What you need to know about menopause
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Menopause describes the time when a person with ovaries has gone one full year without a menstrual period. Reaching this phase is a natural aging process that marks the end of reproductive years.
Read on to learn more about the causes, stages, signs, and management of menopause.
What causes menopause?
As you age, your ovaries begin making less estrogen and progesterone—two of the hormones involved in menstruation—and your fertility declines, causing menopause.
Most people begin perimenopause, the transitional time that ends in menopause, in their late 40s, but it can start earlier. On average, people in the U.S. experience menopause in their early 50s.
Your body may reach early menopause for a variety of reasons, including having an oophorectomy, a surgery that removes the ovaries. In this case, the hormonal changes happen abruptly rather than gradually.
Chemotherapy and radiation therapy for cancer patients may also induce menopause, as these treatments may impact ovary function.
What are the stages of menopause?
There are three stages:
- Perimenopause typically occurs eight to 10 years before menopause happens. During this stage, estrogen production begins to decline and ovaries release eggs less frequently.
- Menopause marks the point when you have gone 12 consecutive months without a menstrual period. This means the ovaries have stopped releasing eggs and producing estrogen.
- Postmenopause describes the time after menopause. Once your body reaches this phase, it remains there for the rest of your life.
How do the stages of menopause affect fertility?
Your ovaries still produce eggs during perimenopause, so it is still possible to get pregnant during that stage. If you do not wish to become pregnant, continue using your preferred form of birth control throughout perimenopause.
Once you’ve reached menopause, you can no longer get pregnant naturally. People who would like to become pregnant after that may pursue in vitro fertilization (IVF) using eggs that were frozen earlier in life or donor eggs.
What are the signs of menopause?
Hormonal shifts result in a number of bodily changes. Signs you are approaching menopause may include:
- Hot flashes (a sudden feeling of warmth).
- Irregular menstrual periods, or unusually heavy or light menstrual periods.
- Night sweats and/or cold flashes.
- Insomnia.
- Slowed metabolism.
- Irritability, mood swings, and depression.
- Vaginal dryness.
- Changes in libido.
- Dry skin, eyes, and/or mouth.
- Worsening of premenstrual syndrome (PMS).
- Urinary urgency (a sudden need to urinate).
- Brain fog.
How can I manage the effects of menopause?
You may not need any treatment to manage the effects of menopause. However, if the effects are disrupting your life, your doctor may prescribe hormone therapy.
If you have had a hysterectomy, your doctor may prescribe estrogen therapy (ET), which may be administered via a pill, patch, cream, spray, or vaginal ring. If you still have a uterus, your doctor may prescribe estrogen progesterone/progestin hormone therapy (EPT), which is sometimes called “combination therapy.”
Both of these therapies work by replacing the hormones your body has stopped making, which can reduce the physical and mental effects of menopause.
Other treatment options may include antidepressants, which can help manage mood swings and hot flashes; prescription creams to alleviate vaginal dryness; or gabapentin, an anti-seizure medication that has been shown to reduce hot flashes.
Lifestyle changes may help alleviate the effects on their own or in combination with prescription medication. Those changes include:
- Incorporating movement into your daily life.
- Limiting caffeine and alcohol.
- Quitting smoking.
- Maintaining a regular sleep schedule.
- Practicing relaxation techniques, such as meditation.
- Consuming foods rich in plant estrogens, such as grains, beans, fruits, vegetables, and seeds.
- Seeking support from a therapist and from loved ones.
What health risks are associated with menopause?
Having lower levels of estrogen may put you at greater risk of certain health complications, including osteoporosis and coronary artery disease.
Osteoporosis occurs when bones lose their density, increasing the risk of fractures. A 2022 study found that the prevalence of osteoporotic fractures in postmenopausal women was 82.2 percent.
Coronary artery disease occurs when the arteries that send blood to your heart become narrow or blocked with fatty plaque.
Estrogen therapy can reduce your risk of osteoporosis and coronary artery disease by preserving bone mass and maintaining cardiovascular function.
For more information, talk to your health care provider.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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Antidepressants: Personalization Is Key!
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Antidepressants: Personalization Is Key!
Yesterday, we asked you for your opinions on antidepressants, and got the above-depicted, below-described, set of responses:
- Just over half of respondents said “They clearly help people, but should not be undertaken lightly”
- Just over a fifth of respondents said “They may help some people, but the side effects are alarming”
- Just under a sixth of respondents said “They’re a great way to correct an imbalance of neurochemicals”
- Four respondents said “They are no better than placebo, and are more likely to harm”
- Two respondents said “They merely mask the problem, and thus don’t really help”
So what does the science say?
