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Perimenopause: How women can speak up and get support

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I recently asked about perimenopause on social media. The answers are best characterized by frustration, anger, and the question, “Why didn’t anyone tell me this was going to happen?”

Several problems complicate the diagnosis and management of perimenopause – the age range for onset of symptoms is not well defined; and symptoms are varied, sometimes not specific to the disease, and can last for several years.

There is also a possible timing in healthcare. When women rely on family doctors for well visits and routine Pap smears, they miss opportunities to communicate with an obstetrician / gynecologist who is better prepared for the transition into perimenopause.

“There was no support from my PCP, which is usually great,” said Christie Getto Young, a 52-year-old mother of two from Arlington, Massachusetts.

“Since the guidelines for Pap screening – which are based on valid findings – suggest screening every three to five years, there is less need to meet with a gynecologist annually,” noted Dr. Caryn Dutton, family planning medical director in the Beth Israel Deaconess Medical Center’s Department of Obstetrics and Gynecology and a senior lecturer at Harvard Medical School. “Patients see us about pregnancy and birth control and have not yet had a chance to hear about symptoms of perimenopause or menopause.”

The non-specific nature of some perimenopausal symptoms can lead to discharge.

“The first things women speak to their doctor about perimenopausal symptoms often have to do with energy and mood,” said Emily Roach, women’s health trainer and patient advocate, via email. “Doctors will dismiss their concerns and say it’s only part of getting older. They don’t delve into any potential thyroid health issues, low B12 levels, or bowel problems.”

The downside of the layoff can be an undue focus on perimenopause.

“Doctors were certain I had perimenopause after my breast cancer treatment and would be in menopause for the next 12 months,” said Tomika Bryant, a 49-year-old mother of two from King of Prussia, Pennsylvania. “It never happened and they tried to call it another name. Now they’re telling me to prepare for perimenopause at every appointment.”

Outside of the doctor’s office, women feel isolated in their experience. “I feel like I’ve been mugged. By myself,” said Monica Sakala, a 46-year-old mother of two in Washington, DC.

The lack of conversation unsettles the 51-year-old Deborah Reber from Brooklyn. “I felt incredibly let down by all of the women who came before me. If I understood why I went through what I went through, I would probably have coped better with it.”

So how can women become active in this normal phase of life?

Talk about your experiences

Break the cycle of stigma and shame through conversation. “We tell teenage girls what’s going to happen,” said Stephanie Pitney, a 48-year-old mother of two from East Granby, Connecticut. “Why don’t we 45-year-old women tell what’s going to happen? Why is it still taboo to talk about?”

Living with the short sleep gene:

These conversations may feel awkward, but vulnerability can strengthen relationships. “Being specific about our physical ailments – rather than vague and dismissive – can actually deepen relationships and help us all feel less isolated in the process,” said Laura Tremaine, author of “Share Your Stuff.” I’ll go first. 10 Questions to Take Your Friendships to the Next Level. ”

Take notes

Write down the date, time, symptoms, and other life events to provide specific information to your doctor.

“It really helps when a patient comes in with notes on their phone or calendar and can say, ‘I didn’t sleep well and my hot flashes were worse the next day.’ It helps narrow down the triggers and spot patterns, “Dutton said.

You can also discover patterns for yourself.

Sakala began struggling with insomnia a few months ago. “For a while I thought it was related to a pandemic. Then I realized it was hormonal; two weeks before my period, like clockwork. Got up at 3am every night, ”she wrote via email.

Roach also encourages the use of food diaries as a tool for identifying food intolerances. She wrote by email, “Our digestive systems change as we age and we don’t make food the way we did in our 20s and 30s.”

Look at your medical history

Your medical history can reveal unexpected connections. “I lived with epilepsy when I was 20 and had two children in my 30s while continuing treatment for epilepsy,” said Julia Beck, a 54-year-old labor lawyer and strategist from Chevy Chase, Maryland. When Beck had her IUD removed at the age of 40, she suffered two severe attacks.

These innovative designs address taboo health problems for women

Beck learned the connection between epilepsy and menopause from a neurologist and gynecologist in Boston. “I went through a series of tests and inpatient diagnostics. They started tracking and seeing patterns that eventually ended in perimenopause,” she said.

Medications that took Beck from perimenopause to menopause helped control her seizures, but then insurance problems made her medication out of reach. “As soon as I stopped the medication, the seizures started again,” she said.

