Tag Archives: Menopause

The power of community

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A social group can provide much-needed support and a sense of connectedness during menopause. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


Menopause can often cause feelings of loneliness.


Women don’t always want to talk about their difficult moments and, sometimes, they may even think they’re somehow to blame for how they feel.


As a result, too many women suffer in silence.


Midlife and menopause can be a confusing time as women deal with common experiences such as night sweats, anxiety, weight gain and low sex drive.


About 80% of women have symptoms that lower their quality of life and affect their work and relationships with family and friends. It can disrupt a woman’s sense of normalcy.


As Laura, a nurse practitioner I work with, says: “Menopause is normal, but suffering is not.”

Happy and connected

One of the highlights of summer in West Michigan is the Coast Guard Festival in Grand Haven, Michigan.


This big event reminds me of the power of community.


I grew up in Grand Haven and I’ve always loved how the week-long Coast Guard activities bring so many people home to experience the downtown streets, all bustling with families and friends out walking and enjoying the events.


It’s a time for reconnecting to people and place.


Being intentional about maintaining close ties with family and friends doesn’t just feel good—it’s a practice that helps us cope when times are hard.


Researchers have conducted studies to understand why some people cope with change and hardship better than others. One of the things they’ve found is that people who do three things in particular cope better than others:

  • They believe they deserve to be happy.
  • They keep a support network around them.
  • They ask for help when they need it.

Menopause is a time to reach out to others for help, just as you would with health issues like PMS or postpartum depression.


You must get the support you need.


Many women turn to the Midlife, Menopause & Sexual Health team to help them find solutions for the symptoms of menopause.


Our patients say they don’t feel embarrassed about their questions when they come to us. They know we will provide answers about why something is happening to them.


Most importantly, we give them options that will help them feel better.


We become a woman’s support network, which in itself starts a chain reaction in which we’re able to help others—one woman will come see us, then tell her friends and family about us. Soon, we’re seeing her whole group.


And that group becomes the support network for each other, too, as they discover they can understand and help each other.

A friend in need

One of our patients experiencing menopause—I’ll call her Janine—had felt like many women, in that she felt alone.


She felt embarrassed about her hot flashes and she did everything she could to keep people from noticing.


The anxiety about the possibility of having a hot flash, however, would only make a hot flash come on.


Night sweats kept her up at night. She grew more and more anxious and stressed. Out of the blue she experience some bleeding.


When her husband mentioned something about not having sex anymore, she felt really bad.


She’d been afraid that her pulling away would make her husband mad, or lead to something even worse.


But she just didn’t feel like herself. And she didn’t know what to do.


She felt alone, without answers.


Thankfully, Janine has a good friend—a friend who got frustrated at her for canceling dates to get together.


Her friend, Sue, showed up at her home one day and said, “I am not leaving without us talking.”


By the end of the conversation, Janine knew she was not alone in her symptoms of menopause.


There was hope.


As it turns out, Sue had been in to see us at the Midlife, Menopause & Sexual Health clinic. She chose to take hormones and she had been following our SEEDS program.


She was now drinking plenty of water, she’d given up sugar, she had quiet time each day and she walked every morning.


She had found a support group and got help when she needed it—and then she shared that info with her friend.


That connection could change Janine’s life.


Whether you’re in Grand Haven or in your own hometown this summer, take a minute to be grateful for beautiful communities. Be grateful for supportive family and friends.


When you have problems, reach out to them and ask for help.


Whatever group you turn to for help—a book club, a wine club, women at the hair salon, the church, the YMCA—recognize that it’s possible for other women to feel the same way you do. It’s OK to ask for help.


Reprinted with permission from Spectrum Health Beat.



Cope with the ‘perfect storm’ of menopause

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A healthy diet is the best way to lose pounds during menopause. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


Menopause is often referred to as a “perfect storm” where all the odd changes and symptoms women experience collide.


This collision creates insulin resistance resulting in increased belly fat.


At the Spectrum Health Medical Group Midlife and Menopause Clinic, we have an entire team to help women with menopause symptoms, including weight gain.


One of our team members, Irene Franowicz, is a registered dietician who practices what she preaches. She encourages healthy eating and cooking and she teaches others how to prepare healthy foods in her weight management program, Eating the Mediterranean Way with Low Glycemic Carbohydrates.


Even better, Irene demonstrates techniques to counteract the effects of aging and menopause.


Right before and during menopause, one of the most common complaints women experience is weight gain. Many of my patients say, “I am doing the same things with my diet and activity level, but I keep gaining weight.”


One of my patients—we’ll call her Sarah—has experiencing this. At age 49, Sarah struggled to stop gaining weight. She knew she already had a bit of a weight problem, and at age 45 she noticed it was becoming more difficult to lose weight.


Busy juggling family and work, Sarah would often eat on the run as she and her family headed out the door to soccer games, school events and other functions. She exercised when she could, but it wasn’t enough. To make matters worse, when Sarah was 48 years old, she broke her foot and couldn’t move around for five weeks.


Unfortunately, she gained 15 pounds during that time.


Sarah knew her risk of gaining even more weight was high, because she had two strikes against her: she had diabetes when she was pregnant and diabetes ran in her family.


When her periods became very sporadic and she started having hot flashes, she came to see us in the Midlife and Menopause Clinic. From this visit, Sarah learned she was in perimenopause and smack dab in the middle of a perfect storm.

Modify meals

Sarah came to the right place for answers.


We helped her understand that her low estrogen was making her metabolism worse by making her more insulin-resistant. As a result, her body was storing every calorie it could.


No wonder she continued to gain weight. She was trying very hard to make some positive changes, including getting more sleep, drinking more water and exercising more regularly. Sarah still needed more help with her diet, so we sent her to Irene’s class at Spectrum Health.


Irene centers her teaching on the Mediterranean diet because it is low glycemic, meaning it’s low in simple sugar.


Irene’s real passion is working with women in perimenopause and menopause and teaching them how to eat in a way to overcome weight gain. Her low glycemic meal plans are carbohydrate-controlled and high in antioxidants. She created the Mediterranean diet program to help the thousands of women who come to her and say, “I can’t seem to lose weight any more, even though I am eating the same.”


In her classes, Irene offers ideas for meal plans, plus recipes for breakfast, lunch, dinner and snacks. Each week, the participants sample delicious recipes and leave with a list for grocery shopping.


Irene has seen great success in women who have adopted her Mediterranean diet program and she enjoys teaching how dietary modifications can reverse the metabolism. It’s simple—even with small weight loss, sugar levels drop.


After seeing me and then talking to Irene, Sarah was thrilled to learn we’re all teaching the same concepts.


She started preparing meals in advance and making healthy, tasty snacks for her entire family. Before too long, Sarah had lost 9 pounds and her sugar level dropped while her energy level went up—she was overjoyed.


Instead of feeling like her life was on the downslide, Sarah now envisioned a much brighter future for herself. She even considered joining Irene’s strength training and yoga classes, something she never thought she could do.


Using a team approach to health care, Irene and I often refer patients to each other. When Irene sees women struggling with hormone issues, she refers them to us in the Midlife and Menopause Clinic and we also send patients to Irene’s classes. We share our skills to provide a wide net of support to as many women as possible.


Reprinted with permission from Spectrum Health Beat.



Women: Don’t suffer in silence

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A new study of pre-menopausal and menopausal women has helped shed light on how every woman experiences menopause differently, and what treatments are most effective. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


Every woman experiences menopause in her own unique way with a variety of symptoms.


She may suffer from hot flashes, night sweats, mood swings, weight gain, fatigue and a sense of not feeling right. Some of these symptoms may sound familiar to you—possibly all of them.


I’ve seen several patients recently who each complained of different issues related to menopause.


A woman I’ll call Peg had to stop wearing silk shirts to work because she sweat through each one. Another patient, Sue, became embarrassed in meetings because her face becomes very red when she makes presentations to her peers. Cindy felt depressed that even though everything in her life was great, she had a sadness she just couldn’t shake. And then there’s Gloria, who expressed frustration with weight gain she recently began experiencing.


The four women felt betrayed by their bodies.


Fortunately, I had some encouraging information to share with each of these patients, thanks to a comprehensive women’s health study called the SWAN study.


