Fight Menopausal Weight Gain: Your Diet

During menopause, weight is easy to gain (in fact, some weight gain is almost inevitable) and hard to lose, for all the reasons we mentioned in the last post: metabolic change, loss of muscle mass, hormonal change, sleep deprivation, and stress.

So, ladies, if you’re just entering menopause—heads up! Game-changer ahead! Women who enter menopause close to their ideal weight have a better chance of maintaining it; however, women who tend to yo-yo or who have a hard time maintaining a healthy weight will tend to end up at the high end of their weight range.

Don't eat anything your great-great grandmother would not recognize as food.Whatever you did in your 30s to keep your weight in check isn’t going to work anymore. You’ve lost about 20 percent of your muscle mass and you need about 200 fewer calories per day you enter your 50s and 60s. Forewarned is forearmed, as they say. Simply recognizing this fact may help you step away from the hamster wheel of yore and toward a regimen that actually works.

The good news is that the best weight management strategy—the one that will work for the long haul—will also keep you stronger, more flexible, healthier, and capable of maintaining an active lifestyle for far longer. You’ll be able to travel, garden, play with the grandkids, get up off the floor, carry heavier loads, and remain generally pain-free.

The bad news is that it’s hard. A realistic and effective strategy to maintain a healthy weight requires self-discipline and lifestyle change. For the rest of your life. As you’ve probably guessed, you have to get serious about exercise and your diet—how much and what kind of food you put in your mouth.

Sure, you can go on a killer diet; you can take medications that will help you lose weight. But you probably already know the drill here—without lifestyle change, you’ll put it right back on and then some. Only now, you’re much more vulnerable to a host of serious, life-altering ailments, such as joint problems, diabetes, and cardiovascular trouble.  

So let’s talk about ways of eating that work for older women. We’re not talking about draconian measures that you’ll have a hard time maintaining. In fact, overly rigorous dieting can actually cause you to lose muscle mass and slow your metabolism even more, which is the last thing you need right now.

  • Focus on fresh, real, homemade food. You need to consume fewer calories, but they need to be high-quality, nutritious calories. Think whole grains, fresh fruit and vegetables, nuts, and legumes. Don’t go crazy on low- and non-fat foods, which are unhealthy in hidden ways. Instead, go for the unsaturated fats in olive or sesame oils, avocados, nuts, and salmon or tuna. “…[nutrient-rich, unsaturated fat] keeps your skin supple and your body from drying out. Basically, it’s like putting lotion on your body but from the inside out,” says Dr. Christine Gerbstadt in this article.  
  • Speaking of calories: A sedentary older woman in her 50s and 60s should consume about 1600 calories per day. If you’re more active, bump that up to 1800 calories. To lose one pound per week, you need a daily 500-calorie deficit, either through diet or exercise. I’m thinking it’s better not to gain that weight in the first place.  
  • Protein is important to replace muscle and protect bones—5 to 6 ounces of lean protein per day, such as that in dairy products, poultry, and fish.
  • The best diets for older women are the Mediterranean diet and the low-carb diet. Vegan and vegetarian diets are also good for weight loss and have been linked to greater longevity.
  • In the beginning, a structured meal plan is helpful. Write down what you’ll eat in the morning, so you don’t find yourself peckish in the mid-afternoon and absentmindedly reaching for the cookies. Later, you can mentally plan your daily menus. Try to establish a regular pattern, so you get used to eating at about the same time each day.
  • Avoid sugar, but don’t be obsessive about it. If you’re too rigorous, you may just be setting yourself up for a binge. An occasional treat is a nod to mental health.
  • Alcohol (even in red wine) is not your friend. Alcoholic drinks are full of sugar and high in calories. One 4-oz. (half-cup) wine or beer per day is the limit. 1.5 oz. for spirits.
  • If you slip up, it’s not the end of the world. Start fresh the next day. Just don’t give up.
  • Bariatric surgery is a highly risky last-resort. But it does work, and may be less risky than years of obesity,
  • Oh, and drink plenty of water.

“My body has changed, so I’ve got to change with it. I can’t do what I did 20 years ago and expect to stay slim,” says nutritionist and co-author of The Full Plate Diet Dr. Diana Fleming in this article.

