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Elissa Epel, PhD
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The Hot Years
No 43
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My Menopause Magazine
In this Issue: Elissa Epel, PhD Secrets to Aging Backwards
#MeToo, Midlife Women, And Work
Feel Better! Depression Treatment Guidelines
Make Work into a Workout
Delicious Dried Plums
New Bioidentical Estrogen and Progesterone
Vaginal Laser Safety Update
Is it Menopause 25 to 40?
Insider Information
Editorial
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The
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Winter Issue
his issue of The Hot Years features groundbreaking research and topics that will provide insight, information and inspiration to help you navigate perimenopause and beyond. Recognizing that menopause is complex, our holistic approach includes articles that will help you, “Take care of the SUM of you, not just SOME of you.” The feature article about Dr. Epel’s work on the effect of stress on your telomeres and chromosomes is insightful and actionable. Its information you must know because there are things you can do to prevent this telltale sign of early aging. The interview with Dr. Rebecca Thurston on workplace sexual harassment and assault in women ages 40 to 60 is eye opening and disturbing. It is a topic that needs to be recognized and addressed. To help you stay fit at work, we’ve asked Zumba Gold cofounder Josie Gardiner to offer some exercises you can do at your desk in less than a minute. And to keep your bones strong you’ll find a recipe that takes minutes to prepare.
In News From NAMS (North American Menopause Society), Executive Director JoAnn Pinkerton shares three new things you should be aware of: A new FDA approved bioidentical hormone for menopause; a new FDA approved test for perimenopause; and a vaginal laser safety update. Finally, you will discover what to be on the lookout for if you are 25 to 40 and wondering, “Could my symptoms be menopause?” It’s all here for you, easy to download into your inbox. We’d love to hear your thoughts and suggestions. Drop us a note at info@HotYearsMag.com. And please share The Hot Years with your friends by sending them to www.HotYearsMag.com. Yours in good health, Dr. Mache Seibel Dr. Sharon Seibel
Editor
Associate Editor
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Secrets to Aging Backwards
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Elissa Epel, Ph.D
Anti Aging specialist shares her research and discusses things you can do to help turn back the clock.
Elissa Epel, Ph.D, is Professor of Psychiatry at the University of California, San Francisco. She is co-author of the New York Times bestselling book, The Telomere Effect: A Revolutionary Approach to Living Younger, Healthier, Longer.
Dr. Mache Seibel: I just heard the outstanding talk you gave on telomeres. For those of our readers who don’t know, what exactly are telomeres? Dr. Elissa Epel: Telomeres are protective caps at the ends of chromosomes and they wear away and shorten as we age and when cells divide.
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Dr. Mache: So if your chromosome was a shoestring, telomeres are the tips of the shoestring. Dr. Epel: Yes. Dr. Mache: And what are they there for?
during pregnancy also affect us at the cellular aging level. Dr. Mache: It’s really in our interest to keep our telomeres as long as we can for as long as we can. What helps telomeres stay long?
All the things that help the heart and the brain are also associated with longer telomeres - being active every day, eating a whole food diet, and eating lots of vegetables of every color.
Dr. Epel: They protect the linear chromosomes. The issue is that when our cells divide, the enzymes can’t recreate the full length of the telomere, so they progressively shorten. And when they get too short, it sends signals to the cell that it either can’t do its job, or it dies. Dr. Mache: So telomeres act like a timer on the chromosomes’ ability to divide. And as you get older, your telomeres get shorter.
Dr. Epel: That’s right. It’s one of many ways that our bodies age. But it’s not the only way. We know that depression or high stress during pregnancy is related to worse birth outcomes and of course, poorer health for the mom and for the baby. This shows us that good nutrition and good mental health
Dr. Epel: Maintain a healthy lifestyle. All the things that help the heart and the brain are also associated with longer telomeres - being active every day, eating a whole food diet, and eating lots of vegetables of every color. Eating more processed meats and sugars, and especially sugary drinks, are related to shorter telomeres. Dr. Mache: So a healthy lifestyle is going to keep your telomeres longer and help you live longer, and an unhealthy lifestyle can do the reverse. Dr. Epel: Right. And psychologically, it’s also important to consider feeling supported. So having a good social support network, managing stress, and getting out of chronically stressful situations are definitely good for telomeres and mental health.
