Oxidative Damage: You may have heard about “free radicals,” which Bowden describes as “dangerous molecules created from oxygen that attack your cells and damage your DNA and slowly wear you down, aging you from within.” He recommends eating plenty of vegetables and fruits, all high in ANTI-oxidants.  Berries, apples, prunes and green leafy vegetables are especially good for you.

Inflammation: We need some inflammation to heal an injury or irriation, but too much can be detrimental to  your health. Bowden explains that inflammation  ”damages the vascular walls and is a factor in every single degenerative disease including heart disease, Alzheimer’s, diabetes, cancer and obesity.”  His prescription includes supplementing daily with fish oil, “one of the great natural anti-inflammatory agents on the planet.”  He also recommends getting a high-sensitivity CRP test (C-Reactive Protein) the next time you have blood work done.  ”It’s the most reliable measure of inflammation now available.

Glycation: The third “horseman of aging” occurs when sugar molecules “glom onto protein or fat molecules, causing “sticky proteins that gum up the works and age your body and all its systems.  These sticky proteins accumulate everywhere in your body and are implicated in many of the diseases of aging,”  he explains.  Bowden recommends supplementing your diet with Carsonine, which he describes as the “ultimate anti-aging nutrient” to help prevent glycation from happening in the first place.

Stress:  Another insult to our bodies, says Bowden, is “any physical, mental or emotional factor that causes mental tension or bodily harm.” Stress produces hormonal reactions that can be detrimental to our health in many ways and make recovery from illness much more difficult.  His prescription includes meditation, relaxation, recuperative sleep and gentle excercise such as Yoga or Quigong.

Before you take any supplements, I urge you to consult an integrative medicine specialist, or naturopathic doctor to help you determine which supplements you should (or should not) be taking and in what dosages.

Wendy: What kind of tests can help doctors pinpoint exactly what’s going on with a woman’s hormones?

Dr. Hanaway: A woman’s total hormones can be done with a serum (blood) test. A saliva test will measure reactive hormones.  Urine will measure  how your body uses the hormone.  It’s important to find a doctor who is comfortable with one of these tests.

Wendy: Will you explain what the 24-hour urine test is and why it’s superior to a simple urine or blood test?

Dr. Hanaway: The 24-hour and First Morning Void (FMV) urine hormone tests are useful for measuring how the body uses hormones inside the cell.  We get a picture of the levels of the “parent hormones” (progesterone, testosterone and estradiol) from urinary testing. We also begin to understand how these hormones are broken down or metabolized.  Metabolites tell us about levels of stress, nutritional status and they can highlight risk of disease such breast cancer and osteoporosis.

Estrogen metabolites, in particular, are very useful to better understand modifiable risks of breast cancer. Of the two types of urine hormone testing, 24 hour urine testing is recommended for women using bio-identical hormone replacement therapy.

Wendy: There is much debate about whether saliva testing is a reliable way to measure a woman’s hormone levels. What is your opinion about saliva testing?

Dr. Hanaway: Salivary testing has been used for measuring hormones for the past 30 years. While many endocrinologists and OB-GYNs don’t have experience with this testing, they do reliably measure the free hormones in women (and men).  However, it’s important to note that salivary hormone measurements in women taking trans-dermal hormone creams may not be reliable.  Those tests should be run by a laboratory that has a demonstrated track record of reliability and reproducibility.

*   *   *

P.S.  from Wendy: Not all doctors have the experience with or see the need for the kind of specialized testing that Dr. Hanaway describes.  If yours won’t, add a “specialist” to your health and wellness team who specializes in hormone balancing.  This can be a naturopathic doctor, or an M.D. who practices integrative, holistic medicine.  My earlier blog post on “finding an integrative medicine doctor” can help as can the websites of the American Association of Naturopathic Physicians and Genova Diagnostics, which will provide a list of physicians in your area that use their lab tests. Of course, personal referrals are always helpful, so if  you’ve been working with a medical professional who has been espeically helpful for you, tell us about your experience in the comment box below and be sure to indicate where you live.

Is there anything that can prevent wrinkles???  The answer to this is YES! But first, understanding what causes them is important.  There are 3 kinds.

• Wrinkles caused by overactive facial muscles (think frown lines).
• Wrinkles caused by loss of volume  – mostly fat pads in our faces, and our bones (think what happens when you pull your skin up at the ears).
• And lastly, wrinkles caused by damage to the structure of our skin itself primarily the collagen and elastic fibers (think the thinning of the skin). These type of wrinkles are mostly due to sun damage but some to intrinsic aging and hormone changes.

