For Menopause-Related Sleep Problems, Study Suggests Trying Acupuncture

If you’ve reached menopause and just can’t sleep like you used to, you might want to learn about a special spot on your body. No, not that one. It’s the Sanyinjiao acupoint, or Spleen 6 — a small area just above the ankle on the inside of the leg. New research suggests that for women with menopause-related sleep problems, acupuncture, particularly on that point, may offer relief.

(Fairy heart/Flickr)

(Fairy heart/Flickr)

Among the myriad discomforts that afflict menopausal women, sleep problems may not get as much attention as hot flashes. But all manner of sleep disturbances — from waking up at the crack of dawn unable to fall back asleep to full blown insomnia — are pervasive among this demographic.

Researchers report that the prevalence of menopause-related sleep disturbances ranges from 8.4 to 56.6 percent. Estrogen deficiency contributes to the problem; nocturnal hot flashes are also sometimes a factor.

In the new review, a meta-analysis of more than 30 clinical trials involving 2,433 participants published in the journal Obstetrics and Gynecology, researchers in China found a “substantial association” between acupuncture and improved sleep in peri-menopausal and post-menopausal women. Specifically, the researchers say they demonstrated “that the association of reduction in menopause-related sleep disturbance and acupuncture was correlated with changes in serum estradiol levels particularly when the Sanyinjiao acupoint was stimulated.” (Estradiol is the estrogen mostly produced from the ovaries, and can also be used to treat peri-menopausal symptoms.)

The researchers theorize that the elevated serum estradiol levels may be the key to why acupuncture could help alleviate the sleep disturbances.

There are caveats: the researchers report an association only between acupuncture and a decrease in sleep disturbances; also, sleep quality assessments were mostly based on patients perceptions; in addition, the researchers report that their analysis only looked at articles in English and Chinese, which might limit the generalizability of the review.

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Why To Exercise Today: Minimizing ‘Menopause Misery’



A new report suggests a path toward reducing “menopause misery”: Give up your sedentary lifestyle.

A paper — titled “Sedentary lifestyle in middle-aged women is associated with severe menopausal symptoms and obesity,” and published online in the journal Menopause — looks at more than 6,000 women across Latin America ages 40-59. Researchers found that compared to active women, sedentary women (who made up about 63 percent of participants) reported more “severe” menopause symptoms, including hot flashes, joint pain, depressed mood and anxiety and other symptoms like sex problems, vaginal dryness and bladder problems.

Sedentary lifestyle was self-reported (always a possible red flag in a study like this) as less than three 30-minute sessions of physical activity per week; activities included walking, biking, running, jogging, swimming or working out.

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Patient Empowerment: Why Angelina Jolie’s Menopause Matters

Angelina Jolie (Gage Skidmore/flickr)

Angelina Jolie (Gage Skidmore/flickr)

You’ve probably never linked Angelina Jolie Pitt and menopause in a single thought before.

But there they were, connected on the opinion page of The New York Times Tuesday: The actress and filmmaker whose fecund family life and sexy beauty seem to embody female fertility, and the hormonal changes that mark female fertility’s end.

Jolie Pitt, 39, explained in her piece that because she carries a genetic cancer mutation and a strong family history of fatal ovarian cancer, she decided to get preventative surgery — the removal of her fallopian tubes and ovaries — to reduce her cancer risk. (Jolie Pitt previously underwent a preventive double mastectomy to lower her risk of developing breast cancer.)

Due the recent surgery, she writes: “I am now in menopause. I will not be able to have any more children, and I expect some physical changes. But I feel at ease with whatever will come, not because I am strong but because this is a part of life. It is nothing to be feared.”

Needless to say, the Times piece has triggered a media storm of opinion (“Hollywood will finally have to start talking about menopause”) and praise (for her “eye-watering courage”), including a thoughtful medical discussion on Here & Now.

Here, an expert on sexual health after cancer weighs in. Sharon Bober, Ph.D. is the director of the Sexual Health Program at the Dana-Farber Cancer Institute and assistant professor of psychology in the Department of Psychiatry at Harvard Medical School. She writes about the need for more education and frank talk about how patients can have a healthy sexual life after cancer and cancer-related surgeries:

Angelina Jolie Pitt has issued a resounding call for women at high risk for hereditary breast/ovarian cancer to learn about their options, “take control” and make decisions to manage their cancer risk. Jolie carries a mutation and has strong family history of this lethal disease. Because there is no effective screening for ovarian cancer, she has decided to follow her doctors’ recommendation to remove her ovaries at the age of 39.

