist, said some sunscreen ingredients have been used for 30 years without any population-level evidence that they have harmed anyone. “The issue for me isn’t the safety of the sunscreens we have,” he said. “It’s that some of the chemical sunscreens aren’t as broad spectrum as they could be, meaning they do not block UVA as well. This could be alleviated by the FDA allowing new ingredients.”

    Ultraviolet radiation falls between X-rays and visible light on the electromagnetic spectrum. Most of the UV rays that people come in contact with are UVA rays that can penetrate the middle layer of the skin and that cause up to 90% of skin aging, along with a smaller amount of UVB rays that are responsible for sunburns.

    The sun protection factor, or SPF, rating on American sunscreen bottles denotes only a sunscreen’s ability to block UVB rays. Although American sunscreens labeled “broad spectrum” should, in theory, block UVA light, some studies have shown they fail to meet the European Union’s higher UVA-blocking standards.

    “It looks like a number of these newer chemicals have a better safety profile in addition to better UVA protection,” said David Andrews, deputy director of Environmental Working Group, a nonprofit that researches the ingredients in consumer products. “We have asked the FDA to consider allowing market access.”

    The FDA defends its review process and its call for tests of the sunscreens sold in American stores as a way to ensure the safety of products that many people use daily, rather than just a few times a year at the beach.

    “Many Americans today rely on sunscreens as a key part of their skin cancer prevention strategy, which makes satisfactory evidence of both safety and effectiveness of these products critical for public health,” Cherie Duvall-Jones, an FDA spokesperson, wrote in an email.

    D’Ruiz’s company, DSM-Firmenich, is the only one currently seeking to have a new over-the-counter sunscreen ingredient approved in the United States. The company has spent the past 20 years trying to gain approval for bemotrizinol, a process D’Ruiz said has cost $18 million and has advanced fitfully, despite attempts by Congress in 2014 and 2020 to speed along applications for new UV filters.

    Bemotrizinol is the bedrock ingredient in nearly all European and Asian sunscreens, including those by the South Korean brand Beauty of Joseon and Bioré, a Japanese brand.

    D’Ruiz said bemotrizinol could secure FDA approval by the end of 2025. If it does, he said, bemotrizinol would be the most vetted and safest sunscreen ingredient on the market, outperforming even the safety profiles of zinc oxide and titanium dioxide.

    As Congress and the FDA debate, many Americans have taken to importing their own sunscreens from Asia or Europe, despite the risk of fake products.

    “The sunscreen issue has gotten people to see that you can be unsafe if you’re too slow,” said Alex Tabarrok, a professor of economics at George Mason University. “The FDA is just incredibly slow. They’ve been looking at this now literally for 40 years. Congress has ordered them to do it, and they still haven’t done it.”

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

    Subscribe to KFF Health News’ free Morning Briefing.

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  • The Twenty-Four Hour Mind – by Dr. Rosalind Cartwright

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    We’ve reviewed books about sleep before, and even about dreaming, so what does this one have to offer that’s new?

    Quite a lot, actually! Before Dr. Cartwright, there were mainly two models of sleep and dreaming:

    • The “top-down” model of psychoanalysts: our minds shape our dreams which in turn reveal things about us as people
    • The “bottom-up” model of neuroscientists: our brains need to go through regular maintaince cycles, of which vivid hallucinations are a quirky side-effect.

    And now, as Dr. Cartwright puts it:

    ❝I will lay out a new [horizontal] psychological model of the twenty-four hour mind; that is, how the predominantly conscious (waking) and unconscious (sleeping) forms of mental behavior interact through the brain’s regular, but differently organized, states of waking, sleeping, and dreaming.❞

    This she does in the exploratory style of a 224-page lecture, which sounds like it might be tedious, but is actually attention-grabbing and engaging throughout. This book is more of a page-turner than soporific bedtime reading!

    Bottom line: if you’d like to know more about the effect your waking and sleeping brain have on each other (to include getting in between those and making adjutments as appropriate), this is very much an elucidating read!

    Click here to check out The Twenty-Four Hour Mind, and learn more about yours!

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  • Anchovies vs Sardines – Which is Healthier?

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    Our Verdict

    When comparing anchovies to sardines, we picked the sardines.

    Why?

    In terms of macros, sardines have slightly more protein and more than 2x the fat, but the fat profile is healthier than that of anchovies, meaning that the amount of saturated fat is the same, and sardines have more poly- and monounsaturated fats. Breaking it down further, sardines also have more omega-3. Unless you are for whatever reason especially keen to keep your total fat* intake down, sardines win here.

    *or calories, which in this case come almost entirely from the fat, and sardines are consequently nearly 2x higher in calories.

    When it comes to vitamins, sardines further distinguish themselves; anchovies have more of vitamins B2 and B3, while sardines have more of vitamins A, B1, B6, B12, B9, E, and K—in some cases, by quite large margins (especially the B12 and K, being 14x more and 26x more, respectively). A clear win for sardines.

    Minerals are closer to even; anchovies have more copper, iron, and zinc, while sardines have more calcium, manganese, phosphorus, and selenium. That’s already a slight win for sardines, before we take into account that sardines’ margins of difference are also much greater than anchovies’.

    In short, enjoy either in moderation if you are so inclined, but sardines win on overall nutritional density.

    Want to learn more?

    You might like to read:

    Farmed Fish vs Wild Caught: More Important Than You Might Think

    Take care!

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