Prepare to stand up for yourself

Women have to stand up for themselves. “I was pushing my PCP to treat me for my symptoms and hypothyroidism,” said Rebekah Dunkley, a 46-year-old mother of four from Boise, Idaho.

“I asked my PCP to refer to an endocrinologist,” said Dunkley. “I needed the help of a good endocrinologist to manage my symptoms and I had to deal with some disagreement between my endocrinologist and obstetrics / gynecologist. It’s amazing how much better I feel with the right treatment!”

Women's health coach and patient advocate Emily Roach advises clients to come forward and get a second opinion if necessary.

Roach encourages women to ask questions and seek alternatives and second opinions if necessary. “If something doesn’t feel right to you, trust your gut instinct and then work with a health advocate who can help you.”

Dutton recommended looking for doctors with perimenopause and menopause among their interests. “You can also find a certified menopause practitioner with the North American Menopause Society,” she said. Subscribe to CNN’s Fitness But Better newsletter: Back into the groove. Sign up for our series of newsletters to find a healthy routine supported by experts

Make lifestyle adjustments

Basic preventive measures are important. “We know that diet, sleep and exercise play a big role, not only in most chronic diseases, but also in minimizing the symptoms associated with the transition into menopause. For example, exercise can reduce the severity of hot flashes, ”said Dutton.

Women were more likely to skip health care than men during the pandemic, the report says

Small adjustments are worth investigating. “Perimenopause made my inattentiveness, concentration, and productivity worse,” said Julianna Miner, a 48-year-old mother of three from Cincinnati, via email. “I switched to a different type of planner and found that a bullet journal helped me stay focused and organized. I also gave myself the freedom to measure my productivity differently. I’ll see what’s done in a week instead of beating myself up when I’m having a bad day. “

Miner also prioritizes taking multivitamins, eating a healthier diet, less caffeine, and more outdoor activity. “It was important because the perimenopause made my blood sugar fluctuations worse, which made me dizzy, foggy, and cranky,” she wrote via email.

The pandemic forced medical appointments to be canceled early on. Now as we are trying to recover, it is not surprising that we are questioning ourselves.

“Do I feel bad enough to warrant more testing, more appointments, especially during a pandemic when everyone is fighting?” asked Arlington’s mother, Getto Young.

If you don’t feel like yourself, the answer is likely yes.

Christine Koh is a former music and brain researcher who has now become a writer, podcaster, and creative director. You can find her work on christinekoh.com and on Instagram, Twitter and Facebook at @drchristinekoh.

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Women’s Health

Plant-based food consumption associated with lower CVD risk

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August 04, 2021

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Disclosure:
Choi does not report any relevant financial information. Glenn reports that she has received grants from the Banting & Best Diabetes Center Tamarack Graduate Award in Diabetes Research, the Nora Martin Fellowship in Nutritional Sciences, the Ontario Graduate Scholarship, and the Peterborough KM Hunter Charitable Foundation Graduate Award; Consulting fees from Solo GI Nutrition; and fees from the Soy Nutrition Institute. Please refer to the study for all relevant financial information from the other authors.

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According to two studies published in the Journal of the American Heart Association, a more plant-centered diet was associated with a lower risk of cardiovascular disease in both young adults and postmenopausal women.

“Previous research has focused on individual nutrients or individual foods, but there is little data on a plant-centered diet and long-term risk of cardiovascular disease.” Yuni Choi, PhD, Postdoctoral fellow in the Department of Epidemiology and Community Health and the Department of Food Science and Nutrition at the School of Public Health at the University of Minnesota, Minneapolis, said in a press release.

a bowl of lettuce and chickpeas

Source: Adobe Stock

Young adults

The multicenter, prospective cohort study by Choi and colleagues included 4,946 adults, initially 18 to 30 years of age, without CVD. All participants were observed through 2018 and their diets were assessed using a validated nutritional history conducted through interviews. The quality of a plant-centered diet was assessed by the A Priori Diet Quality Score, with higher values ​​indicating higher consumption of nutrient-rich plant foods and lower consumption of high-fat meat products and less healthy plant foods.

The researchers observed 289 cases of CVD during the 32-year follow-up. A lower risk of cardiovascular disease was associated with long-term consumption and a switch to a plant-based diet. Those in the highest quintile of the time-varying mean diet scores had a reduced incidence of CVD compared to the lowest quintile (HR = 0.48; 95% CI 0.28-0.81). In the following 12 years in analysis of changes, an increase in diet scores over 13 years was also associated with a lower risk of CVD (HR = 0.33; 95% CI, 0.16-0.68).

