Posts made in April, 2010

Are you an ‘old bag?’ An open letter to a reader.

Posted by on Apr 30, 2010 in Uncategorized | 19 comments

Evidently if you are over 40, you are at risk of becoming one, especially if you are not ‘nice to men.’

I was struck and a bit stunned by a reader comment that I received this week. The comment was in response to a post about the Cougar Convention, and made a point to denigrate women as much as possible.

This is what Jimbo wrote:

Yes, most all women are desparate. Look how they dress. Look at the makeup. Look at what they show off. It is obvious. They are desparate for sexual attention. Yet, they want the attention as if they are in control and giving themselves as a gift. This is a none truth. Women need to get real and look at themselves and their own behavior. They are desparate for sex and men.

When women get to be 40+, they start to get honest. Heck, there is not much time left to pretend. They need to find a man and be real nice to him before they turn into old bags.

A number of readers have responded to Jimbo’s comment, obviously taking offense. I chose to leave Jimbo’s comment up up for the very reason that I don’t censor; afterall, Jimbo is entitled to his opinion. However, I would like to leave Jimbo with this:

Jimbo –

40 year-old+ women are sexy, beautiful and self-assured. They have lived long enough to have gained the wisdom to allow them to feel comfortable in their bodies. And have a tendency to embrace who they are, sometimes even more than their younger peers. Nevertheless, in all fairness, you responded to a post entitled “Pimp your hide,” in which I referred to certain women attending a convention that encourages them to use their sexuality to attract a younger man. This however, is the exception and not the rule; the majority of women I know do not have fake boobs or plumped lips and have not done liposuction. While many color their hair (present company included), don’t be surprised if you find them out and about without makeup or wearing jeans and a tee shirt. Or better yet, out with men their age or older. Yes, Jimbo, women don’t always ‘dress to kill.’

So, Jimbo, I’d like you to see what a soon-to-be 49 year-old looks like – at the gym and home, with or without make-up. I can assure you; I am not an old bag nor do I ever intend to be one.

What does your 40+ look like? Comment or send me a photo and I’ll post! Let’s make Jimbo eat his words.

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Wednesday Bubble: HRT and the “Window Hypothesis:” Hope or Hype. Guest post c/o The Better Health Blog

Posted by on Apr 28, 2010 in HRT | 4 comments

HRT and the Window Hypothesis. Sounds a bit daunting, doesn’t it?

I was awed and inspired by this post on HRT, which was written by Dr. Peggy Polaneczky and appeared on the Better Health Blog on April 21. As the author states, Pfizer (formerly Wyeth), the maker of Premarin, is working furiously to frame the HRT argument around the Window Hypothesis, which refers to the time period in which a woman must start HRT in order to fully gain its benefits. Is the Window real? Or another mother of all inventions to convince women that HRT is as necessary as a daily vitamin?

So, dear readers, I’ll leave it to you to decide. Despite the length of the post, I am including it in its entirety because the issue is so important. I’d also like to state that I am grateful to Dr. Val Jones, the founder and CEO of Better Health, LLC,  who has graciously granted me permission to repost the piece on Flashfree.

It’s only Wednesday, and so far three patients have come to their office visits carrying Cynthia Gorney’s article from Sunday’s New York Times entitled “The Estrogen Dilemma.”

The article explores the stories of three women who found relief from perimenopausal symptoms by using hormone replacement, framing the discussion in the larger context of what is being called the “window hypothesis” — the idea that starting estrogen replacement in the perimenopause and continuing it into later life may be neuroprotective and even cardioprotective, in contrast to beginning its use 10 or more years after menopause, where it can trigger heart disease, stroke and dementia.

The window hypothesis is one way of explaining away the findings of the Women’s Health Initiative, and goes something like this: “The WHI enrolled women who were too late into menopause to benefit from estrogen. If we had instead studied women starting estrogen at the right time, namely the perimenopause, we would have found that it protects against heart disease and Alzheimers.” Or as I explain it to my patients: “Think of it like exercise. If you work out vigorously and regularly from a young age, you can prevent heart disease. But take an overweight, out of shape 65 year old and have him/her run full out and you could trigger an MI.” (It’s a crude analogy, but it works.)