Staying fit and trim after menopause is no picnic, but feeling healthy, capable, and in control of your life is worth every uneaten ounce of chocolate.

 

 

Weight Gain: Dirty Menopausal Trick

As if the hot flashes, mood swings, night sweats, and sexual challenges weren’t enough, now you can add weight gain to the menopausal whammy.  

That’s right. In case you hadn’t noticed (fat chance!), women tend to gain about 10-15 pounds on average—from 3 to 30 pounds is the typical range—during and after menopause. And because our entire metabolic mechanism is different now, that weight is blessedly hard to take off.

“I feel like my body has betrayed me,” said one of my patients.

“Prior to menopause I was able to maintain a weight loss of 70 pounds. I see that 25 pounds have come back and nothing I seem to do is helping,” said another woman.

Weight gain during menopause isn’t totally related to “the change.” Lifestyle, genetics, and, yes, hormonal fluctuation all play their respective roles, for better or for worse. But the weight goes on, and the way that happens is different from weight gain in previous years.

So, if you’re accustomed to losing weight easily—or not gaining it in the first place—this development may come as a puzzling and unpleasant surprise. And if you struggle with your weight, be forewarned: The deck is about to be reshuffled, and that struggle may become harder yet. The single bright spot is that you’re in a very big boat with a lot of other menopausal gals—up to 90 percent of us gain weight during this transition, according to this article.

Menopausal weight gain is different because:

  • It’s slow and steady—one or two pounds per year. Not enough to really notice, but the cumulative effect sneaks up on you.
  • It accumulates attractively around the abdomen. Belly fat. The kind that’s linked to heart disease and diabetes.
  • Breasts are bigger and the back is fattier. This might be nice for those of us who’ve always been lacking in that department, except that now, accompanied by a slowly enlarging belly, not to mention the back fat, the overall effect is less than flattering to our contemporary visions. And for those who were always well-endowed, well, a little (or a lot) more may simply be overkill.
  • It’s hard to lose. While “hard to lose” is a functional definition of weight gain, this is different because it’s part and parcel of a more profound change in how your body processes energy.
  • Body shape changes. Previously, you may have been a string bean or a curvaceous plum. Now you’re a round apple.

In order to effectively tackle this unsettling turn of events and to grasp why the things you did before aren’t working now, it helps to understand the underlying mechanism.

For one thing, muscle mass, which is an efficient burner of calories, slowly decreases with age. Now, even your resting metabolism (when you aren’t active) is lower. Adding insult to injury, loss of estrogen compounds this effect. Studies of lab animals suggest that estrogen has a regulating effect on appetite and weight gain. Animals with lower estrogen levels ate more and moved less.

When the ovaries stop producing estrogen, fat cells tend to take over. Ovaries produce estradiol, a “premium” estrogen; fat cells produce estrone, which is a weak, inefficient estrogen. This hormonal change increases the body’s efficiency at depositing fat, especially, we find, around the abdomen.

What used to work in the past may not now.A recent study confirmed that certain proteins and enzymes that enable cells to store more fat and to burn it less become more active in post-menopausal women. “Taken together, these changes in bodily processes may be more than a little surprising—and upsetting—for women who previously had little trouble managing their weight,” comments Sylvia Santosa, assistant professor in Concordia University’s Department of Exercise Science in this article.

You got that right, sister.

Menopause packs a couple more weight-inducing changes: insomnia and stress. When you don’t sleep well (and who does, what with night sweats and cratering mood swings?), levels of ghrelin, known as the “hunger hormone,” rise and levels of the “fullness hormone” leptin drop. That’s why you get the nighttime munchies. A study of over 1,000 volunteers (The Wisconsin Sleep Cohort Study) found that those who slept less had higher ghrelin levels and lower leptin levels—and also had a higher body mass index (BMI), i.e. they weighed more.

And we all know what stress eating does to our waistline.

So, what’s a stressed-out, sleep-deprived, menopausal woman to do? It’s a challenge, without doubt. However, when we understand the mechanism—what’s happening to our bodies on a biological level—then we realize that doing what we did before isn’t going to work. We need to change up the paradigm if we want to control our weight and maintain a healthy, active post-menopausal lifestyle.