❝They are no better than placebo, and are more likely to harm? True or False?❞
True or False depending on who you are and what you’re taking. Different antidepressants can work on many different systems with different mechanisms of action. This means if and only if you’re not taking the “right” antidepressant for you, then yes, you will get only placebo benefits:
- Placebo Effect in the Treatment of Depression and Anxiety ← randomly assigned antidepressants are, shockingly, luck of the draw in usefulness
- Antidepressants versus placebo in major depression: an overview ← “wow this science is messy”
- Comparative efficacy and acceptability of 21 antidepressant drugs: a systematic review and network meta-analysis ← “oh look, it makes a difference which antidepressant we give to people”
Rather than dismissing antidepressants as worthless, therefore, it is a good idea to find out (by examination or trial and error) what kind of antidepressant you need, if you indeed do need such.
Otherwise it is like getting a flu shot and being surprised when you still catch a cold!
❝They merely mask the problem, and thus don’t really help: True or False?❞
False, categorically.
The problem in depressed people is the depressed mood. This may be influenced by other factors, and antidepressants indeed won’t help directly with those, but they can enable the person to better tackle them (more on this later).
❝They may help some people, but the side-effects are alarming: True or False?❞
True or False depending on more factors than we can cover here.
Side-effects vary from drug to drug and person to person, of course. As does tolerability and acceptability, since to some extent these things are subjective.
One person’s dealbreaker may be another person’s shrugworthy minor inconvenience at most.
❝They’re a great way to correct an imbalance of neurochemicals: True or False?❞
True! Contingently.
That is to say: they’re a great way to correct an imbalance of neurochemicals if and only if your problem is (at least partly) an imbalance of neurochemicals. If it’s not, then your brain can have all the neurotransmitters it needs, and you will still be depressed, because (for example) the other factors* influencing your depression have not changed.
*common examples include low self-esteem, poor physical health, socioeconomic adversity, and ostensibly bleak prospects for the future.
For those for whom the problem is/was partly a neurochemical imbalance and partly other factors, the greatest help the antidepressants give is getting the brain into sufficient working order to be able to tackle those other factors.
Want to know more about the different kinds?
Here’s a helpful side-by-side comparison of common antidepressants, what type they are, and other considerations:
Mind | Comparing Antidepressants
Want a drug-free approach?
You might like our previous main feature:
The Mental Health First-Aid That You’ll Hopefully Never Need
Take care!
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Palliative care as a true art form
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How do you ease the pain from an ailment amidst lost words? How can you serve the afflicted when lines start to blur? When the foundation of communication begins to crumble, what will be the pillar health-care professionals can lean on to support patients afflicted with dementia during their final days?
The practice of medicine is both highly analytical and evidence based in nature. However, it is considered a “practice” because at the highest level, it resembles a musician navigating an instrument. It resembles art. Between lab values, imaging techniques and treatment options, the nuances for individualized patient care so often become threatened.
Dementia, a non-malignant terminal illness, involves the progressive cognitive and social decline in those afflicted. Though there is no cure, dementia is commonly met in the setting of end-of-life care. During this final stage of life, the importance of comfort via symptomatic management and communication usually is a priority in patient care. But what about the care of a patient suffering from dementia? While communication serves as the vehicle to deliver care at a high level, medical professionals are suddenly met with a roadblock. And there … behind the pieces of shattered communication and a dampened map of ethical guidelines, health-care providers are at a standstill.
It’s 4:37 a.m. You receive a text message from the overnight nurse at a care facility regarding a current seizure. After lorazepam is ordered and administered, Mr. H, a quick-witted 76-year-old, stabilizes. Phenobarbital 15mg SC qhs was also added to prevent future similar events. You exhale a sigh of relief.
Mr. H. has been admitted to the floor 36 hours earlier after having a seizure while playing poker with colleagues. Since he became your patient, he’s shared many stories from professional and family life with you, along with as many jokes as he could fit in between. However, over the course of the next seven days, Mr. H. would develop aspiration pneumonia, progressing to ventilator dependency and, ultimately, multi-organ failure with rapid cognitive decline.
What strategies and tools would you use to maximize the well-being of your patient during his decline? How would you bridge the gap of understanding between the patient’s family and health-care team to provide the standard of care that all patients are owed?