The Times article does a good job framing both the hope and the hype around the window hypothesis, and the dilemma it appears to pose for women entering menopause today, which is this: If you wait for data that proves the window hypothesis is right, by the time the results are in, you’re outside the window and it’s too late to start HRT. If you start HRT now and the hypothesis is proven wrong, then you’ve been taking medication with potential risks for years without any benefit. Or as author Cynthia Gorney so succinctly put it:

“If I make the wrong decision about this, I am so screwed.”

The pharmaceutical industry, particularly Wyeth, the maker of Premarin, is, not surprisingly, working hard to get the word out about the window hypothesis. Indeed, several of the researchers working on the hypothesis who are quoted in Gorney’s article have ties to Wyeth. At the risk of further hyping a hypothesis that may prove to be unfounded, I encourage you to read the Times article, and then take the time to peruse the intelligent discussion in the comments section. If anything it is testimony to just how well-informed the American public has become about HRT.

I myself have been hearing about the hypothesis for years now, but have yet to see definitive data to prove it.  Fortunately, there are studies in progress that may settle the question within the next few years. But even if the window hypothesis proves to be correct, it will not mitigate the risks of breast cancer that accompany long term estrogen use in the menopause. That risk remains, in my opinion, the biggest concern for my patients when it comes to HRT, and it is surprisingly downplayed in the Times article.

The biggest problem I have with the article is that Gorney’s experience with both menopause and HRT is anything but typical. Most women get through the transition without major mood issues, although crankiness and irritability are common, especially in women who are not sleeping because of night sweats. When true depression hits, as it did for Gorney, antidepressants are needed, with or without HRT (Gorney takes both). I have seen the occasional woman who declares “I am back!” after starting HRT, and one particularly memorable patient whose depression was cured, but this is the exception, not the rule. Most perimenopausal women who take HRT are just relieved to be able to sleep through the night or get through a meeting without hot flashes.

But most importantly, what does Gorney’s individual experience with HRT and mood have to do with the window hypothesis? She is not taking HRT to prevent Alzheimer’s or heart disease, she is using it to augment the effects of her antidepressants. The whole window discussion thing is distracting from the real question at hand for her, which is sinply this: How long should she take HRT? That depends, not on whether the window hypothesis is true, but on how she feels when she tries to stop taking HRT.

If I were Gorney’s doctor, I’d be focusing her off the window hypothesis and onto why she is taking HRT in the first place — for emotional well-being. Now that it’s been a few years on the stuff, I’d say, let’s lower your dose and see how you do. If you do well, then stay on that dose for 6 months to a year, then go off and see if you still need it. Based on Gorney’s experience with occasional missed patches, I’ll predict she’ll still need HRT, but will be able to get away with a lower dose. But if she feels just as well off HRT, then I would advise her to stay off. Do everything else she can do to prevent heart disease – diet, exercise, low salt, get enough sleep (you know the drill.)

As for using estrogen to prevent Alzheimers, well, that’s a big leap of faith that I for one am not yet ready to take.  Which does not mean that I don’t have an occasional patient (usually a scientist) taking HRT because she hopes it will prevent Alzheimers. Such women, in my experience, are much less worried about breast cancer than about cognitive decline, in an attitude similar to that of Julia Berry, one of the women profiled in the Times article, who had this to say:

“I could have my breasts removed. I like them. But they’re not my life.”

Recent data suggests that Berry may not need to make this Sophie’s choice between her brain and her breasts. The mental confusion so many women experience in perimenopause may in fact resolve itself once we come out the other side, irrespective of hormone use. This suggests that it is the widely swinging hormones of perimenopause that pose the most trouble for women, but that once things settle down, so do we.

Now that’s a window hypothesis you won’t hear Big Pharma talking about.