Compared to the lowest quintile, the highest quintile of the 13-year diet change was associated with a 61% lower subsequent 12-year risk of CVD (HR = 0.39; 95% CI, 0.19-0.81). In addition, the researchers found strong inverse associations for CHD (HR = 0.21; 95% CI, 0.06-0.75) and CVD-related to hypertension (HR = 0.34; 95% CI, 0.16-0.75) , 74) with a time-varying average or diet change firmly favor those with a healthy plant-centered diet.

“A nutritious, plant-centered diet is beneficial for cardiovascular health. A plant-centered diet is not necessarily vegetarian, ”Choi said in the press release. “People can choose between plant-based foods that are as natural as possible and not heavily processed. We believe that from time to time individuals may ingest in moderation animal products such as unroasted poultry, unroasted fish, eggs, and low-fat dairy products. “

Post menopausal women

In another study, Andrea J. Glenn, MSc, from the University of Toronto’s Department of Nutrition Sciences, the Clinical Nutrition and Risk Factor Modification Center, and the Toronto 3D Knowledge Synthesis and Clinical Trials Unit, and colleagues prospectively followed a cohort of 123,330 postmenopausal women without CVD from the Women’s Health Initiative from 1993 to 2017 Participants were evaluated to assess the relationship between compliance with a portfolio diet score and CVD scores.

The primary endpoints were CVD, CHD, and total stroke, and secondary endpoints included HF and atrial fibrillation.

The researchers observed a total of 13,365 CVD events, 5,640 CAD events, 4,440 stroke events, 1,907 HF events, and 929 AF events during a mean follow-up of 15.3 years.

There was an association between women adhering to the Portfolio Diet Score and a lower risk of CVD (HR = 0.89; 95% CI, 0.83-0.94), CHD (HR = 0 , 86; 95% CI, 0.78-0.95) and HF (HR = 0.83; 95% CI, 0.71-0.99 when comparing the highest quartile of adherence to the lowest. Es however, there was no association between adherence to the portfolio diet score and stroke (HR = 0.97; 95% CI 0.87-1.08) or AF (HR = 1.1; 95% CI 0.87) -1.38).

These results remained statistically significant even after several sensitivity analyzes.

“These results provide the strongest evidence yet of the long-term benefit of portfolio dieting in primary prevention of CVD, although our portfolio diet score in other cohorts / populations must be assessed to confirm these results,” the researchers wrote.

According to the researchers, the results of the PortfolioEX study, which looked at the effects of the Portfolio Diet plus exercise on a surrogate marker of atherosclerotic CVD risk, are ongoing.

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Women’s Health

You should be relaxing your pelvic floor, not just strengthening it

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We as women often talk about our pelvic floor muscles in terms of whether they are weak or not (Image: Getty Images / iStockphoto)

It’s a pounding, spasmodic feeling in the space two or three inches below my belly button, deep under the layers of skin and fat where my uterus sits.

The pain comes quickly in waves, so strong that I lose my train of thought or can no longer concentrate on my surroundings. Everything in me feels tense and tense, but as hard as I try, I can’t let go or relax.

It hurts so much that all I can do is sit in the aching sensation, so I have to go to bed.

I usually wake up an hour or two later and the feeling is less intense but still there. I still have to find a way to completely drive it off without simply spending the day waiting for a clean start in the morning. Painkillers are pointless and do nothing to reduce the strong grip that grips my body and squeezes everything inside me so tightly that I feel passed out.

It started in the depths of the lockdown last year – easily dismissed as a coincidence or a one-off, I remember feeling incredible discomfort and going straight to bed. At that time I traced it back to being a woman and forgot about it. But soon it happened again and then again. Sometimes the pain bled for the next day and the day after, and sometimes it went away as quickly as it appeared.

As someone in the women’s health field, I was at a loss when I tried to match my symptoms against one of the online resources available. I searched for “pelvic pain” and couldn’t pinpoint what was happening to my body with any of the disorders or syndromes reported on the NHS website. I had blood tests and everything seemed fine so why did I (seemingly random) pass out for days?

Help came unexpectedly from Clare Bourne, someone I once interviewed for an article and later followed on Instagram who worked as a pelvic health physiotherapist (a what? I hear you say. Yes, there is).

I explained what was going on and her first reaction was to ask her how I was feeling emotionally. It seemed like an odd question since the focus of our conversation was on my pelvic health, but I answered anyway.