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Dr. Mache: You talked about stress in particular as a grinding stone for telomeres that adds to aging, and how pregnancy affects telomeres in a positive or negative way. Could you address that a little bit more? Dr. Epel: Sure. What we know about pregnancy is that telomeres don’t necessarily change in the woman’s blood during pregnancy, but the women’s health and mental health during pregnancy does affect the baby’s telomere length. I think we’re so focused on how long we want to live that we don’t think enough about the quality of our lives. So really, we ought to focus on reducing disease risk and slowing our aging process so we live healthy for a longer period of time. That makes sense for us personally and for public health. . Dr. Mache: If your lifestyle hasn’t been perfect and then you read this article, is there anything you could do to make things better?
The women’s health and mental health during pregnancy does affect the baby’s telomere length.
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Dr. Epel: Oh, absolutely. Health is completely malleable. And the things we’re talking about are malleable systems. So any change in the right direction can change the aging systems. Things like lowering our levels of inflammation, or quitting smoking.
And if you haven’t done everything the best way, you can reverse it. Dr. Epel: It’s never too late to improve your health. Dr. Mache: One final thing. Is it possible for people to test their telomeres?
Even little changes like reducing the amount of sugary beverages or getDr. Epel: It is. I would say it’s not very ting rid of toxic influences are super advanced science at this point, meanimportant. An example is adding a ing it would be nicer to have even positive mind/body activity like yoga, more accurate tests that are cheaper or something else that you like that is and more frequent so we can really get actually reducing a sense of what Any change in the right stress. our telomeres direction can change the are now and how Dr. Mache: You they change over aging systems. Things also talked about time. social support like lowering our levels of If you’re planning and having a netinflammation, or quitting on testing, know work. that it’s not a dismoking agnostic test for Dr. Epel: That’s a individuals. It’s not that accurate. You critical factor. It’s often overlooked with don’t want to apply what we know from people who are looking at what they huge population studies and think that can do that’s anti-aging, but it’s a real if you’re telomeres are shorter, you’re fundamental one. Loneliness speeds statistically more likely to get a disease up aging and mortality, and good soearly or die early. cial support and quality relationships look like they’re very protective. Super It’s more important to know what to important. change to maintain good cellular aging; the things we talked about. Dr. Mache: If your telomeres shorten, if you do the right things, the length of Dr. Mache: What about if people realyour telomeres and the length of your ly want to get tested? life will be extended.
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Loneliness speeds up aging and mortality, and good social support and quality relationships look like they’re very protective Dr. Epel: My colleague, Dr. Elizabeth Blackburn, who helped discover telomere biology, and I put together information explaining what you should know if you’re going to do testing. Its available on my website, amecenter. ucsf.edu AME stands for Aging Metabolism Emotions Center. Dr. Mache: What is the name of your book? Dr. Epel: The book is called The Telomere Effect. We wrote it for the public and we really wanted to get the whole story out to the public rather than the piecemeal - one paper shows this, vitamin D is important, sleep quality is
important. Those are all sporadic little things. The whole story together is worth knowing. The book is very science-based but we try to really summarize what’s important for people to know, what are the tips and strategies so you can assess what in your life you want to change the most. You choose one goal and then we have tips on what you might do. Dr. Mache: It’s tips for the tips! Learn more about Dr. Epel and her work at www.amecenter.ucsf.edu.
Menopause Quiz:
Your personal menopause assessment
Find out how much your menopause symptoms impact your health, your happiness and your life.
Visit MenopauseQuiz.com to take the free Menopause Quiz. It only takes a minute, then watch your email for your results and some suggestions on next steps to support you. Your menopause mentor, Mache Seibel, MD
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#MeToo, Mid-life Women, And Work In addition to the symptoms of menopause, a recent study shows that midlife women frequently face sexual assault and sexual harassment challenges at work, and they are linked to physical and mental health issues.
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study reported at the Annual Meeting of the North American Menopause Society revealed some startling findings.
According to Dr. Rebecca Thurston, Professor of Psychiatry and Epidemiology at the University of Pittsburgh, 1 in 5 midlife women between the ages of 40 and 60 reported being sexually assaulted at work. The study excluded women who were taking anti-depressants, who were smokers, or who were complaining of menopause related symptoms.
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The study, which was reported in JAMA Internal Medicine, asked women, “Have you ever been forced to, or pressured to have unwanted contact with someone else’s private parts, or has someone else pressured you to have contact with your private parts?” One in five women responded, “Yes.”