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Little Girl Blue

Posted by on Apr 26, 2010 in depression | 0 comments


Depression in the perimenopause and postmenopausal years is no joke. I’ve written about it several times on this blog and will continue to do so until experts figure out an effective, acceptable strategy for combating the blues.

As I’ve noted before, researchers are not quite sure of the exact reasons for the depression surge during the transition,  (e.g. dramatic surge and declines in hormones, vasomotor issues, sleep issues, life stress and prior history). However, they do acknowledge that many women tend to suffer the blues during this time.

In the latest bit of research, published in the online edition of the journal Menopause, researchers found that over 40% of women studied (out of a pool of 685) suffered from symptoms of depression. What was more interesting, however, is that depression was almost twice as likely to develop in the peri/post menopausal stages than before menopause. (Note that other studies have found this likelihood to be as high as 4 times during the perimenopause). Moreover:

  • Women who reported having had experienced some sort of negative event in their were 3.6 times likelier than those who hadn’t to develop depression
  • Weight appeared to play a role, with obese women twice as likely as those of normal weight to develop depressive symptoms

Although I’ve discussed some potentially effective strategies for combatting the menopausal blues (e.g., exercise, chamomile, antidepressants, red clover, St. John’s Wort, soy isoflavones), none are a quick fix or a ‘one size fits all.’

Personally, I’ve noticed that fluctuating hormones coupled with elevated stress tends to heighten depression at specific times, while at other times, it’s easier to deal with. Pile it on and well, I become a pile of mush. My strategy entails an insane amount of physical activity, deep breathing, therapy and admittedly, some medication. Still, I’ve found that while I can usually keep the blues at bay, they do tend to crop up at the most inopportune moments.

What do you do to chase the blues away? Have they gotten worse or stayed the same during your transition? What advice do you have to offer for other readers? I’d love to hear!

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Want your brain back? How about an exercise in sustainability? Andrea Learned explains…

Posted by on Apr 23, 2010 in memory/learning | 2 comments

Remember your Brain on Midlife? Perhaps not! But my pal Andrea Learned wrote a wonderful piece on her blog the other day that I’m stealing. (Well, not really stealing since Andrea, god bless her, has granted me permission to repost it on Flashfree). The theme is sustainability and the gist, that we might be able to boost our midlife brains and preserve all those precious bits of information that seem to swirl around endlessly and never land in the same place. Thanks for the post Andrea!

As a mid-40-something myself, I took heart in an interview Terry Gross did with author Barbara Strauch on NPR’s Fresh Air the other day.  In talking about her new book, The Secret Life of the Grown-up Brain: The Surprising Talents of the Middle-Aged Mind, Strauch mentioned a few brain science backed facts that bode well especially for those of us “middle-agers” entering into this whole new world of sustainability.  It also made me think we have but one more case to make for any business that is lagging in their efforts on that front.

While I have not yet read the book, following are two points Strauch made in that interview, and why I think there may be sustainability implications:

1) Bi-lateralization.  Younger people tend to use one side of their brain to learn and another to recall.  But, as people age, their brains are more likely to use both sides of the brain to do both tasks.  Along similar lines, research into how women make purchasing decisions, too, cite a more “holistic” process of integrating the linear (left hemisphere thinking) with the relational (right hemisphere thinking).  The sustainability angle?  To think and engage with sustainability, you’ve got to be able to get your brain thinking more bi-laterally.

2) Exercising your frontal cortex.  One way to keep your brain highly functioning is to push it, by doing such things as: “creating a disorienting dilemma,” confronting ideas that are different from your own, or, talking with people with whom you disagree. All of these “challenges” sharpen your brain.  The sustainability angle?  For a lot of business types (and consumers, as well), thinking sustainably is indeed a “disorienting dilemma.”