The Study of Women Across the Nation (SWAN) is an ongoing study that follows women between ages 42 and 52 in order to understand how they will experience the menopause transition. There are seven SWAN sites across the nation: Boston, Chicago, Detroit, Los Angeles, Newark, Pittsburgh and Oakland.


Each woman receives a physical exam that includes measuring her height, weight, waist circumference, blood pressure and lab work levels. The study also records whether or not she smokes, how much alcohol she consumes, her education status and family history. Race/ethnicity is categorized as African American, non-Hispanic Caucasian, Chinese, Japanese or Hispanic.


The results of the SWAN study are interesting and have helped doctors understand why each woman’s menopause experience is unique.


For example, the study showed that women who became at higher risk for heart disease—increased cholesterol, belly fat and blood sugar levels—tended to fall in the following categories: Hispanic or Japanese, less physically active, less likely to be highly educated, and most had higher BMI and cholesterol levels before the study began. Pre-diabetes was found to be a very high risk factor across all ethnic groups.


Another study done in Pittsburgh evaluated Caucasian and African-American participants at risk of depression. Twenty percent to 30 percent of participating women had new onset depression between the ages of 42 and 52.


The women in the study had an average age of 46, and 31 percent were African American. In addition, 34 percent had a family history of depression. The women who had a family history of depression proved to be more likely to be highly educated and have experienced at least one episode of depression.


The SWAN study has also taught doctors so many other important facts about women in menopause:

  • Hot flashes are different for each woman.
  • Women of color experience hot flashes for the longest period of time (average of 10 years).
  • Women of Asian descent have hot flashes for the shortest period of time, but they suffer more with depression and irritability.
  • Hispanic women suffer from hot flashes an average of 8.9 years.
  • Caucasian women experience hot flashes an average of 6.5 years.
  • The earlier women start having hot flashes, the longer they last.

There are so many other fascinating findings that have occurred as a result of this ongoing study, but the bottom line is that women do not have to suffer the symptoms of menopause.


There is help for you and plenty of research to back up the findings. Strong, scientific research is being done to help us know what works best and determine the safest method for treating menopause symptoms.


I recommend being active, drinking plenty of water, maintaining a healthy weight, staying off the sugar, and being grateful in your life daily. These are simple but very powerful tools used to combat the symptoms of menopause.


In addition, there are FDA-approved hormones that may help those who need them. They are a safe option for many women.


If you think you may benefit from this type of treatment, ask your doctor, or come see us at the Spectrum Health Menopause offices. If we discover that hormones are not safe for you, there are many other options to try.


Reprinted with permission from Spectrum Health Beat.



Get the dish on aging well

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Mediterranean food that’s full of vegetables, extra virgin olive oil, and fish tend to reduce insulin resistance. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


The best way to get through midlife and menopause is to know the tricks.


One of the tricks for healthy aging is to eat the Mediterranean way. This way of cooking and eating is healthy, tasty, satisfying and good for staying on a budget.


Mediterranean cooking includes whole grains, lean protein such as seafood and chicken, extra-virgin olive oil and lots of veggies.


For flavor and health benefits, the recipes use lemons, lots of garlic, and spices such as oregano, dill and parsley.


There are so many options to consider, and my favorite cookbook for Mediterranean cooking is Live to Eat by Michael Psilakis.


He organizes everything by key items to keep on hand: Greek yogurt for sauces and dips, garden-fresh veggies and fruits, peppers, onions, roasted cherry tomatoes, tomato sauce and garlic confit. From these items, healthy meals are a snap.


Mediterranean cooking has been proven to reduce risk of heart disease, stroke and type 2 diabetes.


Insulin resistance is the common denominator for all these issues, which combined are the cause of death for a third of women.


Insulin resistance is when the blood sugar stays higher longer after consuming food—and especially higher after consuming simple carbs such as white flour pasta, white bread, white rice, alcohol or treats.


When blood sugar stays high, it can damage tissue and cause higher levels of insulin, which increase cravings for sugar, as well as promote storage of sugar into belly fat.


One of the other things sugar does is make blood vessel linings sticky, which allows fat to adhere to them, increasing the risk of a blockage.


The bottom line, a diet high in foods made with simple carbs cause preventable disease.


Learning how to cook the Mediterranean way can save lives.


Reprinted with permission from Spectrum Health Beat.


When life hits you like a hurricane

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Find your way through the menopause storm with an overall health and wellness approach. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


So many women come into the office and share now familiar symptoms.


“Why am I gaining weight?”


“I do not feel like myself!”


“How do I avoid a heart attack so I do not suffer like my mom?!”


“I am afraid to go out in the winter because I do not want to break a hip.”


“How do I deal with all of my stress?!”


Women’s health is different than men’s health and the topic deserves research and attention to better recognize and offer the best prevention and treatment options to women.


Menopause symptoms are important to understand and treat as these symptoms can be a sign more is going on under the surface.


Low estrogen causes hot flashes, night sweats and vaginal dryness. It also accelerates development of heart disease, bone loss, diabetes and obesity.


Emotional changes can be a sign of the existence of a high level of stress from handling kids and aging parents. Or this can be a red flag symptom of changing levels of brain chemicals, less sleep and a need for improved coping tools.


Women who cope well with life and body changes have three things in common:


1. They believe they deserve to be happy.


2. They keep a support network around them.


3. They ask for help when they need it.


A patient I’ll call Katie came to us because she was facing the perfect storm of menopause and felt like it was a hurricane.


She had all the symptoms—hot flashes, night sweats, irritability, insomnia, bladder urgency and low sex drive.


She no longer felt motivated to get up early to exercise and ate cookies at 3 p.m. to stay awake.


She and her husband argued about minor things, especially about how to deal with their son who was failing his class. Her mom, who’d suffered a stroke, fell and broke her hip in the assisted living center.


Work seemed crazy as her boss had left and she had to do both their jobs until a replacement could be found.


She came to us at Midlife, Menopause & Sexual Health and said, “I do not even know where to start! My life is a mess.”


Katie came to us because she heard we could help with hot flashes. We certainly could offer meds and call it a day, but we see such a situation as an opportunity to become her partner in her health and consider all options.


This included a practical plan for a healthy lifestyle using the SEEDS, tracking and treating her symptoms, and assessing her health risks for bone loss, stroke and heart attack.


We also know emotional health is a big part of healthy aging. We support this facet of wellness by listening, discussing how the SEEDS can support the body and mind, and also having a team that includes a psychotherapist who can help our patients cope with strong emotions.


Three months later, Katie had improved sleep, better moods, only a rare hot flash, and she and her husband had a plan worked out with their son. Her mom had started to heal and feel better, and she was excelling in her new role at work.


Further, she ate better, took her vitamin D and calcium, and made time for small bursts of exercise. She no longer needing cookies to stay awake.


Best of all, she had a plan to reduce her risk of stroke, heart attack and bone loss.


Her hurricane of menopause had passed and life returned to smooth sailing.


Reprinted with permission from Spectrum Health Beat.


Hormones? Let’s clear the confusion

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Hormone replacement therapy can be the right choice for the right person. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


Hormone replacement therapy can be a good option for many women as they struggle through menopause.


It’s used not only as an aid to reduce hot flashes, but also as a medicine to replace hormones and help women improve their overall health.


Hormones are safe for many women, but not all, so it’s important to separate the facts from the myths to make sure you’re well informed.


You probably already know that menopause is a time when most women experience a variety of body changes and symptoms. In fact, 80 percent of women will experience at least one symptom and 45 percent will have significant distress from symptoms.


These are pretty significant numbers.


It’s also important to know that, during menopause, body changes in women can cause more than just sleep issues and mood swings.


The risk of heart disease in women surpasses the risk in men within five years of menopause, and the risk of diabetes and obesity in women climbs rapidly. In addition, many women gain 10 pounds or more of belly fat during this transition.


The facts are scary, but the more you know about the changes happening to your body, the more you can do to stay healthy during menopause.

Risks and rewards

Menopause symptoms and body changes are a result of estrogen loss.


Estrogen affects many cells in the body, including your brain, bones, liver, skin, vagina and uterus. Research over the years has given health care professionals valuable insight into who should and should not take estrogen.


A large study performed by the Women’s Health Initiative included 110,000 women who were randomly selected to take estrogen or to not take estrogen. The results taught doctors about the safety and effects of estrogen in women, and it also showed us that not all women have the same risks.


The timing of estrogen treatment is a key factor in a woman’s risks.