I was stressed, I said, even though I didn’t feel stressed. I knew I was due to an increase in tension headaches and a general inability to relax.

As someone who has struggled with mental health in the past, I found it strange that my emotions felt balanced and even calm during one of the most difficult periods in history that many of us will go through.

Clare’s response was to see a pelvic health physiotherapist as it sounded like I had a hypertonic pelvic floor. ‘What does that mean?’ I asked. “It means,” she said, “that your pelvic floor muscles forgot to relax.”

As women, we often talk about our pelvic floor muscles in terms of whether they are weak or not. I remember squirming with embarrassment in an exercise class in 7th or 8th grade when all the girls were told to do kegel exercises, where you contract your pelvic floor muscles to strengthen them.

The health benefits of this type of exercise are well known as a strong pelvic floor is known to help with continence, increase the enjoyment of sex, and if you want to give birth one day, it will reduce the time for your body to recover.

It will take years to undo centuries of work in which the male body was privileged at the center of medical research

It seems strange now to think that at the age of 12, I took the time to squeeze and tone those muscles, as none of these issues were particularly relevant at the time. But still it can’t hurt, can it?

The problem is that in everything we as women talk about strengthening our pelvic floor, we talk much less about relaxation. It may sound so simple, but for some of us it is anything but.

As it turns out, knowing how to relax your pelvic floor is just as important as knowing how to strengthen it. Those who are unable to do so can experience all sorts of uncomfortable secondary problems, from pain to incontinence and problems with penetrative sex. And yet, when I look up the NHS website, there is little or no guidance for women who may be suffering from these problems, and even lower abdominal pain does not list it as a possible cause.

The problem is that symptoms increase during periods of acute stress, as I don’t know, during a pandemic. When it comes to research by women’s health journalist Sarah Graham, my experiences are unfortunately not unique. So why don’t we talk about it anymore? And why are so many of us so ill informed about how to care for our pelvic health?

As always, a general lack of research and information on women’s reproductive health is at the heart of the problem. The government recently attempted to address this with a women’s health strategy that called for evidence earlier this year. I hope it touches on some of the many ways in which women’s agony is systematically ignored and the many areas in which medical treatment centered (and evolved) on the male body has met different challenges or does not take into account realities that women face.

It will take years to undo centuries of work in which the male body was privileged at the center of medical research.

But in the meantime, it seems to me that the most important thing we can do is talk to each other, to our friends, to our mothers and to our children about our experiences and how we can maintain our pelvic health.

I was fortunate to have the resources because of my job to find a way to understand what was going on and then get access to treatment – but a lot of women didn’t want to.

Despite this benefit, it took over a year from the onset of symptoms to the first visit to a pelvic health physiotherapist through the NHS. During this time I canceled work (and lost money), was late delivering items, spent entire weekends on the sofa and – during the limited time I was actually allowed to socialize – had to go to dinner or meet up with friends renounce because of the pain.

I know I’m not the only one going through this because I’ve connected with a lot of other women through social media who have had the same experience.

The good news is that there is a solution, but it takes time and working closely with a professional to learn how to loosen your pelvis and relax completely. It’s frustrating to think how long I would have had to experience all of these ailments if I hadn’t known exactly what to say to the GP (who told me that pelvic health physiotherapy is a scarce resource for women who are born and what not Case is).

More: women

To me, it’s just another example of how we are expected to tolerate and endure so much pain as women. It is encouraging to see politicians finally being promised to address this. I hope the government’s strategy will help address any shortcomings in our current health service related to women and reduce the gender health gap.

However, what it cannot and cannot do – for me and the millions of other women who have suffered the impossible obstacle course of getting a diagnosis for chronic health problems that are specific to the female body – is to give us the time back that is already over lost in an unimaginable amount of physical (and emotional) agony. Don’t we all deserve better?

Do you have a story you’d like to share? Contact us by email at jess.austin@metro.co.uk.

Do share your views in the comments below.

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Kristina Timanovskaya: Belarusian Olympic sprinter boards Vienna-bound flight out of Tokyo

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The 24-year-old athlete was scheduled to compete in the women’s 200m at the Tokyo Olympics on Monday, but said team officials tried to force her back to Belarus against her will after criticizing sports authorities. Her dire plight has dominated global headlines around the Games, and while her comments were not overtly political, her case has fueled fears for the safety of those speaking out against Belarusian officials.