But, as Jolie Pitt explained in her New York Times editorial, this blunt instrument of cancer risk-reduction comes with a high cost: immediate surgery-induced menopause.

One of the primary reasons that many high risk women do not move ahead with the same recommendation to remove their ovaries is fear of menopause and worry about quality of life.

Young women are understandably distressed about losing their sex life, their sense of femininity and are worried about the impact of these changes on dating or relationships. Unfortunately, these fears often go unaddressed and women assume that profound side effects are part of the high cost they must pay for undergoing potentially life-saving surgery.

In fact, for both high-risk women contemplating risk-reducing surgery like Jolie, as well as for young women who have been treated for cancer, it has been shown that sexual health is one of the most common and distressing treatment-related concerns. And yet, women’s sexual health is rarely discussed in most treatment settings.

Jolie Pitt declares that knowledge is power and I agree. I believe strongly that all women should have the information and education needed to address the side effects of treatment-induced menopause including how to manage changes in sexual health. For example, Jolie’s decision to use a regimen of hormone replacement to manage the shift into menopause makes sense for her but it is not a course of action that would be recommended for women who previously had breast cancer. However, breast cancer survivors struggle with treatment-induced changes like vaginal dryness, atrophy and loss of libido.

I recently worked with a 40-year-old breast cancer survivor who had been having painful sex with for 4 years and had no idea that help was available. Her first comment was that because no one ever spoke about it, she assumed this problem was supposed to get better on its own and when things got worse, she concluded that nothing could be done. Continue reading

Why To Exercise (Outdoors) Today: Tranquility For Aging Ladies



It’s cold, it’s dark, it’s uninviting out there. So, all the more reason to drag yourself outside and do something.

In yet another study on how exercise can combat the bad physical and mental effects of aging, new research suggests that women who can get out the door, fight the elements and exercise might find some nifty benefits. Those benefits include alleviating depression and increasing adherence to an exercise program.

The small study, published in the journal Menopause, asserts it’s the outside air that really helps (as opposed to the stuffy gym or the treadmill in your basement, though I’ve found that when you’re desperate, those work too):

“Between baseline and week 12, depression symptoms decreased and physical activity level increased only for the outdoor group…” write the authors, led by Isabelle Dionne of the University Institute of Geriatrics of Sherbrooke in Quebec.

From the Reuters report:

Outdoor workouts left women in a better mood and kept them exercising longer than counterparts who exercised indoors, according to a small study from Canada.

Results of the three-month trial involving women in their 50s and 60s suggest that outdoor exercise programs should be promoted to help older women keep active, the researchers conclude…Only about 13 percent of Canadian women older than 59 years and less than 9 percent of older American adults get at least 150 minutes of physical activity each week… Continue reading

Good News-Bad News On PMS and Menopause

Young women, take heart: if you are among the vast majority of us who suffer from PMS —  the irritability, anxiety, headaches, breast tenderness, or bloating — it doesn’t mean you’re doomed to suffer from hot flashes when you hit menopause.

But don’t go out and celebrate just yet.

Because this is a good news/bad news kind of report:

pixel pro photography/flickr

pixel pro photography/flickr

The Good: Researchers found no connection between having a history of PMS and then experiencing hot flashes during menopause.

The Bad: They did find a connection between PMS and other seriously annoying problems shortly after menopause —  including impaired memory and concentration, poor sleep and depression.

Oh well.

The study of 150 recently menopausal woman published in the journal Menopause, claims its findings — linking a history of PMS with worsened so-called “health-related quality of life” measures, but not with hot flashes — are “novel.”

Here’s more on the mechanics of the connection, from the study:

The resemblance between premenstrual and menopausal symptoms raises a question on whether they also share similar physiological characteristics. One mechanism that has been suggested to contribute to premenstrual symptoms is deficiency in, or abnormal functioning of, neurotransmitters in the central nervous system, Continue reading

The Grandma Effect: A Little Caregiving Sharpens Brain, A Lot Dulls It



There’s an old saying in medicine: “The dose makes the poison.”