This paradigm shift involves a different approach to both diet (Note: I did not say dieting!) and exercise. No magic pharma pill or painless regimen. Still, we can regain control of the bathroom scales despite the slings and arrows of our slowing metabolism and estrogen-storing fat cells. And honestly, we might end up with better health habits than we ever had before. 

I Will {Heart} my Heart

Resolution #3

This is the tough one, ladies, but it’s also the most important. Cardiovascular disease (heart attack and stroke) is the #1 killer of women today. One in 3 women die from it. By comparison, 1 in 8 women die from breast cancer.

The news gets worse: about 44 million women in the US are affected by cardiovascular disease right now. Ninety percent of us have at least one risk factor, such as high blood pressure, diabetes, smoking, or being overweight. We are less likely than men to survive our first heart attack.

Fortunately, perfection isn't required.But the really good news is that 80 percent of cardiovascular problems can be prevented by knowledge and lifestyle change, according to the American Heart Association (AHA). The other bright spot is that improving heart health also improves our brain health, because good brain function relies on good cardiovascular function. And we know that as we age, we are at higher risk for various dementias.

It’s important to honestly tackle those lifestyle changes right now because as we age, our risk factors for heart disease increase: cholesterol and blood pressure tend to rise; we tend to gain weight; sleep may be more difficult. So time, very literally, is of the essence.

Unfortunately, lifestyle change of the type required for good cardiovascular health is hard. Honest, systemic lifestyle change demands consistency, and self-discipline, and this is hard. Few among us achieve perfection when it comes to an overall health care regimen.

Fortunately, perfection isn’t required. Getting started and sticking to it is.

To get started, assess your current baseline. These are the most important numbers:

  • Total cholesterol less than 200 mg/dL
  • HDL (good) cholesterol 50 mg/dL or higher
  • LDL (bad) cholesterol less than 100 mg/dL
  • Triglycerides 150 mg/dL
  • Blood pressure less than 120/80 mm Hg
  • Body Mass Index less than 25 kg/m2 (Find your BMI here.)
  • Waist circumference less than 35 inches

Second: discuss your numbers with your doctor to get your marching orders: hash out what to focus on; what is possible, and how best to begin, especially regarding an exercise regimen.

And third: Get started! Every one of those important numbers measuring cholesterol levels, blood pressure, blood sugar levels, and weight can be moderated or controlled through diet and exercise. That’s it. A clean, heart-healthy diet and regular moderate activity could extend your life and help you to avoid the serious consequences of heart disease. Plus, you’ll feel better, experience less pain, and be more flexible.

This is a once-in-a-lifetime deal.

A heart-healthy diet for a woman over 50 should rely heavily on fresh fruits and vegetables, lean meat and lots of fish, whole grains, and unsaturated fat, such as olive oil. Cut way back on salt, sugars of all sorts, saturated and trans-fats.

Cook your own food so you know what’s in it. Processed foods are full of sodium and unpronounceable additives. Make eating out a rare treat.

Both Weight Watchers and the Mediterranean diet get high marks from nutritionists as being heart-healthy, not too restrictive, and easy to follow—thus good candidates for a successful lifelong change.

Drink lots of water (we lose the tendency to feel thirsty as we age) and take your multi-vitamins and supplements, such as calcium and vitamin D, as advised by your doctor. Here’s a ton more diet information from the AHA’s Go Red for Women campaign.

Exercise is the second leg of cardiovascular good health. It’s hard to overestimate the benefits of regular, moderate activity—it regulates blood pressure, strengthens your heart and other muscles, increases bone density, and improves your mood.

The trick with exercise is to get started and to keep going because you will use every distraction in the book to procrastinate. It doesn’t have to be hard or expensive. A brisk, 30-minute walk 5 times a week—that’s all! Start with 10 minutes if you’ve been sedentary, but keep challenging yourself.

If you live in an area with cold winters, you can walk in the mall or do cardio workouts at home with some of the very good fitness videos available online. Here’s a beginner workout from the inimitable Jane Fonda, who imparts salty health advice along with encouragement. Here’s a no-nonsense and very comprehensive set of workout programs to explore once you’ve built up some stamina. Stick with low-impact workouts, warm up thoroughly, and don’t overdo. Steady, consistent progress is better—and safer—than a jackrabbit start.

Finally, stop smoking. Not negotiable. Smoking adds incredible risk to your health. Do whatever it takes to eliminate nicotine from your life.