All three of these contribute to cause what we see on our faces as crepiness, lines, and valleys. So … what can women who are focused on prevention do???  There’s way more to say on this topic but I’ll do the basics here.

For hyperactive muscles (#1), the best solution is still Botox used expertly so as not to be detectable. For wrinkles caused by #2, we must prevent bone loss as much as we can, and replace lost volume with fillers.  (That’s another blogpost altogether!) The only wrinkles you can affect with skin care creams or lotions are wrinkles caused by #3.  Here’s what works;

Vitamin A in the right forms and concentrations; Vitamin C and some other antioxidant and possibly cell growth factors.  Here are the products to start first.

• Renova(prescription) or SkinMedica Retinol Complex (Vitamin A) and always use these at night.

• TNS Recovery Complex for a cell growth factor and, for an antioxidant, try either SkinMedica Vitamin C Complex or Replenix Cream with 90% polyphenols.

Dr. Brandith Irwin is a board-certified dermatologist in Seattle and the author of The Surgery-Free Makeover: All You Need to Know for Great Skin and a Younger Face.  You’ll find more in-depth information about wrinkles – causes and treatment options – on her website.  

Can diet and exercise really eliminate belly fat? Recent research has shown that eating fewer calories, no matter what program you sign up for, will contribute to weight loss and thus, a smaller paunch.  But what about exercise?  Will just burning calories help eliminate the “muffin top” that a lot of middle-aged women (and men!) carry around?  Or do we need to target ab muscles with 100 crunches every day to do the trick?

I asked fitness expert Joan Pagano, whose newest book, “15 Minute Abs Workout” has recently been published.  As in her earlier books, Strength Training for Women and 15 Minute Total Body Workout (+DVD), Joan lays out specific routines with excellent photos (and a CD-ROM) that show proper form and execution.  They’re well organized and very easy to follow.

Joan: You need to do strengthening exercises as well as cardio to get results.  Abs exercises flatten and tone the abdominal muscles underneath the belly, while cardio exercise reduces the size of fat cells in that area.  If your abs are toned, but you have a layer of fat over them, do at least 30 minutes of cardio most days of the week to burn calories and reduce fat.  If you do not have excess belly fat, but lack of muscle tone causes your belly to hang, concentrate on the abs routines to firm up.  If you are both lacking muscle tone and carry excess fat, step up both cardio and abs routines.

Wendy: You state in your book that the classic crunch is one of the most effect ab exercises.  Can you explain why? How many and how often do you recommend?

Joan: The crunch is a versatile exercise, suitable for beginners and adaptable to many advanced modifications.  It targets the rectus abdominis, best known as the coveted “six pack” muscle, which describes the sections that develop when this muscle is toned.  It is the most superficial abdominal muscle, running from the sternum to the pubic bone, and is easy to isolate with the crunch.   Quality is more important than quantity: do three sets of 20 crunches in perfect form every other day.

Wendy: Your book includes “core training.” Can you explain why this is so important and how it contributes to overall abdominal strength and toning?

Joan: Core training is an integrated approach to working the muscles in the anatomical center of the body – the core – and training them to function as a unit (as in a plank) instead of in isolation (as in the crunch).  The abdominals and spinal extensors are key players in core conditioning, working together as a team to provide support for the spine and maintain its proper alignment.  Core strength enhances the overall appearance of the torso, improves posture and provides a foundation for quality of movement in the whole body.

Question to readers….Are you seeing results from doing ab exercises?  What’s helped you?   Do tell!

Update 3/27/09-  If you’d like to read more about Joan’s book read “Fab abs in 15 Minutes” at the “She Knows”website.

As if weight gain and belly fat aren’t insulting enough, a loss of estrogen in Menopause can also cause our hair to fall out!  And what’s left often turns thin and brittle, “like hay,” as one friend put it.  Why is this happening? And is there anything we can do about it?

I asked Dr. Diane Berson, a dermatologist in New York City, who explained that there’s a perfect storm of conditions that are conspiring to ruin (my word not hers) our hair as we begin the second half of our lives.

“Certainly aging and genes are contributing factors. But as we  lose estrogen in Menopause, our hair gets thinner and dryer, just as our skin and mucous membranes do.  Hair follicles becomes “miniaturized” causing hair to shed – first on top, then along the forehead hair line.