If a woman starts taking estrogen early in menopause, her risk of heart disease, stroke, diabetes and obesity decreases.


However, if a woman is already at high risk for heart disease, stroke, diabetes or obesity, and she then begins taking estrogen later in menopause, her risk for all of these issues becomes higher.


You can see why it’s important to talk to your physician about taking hormones before you make any decisions.


Estrogen in the system—versus estrogen in the vagina—is very different is terms of effects and risks.


Vaginal estrogen barely, if at all, goes into the blood. It stays in the vagina and greatly improves the vaginal and bladder symptoms of menopause. These symptoms include dryness, difficulty in achieving orgasm, pain with sex, bladder urgency and some forms of incontinence.


So, who cannot take systemic estrogen? A woman who:

  • Is more than 10 years from her last menstrual period.
  • Already has heart disease.
  • Has previously had a stroke.
  • Has migraines with significant visual issues.
  • Had a prior blood clot in the deep veins of her legs or lungs.
  • Had breast cancer.

Most of the estrogen I prescribe is bio-identical, which means it is identical to the estrogen made by the ovary.


The estrogen I prescribe is FDA-approved, which means there are safety checks and consistencies not found in compounded hormones. When I prescribe hormone medication, I do not receive any financial gain from any of the manufacturers.


Estrogen prescription medicine can be given in the form of a patch, spray, or pill. (More good news: Many estrogen medicines are covered by insurance.)


My goal in prescribing estrogen medicine is my patient’s safety first, and then reducing her symptoms and improving her quality of life.


Another important hormone study, the Kronos Early Estrogen Prevention Study trial, found that women who took patch estrogen had a lower risk of gaining belly fat and sugar cravings, and they saw significant improvement in symptoms and quality of life.

Cindy’s story

One of my patients, who I’ll call Cindy, is a good example of someone who experienced menopause symptoms but didn’t know what to do about them.


In the beginning, Cindy felt she’d been on auto pilot for years.


She felt blessed to have the life she had always wanted—she graduated college, landed a good job at a bank, fell in love, got married, had two children. She loved her busy life and felt lucky to rarely get sick or need a doctor’s visit.


At her yearly exams, she was always told to watch her weight and her cholesterol. She would think, “Watch them do what?” and then she’d rush out of the office to pick up the kids and start dinner.


It was all very uneventful, and Cindy liked it that way.


Life continued in this same pattern for many years—until Cindy’s periods started becoming very irregular.


She also noticed she was more tired than normal, and she began to experience night sweats. She was having crazy mood changes. Even worse, she noticed her spring clothes didn’t fit when she went to put them on after a long winter. She craved sweets (not normal for her) and she couldn’t remember things.


She began to wonder what was happening. She didn’t think these changes were normal.


Cindy and her family had enough, so she called her doctor.


Her symptoms prompted a referral to Spectrum Health Medical Group’s Menopause Clinic, where we talked about why these things were happening and what could be done to make her feel better.


Cindy’s history was good overall: no smoking, no migraines, no diabetes, and no blood clots in her legs or lungs. Her cholesterol was slightly high, but she didn’t have any signs of heart disease and she always had regular mammograms.


The first step to relieve her symptoms: Add some healthy habits back into her life. She needed regular sleep, adequate water intake, vitamins, less sugar, more exercise, meditation and gratitude.


She was also a perfect candidate for estrogen prescription therapy, so we talked about her options. She chose estrogen in the form of a patch prescription bio-identical estrogen, which she would need to change twice a week.


Cindy had never had a hysterectomy and still had her uterus; therefore, to be safe, she had to take progesterone along with the estrogen.


I prescribed Prometrium, which is bio-identical progesterone dissolved in peanut oil in a capsule that she would take every night.


Within two weeks, Cindy was experiencing fewer night sweats and hot flashes. After one month with hormone replacement therapy, she was sleeping better, she felt like exercising, she was motivated to make better food choices and she had lost weight.


Most importantly, she felt like herself again—and her family noticed.


Reprinted with permission from Spectrum Health Beat.

The key to avoiding diabetes

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Those approaching menopause should be extra careful about diabetes. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


Diabetes is a far too common disease, and unfortunately, it is on the rise.


The statistics are sobering: Diabetes is the seventh leading cause of death among Americans. Sadly, 1 in 11 (29 million) Americans suffer from diabetes, and 1 in 3 (86 million) have pre-diabetes.


The good news is that some forms of diabetes can be prevented, and the best way to prevent this disease is to become educated about what it is and how you can avoid it.


First, let’s be clear about the definitions.


Type 1 diabetes is typically diagnosed in kids or young adults. In Type 1 diabetes, the body (specifically the pancreas) does not make insulin and, therefore, cannot process sugar. The sugar then stays in the blood and can’t get in the cells to be used as energy. Symptoms of this type of disease include weight loss, fatigue, thirst, frequent urination and extreme hunger, even after eating. Type 1 diabetes does not tend to run in families, and diagnosis is done with a simple blood sugar test.


Type 2 diabetes does tend to be hereditary, by both genetic risk factor for insulin resistance and health habits (physical activity and diet). Type 2 diabetes is preventable and is caused by high blood sugar from insulin resistance. Symptoms of this disease include those listed for Type 1 diabetes, plus blurred vision and headaches.


What exactly does insulin resistance mean? Here’s how it works: Insulin is the key to getting blood sugar into the cells—brain cells, liver cells and muscle cells. If someone has insulin resistance, it takes more insulin to get the door of the cell to open. Therefore, while waiting for the pancreas to make more insulin, the blood sugar rises and not only gets pushed into fat, but also causes the many complications of diabetes. As the belly fat increases, it leads to more insulin resistance.


Here’s a simpler way to think about it: When someone with pre-diabetes says they are “craving carbs,” or they are a “carbaholic,” I like to say that they aren’t actually craving carbs; instead, their fat is craving sugar. Unfortunately, when they eat the sugar, it goes straight to their fat, instead of going to their muscles, brain or liver. When people with pre-diabetes eat sugar, they are starving themselves and feeding their fat. To stop the craving, they must stop the sugar for 10 days and tell the fat to “shut up.”

Not all carbs are bad

Now let’s focus on carbs.


Carbohydrates are necessary fuel for our bodies—especially our muscles and our brain. Our liver needs to store a little bit of carbs as glycogen for when we need a boost, like after walking at a good pace for 40 minutes. However, there is a difference between healthy and unhealthy carbs.


Complex (healthy) carbs raise the blood sugar slowly and allow the pancreas to make insulin slowly and push the sugar into the right cells—not into the fat on your body. We need complex carbs at breakfast, morning snack, lunch and afternoon snack, and then not so much for the rest of the day. Healthy carbs include whole grain whole wheat bread, brown rice, sweet potatoes, quinoa, oatmeal (cooked—not the sugary packets), beans, peas and green vegetables.


Simple (unhealthy) carbs raise your blood sugar quickly, overwhelm the insulin in your body and get pushed into your fat. Think of simple carbs as a treat—white rice, white tortillas, baked goods, candy, many cereals, and anything made with mostly white flour.


Unfortunately, too many people think they are doing the right thing by staying away from all carbs. That is the wrong tactic.


When my patients (all women, of course) tell me they don’t eat any carbs, I let them know that’s the wrong approach to good health. The goal is to achieve an even blood sugar with minimal insulin spikes. High insulin can make us hungry for sugar and then pushes the sugar into fat. A healthy diet only contains one small treat per day—a piece of chocolate, a serving of alcohol, or a white flour tortilla.


Think of these types of carbs like a budget—you can have some carbs, but you can’t have them all at once.


Blood sugars and Type 2 diabetes can cause many complications—kidney disease, hypertension, stroke, skin problems, neuropathy, foot problems, infections resulting in loss of toes, eye issues (glaucoma and blindness), and impotence in women and men.


High blood sugars damage and clog small blood vessels, and if organs, including the eye, heart, kidney and sex organs, do not get blood, the various organs can’t work properly and problems occur.

Risk factors to know

It’s important to know the risk factors associated with this disease. Family history of diabetes, being overweight (especially with belly fat), and inactivity are all serious risk factors. In addition, women have two other factors that can work against them: having diabetes during pregnancy and menopause.