It’s January. This is a good time to seriously take charge of your health. Imagine how incredible you'll feel after spending the entire year working out and eating clean. Imagine actually witnessing the change in those numbers. Buckle up for a life-changing year.

 

 

 

Just a Perfect Day

If you could plan out a perfect day, what would it look like?

Two researchers explored that question in a study, “Developing a Happiness-Optimized Day Schedule,” published in the Journal of Economic Psychology. The researchers, Christian Kroll and Sebastian Pokutta, took data on how a large number of women spent a typical day and how much they enjoyed each activity. Then they had some fun with the numbers.

Subtracting 8 hours for sleep, they were left with 16 hours to divide up, minute by minute, into a day that would offer the most pleasure and satisfaction. Here is what they came up with:

  • 106 minutes “intimate relations”
  • 82 minutes socializing
  • 78 minutes relaxing
  • 75 minutes eating
  • 73 minutes praying or meditating
  • 68 minutes exercising
  • 57 minutes talking on the phone
  • 56 minutes shopping
  • 55 minutes watching TV
  • 50 minutes cooking
  • 48 minutes using a computer
  • 47 minutes doing housework
  • 46 minutes taking a nap
  • 46 minutes childcare
  • 36 minutes working
  • 33 minutes commuting

Some journalists joked about these oddly precise numbers. Simon Kelner asks whether a perfect day is different for men (likely answer: yes) and recalls Lou Reed drinking sangria in the park in his classic song.

But the researchers’ method actually makes sense. They write, “Our research asks what a perfect day would look like if we take into account the crucial fact that even the most pleasurable activities are usually less enjoyable the longer they last and the more often we do them.”

Imagine doing a jigsaw puzzle for twelve hours straight. If you like jigsaw puzzles, you would enjoy the first hour or two, especially if you don’t do jigsaws every day. But over time it would get way less fun.

Using that idea, the researchers took 16 common activities and allotted a number of minutes to each one, so that the last minute of each offered an equal amount of happiness. The more pleasurable the activity, the longer it took for the pleasure to diminish enough to match the others.

True, anyone who tried to follow the suggested schedule would go berserk. That wasn’t the authors’ intention! It’s a thought experiment: a way to think about what’s most important for an individual or a society. As the researchers point out, their computation “differs considerably from how people usually spend their time.”

If I use myself as a test case, I ask: Only 36 minutes of working? Fortunately, I love my work. I hope my perception of pleasure throughout a whole day of seeing patients is not an illusion. And 56 minutes of shopping? That’s not at all attractive to me as a daily activity.

But the study encourages us to be intentional with what we do with our precious time. The six activities at the top of the list, which the women enjoyed the most—intimacy, socializing, relaxing, eating (eating well, we hope), praying or meditating, exercising—are all vital to health in body or mind. We can think of each one as a different color thread, and make sure to weave them all through our days—with intentional planning of time for our relationships, for example.

We will be happier, and so will the people we love.

A New Way to a Better You

As we mentioned last time, 47 percent of New Year’s resolutions are related to self-improvement—losing weight, quitting smoking, getting organized, or saving money. “Improving sexual health and wellbeing” doesn’t make the list (at least not the one in this study) but we think they should.

Because—let’s face it—chances are, they won’t magically get better on their own.

They used to, though, didn’t they? Or it seemed like it. Over the course of our relationships, all of us have probably experienced sexual desire come and go, as we went through things like pregnancy, health-related issues (for us or our partners), and times of stress. Looking back, we remember that desire always bounced back, as it does for most people who are generally healthy and on the young side of middle aged.

But at this stage of the game, how long should you let it go, hoping it will self-correct, before resolving to do something about it? Our take: Not long. Start now. You’ve got nothing to lose and so much to gain in the area of self-improvement.

Although we may not think of intimacy and sex falling into the “self improvement” category, it actually does. Do you want to lose weight? Be healthier? Feel better about yourself? Then get busy, sister, because having sex can help in all those ways. Equally as important is that when sex is good, as you’ll recall, it adds 15 – 20 percent additional value to a relationship; when it’s bad or nonexistent, it drains the relationship of positive value by 50 to 70 percent.