“Hormones keep hair in a growing phase,” Dr. Berson continued.  “That’s why during pregnancy, when all hairs enter the growth cycle at the same time, a woman’s hair gets nice and thick.  After childbirth,  her hair enters a falling out stage and you begin to see hair loss.  Estrogen has a beneficial effect on hair loss, so if a woman is on birth control pills or hormone replacement, she will see an improvement in the quality and thickness of her hair.”

Dr. Berson told me that in addition to hormonal changes, hair loss can result from medical stress on our bodies such as:

• high fever
• general anesthesia
• certain medications for the treatment of blood pressure and depression
• psychological stress such as grief
• protein deficiency (the result of a crash diet)

But if a post-menopausal woman is experiencing hair loss, and none of these situations apply to her, she does have a few options, according to Dr. Berson.

“Assuming that you’ve ruled out anything medical that could cause hair loss, such as a thyroid problem, anemia (iron deficiency)  or auto-immune disease,  I’d suggest trying Rogaine (or Minoxidil, the active ingredient) which is rubbed into the scalp.  (Rogaine is one of only two drugs approved by the FDA for the treatment of hair loss). No one knows exactly how this works. It may increase circulation to the hair follicles, but the sooner you start using it when you notice the thinning, the better the chance it has of working, particularly for women who have diffused thinning.

“Another alternative in Biotin (a B vitamin) supplements, which often makes nails and hair stronger.  You have to take adequate doses of it. I usually prescribe 2000 mcg daily.

“A third option is a hormonal treatment -  either estrogen in the form of HRT or possibly Spironolactone, an androgen blocker.  It blocks the androgen –or testosterone — receptor.  Some women have found it to be helpful for hair thinning whether they’re pre-menopausal or post-menopausal.  We prescribe it for hair thinning and for women who have excess facial hair growth or acne.”

Dr. Berson also recommends non-medical, camouflage techniques such as getting makeup that matches your hair color and applying it to the thin areas of your scalp, or wearing a short, curly hairstyle or hair extensions.

Have you noticed changes in your hair (i.e. amount, texture) since you began the menopause transition?  Have you found any remedies or products that work? I hope you’ll share your stories below.

Wendy:   What do you recommend to your patients who complain of feeling debilitated by the classic menopausal symptoms, such as hot flashes, insomnia or anxiety?

Dr. Low Dog:  I first ask her what’s she looking for, what she has tried and what she wants. Some women don’t want any kind of hormone due to a family history of breast cancer. Others ask for it.

I would probably do a blended approach. For example, I’d use Hops instead of Valerian to help her sleep at night.  I’d probably put her on fermented soy – not just soy, but fermented soy products to see if that helps.  If she’s having a lot of anxiety, then I might use Kava. But there is not one, simple answer.

Natural products just don’t work as well as hormones. They don’t have the same degree of adverse effects, but they also don’t have the same degree of benefits. I tend to think that women who have more severe menopausal symptoms should use hormones and you can taper them down over time, unless she has a real risk.  If you have mild symptoms, I don’t know why you’d pull out the heavy artillery. For many women, products like Black Cohosh will take the edge off and that’s all they will need.  It’s a misperception that herbs will be as strong as hormones.

Wendy:  You were commissioned by the NIH to review all the supplements for the State of the Science Conference. What’s the bottom line on Black Cohosh for hot flashes?  

Dr. Low Dog:  It helps in some women, but not in others.  I like the combination of St. John’s Wort and Black Cohosh better and I recommend it for women who are not taking a lot of other medications.  This approach is much more popular in Europe.

St. Johns Wort is undergoing a phase two trial at the National Cancer Institute,  for women who’ve had breast cancer, who have hot flashes and symptoms, but can’t take hormone therapy.  For many women, St. John’s Wort can be effective for hot flashes in the same way we’re using Effexor and Paxil and other anti-depressants.

Wendy: In addition to hot flashes – and often because of hot flashes, insomnia is a major problem for women beginning in their mid to late 40s.  Is there a natural remedy that helps?

Dr. Low Dog: With insomnia, it’s not just about sleep – it’s about the quality of the sleep and there are many herbs that can help.   If you have trouble falling asleep, then I’d suggest trying melatonin, where the best evidence is.  If the problem is staying asleep, then I’d probably suggest a combination of valerian and hops for at least 2-3 weeks to see how you do.  Sometimes inositol can be useful or L-theanine.