To give Mr. H. the type of care he would have wanted, upon his hospital admission, he should have been questioned about his understanding of illness along with the goals of care of the medical team. The patient should have been informed that it is imperative to adhere to the medical regimen implemented by his team along with the risks of not doing so. In the event disease-related complications arose, advanced directives should have been documented to avoid any unnecessary measures.
It is important to note, that with each change in status of the patient’s health status, the goal of treatment must be reassessed. The patient or surrogate decision-maker’s understanding of these goals is paramount in maintaining the patient’s autonomy. It is often said that effective communication is the bedrock of a healthy relationship. This is true regardless of type of relationship.
This is why I and Megan Vierhout wrote Integrated End of Life Care in Dementia: A Comprehensive Guide, a book targeted at providing a much-needed road map to navigate the many challenges involved in end-of-life care for individuals with dementia. Ultimately, our aim is to provide a compass for both health-care professionals and the families of those affected by the progressive effects of dementia. We provide practical advice on optimizing communication with individuals with dementia while taking their cognitive limitations, preferences and needs into account.
I invite you to explore the unpredictable terrain of end-of-life care for patients with dementia. Together, we can pave a smoother, sturdier path toward the practice of medicine as a true art form.
This article is republished from healthydebate under a Creative Commons license. Read the original article.
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Managing Sibling Relationships In Adult Life
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Managing Sibling Relationships In Adult Life
After our previous main feature on estrangement, a subscriber wrote to say:
❝Parent and adult child relationships are so important to maintain as you age, but what about sibling relationships? Adult choices to accept and move on with healthier boundaries is also key for maintaining familial ties.❞
And, this is indeed critical for many of us, if we have siblings!
Writer’s note: I don’t have siblings, but I do happen to have one of Canada’s top psychologists on speed-dial, and she has more knowledge about sibling relationships than I do, not to mention a lifetime of experience both personally and professionally. So, I sought her advice, and she gave me a lot to work with.
Today I bring her ideas, distilled into my writing, for 10almonds’ signature super-digestible bitesize style.
A foundation of support
Starting at the beginning of a sibling story… Sibling relationships are generally beneficial from the get-go.
This is for reasons of mutual support, and an “always there” social presence.
Of course, how positive this experience is may depend on there being a lack of parental favoritism. And certainly, sibling rivalries and conflict can occur at any age, but the stakes are usually lower, early in life.
Growing warmer or colder
Generally speaking, as people age, sibling relationships likely get warmer and less conflictual.
Why? Simply put, we mature and (hopefully!) get more emotionally stable as we go.
However, two things can throw a wrench into the works:
- Long-term rivalries or jealousies (e.g., “who has done better in life”)
- Perceptions of unequal contribution to the family
These can take various forms, but for example if one sibling earns (or otherwise has) much more or much less than another, that can cause resentment on either or both sides:
- Resentment from the side of the sibling with less money: “I’d look after them if our situations were reversed; they can solve my problems easily; why do they resent that and/or ignore my plight?”
- Resentment from the side of the sibling with more money: “I shouldn’t be having to look after my sibling at this age”
It’s ugly and unpleasant. Same goes if the general job of caring for an elderly parent (or parents) falls mostly or entirely on one sibling. This can happen because of being geographically closer or having more time (well… having had more time. Now they don’t, it’s being used for care!).
It can also happen because of being female—daughters are more commonly expected to provide familial support than sons.
And of course, that only gets exacerbated as end-of-life decisions become relevant with regard to parents, and tough decisions may need to be made. And, that’s before looking at conflicts around inheritance.
So, all that seems quite bleak, but it doesn’t have to be like that.
Practical advice
As siblings age, working on communication about feelings is key to keeping siblings close and not devolving into conflict.
Those problems we talked about are far from unique to any set of siblings—they’re just more visible when it’s our own family, that’s all.
So: nothing to be ashamed of, or feel bad about. Just, something to manage—together.
Figure out what everyone involved wants/needs, put them all on the table, and figure out how to:
- Make sure outright needs are met first
- Try to address wants next, where possible
Remember, that if you feel more is being asked of you than you can give (in terms of time, energy, money, whatever), then this discussion is a time to bring that up, and ask for support, e.g.:
“In order to be able to do that, I would need… [description of support]; can you help with that?”
(it might even sometimes be necessary to simply say “No, I can’t do that. Let’s look to see how else we can deal with this” and look for other solutions, brainstorming together)
Some back-and-forth open discussion and even negotiation might be necessary, but it’s so much better than seething quietly from a distance.