Personally, I find the adage holds true in many contexts, from nutrition to exercise to parenting: often too much of a good thing turns toxic.

Here’s the latest twist: A new report finds that grandmothers who care for their grandkids once a week experience a boost in mental sharpness. But if that one day of cozy caregiving expands to five or more days a week, it can put grandma on edge, and her brain can grow duller, with more memory and other cognitive problems.

Here’s what the researchers conclude, from the abstract:

The data suggest that the highest cognitive performance is demonstrated by postmenopausal women who spend 1 day/week minding grandchildren; however, minding grandchildren for 5 days or more per week predicts lower working memory performance and processing speed. These results indicate that highly frequent grandparenting predicts lower cognitive performance.

And here’s more info on the study (via news release) published online in the journal Menopause:

Taking care of grandkids one day a week helps keep grandmothers mentally sharp, finds a study from the Women’s Healthy Aging Project study in Australia…That’s good news for women after menopause, when women need to lower their risks of developing Alzheimer’s disease and other cognitive disorders.

On the other hand, taking care of grandchildren five days a week or more had some negative effects on tests of mental sharpness. “We know that older women who are socially engaged have better cognitive function and a lower risk of developing dementia later, but too much of a good thing just might be bad,” said NAMS Executive Director Margery Gass, MD. Continue reading

Hormone Therapy? No To Prevent Disease, Yes To Ease Menopause Woes

Dr. JoAnn Manson considers the evolution of menopause management and hormone therapy (Brigham & Women’s Hospital)

Here’s how we usually describe the medical pendulum swings on hormone treatments for menopausal women:

A couple-three decades ago, some doctors were touting hormone “replacement” therapy as a fountain of youth that might beat back not just hot flashes but many diseases that come with aging. Then research turned up more and more potential risks, from blood clots to strokes and breast cancer. Perhaps, researchers posited, hormone therapy might be okay in younger menopausal women but not in older? The rule became, “It’s complex; talk to your doctor.”

It’s still complex, but a new paper just out in the Journal of the American Medical Association at long last refines 13 years of intense research by the Women’s Health Initiative into a form that I can easily wrap my mind around. In short: Whether you’re in your fifties or beyond, no woman should be taking hormone therapy long-term, in hopes of preventing diseases of aging. Those benefits don’t outweigh the risks. But younger menopausal women with hard-to-take symptoms like hot flashes and night sweats can still consider taking hormones to alleviate them short-term.

To quote Dr. JoAnn E. Manson, the lead author of the new paper and chief of Preventative Medicine at Brigham and Women’s Hospital:

“This is the most comprehensive evidence base available for clinical decision making and it does suggest that hormone therapy should not be used for long-term chronic disease prevention — but it remains an appropriate option for short-term management of menopausal symptoms in early menopause.”

Got that? I asked whether there might be a medical profile that might rule out hormone therapy even for younger menopausal women.



Yes, Dr. Manson said, “If a woman is at very high risk of cardiovascular disease — if she’s had a prior stroke or blood clots in her legs or lungs, or has multiple risk factors, she may not be an appropriate candidate for even short-term treatment. But most women who do have the very significant symptoms — of hot flashes and night sweats and interrupted sleep in early menopause — could be considered for short-term therapy to manage these symptoms.”

Only about 15 to 20 percent of newly menopausal women have symptoms severe enough to consider hormones, she said.

An additional note: If “short-term” use of hormone therapy for menopause symptoms may be all right, just how long is short-term? That remains controversial, Dr. Manson said, but it can be as long as several years.

It has surely been a long, zig-zagging journey toward what now looks like nicely definitive data on hormone therapy.

“The science has advanced in incremental steps,” Dr. Manson said, and it really required a large-scale randomized trial, such as the Women’s Health Initiative, to understand the balance of benefits and risks. And it’s taken a while; there have been many swings of the pendulum. Hormone therapy was once believed to be a fountain of youth, and then it was believed to be too dangerous for anyone to use, and now we understand that there are women who are appropriate candidates, for at least short-term use, and hormone therapy should not be used for long-term chronic disease prevention.” Continue reading

Why To Exercise Today: So You Can Be A Cover Girl

A while back, my co-host Carey Goldberg came to me with her classic buoyant optimism: “I have good news,” she chirped. “And arguably less good news.”