The connections my own perhaps overly active brain made were these:

– While we’ve got to love what the younger generations bring to the table in terms of passion and enthusiasm for sustainability, we middle-agers may have brains that predispose us to better see all sides of the story and the mission.  Like the younger generations, we are very excited about green for green’s sake and want it to happen NOW.  However, we have the more holistic view that helps us step back and possibly make compromises in order to get to that longer term sustainable ideal.  We are more allowing of the long journey, because we’ve been on it longer.

– It isn’t just me and my marketing to women background.  It makes sense that the way women more naturally think aligns with how we sustainability-advocates would like all business people to start to think – more holistically and more EVERY stakeholder-aware.  What can we all learn from that realization to move sustainability forward?  I believe that women’s buying ways are a great filter both for understanding the sustainably-minded consumer and for training business brains to integrate sustainable practices.

– Finally, being IN the sustainability field is great exercise for our brains!  It automatically puts us in disagreement with a whole host of conventional business thinkers.  It forces us to learn new things almost moment to moment.  If we’ve got long experience in business done the old way, sustainability can be incredibly disorienting .  If all the other fascinating ideas and solutions that come from thinking sustainably weren’t enough, we can selfishly and simply give our own brains major frontal cortex exercise!  (Maybe Barbara Strauch will write her next book about the amazing ways our brains end up changing culture?)

Needless to say, those of you who have been reading my work for years know that my throwing out something new to ponder is par for the course.  I wonder if my brain knew I needed to get into sustainability long before I actually acknowledged it?  Anyway – your counterintuitive “Learned On” lesson for the day is that middle age may well help you engage with and understand sustainability better.  Now, go out and use that oh-so wise brain to make your company smarter too!

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Wednesday Bubble: herbs and breast cancer

Posted by on Apr 21, 2010 in breast cancer, herbal medicine | 1 comment

Can herbal medicines used for hot flashes, namely black cohosh and phytoestrogens, be safely used in women who’ve had breast cancer?

If you’ve had breast cancer, you’ve probably been told to stay away from herbal medications, right? Yet, women who’ve had breast cancer know that hot flashes are a common side effect of many cancer therapies. Research also suggests that the older a woman is at the time she receives chemotherapy, the more likely she is to develop menopause as soon as treatment stops. Moreover, roughly 80% of women taking Tamoxifen have hot flashes and about a third of those women rate them as severe. Hormones are not even an option due to the increased breast cancer risk.

The good news is that an extensive analysis of scientific studies shows that black cohosh might be safe for women who have had breast cancer. Although the researchers note that the evidence for the effectiveness of black cohosh for alleviating hot flashes is mixed, they cite research from the National Institutes of Health and other reviews that suggest that use of black cohosh in former breast cancer patients requires only standard screening. They also report that there is “little reason for excluding patients with estrogen-responsive tumors from using black cohosh.” In fact, recent laboratory studies, although not yet carried out in humans, suggest that black cohosh may actually protect the breast from developing tumors.

The case for or against the use of phytoestrogens (e.g. soy, red clover, chaste tree berry and flaxseed) in women with breast cancer is not quite as clear as it appears to be for black cohosh. In one of the largest reviews examining soy or red clover for menopausal symptoms, the outcomes were equivalent to placebo. Other studies have shown that they might be beneficial for women with mild to moderate symptoms who start menopause early.  Moreover, while red clover in particular does not appear to affect certain breast cancer risk markers, reports about phytoestrogens in general, especially in estrogen positive cancers is conflicting. Still, the American Cancer Society does not advise against eating soy-rich foods by women who’ve had breast cancer. Some studies have also showed improved prognosis.

If you are wondering if there are any drawbacks, one of the largest challenges is that there are not that many studies looking at herbal medications in women with breast cancer and the ones that do exist are mostly short in duration. The researchers point out that because herbs can take awhile to work, a three month study might be too short to form a conclusion.

Clearly, more study is needed. In the interim, it appears both black cohosh and soy might be safe to try if you’ve had breast cancer. As always, the most important consideration is to speak to a certified practitioner who is well versed in herbal medicine and make sure that she or he works with your oncologist.

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