Menopause increases the risk by causing insulin resistance, and menopause can also make things worse by causing poor sleep from night sweats. The cycle continues because poor sleep makes it more difficult to have the energy to exercise and make good food choices. Menopause can definitely wreak havoc for women and diabetes.


I see many menopausal women in my office each year, and so many of them tell me about their struggle with weight. I remember one patient in particular I’ll call Sue.


Sue came to see me for heavy bleeding around the time her menopause had started. We did an ultrasound, which showed a thick uterine lining, so I scheduled a dilation and curettage.


During her exam, I also asked her what was the No. 1 struggle in her life. She started crying and told me her weight was her biggest struggle. Over the years, she had managed to keep her weight at a “tolerable” level, but in the past six months (around the time she started menopause), her weight continued to climb and she was giving up.


I couldn’t let Sue leave my office without trying to see what she could change to help with her weight struggle. We went through her diet, and she mentioned that she was avoiding carbs most of the day. She would eat some protein throughout the day and try to starve herself by eating little else.


By the time she began preparing dinner, she was extremely hungry and tired. As a result, she would eat the same meal she had just made for her family—some type of meat and a potato or pasta.


Even though Sue limited her portions throughout most of the day, she was actually causing herself to put on more weight. Her body was so hungry that whatever food was being consumed was being pushed into belly fat. Sue was surprised to learn she was making it worse, but I helped her develop a simple and easy plan to incorporate complex carbs into her diet.


By the time I saw her for her dilation and curettage several weeks later, she was feeling better, had more energy, and had lost six pounds for the first time in years.


It’s important for all of us to know as much as we can about diabetes in order to avoid falling victim to this disease.


Knowing the risk factors plus ways to avoid diabetes (exercise and diet) are imperative.


Reprinted with permission from Spectrum Health Beat.

Menopause—a hair loss culprit?

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Hair thinning is an unexpected, yet common, symptom of menopause. (Courtesy Spectrum Health Beat)

By Alyssa Allen, Spectrum Health Beat


Hot flashes. Night sweats. Mood swings.


Most middle-aged women are on the lookout for these typical symptoms of menopause.


But hair loss? That one can take some women by surprise—and cause big worries.


“It’s a big deal because our hair affects so much of our self-image and how we think of ourselves,” said Natasha Peoples, NP-C, NCMP, a nurse practitioner specially trained and nationally certified in caring for patients with menopause concerns.


Peoples works with the Spectrum Health Medical Group Midlife, Menopause & Sexual Health practice. She sees women experiencing various menopause symptoms, including hot flashes, night sweats, mood swings, sleeping issues, vaginal dryness, irregular bleeding and more.


“Just like all menopause symptoms, it varies from person to person,” Peoples said. “Women come to us and they’re all going through the same process, but they all experience it completely differently.”


Any degree of hair thinning causes concern among women, but it’s often hard to quantify how much hair you’re losing to know if it’s been a significant change, she said.


Also, unlike with hair loss after pregnancy—a common occurrence—women experiencing it during menopause might wonder if it’s ever going to stop.


“(Post-pregnancy hair loss) always balances out,” Peoples said. “And with women experiencing menopause it’s more concerning because there’s not that expectation that it’s going to reverse.”


While doctors don’t always know why hair loss is happening during menopause, Peoples said that as women experience menopause and normal menstrual cycles stop, they lose the estrogen and progesterone that the body would cycle normally.


With the loss of female hormones, testosterone and male hormones can become more active in the body. And that can affect hair follicles, among other things.


She urges women to talk to their medical providers about all their symptoms of menopause, including hair loss.


The first step would be to rule out other possible causes of the hair loss. Possibilities include thyroid imbalance, anemia, vitamin deficiency, new medication side effects or stressful physical events, such as surgery or illness.


“Whatever they can do to manage stress can be helpful,” Peoples said. “Hair follicles have a four-month life cycle and any change you make to reverse hair loss, you’re not going to see for four to six months down the road. It’s a slow process, which can be frustrating.”


If hormones are to blame, hormone replacement medications or those that block testosterone receptors might be helpful, she said.


Patients also might need to see a dermatologist, she said.


While some menopause symptoms, including hair loss, might be unavoidable for some women, there are things that might help minimize symptoms.


Peoples encourages women to limit caffeine, drink plenty of water, get regular exercise, maintain a healthy weight, keep good sleep habits and quit smoking.


The most important thing: Women need to realize they’re not alone. Help is available.


“It’s nice to be able to help women who start to have these struggles and feel like there’s nowhere to turn,” Peoples said.


Reprinted with permission from Spectrum Health.

Have the dry eyes of menopause?

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A common complaint among middle-aged women, there is help for dry eyes. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


Menopause can be tough enough to handle, but when hot flashes and weight gain are accompanied by dry, scratchy, irritated and red eyes, it’s time to take action.


This condition actually has a name associated with it—dry eye of menopause—and it is a common complaint of women over 50.


Many women talk about it, ask their physician about it, and don’t like it, but there are no clear answers as to why women suffer from this condition. And, unfortunately, we don’t really know what to do about it. Is dry eye really associated with menopause, or is it a product of aging? We aren’t completely sure.


A patient I’ll call Rhonda suffered from several symptoms during menopause, including dry and irritated eyes. The 54-year-old finally decided to call our office for help.


She had been period-free for about 15 months, and her menopause symptoms were not going away. She started with night sweats and irritability roughly six months before her last period, but soon after her final period (not knowing it was her last one), the hot flashes started with a vengeance.


And the symptoms just kept coming. Rhonda didn’t sleep well, her moods became erratic, and she gained weight without changing her diet or exercise plan. For many months, Rhonda thought she could just handle everything, but after blowing up at a lady who left her cart in the middle of the aisle in the grocery store one day, she knew something had to change.


Rhonda took her first step by seeing her family practice physician. Although helpful, Rhonda wasn’t sure about her doctor’s recommendation to start taking hormone supplements.


So, instead, her doctor started her on the medicine Lexapro for the hormone-related mood changes. Lexapro increases the brain chemicals lost with poor sleep and lower estrogen levels. The medicine quickly helped with her mood swings and also cut her hot flashes in half.


Unfortunately, the weight gain continued, and she started having really scratchy eyes. She went back to her doctor thinking she had something stuck in them. After a thorough examination of her eyes with a special lamp, the doctor concluded they were clearly red and irritated despite having no foreign particles in them. She told Rhonda she had seen many women with dry eyes when they started menopause and perhaps it was time to consider hormone medication.


Rhonda left the office determined to take the next step in getting relief for this annoying symptom. She made an appointment at the Spectrum Health Medical Group Midlife and Menopause Offices with Natasha Peoples, a nurse practitioner and certified menopause practitioner. Peoples walked her through our menopause symptom and lifestyle assessments, also known as SEEDS (Seven Essential Elements of Daily Success).


The assessment confirmed that Rhonda had many of the symptoms, even though some of them were better with the Lexapro. Rhonda’s No. 1 goal was to get help for her dry eye issue, and she hoped Natasha could give her some advice. Her job required her to sit at a computer screen for several hours each day, and her eye symptoms made it difficult to concentrate.


After listening to Rhonda’s concerns, Natasha explained how the body changes with menopause, focusing specifically on the dry eye problem. We know that dry eye of menopause in women is common, no matter what age they experience menopause—at 30, 45 or 55. And, for many women, the symptoms of dry, scratchy eyes get better with estrogen. Testosterone is thought to possibly play a role in tear formation as well, and, without good studies to help us, testosterone in low doses added to estrogen could also help.


There are also some other options that may help dry eyes if a woman either can’t (because of medical reasons) or simply won’t add hormones to her daily routine. Dry eye of menopause is thought to be from quicker evaporation of tears and lower-quality tears (tears that are watery and don’t have much oil to coat the eye surface). Conversations with patients tell us that over-the-counter medications such as artificial tears and lubrication ointment can be effective for some, as well as adding fish oil or flax seed supplements to their diet. Even the basic habit of drinking water and staying hydrated can also play a positive role in eliminating this symptom.


Peoples thought Rhonda would benefit from taking hormones, but she first needed to make sure Rhonda was a good candidate. Natasha asked many questions about Rhonda’s medical history and lifestyle habits, and determined she was very healthy, except for being overweight. They talked about getting back to the basics and incorporating the SEEDS into her daily routine. And, they also worked out a plan to start menopause hormone therapy, deciding on the patch and FDA-approved progesterone capsules called Prometrium-bioidentical.