Sometimes people do really well with Kava.  It was associated with some rare liver problems but in otherwise healthy people and good quality Kava products, I still use them and think they can be very effective for people with anxiety, irritability and difficulty sleeping.

I strongly suggest that any one with insomnia cut out caffeine in the daytime, eat lighter and not drink alcohol with dinner. Alcohol is one of the worst offenders for people who wake up in the middle of the night.  A lot of people drink wine to help them fall asleep, but that’s the stuff that will disrupt your sleep.

If TV commercials are an accurate reflection of our lives, then you’d have to conclude that bladder problems are a big concern for women and men.  Since the ads I’ve seen show people who appear to be 50-ish in age, they suggest that incontinence isn’t just a problem of the elderly.  It’s one of the few health conditions still considered too private to discuss openly,  so I wondered just how prevalent it is for women in mid-life and if there’s a connection with Menopause.  For expert information and advice, I contacted Dr. L. Elaine Waetjen, an OB-GYN with a specialty in Urogynecology, as well as a researcher and associate professor at the University of California, Davis. I asked her at what age do women typically notice bladder problems?

Dr. Waetjen: Bladder problems can happen at any point in our lives, but for many women, they seem to begin occurring in mid-life and symptoms, including incontinence, may increase due to the direct effects of aging. For example, as women get older, the bladder capacity can decrease due to changes in the wall of the bladder, making it less elastic.  Older women are more likely to lose strength and/or coordination of their pelvic floor muscles, which can also affect how the bladder functions to store and empty urine. The rise in incontinence may also be related to other factors associated with aging. For example, women tend to gain weight as they get older and weight gain is associated with incontinence.

Wendy: Is there a connection with Menopause?

Dr. Waetjen: Though there is a peak in the prevalence of urinary incontinence between 45 and 55, it turns out that this rise is likely due to mild symptoms that then seem to resolve after about 55.  There is no data that can suggest Menopause, or changes in the hormones around Menopause, cause this rise in incontinence symptoms. What might be common is for women between 45 and 55 to notice some occasional leakage of urine. If this occurs only occasionally and does not impact lifestyle, it appears more likely to be transient or at least not likely to worsen.

Wendy:  Is there something that we can do to help prevent it?

Dr. Waetjen: We have no clear knowledge that confirms ways to prevent the development of incontinence. But because of specific associations, we can make educated guesses.  For example, as I mentioned, weight gain is associated with the development and worsening of incontinence and that incontinence decreases with weight loss. Therefore, maintaining a healthy weight and avoiding weight gain may prevent it. We also know that some women can gain control over incontinence when they regain the strength and coordination of their pelvic floor muscles, so it makes some sense that keeping these muscle strong and coordinated may prevent incontinence.

Wendy:  Does estrogen replacement resolve the problem?

Dr. Waetjen:  Many women have been told that taking estrogen after menopause can prevent or treat incontinence, but this has not been shown to be true. In fact, taking estrogen after menopause may actually increase the risk of developing or worsening incontinence though this effect is very small.

Wendy: Menopausal women often complain of urinary tract infections. Do they typically occur more frequently in later life?  

Dr. Waetjen: UTIs do occur more frequently later in life. This may be related to the changes that occur in the vagina related to aging and changes in estrogen levels. For example, after Menopause, the types of bacteria that colonize in a woman’s vagina may change. Some women lose the helpful bacteria that suppress the growth of bacteria that cause bladder infections. The loss of this bacteria is likely multifactorial, but is related to aging, change in vaginal acidity, and the effect of estrogen on the vaginal tissues. There may be other reasons for the increase in bladder infections, such as changes in the strength of the urinary stream that washes away the bacteria in the urethra, how well the bladder empties, and the effectiveness of the immune system.

Wendy:  What do you advise women who are beginning to experience incontinence?

Dr. Waetjen: There are a number of simple things women can do:

• Don’t drink too much. Our society encourages hydration but many interpret this to an excess. While there is no  clear evidence to say what amount women need, one general rule is 64 oz of total fluid per day for the average woman not working out or seating in heat.
• Avoid large amounts of caffeine as it is both a diuretic (causes more urine production) and a bladder irritant. Anything more than one soda or one cup of coffee/tea per day may create or exacerbate the problem of barely or not making it to the bathroom in time.
• I recommend doing “kegels” (pelvic floor muscle contractions) correctly and use those muscles when they feel that sudden urge to urinate or that they might leak. Many women think they are using the correct muscles. Rather than saying these exercises don’t work, which I hear frequently, ask their OB/GYN whether they are actually using the correct muscles and whether they have gained enough strength to be effective.