Timanovskaya arrived at Narita Airport on Wednesday morning with luggage and wearing blue jeans and a blue sweatshirt. Later she boarded the Austrian Airlines flight OS52.

The athlete was to travel to Warsaw, Poland, where the country’s prime minister had offered her safe refuge and a humanitarian visa. It is unclear whether she wants to change trains in Vienna on the way to Poland, stay in Austria or travel somewhere else.

In an Instagram post, Timanovskaya said team officials forced her to pack her things and said she would be cut out of the Olympic team and flown back to Minsk. She was taken to Haneda Airport on Sunday but refused to board the flight from Japan as she feared for her safety and would be detained in her home country.

Timanovskaya said she was threatened by team officials for speaking out against a decision to include her in the 4 × 400 meter relay without her consent – an event she had not previously attended. She said her coaches didn’t tell her who made the decision to send her home.

Speaking to CNN on Tuesday, Timanovskaya said she was upset that she was denied her chance to participate in the Olympics.

“I was ready for the games, especially for the 200 meters. They took away my dream of the Olympics. They took this chance,” she said.

International Olympic Committee spokesman Mark Adams said Wednesday that the IOC would set up a “disciplinary committee” to clarify the facts of the case and, as part of it, hear national coach Yuri Moisevich and Belarusian sports official Artur Shumak. Adams also said that the National Olympic Committee of Belarus had submitted a written report on the situation.

On Tuesday, the IOC opened a formal investigation into the incident.

The Belarusian NOK said Timanovskaya had been withdrawn from the games because of her “emotional and psychological state”.

However, Timanovskaya refutes this claim, saying that she has not been examined by a doctor and that she has no health or psychological problems.

Timanovskaya told CNN that she realized she might be in danger when she called her grandmother before being taken to the airport by team officials.

“She said that I should not go back to Belarus because it was not safe for me there. She said that they said bad things about me on (state) television: that I was sick, that I had mental health problems,” said Timanovskaya said.

“My parents understood that if they said things like that about me on TV, most likely I would not be able to return to my home in Belarus… I don’t know where they would take me. Maybe to jail or maybe to a psychological hospital. “

At the airport, Timanovskaya said she used a translation app on her phone to type that she needed help and showed it to a Japanese police officer.

Although their Instagram post was not explicitly political, Belarusian athletes were faced with retaliatory measures last year after mass protests against the strong President Alexander Lukashenko, who has ruled the Eastern European country since 1994, and were arrested and expelled from national teams for criticizing the government in Bei During the protests, people were arrested and brutally suppressed by the authorities amid widespread reports of ill-treatment and torture. As the Timanovskaya case developed, a Belarusian activist was found dead on Tuesday in a park in the Ukrainian capital, Kiev. Vitaliy Shishov was the head of the Kiev-based Belarusian House in Ukraine (BDU) organization, which helps Belarusians escape persecution.

The activist was found hanged in a wooded area of ​​a park near his home on Tuesday. Ukrainian police opened criminal proceedings and said they would investigate whether Shishov’s death was suicide or “willful murder that was supposed to look like suicide”.

What’s next with Timanovskaya?

It is unclear where Timanovskaya will land, but several offers have been made to the athlete. Her husband, Arseni Zdanewich, left Belarus and entered Ukraine on Monday.

Poland’s Prime Minister Mateusz Morawiecki said he had spoken to Timanovskaya and assured her that she could count on Poland’s support. Deputy Foreign Minister Marcin Przydacz told Sky News that she expected her to visit Poland and “stay there for at least a few days”.

He said Poland gave her the opportunity to continue her sporting career in the country but “of course it’s up to her,” he said.

Kristina Timanovskaya at the Austrian Airlines gate at Narita International Airport on August 4th.

“We know that your training center is in Austria and your trainer is also stationed in Austria. She is waiting for her husband to come to Warsaw. So it will probably be her decision whether to stay in Poland or continue somewhere else. “Travel to any other European country and she is very welcome to stay in Poland.”

Przydacz said it was “most important” that Poland intervened and prevented Belarus from “kidnapping people to force them to return home against their will”.

“We gave them the opportunity to come and live in Poland safely and securely,” he said.

Poland has received 120,000 visa applications from Belarus since President Lukashenko’s controversial election victory last August, said Przydacz.

CNN’s Nick Paton Walsh, Amy Cassidy, Antiona Mortensen and Gawon Bae contributed to the coverage.

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