Three months later, Rhonda returned to see Peoples for her checkup and happily reported she felt better. She added one more walk to her week, started doing a DVD with weights, added yoga once a week, and began a routine of daily stretching. In addition, she drank more water, got better sleep and took a multivitamin, Vitamin D and fish oil.


Two weeks after starting the hormones, her hot flashes disappeared, and although her dry eyes weren’t completely back to normal, they were only a minor nuisance and no longer bothered her at work. Even her friends and family members noticed she was acting and feeling better.


Women, including Rhonda, do not have to suffer during menopause. Sometimes even the most basic habits can make all the difference in helping us feel better. And, even though Rhonda’s health care providers aren’t completely sure which change helped her eyes improve the most, Rhonda enjoyed feeling better than she had in a long time.


Reprinted with permission from Spectrum Health Beat.

Reclaiming her spark

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By Eve Clayton, Spectrum Health Beat, photos by Taylor Ballek


If you were to meet Judy Pellerito today, you would say she’s full of life.


Newly retired after 31 years of teaching, the Kentwood, Michigan, resident is animated, outgoing and full of dreams.


She’s starting a community choir “open to anyone ages 13 to 103.” She plans to play her ukulele for nursing home residents and bring her pup Mabel along as a therapy dog.


So Pellerito would agree with you: At age 54, her life is good.


“I have energy and hope and optimism and gratitude,” she said on a recent fall morning.


But wind the clock back a year or two and get Pellerito to level with you, and you might hear a different story. A story marked by anxiety, depression, poor sleep and low energy.


Sure, she still got up and went to school every day. The former Northview High School choral director loved teaching, loved her students and her colleagues.


But it became harder and harder to summon the “energy and the stamina and find the joy day after day,” she said.


Finally a good friend saw through her smiling façade and nudged her to get help. To find out what was going on. Tired of saying, “I’m fine, I’m fine,” Pellerito acquiesced.


She made an appointment with a psychologist, who listened as Pellerito talked about life—and heard her describe many of the classic symptoms of menopause.

Hormone decline

Pellerito’s counselor referred her to Marjorie Taylor, NP, a member of the Spectrum Health Midlife, Menopause & Sexual Health team who specializes in hormone-related issues.

Photo by Taylor Ballek

Recognizing her symptoms as typical of a woman going through midlife hormonal changes, Taylor did a physical exam and a thorough blood workup, paying close attention to Pellerito’s thyroid and other hormone levels.


Not surprisingly, Pellerito’s blood levels showed that “her estrogen was really low,” Taylor said.


Taylor’s message for her patient? There’s help for you. You don’t have to struggle.


Taylor started Pellerito on an antidepressant and hormone therapy tailored to her medical situation. After just five months, Pellerito felt like herself again—or, perhaps, like a more jubilant version of herself.


“I didn’t know that my hormones had bottomed out,” she said. “It’s not like there is a switch that’s flipped—you don’t one day get symptoms. It’s so gradual that it’s almost imperceptible. You don’t realize until you look back.”


In retrospect, Pellerito says her menopause symptoms probably escalated over the course of five to 10 years, gradually stripping away her joy.


“I can look back now and just see an incredible difference,” she said. “And an incredible future.”

Feeling good again

Stories like Pellerito’s fuel Taylor’s enthusiasm for her work.


“It’s so fun to do because every visit you see improvement, and you see this person find their spark again,” she said. “When everything gets balanced, whether it’s thyroid, hormones, whatever it is, we see not only their energy come back, but they sleep better. It helps relationships, it helps—just their whole quality of life improves.”


Taylor acknowledges that hormone therapy isn’t right for everyone, but as a strong advocate of its benefits, she gives her patients lots of information and works hard to clear up the misperceptions about its risks.


“People have no clue of the wonderful benefits that hormone therapy can bring,” she said.

Photo by Taylor Ballek

Hormone therapy can contribute to women’s longevity, Taylor said, by preventing heart attacks, strokes and osteoporosis, and by helping to alleviate fatigue, depression, anxiety, vaginal issues and bladder issues.


“But the biggest thing is that it brings the spark back to their life and they feel normal again,” she said. “When people start going through perimenopause, they think, ‘Ugh, I’m aging and I’m just never going to feel good again. … And that’s not true.”

Start sooner

Pellerito’s experience is a vivid case in point. She now feels healthy, both physically and emotionally, and is eager to explore new opportunities as a young retiree.


Once a week she returns to her previous school district to work as a vocal coach.


“I’m still pouring love into teenagers and adults in different ways,” she said, “but everything is different now.”


For other women who may be feeling some of the symptoms she experienced, Pellerito says not to wait like she did.


“I would just recommend people walk down the path of getting help sooner,” she said. “Sooner, sooner.”


Reprinted with permission by Spectrum Health Beat.

Are hormones safe?

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For many women, a healthy lifestyle is not enough. They want some kind of treatment to help them feel better and get back to feeling like themselves. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


Too many women suffer needlessly from symptoms of hormone changes and menopause.


Women want to age with health and vitality, but often are taken by surprise with midlife body changes. It is unfortunate that not enough women know the facts about hormones and options for healthy aging.


We are fortunate these days because there are so many treatment options available.


There has been significant research to help us understand how to individualize these options for each woman depending on her preferences, medical history, stage of menopause and degree of symptoms.

Options abound

The foundation of treatment for the symptoms of menopause is a healthy lifestyle. This is defined by the SEEDS, or seven essential elements of daily success.


Following the SEEDS each day includes:

  • Eighty ounces of water
  • Seven hours of sleep
  • A healthy balance of healthy carbs, protein and fats with only one unhealthy carb treat
  • A multivitamin and vitamin D
  • Exercise and stretching
  • Fiber
  • Calm breathing and gratitude

For some women, this is enough to feel good through menopause. Twenty percent of women get through their transition with only minimal symptoms.


For many women, however, a healthy lifestyle is not enough. They feel so in the hole of symptoms that they want some kind of treatment to help them feel better and get back into good habits. This is when we talk about the most effective treatment for hot flashes, night sweats, pain with sex, sleep and mood disturbances and decreased sex drive.


Estrogen medication works quickly and is safe for many women. There are many fear-based untruths out there that keep women from using medication that can help them feel like themselves again.


A recent study of hormone use showed that the risk of blood clots has a higher association with oral estrogen use, not with transdermal—absorbed through the skin—estrogen therapy. And for oral estrogen use, the risk was higher with equine estrogen, also known as premarin, and not with the bioidentical, FDA-approved form of estrogen.


Now, for women who have taken premarin for years and do not want to stop, the risk of associated blood clots is mainly in the first year. Switching is possible, but for those women who choose not to, the advice would be to minimize other risks for blood clots by maintaining a healthy weight, staying hydrated, and taking a baby aspirin when on long car trips or plane rides. And always talk to your doctor about your risk.


Bottom line, be informed, make decisions based on facts, and get advice from doctors and other health care providers who are menopause certified. Every woman is different and what works for her or is safe for her may not apply to another.

Test your hormone knowledge

True or false? Hormones will make me fat.


False. Menopause is associated with belly fat, hormone medications are not. Studies show that hormone medication may help with sleep and reduce insulin resistance, so if women do the work to stay healthy, hormones can help maintain a healthy weight.


True or false? Estrogen causes breast cancer.


False. In the aforementioned study, women who were on estrogen because they had a hysterectomy had a lower risk of breast cancer. Estrogen does not cause cancer, but if a woman gets breast cancer, we do not give estrogen in the blood (via a patch or pill) because of concerns it could cause a recurrence. We might prescribe vaginal estrogen, but not systemic. The only women in the Women’s Health Initiative study with more breast cancer were older and on synthetic oral progesterone more than seven years. This study helps us understand safe ways to give hormones and which type.


True or false? Prescription medication is not bioidentical.


False. It is biochemically identical to the estrogen the ovary makes before menopause. We prescribe FDA-approved estrogen and progesterone, meaning it is the same every time you place a patch or take a pill. There is no batch-to-batch variability like in the compounded medications. Insurance will cover the FDA-approved medication.