Make 2015 the year that you make a concerted effort at doing what it takes—kegels for better muscle tone, a vaginal moisturizer as part of your skin-care routine, lubricants or a vibrator to add some spice, an honest conversation about foreplay with your partner—to get your game on in the bedroom. Don’t just say you will; make it your New Year’s resolution. Research shows that if you make a resolution, you’re 10 times more likely to have been “continuously successful” at six months than if you don’t. Good luck and Happy New Year!

Lifestyle Choices for Breast Health

You know that silly song about the thigh bone being connected to the hip bone—and so on?

Well, the kernel of truth in the ditty is that, when it comes to health and our bodies, things are indeed beautifully and intricately connected.

You can’t do healthy things for your thigh bone—or your heart or your sex life—and not have it affect other corporal systems as well. So, while we might focus on breast health in honor of Breast Cancer Awareness Month, rest assured that healthy, cancer-free breasts involve habits and choices that are good for the rest of your body as well.

There’s a lot to celebrate when it comes to breast cancer, like steadily decreasing rates since the year 2000. But we still have a long way to go. About 12 percent—1 in 8 women in the US—will develop invasive breast cancer sometime in her life. Our most significant risk factors are 1. being a woman and 2. being older.

Women over 55 account for two-thirds of invasive breast cancers diagnosed each year. This is because, over time, we tend to accrue genetic mutations, and with age we’re less adept at repairing them.

Those are the facts. But we don’t have to helplessly wait for the shoe to drop. We can make lifestyle adjustments that will lower our risk of getting this cancer and improve our overall quality of life, including our sex life. (And don’t forget that a healthy sex life is also good for our health.)

Because it’s all connected, right?

So here are lifestyle changes that you can make specifically targeted toward breast health:

Maintain a healthy weight. Being overweight or obese—those with a body mass index (BMI) over 25—increases one’s risk of developing breast cancer, especially in postmenopausal women. This could be because estrogen is stored in fatty tissue, and women who have more fat are also exposed to higher levels of estrogen, which has been undeniably linked to breast cancer. But other issues related to obesity may also be involved, such as insulin and glucose levels. Some estimates suggest that 17 percent of breast cancers in North America could be avoided simply by maintaining a healthy body weight. Check out this page for a solid, common-sense approach to weight loss.

Eat healthy food. Not only will a healthy diet help maintain a healthy weight, but it’s a critical component to avoiding cancer. Some foods contain properties that help repair the wear and tear to our bodies in the normal course of life. These “super foods” contain antioxidants that help protect our bodies from cancers.

The link between food and cancer isn’t always straightforward or well-understood, and dietary fads change with the season. Basically, though, the approach to healthy eating remains the same: eat a variety of foods with an emphasis on fruits, vegetables, and whole grains. Avoid processed foods. Avoid fats and sugars. Above all, avoid super-sugary beverages, which are directly linked not only with obesity but also with some forms of cancer.

Finally, eat fresh and eat at home. (You can’t control what goes into your food at a restaurant.) Eat organic foods to avoid exposure to synthetic chemicals.

While the voices touting various diets and food fads are myriad, confusing and contradictory, here are some basic food facts from breastcancer.org. The USDA also has a website with tons of food and diet information here.

Exercise. Weight, diet, and exercise. This is the trifecta of good health. Some well-regarded sources say that 30-40 percent of cancers could be avoided simply with these healthy lifestyle choices. That’s staggering. And when you add in quality of life factors that come with the trifecta, well, it’s overwhelmingly worth the difficulty of losing weight, eating well, and exercising regularly, wouldn’t you say?

Regular, moderate exercise can lower your risk of breast cancer. Not to mention all the other good things you get with exercise, such as better mood, cardiovascular and joint health, greater stamina and flexibility, better sleep, better bones, and more regular bowel movements. What are we waiting for?

Even women who have already been diagnosed with breast cancer may improve survival rates or prevent recurrence with moderate exercise, like walking only 4-5 hours per week, according to the American Cancer Institute.

Don’t have time? As the trainers in my exercise video say, “Make time.” It doesn’t matter what your physical ability is right now—just start slow and keep on going.

Don’t drink. Sorry to be a killjoy, but the more you drink, the greater your risk. A woman who has three alcoholic drinks per week is 15 percent more likely to get breast cancer than a woman who doesn’t drink at all. If you’re on hormone replacement therapy or if you’ve already been diagnosed with breast cancer, you should be one of those non-drinking women.