The good news: She’d been selected to be on the cover of a new women’s magazine.
The less good: The magazine was called My Menopause.

Only Carey would agree to write a pro bono piece “sharing how she conquered menopause” with a very large picture of herself, surrounded by greenery, amidst headlines like: “Chinese Medicine Treatments For Menopause,” and “What Every Woman Needs To Know About Sexual Dysfunction.”

Screen shot 2013-08-29 at 12.04.01 PM

(My Menopause was launched earlier this year by a local doctor, Machelle (Mache) Seibel, a professor at the University of Massachusetts Medical School; he’s the kind of guy who sings about health issues, from mammograms and stress incontinence to swine flu and bacterial vaginosis.)

Of course, Carey’s piece is excellent. I got weepy when she described aging and the inevitable physical decline, and losing the “yum” of pleasure in her life; no joy for a child’s achievements, nor at the prospect of a divine slice of chocolate cake.

Her bottom line, however, is brilliant: the thing that saved her, that saves so many of us, is exercise. Not just when you feel like it and not only when the weather’s good, but every day with no excuses, dragging your bum out of the house and letting all those other, far more important things you absolutely must do wait.

For me, exercise has, for decades, helped to preserve my mental health: Continue reading

Study: Hormone Therapy May Not Hurt — Or Help — Menopausal Brains


Here’s the good news for women on hormone therapy for menopause: A new study suggests it will not increase your risk of dementia or otherwise hurt your brain health.

Now here’s the bad news for women on hormone therapy: It doesn’t look like it will improve your brain health either.

I think of this as the period of the Great Shake-Out on hormone therapy. First came the Fountain of Youth period, with some doctors handing out estrogen and progestin like candy to women during and after menopause.

Then, about a decade ago, came seminal Women’s Health Initiative findings that hormone therapy could carry daunting risks, including higher rates of heart attacks, dementia and cancer in older women.

Research led to a new hypothesis, the “Window of Opportunity” theory: That if women started hormone therapy earlier, more like in their fifties than in their sixties or seventies, they might reap benefits with fewer risks. For heart disease, there’s extensive evidence that is indeed the case.

Now, the “WHIMSY” study — for Women’s Health Initiative Memory Study in Younger Women — just out in the journal JAMA Internal Medicine, does seem to bear out somewhat the earlier-window theory when it comes to brain health. At least when it comes to avoiding harm.

Dr. Fran Grodstein of Brigham and Women’s Hospital, who researches the long-term health effects of hormone therapy but was not involved with this latest study, wrote in a commentary accompanying the paper:

Dr. Fran Grodstein of Brigham and Women's Hospital (Courtesy)

Dr. Fran Grodstein of Brigham and Women’s Hospital (Courtesy)

“Approximately 10 years ago, the Women’s Health Initiative Memory Study (WHIMS) found that postmenopausal hormone therapy in older women caused nearly two-fold increases in dementia risk, worse rates of cognitive decline over time, and decreased brain volume on magnetic resonance imaging, compared with placebo treatment.”

But the new study, which looked at over 1300 post-menopausal women who started taking estrogen in their fifties, found no such heightened risks after seven years.

It didn’t find any brain benefits either, though.

Dr. Grodstein sums up: Continue reading

FDA Approves New Pill To Alleviate Pain During Sex

As we’ve reported, about one-third of women in the U.S. say they experience pain during sex.

There a number of non-medical interventions that can help fix the problem, such as pelvic floor physical therapy, which we’ve also written about here. Still, for some, medication may be called for, so it looks like a positive development that the FDA earlier this week approved a new drug to alleviate the pain that many post-menopausal women experience during intercourse.

MedPage Today reports that the newly approved “selective estrogen receptor modulator (SERM)” called ospemifene (Osphena) is taken as an oral tablet and “targets vulvar and vaginal atrophy resulting from menopause, which is the underlying cause of dyspareunia, or pain during sex.” There are risks, however:

The treatment, however, will come with a boxed warning stating that it may thicken the uterine lining, with the concern that unusual bleeding may be a sign of endometrial cancer or a condition that can lead to it. Continue reading