Hormone guidelines to consider

If the below criteria describes you, hormones could be a safe option:

  • Less than 10 years from last period
  • No history of breast cancer
  • No vascular heart disease (heart attack, or high risk for heart attack)
  • No history of blood clot in the leg or lung
  • No prior stroke
  • No dementia
  • No metabolic syndrome (combo of high blood pressure, central obesity, high blood sugar, high cholesterol)

These are only guidelines. If there are any questions regarding risk, your provider will bring in partners from cardiology, diabetes, hematology, and cancer care to help guide decisions.


Reprinted with permission from Spectrum Health Beat.

Kick dreaded belly fat to the curb

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Avoid the accumulation of dangerous belly fat. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum HealthBeat

I’ve told all of you about my mantra—lean and ease of movement—in some of my earlier blogs.

My plan to help me achieve this mantra is to eat small, frequent meals of complex carbohydrates and protein, plus one simple carb treat each day.

How many of you came up with your own mantra to help you make good decisions every day? I ask that question because I really believe everyone needs a little help to make smart choices, especially during middle age and menopause.

One of the most important reasons to choose what you eat wisely is because of the relationship between middle age, menopause and belly fat.

Even if you have always had a flat stomach, or mostly gained weight below your waist, you may have noticed that has changed as you’ve reached middle age (and beyond). A common complaint I hear from women who visit my practice is that they gain belly fat easily and have a difficult time losing it.

Why is belly fat so bad? There are several reasons, including both medical and personal issues, with belly fat:

  • Belly fat makes you feel unhealthy.
  • Belly fat can change your mood from cheerful to irritable.
  • Belly fat greatly increases your risk for heart disease, diabetes and overall weight gain.
  • Belly fat adds more insulation, which can cause or worsen hot flashes and night sweats.

In addition, belly fat is extremely powerful because it is inside your abdominal cavity, not just under the skin like fat elsewhere on your body.

When fat is so close to your liver, it can cause a condition called “insulin resistance.” This means that your insulin receptors on your cells require more insulin to make the sugar go into your liver, muscle or brain cells. Thus, as insulin increases to meet this demand, it increasingly makes you crave sugar and promotes fat storage.

When you answer the craving and eat sugar, the sugar goes directly to the belly fat and makes it bigger, which then makes your insulin increase even greater. You get the picture: The belly fat has a voice that says, “Feed me.” That “voice” is insulin, and the only way to shut it up is to starve it of simple sugar.

So, what’s the answer?

It’s simple: Get off the sugar.

There are simple carbs all around you every day, but you need to figure out how to stay away from them without feeling cheated. I was at a baseball game recently, and you can imagine how many simple carbs were right next to me—blueberry muffins, licorice, hot dog buns, slushes.

Here’s what I did before I went to the game: I had a late breakfast of brown rice, poached egg and mixed greens. Plus, I took a baggy of frozen grapes to munch on during the game. I was completely satisfied and had no craving for that blueberry muffin next to me.

You can’t always avoid simple sugars, but you can make smart choices.

Ice cream with the family? Choose a baby cone and throw away the cone (or get the ice cream in a dish).

Heading to a party or a baseball game? Eat a healthy meal or snack before you go and take a sweet snack (like frozen grapes) with you to help you avoid the cravings before they start.

And, keep repeating your mantra—whatever it may be. If you do not feed the fat, you will take back your power to be healthy.

Reprinted with permission from Spectrum HealthBeat.

Weather your perfect storm

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Are you ready for menopause? Or even perimenopause? The storm is coming, so now is the time to act to make it less of a tempest. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum HealthBeat

 

So many women come to see me when they are experiencing what I call the Perfect Storm.

 

Their bodies are changing and they are faced with night sweats, increased belly fat, irritability, depression, lack of energy, irregular or heavy periods and decreased sex drive. That’s quite a list!

 

The Perfect Storm occurs when two fronts collide and cause havoc with your body.

 

The first front is caused by changing hormones, which then leads to an array of symptoms: night sweats, hot flashes, disturbed sleep, anxiety, irritability, decreased motivation and sex drive, and cravings of sweets and simple carbs. The second front is the change in your body chemistry, including changes in hormone levels.

 

The result? Good cholesterol levels go down, bad cholesterol goes up, insulin resistance increases, belly fat builds up and brain chemicals drop.

 

To more fully understand the Perfect Storm, it helps to know the three phases every woman goes through in adult life: reproductive phase, perimenopause and menopause.

Here’s a brief summary of each phase:

  • Reproductive phase—Many women in this phase feel normal and experience regular periods. This is the time we really don’t have to think about our hormones, and our body just makes sense. Toward the end of this phase, symptoms such as menstrual migraines, night sweats, mood changes and sugar cravings sometimes start. These symptoms are predictable and occur the three days before your period starts.
  • Perimenopause—This stage is sometimes referred to as midlife, and it’s also where the Perfect Storm occurs. Your periods start to become irregular, closer together and heavier, and symptoms like night sweats, sleep difficulties, mood changes and belly fat weight gain can become worse. You may even skip some periods and then begin having regular periods again.
  • Menopause—This phase means you haven’t had a period in 12 months—yeah! However, it’s important to note that if you go three months without a period and then you get one, the clock starts all over again. Approximately 80 percent of women experience symptoms during menopause, which typically last between two and five years after the start of menopause. The good news is that women who seem to handle the symptoms the best are the ones who continue to kept their weight in the healthy range, remain active, drink plenty of water and get plenty of sleep each night.

After menopause, it is very difficult to alter the course you are on, so if you want to weather your Perfect Storm and keep your symptoms in check, you need to make sure you are on a healthy path right now. What happens during the storm will determine the course of the rest of your life, so ask for the help you may need to sail through your Perfect Storm.

 

Reprinted with permission from Spectrum HealthBeat.

On the shelf: ‘The Hot Flash Club’ by Nancy Thayer

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By Laura Nawrot, Grand Rapids Public Library, Ottawa Hills Branch

 

When I picked up this book, I was looking for something light to read that involved characters that I could relate to—and I was not disappointed. In The Hot Flash Club, Nancy Thayer introduces the reader to four very diverse women ranging in age from fifty-two to sixty-two. The only things they have in common are a mutual acquaintance and the process of menopause. I found my self quickly drawn into the world of Faye, Alice, Shirley and Marilyn, characters who give the term “aging gracefully” a whole new meaning.

 

As the four women plunge into an unexpected relationship with each other, they explore many current women’s issues with gentle humor, honesty, and nerve. Rather than viewing menopause as the end of childbearing years, Thayer suggests it is the launching point into late middle-age. Her characters are far too busy living their lives and following their dreams to focus on things that might hold them back, like arthritis, divorce, retirement and widowhood. Those topics are simply a part of their lives, not the main focus, and this positive approach works well within the framework of the story.

 

While the story holds a lighter tone than works by authors such as Elizabeth Berg, it is an entertaining and positive look at women and aging, as well as being a gentle reminder that life is a journey, not a destination, and our perception of the process is vital to how much we enjoy the ride.

All hormone medications are not the same

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Think any hormone supplement will do? Think again. Get an expert’s opinion. (For Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat

 

A patient I’ll call Bev recently came to see me for her annual physical, and she had just a few complaints: rare hot flashes, occasional night sweats and irregular spotting.

 

So far, so good.

 

At age 54, her last regular period was approximately 16 months ago. Since that time, she had started using hormone creams prescribed by her chiropractor.

 

Bev brought the creams in to show me, boasting that they were all natural. She told me she had been feeling great since starting the hormone cream.

 

Her hot flashes were rare, and her once-thinning hair was now getting thicker. I continued to listen with an open mind as we discussed the rest of Bev’s health.

 

She happily reported that her hypertension was being controlled with low-dose medications from her primary care physician, and she had no other risk factors for heart disease, stroke, blood clots or diabetes. Furthermore, Bev was a healthy weight.

 

For the most part, I liked what I was hearing.

 

Finally, we confirmed that her health screening was up to date, including lab work, mammogram and colonoscopy. As a final step, I performed a breast exam, Pap smear and pelvic exam. Her pelvic and breast exams were normal, and I had no reason to expect any issues with her Pap results.

 

Now that we had all the background information and physical exam taken care of, I could address her concerns of lingering hot flashes. We were able to relate them to days when she was not drinking enough water, had increased stressed or drank an extra glass of wine.

 

I then felt obligated to voice my concerns about the natural hormone creams she was taking and the possible relationship to her irregular spotting.