What about that healthy glass of red wine? Sorry, it all counts. The benefit of red wine doesn’t outweigh the risk. If you’ve never had breast cancer, just don’t drink every day, but if you have risk factors, switch to non-alcoholic options.

Don’t smoke. This almost goes without saying. Yes, the major risk is lung cancer, but actively smoking as well as exposure to second-hand smoke increases the risk of breast cancer in premenopausal smokers. Plus, women who smoke have greater difficulty recovering from breast cancer treatment.

Avoid chemical exposure. This is like trying to dodge raindrops, given the chemical soup we live in every day. And most of the chemicals in our environment and in the things we use have never been tested for toxicity or carcinogenic properties. Some types of chemicals are known to be hormone-disrupting, which alter the way our natural hormones function. Research is ongoing about the way these substances work and their link to possible cancers, but the connection isn’t well understood.

In the meantime, how do we negotiate the reality of the world we inhabit without neurotic overreaction but also without putting our heads in the sand? Of greatest concern with regard to breast cancer are those chemical with hormone-disrupting properties, including those in pesticides, growth hormone residues in meat and dairy products, and certain plastics.

In general, some precautionary practices would be to

  • Buy organic food. Here’s a list of the “dirty dozen”—the foods that have the highest levels of pesticide residue.
  • Plant a garden. Put up your own food.
  • Use fewer and simpler cleaning and personal care products. Look for certified “green” cleaning products (with GREENGUARD or EcoLogo insignias, for example) or make your own.
  • Don’t use pesticides on your lawn or garden.
  • Use BPA-free plastics or glass or stainless steel jars and bottles. Avoid #3 (PVC), #6 (polystyrene) and #7 (polycarbonate) plastics, which are linked to breast cancer.
You may not be able to tackle everything on this admittedly intimidating list, but it’s better to make a few changes than not to do anything at all. And the foundation you lay now will become even more important in maintaining health and functionality as you age.

Q: How afraid of menopause should I be?

You refer to hot flashes, weight gain, mood swings, and loss of libido as symptoms of menopause, and all of those happen for some women. Menopause doesn't equate absolutely to those symptoms for everyone, though; each woman's menopausal transition will be unique to her. Not every woman has every symptom, and even those women who share a symptom may experience it differently. About two-thirds of women have hot flashes, for example, but for some it means loosening a top button and for others it means running for the ice cubes!

What I've seen in my practice is that the healthier you are overall, the easier the transition is likely to be for you. That means being as close as you can manage to your ideal weight, eating well and nutritiously, exercising regularly, and getting enough sleep. My motto for women at our age: "You're now high maintenance, so you need to behave that way!"

The good news is that the healthy habits that help you through menopause also enrich the rest of your life, so you can be as active as you choose to be for longer. And being well-informed about what's to come will help you be calm and adaptable, which will also help keep symptoms managed.

If you'd like some company along the way, subscribe to this blog or our twice-a-month newsletter or like us on Facebook. And talk to your women friends! We can learn a lot from each other about how we're compensating for the changes we'll all go through.

This Doctor Still Wants to See You

The new medical guidelines and what they mean for you.

Every year, you used to visit your ob/gyn for a Pap test and pelvic exam. Then you’d get your mammogram. Some ladies I know made it a “girlfriends date” and went out to lunch after their mammos.

It was like getting your healthcare seal of approval. All’s well with the world. See you next year.

Now the “guidelines” have changed. You’ve heard that you don’t need these tests every year. In fact, depending on your age and health status, you may not need them any more at all.

Wait, what? Who re-arranged the furniture? What does this mean?

And more to the point: What happens to the girlfriends date?

With a slew of new guidelines from the American Cancer Society and the American College of Obstetricians and Gynecologists (ACOG) and the US Preventive Services Task Force, it’s no wonder you’re confused. One year? Three years? Beginning at what age? Ending when?

These guidelines reflect new thinking and research, not the removal of a time-honored safety net. You won’t be at greater risk—you just may not need the same tests on the same schedule. Also, different professional groups have come to slightly different conclusions about how often these preventive tests should be administered.