The goal here is an outcome where everyone’s needs are met—thus leveraging the biggest strength of having siblings in the first place:
Mutual support, while still being one’s own person. Or, as this writer’s psychology professor friend put it:
❝Circling back to your original intention, this whole discussion adds up to: siblings can be very good or very bad for your life, depending on tons of things that we talked about, especially communication skills, emotional wellness of each person, and the complexity of challenges they face interdependently.❞
Our previous main feature about good communication can help a lot:
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Walnuts vs Pecans – Which is Healthier?
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Our Verdict
When comparing walnuts to pecans, we picked the walnuts.
Why?
It was very close, though, and an argument could be made for pecans! Walnuts are nevertheless always a very good bet, and so far in our This-or-That comparisons, the only nut to beat them so far as been almonds, and that was very close too.
In terms of macros, walnuts have a lot more protein, while pecans have a little more fiber (for approximately the same carbs). Both are equally fatty (near enough; technically pecans have a little more) but where the walnuts stand out in the fat category is that while pecans have mostly healthy monounsaturated fats, walnuts have mostly healthy polyunsaturated fats, including including a good balance of omega-3 and omega-6 fatty acids. So, while we do love the extra fiber from pecans, we’re calling it for walnuts in the macros category, on account of the extra protein and the best lipids profile (not that pecans’ lipids profile is bad by any stretch; just, walnuts have it better).
In the vitamins category, walnuts have more of vitamins B2, B6, B9, and C, while pecans offer more of vitamins A, B1, B3, B5, E, K, and choline. The margins aren’t huge and walnuts are also excellent for all the vitamins that pecans narrowly beat them on, but still, the vitamins category is a win for pecans.
When it comes to minerals, walnuts take back the crown; walnuts offer more calcium, copper, iron, magnesium, phosphorus, potassium, and selenium, while pecans have a little more manganese and zinc. Once again, the margins aren’t huge and pecans are also excellent for all the minerals that walnuts narrowly beat them on, but still, the minerals category is a win for walnuts.
In short: enjoy both of these nuts for their healthy fats, vitamins, minerals, protein, and fiber, but if you’re going to pick one, walnuts come out on top.
Want to learn more?
You might like to read:
Why You Should Diversify Your Nuts!
Take care!
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ADHD 2.0 – by Dr. Edward Hallowell & Dr. John Ratey
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A lot of ADHD literature is based on the assumption that the reader is a 30-something parent of a child with ADHD. This book, on the other hand, addresses all ages, and includes just as readily the likelihood that the person with ADHD is the reader, and/or the reader’s partner.
The authors cover such topics as:
- ADHD mythbusting, before moving on to…
- The problems of ADHD, and the benefits that those exact same traits can bring too
- How to leverage those traits to get fewer of the problems and more of the benefits
- The role of diet beyond the obvious, including supplementation
- The role of specific exercises (especially HIIT, and balance exercises) in benefiting the ADHD brain
- The role of medications—and arguments for and gainst such
The writing style is… Thematic, let’s say. The authors have ADHD and it shows. So, expect comprehensive deep-dives from whenever their hyperfocus mode kicked in, and expect no stones left unturned. That said, it is very readable, and well-indexed too, for ease of finding specific sub-topics.
Bottom line: if you are already very familiar with ADHD, you may not learn much, and might reasonably skip this one. However, if you’re new to the topic, this book is a great—and practical—primer.
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The Uses of Delusion – by Dr. Stuart Vyse
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Most of us try to live rational lives. We try to make the best decisions we can based on the information we have… And if we’re thoughtful, we even try to be aware of common logical fallacies, and overcome our personal biases too. But is self-delusion ever useful?
Dr. Stuart Vyse, psychologist and Fellow for the Committee for Skeptical Inquiry, argues that it can be.
From self-fulfilling prophecies of optimism and pessimism, to the role of delusion in love and loss, Dr. Vyse explores what separates useful delusion from dangerous irrationality.
We also read about such questions as (and proposed answers to):
- Why is placebo effect stronger if we attach a ritual to it?
- Why are negative superstitions harder to shake than positive ones?
- Why do we tend to hold to the notion of free will, despite so much evidence for determinism?
The style of the book is conversational, and captivating from the start; a highly compelling read.
Bottom line: if you’ve ever felt yourself wondering if you are deluding yourself and if so, whether that’s useful or counterproductive, this is the book for you!
Click here to check out The Uses of Delusion, and optimize yours!
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