 

As a result of my concerns, I asked Bev to have a pelvic ultrasound to measure the lining thickness of her uterus. Post-menopause bleeding can be a sign of uterine lining pre-cancer or cancer.

 

When women take FDA-approved estrogen replacement therapy and progesterone, their risk of uterine cancer is lower than women who take nothing. Estrogen stimulates the lining to grow, and progesterone keeps it in check.

 

However, the non-FDA-approved hormones Bev used are not shown to protect the uterine lining and can actually increase the risk of uterine cancer.

 

Bev’s ultrasound of her uterus did show a thick lining, and her endometrial biopsy showed benign thickening. We reversed the thickening first with synthetic progesterone and then switched her to two FDA-approved products: a bio-identical estrogen patch and an oral bio-identical progesterone.

 

Today, Bev feels great—hair and skin included—and I feel good that we are keeping her safe and healthy.

 

Reprinted with permission from Spectrum Health Beat.

Get your groove back

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Don’t allow sexual issues sideline you from the pleasures of life. (For Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat

 

Sexual health is a part of our overall health, and it impacts a woman’s (and a man’s) sense of self and feeling of being healthy.

 

Women who suffer from depression or anxiety are more likely to have sexual health concerns, and women with sexual health concerns are more likely to have depression and anxiety. It’s a vicious cycle—one that can be frustrating and difficult to break.

 

Chronic health issues or chronic health diseases such as heart disease, diabetes, obesity or arthritis can interfere with a woman’s ability, or a couple’s ability, to have a healthy sexual relationship. And common conditions like pain with sex, low desire and relationship issues all play a part.

 

I recently saw a patient who came in for her second visit to our Spectrum Health Cancer, Menopause, and Sexual Health Clinic at the Lemmen-Holton Cancer Pavilion.

 

She shared her excitement about once again being able to have sex after we treated her pain. She told me that cancer had taken so much away from her, but she felt whole again now that she could be intimate with her husband.

 

I love sharing stories like this because it shows how committed we are to helping everyone live better lives—including being as sexually aware and healthy as they wish to be.

 

I recently found the following quote from the World Health Organization:

 

“The purpose of sexual health should be the enhancement of life and personal relationships and not merely counseling and care related to STDs and preventing unwanted pregnancies. Sexual health should involve (1) the capacity to enjoy and control sexual and reproductive behavior in accordance with a social and personal ethic; (2) a freedom from fear, shame, guilt, false benefits and other psychological factors inhibiting sexual response and impairing sexual relationships; and (3) freedom from organic disorders, diseases and deficiencies that interfere with sexual and reproductive functions.”

 

I share this quote with you because, as a physician, I believe in what it says, and I try to keep it in mind when discussing sexual health with my patients.

 

There are many causes of sexual health concerns, and they can be grouped in the following categories: interpersonal issues, physical issues and psychological issues.

 

When discussing interpersonal issues, we think about lack of intimacy, lack of respect and emotional abuse.

 

Physical issues include pain with sex from menopause and dryness, pain from history of pain and/or tight pelvic muscles, and medical conditions such as diabetes or arthritis.

 

Psychological problems include depression or anxiety, history of sexual abuse and poor self image.

 

No matter what your sexual issues include, there are solutions. Reach out to your medical provider for help.

If you have concerns about how to get your groove back, make an appointment to specifically discuss this topic and options with your doctor or a Spectrum Health Midlife and Menopause Clinic expert. Call 616.267.8225 to make an appointment.

 

Reprinted with permission from Spectrum Health Beat.

Manage menopause with a mantra

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Pick and stick to your personal mantra to gain control of your life. (For Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat

 

The other day I had lunch with a friend at Panera. I had been craving my favorite Fuji apple salad and was really hungry when placing my order.

 

I have been avoiding simple carbs for quite some time, so I ordered an apple as a side—not the French baguette I love.

 

My friend ordered the baguette, and it looked so good! It was so fresh and warm, and I could tell it was crunchy on the outside and soft on the inside—exactly the way I like it.

 

I remembered my mantra and grabbed my apple.

 

My mantra is “lean and ease of movement.”

 

It means I can sit with my knees up like I used to when I was younger (and more flexible). It means no extra weight around my middle, and it also means feeling “light” as I move around. My mantra (and everything it represents) is so important to me.

When I am carrying extra weight, I hate the way my clothes feel—tight and restricted. It makes me feel trapped and reminds me of times when I had to sit and practice piano. When I am lean, I feel healthy and in charge of my health, and I don’t have to shop for bigger clothes (an added bonus).

Why do we make the choices we make? Choices imply active decision-making, but sometimes the decision is made by the act of not deciding.

When I was growing up, there was a sign on the wall in the stairwell of my home that read, “Not to decide is to decide.” I think that says it all.

For example, if I choose to not make my lunch or bring a snack to work, I am choosing to be without good choices throughout the day. As a result of not having a plan for lunch or snacks at work, I am choosing to eat fast food or unhealthy snacks, which are not the best for my mind, my mood, or my waistline.

So, what do you care about?

Do you care about your heart and really don’t want to have a heart attack at 50 like your aunt did? Do you want to feel and look great at 60, unlike your sister who smoked and chose not to exercise?

If you dig deep and get at what you really care about and create a mantra to fit, you will claim power over the day-to-day and significant situations that occur in your life.

It could be as mundane as choosing what to eat for lunch (healthy versus unhealthy) or whether or not to exercise when you don’t feel like it, or as important as finding the courage to quit your job to pursue a new career.

Here are a few questions to ask yourself when creating your mantra:

  • What do I really want for my life (or health) in the next six months?
  • When I think about what I really want, what does that mean to me?
  • What feelings do I experience when I look at what I really want for my life?
  • What mantra would capture the feeling of what I want?
  • In what situations would I need/use a mantra?

My mantra helps steer me in the right direction almost daily. Take some time to compose your own mantra and enjoy having more power over the choices you make each day.

To learn more or to schedule an appointment with the Spectrum Health Midlife, Menopause & Sexual Health team, call 616.267.8520.

 

Reprinted with permission from Spectrum Health Beat.

On the shelf: ‘The Hot Flash Club’ by Nancy Thayer

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By Laura Nawrot, Grand Rapids Public Library, Ottawa Hills Branch

 

When I picked up this book, I was looking for something light to read that involved characters that I could relate to—and I was not disappointed. In The Hot Flash Club, Nancy Thayer introduces the reader to four very diverse women ranging in age from fifty-two to sixty-two. The only things they have in common are a mutual acquaintance and the process of menopause.

 

I found my self quickly drawn into the world of Faye, Alice, Shirley and Marilyn, characters who give the term “aging gracefully” a whole new meaning.

 

As the four women plunge into an unexpected relationship with each other, they explore many current women’s issues with gentle humor, honesty, and nerve. Rather than viewing menopause as the end of childbearing years, Thayer suggests it is the launching point into late middle-age. Her characters are far too busy living their lives and following their dreams to focus on things that might hold them back, like arthritis, divorce, retirement and widowhood. Those topics are simply a part of their lives, not the main focus, and this positive approach works well within the framework of the story.

 

While the story holds a lighter tone than works by authors such as Elizabeth Berg, it is an entertaining and positive look at women and aging, as well as being a gentle reminder that life is a journey, not a destination, and our perception of the process is vital to how much we enjoy the ride.

Sound solutions for better sleep

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Bye, bye baaaad sheep! We’re sleeping soundly tonight. (For Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat

 

One of the most frequent complaints women have about midlife and menopause is trouble sleeping.

 

Although not every woman walks through my office door saying, “My problem is poor sleep,” quite a few do.

 

Many talk about their sleeping issues in other ways. What they say usually goes something like this:

 

“I am so irritable, I do not like myself.”

 

“I cannot seem to remember anything.”

 

“Why am I so tired?”

 

But I know the real problem is they are either not sleeping well or enough.

 

Sleep disturbances are common and have many causes. And, although I am not a sleep doctor, I have learned about sleep during midlife and menopause.

 

First of all, just before your periods, the hormone drop can cause little night sweats, which disturb sleep just enough to be noticeable. Many women also describe falling asleep without any problems, but then waking up between 1:30 a.m. and 2 a.m. and not being able to fall back asleep.

 

Does this scenario sound familiar? If so, keep reading.