So, while it’s helpful to be aware of these changes, it’s also critical to discuss them with your own healthcare provider. Because your healthcare situation is unique, and guidelines are one-size-fits-all, the schedule has to be tailored to fit your specific needs. You and your doctor are the best ones to make that decision.

Here’s what some of the discussion is about.

The value of an annual physical, which ACOG also refers to as a “well-woman visit,” is that your doctor can examine and assess your overall level of health and can check for changes or abnormalities. A regular visit also keeps intact the relationship between you and your doctor. After all, it’s important to trust this person when healthcare decisions need to be made.

During your annual physical, your provider may do a pelvic examination. Herein lies some confusion. A doctor may, and often will, do this exam without a Pap test. A pelvic exam allows the doctor to take a thorough look at your external genitalia and to digitally (yes, with a finger in your vagina or rectum) examine your cervix, uterus, and other internal organs.

In its new guidelines, ACOG recommends an annual pelvic examination in women over 21. But the guidelines also state that, while an annual pelvic exam “seems logical… No evidence supports or refutes the annual pelvic examination or speculum and bimanual examination for the asymptomatic, low-risk patient.”

Translation: in the absence of symptoms, the final decision is up to you and your doctor. Pelvic exams are also important if you have any pain, discharge, bleeding, or change in bowel or bladder function. Your doctor needs to know about any of these issues.

As for the Pap test—you probably know that it only screens for cervical cancer—it’s been a very effective tool in that regard. But many women don’t need screening for cervical cancer anymore—if they no longer have a cervix, if they’ve had several normal pap tests and don’t have a lot of sexual partners.

Be aware, however, that there are other cancers of the genitals and reproductive organs, and I’ve occasionally found them during a pelvic exam: You’d better believe I still recommend an annual physical that includes a pelvic exam for my patients.

The guidelines for mammograms are even more confusing. The American Cancer Society still recommends annual screening after age 40. However, the US Preventive Services Task Force recently revised its guidelines after analyzing data extensively, to screenings every two years for women over 50. Women over 74 no longer need mammograms, according to the Task Force.

Meanwhile, physicians routinely do manual breast exams in their offices. That’s the kneading, palpating exam the doc performs to check for changes and lumps. While ACOG and other organizations still recommend a clinical breast exam every one to three years, the US Preventive Services Task Force says that “current evidence is insufficient to assess the additional benefits and harms of clinical breast examinations….”

So, what’s a woman to do?

Again, talk with your doctor. It’s good to be informed about changing guidelines and protocols. These changes only mean that research is ongoing and the body of knowledge is increasing. But you have unique risk factors, heredity, health issues, fears, lifestyle choices, and preferences. The best way to make sense of the guidelines is to discuss them with your provider in light of your personal situation, and then come to a conclusion that you’re both comfortable with.

A Breakthrough in Breast Cancer Research

Breast cancer doesn’t really have much in common with sex. But I know it's hard to be very interested in sex when you have cancer or are recovering from cancer treatments or are working to feel good about your body again after having had cancer.

However, anyone interested in staying vibrant and healthy (not to mention sexy) should be interested in the breakthrough research on breast cancer just announced in the journal Nature.

Turns out, genetic mutations caused by cancer and the unique genetic “fingerprint” they leave may be the new frontier for cancer treatment and could suggest treatments targeted to specific genetic mutations.

This research, which is the scientific equivalent of putting a man on the moon, is an outcome of the Cancer Genome Atlas, a federally funded study to map genetic changes caused by common cancers. Breast cancer is the third (after colon and lung cancer) to come under intense analysis, with several hundred researchers tracking the genetic changes caused by unmetastized tumors from 825 women.

As a result, four new subtypes of breast cancer based on 30 to 50 genetic mutation have been identified, which suggest new approaches to treatment and also explains why some one-size-fits-all treatments may not work.

“When treating breast cancer, we offer specific therapies that have been tested on large populations of cancer patients,” said Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City in an article for HealthDay News. “…This research helps move us to the point where we will look at a tumor's genetic makeup and tailor a specific treatment that will attack the tumor cells based on the tumor's genetic fingerprint.”