Wendy:  …and if bladder problems still persist?

Dr. Waetjen: If women have tried these simple steps and still have bothersome urinary symptoms, they should  ask their primary care doctor for a referral to a specialist. There are a number of treatment options for women depending on the type of incontinence they have. Medications like Detrol may work well for a subset of women with urinary urgency and incontinence associated with urinary urgency.   I usually prescribe it only after women have tried all of these steps since the drugs can be expensive and do have some side effects such as dry mouth.

Clearly, there is growing use of CAM treatments to ease menopausal symptoms, particularly for hot flashes and insomnia. But there’s still a lot of confusion about what really works.  Recently, I asked Dr. JoAnn Pinkerton, a gynocologist in private practice and Director of Mid Life Health at the University of Virginia in Charlottesville, VA., if there are non-hormonal treatment options that are worth trying, in her opionion.  She said that for women with mild menopausal symptoms, there are many options;

Dr. Pinkerton: There is some evidence to support paced breathing- deep, slow diaphragm breathing for 20 min three times a day, Lamaze like breathing during a hot flash, acupuncture and acupressure. Hyponosis, homeopathy and yoga are more difficult to test in a blinded fashion, but may have benefits. Over the counter products have also been evaluated. It is important to remember that placebo works on average 50 percent of the time in hot flash trials compare to estrogen which works up to 85-90 percent at reducing frequency and severity of hot flashes.

Wendy: What CAM treatments have you observed do NOT work?

Dr. Pinkerton: Products that are NOT better than placebo at relieving hot flashes include ginseng, evening primrose oil, dong quoi, red clover and licorice. Phytoestrogens and black cohosh have had mixed reports- some favorable; others no better than placebo. Phytoestrogens may have risks of estrogen stimulation on breast or uterus; black cohosh has had reports of liver toxicity.

Wendy: What guidance do you give your patients about hormone replacement therapy?

Dr. Pinkerton:  In 2007, the Women’s Health Initiative findings were reanalyzed based on years since menopause and age.  The good news is that for women under 60, and within 10 years of menopause, there was NO increase in heart events and mortality was less. There remains concern of a slight increase in breast cancer, among those using estrogen plus progestereone, as well as blood clots, stroke and gallstones. Fewer fractures and less colon cancer were found. Although only one estrogen/progesterone product was studied, it is currently felt that all estrogen and progesterone combinations including so-called bioidentical hormones carry the same potential risks.

Wendy: What about other non-hormonal treatments like anti-depressants?

Dr. Pinkerton: Two types of anti-depressants are being tested – the SSRIs such as Prozac, Paxil, and Zoloft, and the SSNRs such as low doses of Effexor. An anti-seizure medication, Gabapentin, has also been shown to be effective at 300 mg three times a day. All of these medications have side effects, have only been tested in limited trials and none are FDA- approved for relief of hot flashes. Also, none are as effective as estrogen or estrogen plus progesterone for women with a uterus.

I also recommend taking 1000-1500 mg of calcium either through diet or supplements, and 1000 IU of Vitamin D. Additional supplements may be indicated for specific women. If you have a strong family history of heart disease, breast cancer, osteoporosis or other health issues, there may be more specific recommendations for diagnostic testing, or lifestyle changes or medications to decrease your risks.

It is never too late to work to get excess weight off, lose central abdominal obesity, build more muscle mass, and live a healthier, less stressful lifestyle. And stay active! We need to keep our bodies “humming” to maintain the pitch of our busy lives.

Wendy:  In contrast, what are your patients’ biggest complaints or concerns? 

Dr. Pinkerton: In our midlife health center, the major concerns that women want addressed center around their fear of breast or ovarian cancer, difficulty losing weight or persistent weight gain, changes in memory or concentration, mood changes which range from premenstrual syndrome to severe depression and loss of interest in sex or decreased responsiveness during sex. It is important to balance your health risks (heart disease, breast cancer, bone loss) with these additional concerns that you have.

Women’s health is much more complex because of increasing risks and concern for health issues as well as care-taking stress and changes occurring because of aging and hormonal changes. No single answer, regimen or medical treatment is right for everyone.

Wendy:  As a gynecologist specializing in mid-life health, a lot of women  look to you for advice and guidance for getting through this difficult phase.  What is your approach for tackling all of these complex medical issues that you mentioned?