 

Your normal sleep consists of cycles that vary between deep sleep and light sleep. When you are in light sleep, you can usually get yourself back into deep sleep without waking. However, in midlife and menopause, you are more likely to be awakened by a full bladder, your bed partner’s snoring or a little hot flash.

 

Unfortunately, once you are awake and alert, your brain tends to go into overdrive: “Oh, no, I’m awake—what if I can’t get back to sleep? I have a big day tomorrow, and I have so many things to do. There’s that big presentation, cookies for John’s class and my mom’s doctor’s appointment.”

 

The worry machine goes into high gear and the adrenaline starts flowing.

 

Here’s how to fix the problem. Get out of bed, go to the bathroom, get a drink of water and go to a quiet spot in your home (not the bedroom) to practice metered breathing.

 

First, find a comfortable spot with just enough light so it is not totally dark. Glance at the clock so you can keep track of the time. The goal is five minutes. After you are comfortable, close your mouth, open your eyes and find a focal point—a spot on the wall or anything fixed and neutral. As Baron Baptiste says, “By focusing on one spot, it will send soothing messages to your mind.”

 

Then, just breathe through your nose, not deep or forced. Just be and breathe, focusing on the sound of your breath for five minutes. If you think of something that is worrying you, it’s OK. Focus for a second on the thought and then let it go.

 

Then go back to bed. If you find you can’t go back to sleep, get back up, go to your spot and repeat the metered breathing. It may take your body several times to retrain. Just be patient.

 

In addition to metered breathing, keep in mind the Seven Essential Elements of Daily Success (SEEDS) that will help you sleep better and be ready for your day. Not doing these things will trigger more night sweats.

  • Drink plenty of water
  • Get plenty of sleep
  • Take your vitamins daily
  • Eat a balanced diet with minimal sugar, caffeine and alcohol several hours before bed
  • Exercise regularly
  • Eat plenty of fiber
  • Start a gratitude journal

If you have tried the metered breathing and all of the SEEDS, and you’re still having trouble sleeping, it may be time to consult with a Spectrum Health Medical Group sleep specialist. Remember, sleep is everything.

 

Reprinted with permission from Spectrum Health Beat.

‘I just don’t have the energy I used to have’

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Photos by Taylor Ballek, Spectrum Health Beath

 

By Marie Havenga, Spectrum Health Beat

 

Diane Peterman tried everything.

 

She ordered remedies off the internet. She used over-the-counter medications that worked for friends. She visited multiple doctors in Northern Michigan near her Onaway home not far from the Mackinac Bridge.

 

But nothing could stop the hot flashes, night sweats, sleeplessness, weight gain and lack of energy she suffered during menopause.

 

“I started menopause three-and-a-half years ago,” Peterman said.

 

Life hasn’t been the same since.

 

She averaged 25 hot flashes or night sweats a day. Scalding. Miserable.

 

“All my friends in menopause said, ‘Try estrogen,’” Peterman said. “When I went on estrogen, the hot flashes disappeared.”

 

But another issue surfaced: migraine headaches.

 

She tried cutting the estrogen patch in half for a lower dosage. Migraines continued. She tried a quarter of a patch. Same result.

 

Peterman, who has worked for over three decades as a school superintendent’s administrative assistant, said the condition messed with her daily life.

 

“I saw a neurologist,” she said. “He checked for a brain tumor because I had visual migraines, with auras and pressure. They call it vascular migraines. They affect your vision and ability to drive.”

 

The neurologist ran multiple scans before finally discovering the culprit.

 

“He asked, ‘Are you by chance on an estrogen patch?’” Peterman said. “I took it off and threw it away. That was no longer an option for me.”

 

But what was? She needed to find someone who understood her symptoms and could assist.

 

“I tried cutting all caffeine out and exercising more,” she said. “I have no energy and just don’t feel good. No matter what you do or where you go, you are uncomfortable. I’ve never had anything like this and was so frustrated.”

 

She increased her exercise. Decreased her calories. Weight loss remained elusive.

 

“I wear a Fitbit to keep track of my steps, but it also keeps track of how many times you are up in the night and I averaged eight times a night. It gets to the point where I am just exhausted. I just pray my daughters don’t go through this.”

 

Frustrating. Tiring. But always warm.

 

“Some days I just hate the way I feel because I’m so sick of burning up and being sweaty,” she said.

Staying cool

In the winter, she keeps her bedroom thermostat at 50 degrees because of night sweats. Her husband piles on the blankets to keep warm.

 

“My husband (Tom) can look at me and tell,” Peterman said. “You can’t even disguise them. I use cool washcloths on my neck, dress in layers and drink a lot of ice water. I have bought a cooling mattress, cooling mattress pad and cooling pillows. If it said ‘cool,’ I bought it.”

 

She has spent more than $1,000 in search of a solution. But nothing worked. She knew it. Her husband knew it.

 

“When a hot flash starts, I go out on the porch in the winter and you can see the steam come off my body,” she said.

 

Perhaps not only physical steam, but emotional and spiritual steam.

 

With hope evaporating, and options dwindling, frustration built.

 

Peterman’s daughter, who lives near Grand Rapids and works at Spectrum Health was aware of unique services in Women’s Health and recommended the Midlife, Menopause and Sexual Health practice.

 

Peterman made an appointment with Natasha Peoples, NP-C, NCMP, a Spectrum Health Medical Group advanced practice provider who is specialty trained and nationally certified in caring for patients with menopause concerns.

 

“My daughter said you need to see a menopause specialist, your symptoms are extreme and beyond normal,” Peterman said. “My glasses were steaming up my hot flashes were so bad.”

 

Peterman had her first appointment with Peoples in late December.

 

Peoples took her off the medication another doctor had prescribed and put her on a new medication that other menopausal women found helpful.

 

Peterman said her hot flashes have dropped to about half of what she used to have, and she has also lost some weight.

 

For the first time in a long time, she feels hope.

 

“I keep a gratitude journal,” Peterman said. “I’ve always been a very positive person, happy and busy. It’s not that I’m depressed. I just don’t have the energy I used to have.”

 

Her seven grandchildren, with whom she spends as much time as possible, spur her on.

 

“I want to have energy to keep up with the seven grandchildren without struggling,” she said.

 

She credits Peoples for leading her on the first steps to improvement. Finally she felt “heard.” After three and a half years of chasing remedies, she’s experiencing her first symptom relief under People’s care.

 

“She’s a very sweet, compassionate person who is also very knowledgeable,” Peterman said. “Since she is a menopause specialist, this is what she does all day long and she sees every situation. She has already helped me and I’m hopeful she will continue to help me improve so I can get back the quality of life I had before.”

Complicated journeys

Menopause is different for every woman, according to Peoples, but Peterman’s journey has been particularly challenging.

 

“Diane’s symptoms are somewhat complicated due to the fact that she has hormone-mediated migraines, so hormone therapy is not an option for her,” Peoples said. “It’s not uncommon to experience the most severe and disruptive symptoms in the years just before or after the final menstrual period, as is the case for Diane.”

 

Making lifestyle changes and switching medications helped Peterman.

 

“Learning her triggers and patterns for hot flashes has been helpful,” Peoples said. “Being aware of how her daily habits can make a difference is a motivating factor. Her hot flashes have improved.”

 

Peoples said menopause transition symptoms—hot flashes, night sweats, difficulty sleeping, mood changes, vaginal dryness, decreased libido and irregular bleeding—are like an out-of-control roller coaster ride, “one that we hope to help them navigate.”

 

While some menopausal symptoms are genetic—think, “How was menopause for my mother?”—other symptoms can be related to lifestyle, according to Peoples.

 

“They are more severe for women who drink caffeine or don’t drink enough water, for those who don’t exercise and those who smoke,” Peoples said. “Weight gain and poor sleep can both be caused by menopause but also contribute to worsening symptoms.”

 

For women suffering from severe symptoms, it’s important for them to realize they are not alone.

 

“We all do it differently, but we all do it,” Peoples said. “Talk to your peers, talk to your provider and come and talk with us. We hope to help empower women to make the transition in a way that maximizes health and minimizes distress and discomfort.”

 

Take a hard look at your daily habits.

 

“Drink water, keep a good sleep schedule, exercise regularly, make healthy diet choices—watch out for sugar—and practice meditation or mindfulness,” Peoples said. “All of these choices will make a difference.”

 

Reprinted with permission from Spectrum Health.