This research may alter cancer treatments by

  • Basing treatment on the genetic signature of the cancer rather than its location in the body. For example, one of the less common but most deadly breast cancers is genetically very different from other breast cancers but very similar to ovarian cancer, suggesting that treatment for this breast cancer could also be similar to that for ovarian cancer.
  • Avoiding unnecessary, ineffective, and potentially harmful treatment. For example, one of the most common cancers, whose growth is fueled by estrogen, was routinely treated by an estrogen-blocking drug. The genetic study identified two different types of this common cancer, which suggests more targeted treatments. So, besides receiving appropriate treatment, cancer patients may also be able to avoid potentially harmful treatment. “Targeted therapies allow for more effective treatment of tumors, while minimizing the treatment of tumors with less effective therapies and their subsequent side effects,” said Dr.Bernik.
  • Suggesting new avenues for research. When these subtle genetic differences are identified, new research and treatments can begin. For example, some women with the same HER2-enriched gene respond to treatment by the drug Herceptin, and other women don’t. Now, ongoing clinical trials will try to identify the differences in the genetic makeup of the HER2 tumor that may explain the different responses to treatment.

While this research may be seismic for oncologists, it will be years before the laborious process of testing and approvals are complete and we begin to see the results on the ground and in our doctors’ offices.

Still, this affirms the need for informed, individual health decisions, weighing all factors, instead of applying one-size-fits-all thinking. And, taking the long view, this is great news for our daughters and granddaughters.

What I'm Thankful For

Feeling gratitude and not expressing it is like wrapping a present and not giving it. —William Arthur Ward

The good thing about holidays is that they give us an opportunity to reflect (if we’re not too busy preparing for them) and to cultivate good old virtues, like generosity and gratitude. Holidays encourage us to express things, like love and appreciation, that we don’t get around to in the normal course of daily life.

Thanksgiving, of course, is a time for gratitude.

So this holiday gives me a great opportunity to tell you that I’m really grateful for the many people who support and value the work we do here at MiddlesexMD. This work wouldn’t be possible without all you supportive people.

Six years ago I refocused my clinical practice to serve the sexual health needs of women in midlife because I discovered that so many of us were struggling with the physical and sexual changes brought on by menopause. Women, I learned, needed advice and guidance but didn’t know where to look for it.

Now, MiddlesexMD has its own website, newsletter, and blog. We have an online boutique with an array of tasteful, helpful, and woman-tested products to help keep the sexual flame alight. In fact, we’ve become one of the go-to resources nationally for information about sex at midlife.

That’s pretty impressive, if you ask me.

There are only two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle. —Albert Einstein

As I see it, MiddlesexMD is sort of a miracle. The amazing thing is that so many people are involved, interested, and in so doing, have contributed to its success. We have a small army of people who spread the word about what we’re doing, and give us support, encouragement, help, and advice along the way.

We turn to members of our MiddlesexMD advisory board frequently on this blog. We have a fabulous board whose members represent some of the leaders in the field of female sexual health. Despite their own busy practices, they’re always willing to share their expertise with MiddlesexMD readers. So—members of our great MiddlesexMD advisory board—thank you!

We also have a creative and hardworking internal team that plans, organizes, and runs all the disparate parts of this venture and helps to keep me sane and focused. I’m incredibly grateful to the amazing team that operates behind the scenes. MiddlesexMD wouldn’t be here without you.

Gratitude can transform common days into thanksgivings, turn routine jobs into joy, and change ordinary opportunities into blessings. —William Arthur Ward

Finally, no foray into social media is successful unless people spread the word. MiddlesexMD is successful because other practitioners tell their patients about our site and because readers “like,” tweet, "share," and tell their friends about us.

To all of you who spread the word—thank you so much. And don’t stop!

Gratitude is a vaccine, an antitoxin, and an antiseptic. —John Henry Jowett

Finally, let me leave you with a little Thanksgiving Day doctor-ish prescription. (You knew this was coming.)

Studies repeatedly link gratitude with higher levels of satisfaction with life. Grateful people are happy people. They pay attention to the positive stuff. They focus on the good and deal with the bad, sad, or difficult when it comes along. This isn’t denial or wishful thinking. It’s a choice that gradually becomes a habit.

So, along with a healthy diet and regular exercise, I’m prescribing a dose of gratitude every day before breakfast. It’s cheaper than pharmaceuticals, and who knows, it might even make sex better, too.

What are you grateful for right now? Who makes your life joyful? Have you told that person how you feel?