Dr. Pinkerton: I believe in shared decision-making where the provider and you – the patient – identify individual risks and concerns and work together to make positive changes to decrease your health risks and increase your sense of vitality and well being. For example, instead of walking out of the office with an unreasonable goal of 50 pounds weight loss in the next year, it may be more reasonable to identify your current stressors, barriers to exercise and weight loss, and develop a plan that is workable. “I will lose 10 pounds in the next year (or at a minimum, not gain any more); I will find a friend and begin walking 30 minutes three days a week plus climb the stairs in my office or home. I will get my colonoscopy this year.”  Deciding that you “can” make a change (confidence) and are “ready” (the change is important) to make a change- are the first steps.

Wendy:  What about hormones? What do you advise your patients?

Dr. Pinkerton:  Decisions about whether to take hormones, when to start, when to stop, are complex and need to take into account what we know at this point:  for example, timing:  taking hormones before age 60 and within 10 years of menopause appear safe. Then there is the safety and efficacy of the products or alternatives that are being considered – whether they are prescription medications or over the counter products. Lastly, the woman and her provider need to develop a plan about what  is most important to treat, what strategies to start with- for example lifestyle changes first- and how and when to proceed with  medical therapy if it is indicated.<.p>

I also asked Dr. Pinkerton her opinion and experience with alternative therapies, such as Black Cohosh,  for easing menopausal symptoms.  I’ll post her response in my next blogpost.

Feel free to leave comments or questions for Dr. Pinkerton in the comment box below.

Rebecca Hulem is pioneering menopause coaching.  She’s a registered nurse, a Certified Menopause Practitioner and the author of Feelin’ Hot? A Humorous, Informative and Truthful Look at Menopause.  I recently spoke with her to learn more about what a menopause coach does:

Wendy: Please explain your work as a Menopause Coach.

Rebecca: Menopause coaching is very different from working with your doctor. We all know the importance of a yearly “well woman exam” — usually a fifteen minute appointment during which we get a physical examination that includes a breast exam, pap smear and pelvic exam to check for any abnormalities of the female organs. If a woman is transitioning through menopause and is complaining of symptoms, a conversation about the benefits and risks of hormone therapy and possibly alternative therapies will also take place.

This is certainly a lot to cover in one office visit, especially if a woman has questions or needs a more in-depth discussion of her options. That’s where I come in. Menopause coaching provides a longer appointment (the initial one is an hour and a half) to take a history of concerns, what the woman has already tried to relieve any bothersome symptoms, a medical history and, most importantly, belief systems and preferences to take into consideration when suggesting treatment.

Coaching is not all about taking hormones or herbs. Many women have emotional, psychological and relationship issues that can be contributing to or exacerbating the symptoms of menopause. These problems are not usually uncovered in a routine yearly exam and no amount of herbs or hormones will relieve the problem. It’s like putting on a band aid. This time of life is a beautiful puzzle and deserves the time to put it together in such a way that women continue to find joy and happiness in their lives while improving their day-to-day quality of life and longevity.

Wendy: Do you conduct a physical exam?

Rebecca: No, and if one has not been done within the last year it is always my recommendation that the woman go to her doctor first to make sure there is no underlying physical problems that could be causing the symptoms.

Wendy: Do you meet with women in person and how frequently do you meet?

Rebecca: All of this coaching is usually done over the phone unless the woman happens to live close by and if that’s the case I prefer to meet face to face for the first session. The frequency of the contact is determined by the underlying concern or problem. Many women only need one consultation and then follow up emails or phone calls. Some women need several sessions to resolve the problems that she is having.

Wendy: What are the most prevalent problems that your clients complain about?

Rebecca: The top three are weight gain, insomnia and decreased libido. Insomnia and decreased libido are more complicated issues than hot flashes and require more time to resolve.

Wendy: Do you favor one approach to managing menopause symptoms more than others… say, a natural, botanical approach over hormones for example?

Rebecca: I believe strongly that every woman is unique with individual preferences and beliefs and that there is no “one size or one regimen that will fit all women”. Therefore bio-identical hormones or commercially made hormones are all taken into consideration as well as complementary and alternatives such as botanical and herbs or a combination of all three depending on the situation.

Wendy: How can women get in touch with you?

Rebecca: My contact information can be found on my website, where I also offer a monthly newsletter, “The Menopause Moment,” as well as links to other, helpful resources.