If you work at a company with 100 women, between 20 and 33 of your female co-workers may have experienced a workplace sexual assault
As seemingly large as the 1 in 5 number reported in this study is, some other studies have reported workplace sexual assault in women as high as 1 in 3 women. This means that if you work at a company with 100 women, between 20 and 33 of your female co-workers may have experienced a workplace sexual assault.
ing to have these experiences. And we know that stress is linked to mental health problems, sleep problems, and there is quite a lot of literature linking stress to cardiovascular risk as well.”
One would be one too many, but this number is staggering. And so is the impact of sexual assault and sexual harassment on women’s health.
So in addition to the trauma of the event, there’s most likely a stress physiology component that can lead to physical and mental health conditions.
Dr. Thurston reported that, “sexual harassment was associated with an almost doubling of hypertension, clinically elevated sleep complaints consistent with clinical insomnia, and a three-fold elevated odds of having high triglycerides. These were adjusted for things like age, race, obesity, and medication use.”
“The link between suffering a sexual assault and health problems needs to be recognized, especially since help is available,” Dr. Thurston stated.
“Stress is definitely a component of this,” Dr. Thurston added. “It’s distress-
In the case of sexual assault, women should absolutely get help. “Find a counselor, ideally, and if you need to access services, there are community organizations that help with women who are experiencing this kind of violence. For example, RAINN is a nation-
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al sexual assault organization that provides a lot of educational materials.” “When it comes to sexual harassment this is very tricky, because ideally you’d go to your HR department and talk to someone there, or an omnibus person,” said Dr. Thurston. But the usual report methods may not be comfortable in some work settings and their may be a conflict of interest with a company that is trying to protect either itself or the individual. Dr. Thurston suggests reporting this to your supervisor if it’s not your supervisor who’s the perpetrator. She also suggested to rally help around you, in terms of colleagues. But it’s complicated, because sometimes there’s retaliation. That puts women in a bit of a double-bind.
Sexual harassment was associated with an almost doubling of hypertension, clinically elevated sleep complaints consistent with clinical insomnia, and a three-fold elevated odds of having high triglycerides “But as much as you can, Dr. Thurston continued, “report it and seek support from your colleagues and friends. And take notes to document things as they happen.” “You deserve help. Don’t suffer in silence.”
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Depression Treatment Guidelines At last! Guidelines for women and their doctors on how to recognize and treat perimenopausal depression.
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epression is one of the more common symptoms of perimenopause. So the North American Menopause Society, in partnership with the National Network of Depression Centers, recently released a systematic review and guidelines to identify and treat perimenopausal depression.
According to Dr. Pauline Maki, Professor of Psychiatry, Psychology and Obstetrics and Gynecology at the University of Illinois at Chicago, “Perimenopausal depression is a very common problem. In fact, studies show that there is an increase in depressive symptoms as women transition from premenopause into perimenopause.
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Some studies suggest that increase in depressive symptoms continues into postmenopause as well.”
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“In addition to depressive symptoms, such as feeling sad and moody, we also need to be concerned about a major depressive disorder. That is a more serious form of depression that affects work, day-to-day activities and relationships.
There is an increase in depressive symptoms as women transition from premenopause into perimenopause To meet the criteria for major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, an individual must be experiencing five or more of the symptoms below during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure. ●
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Feeling sad, tearful, empty or hopeless Angry outbursts, irritability or frustration, even over small matters
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Lose interest or pleasure in normal activities, like sex, hobbies or sports Sleeping too much or too little Tired and lack of energy, making even small tasks take extra effort Loss of appetite and weight loss, or increased cravings for food and weight gain Anxiety, agitation or restlessness Slowed thinking, speaking or body movements Feel worthless or guilty, fixated on past failures or self-blame Difficulty thinking, concentrating, deciding or remembering things Frequent thoughts of death, suicide, suicide attempts or suicide Unexplained physical problems, such as back pain or headaches
Women with the greatest increased risk for a diagnosis of depression during the transition are women with a prior history of depression. “And it turns out that the number of women affected is enormous.” Dr. Maki pointed out that “59 percent of women with a prior history of depression will experience a recurrence of their depression during the menopausal transition.”
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Women with the greatest increased risk for a diagnosis of depression during the transition are women with a prior history of depression
The new guidelines that also include a patient handout help providers and patients navigate tricky situations. As an example, Dr. Maki said, “We know that sleep disturbance is a symptom of both depression and menopause.” So how can providers and women know if their symptoms are due to depression or menopause, or a combination of the two?
“For example,” Dr. Maki said, “a woman who’s having night sweats may wake up periodically during the night for several nights on end. And if that’s happening, we know it will disturb her mood. Treating the hot flashes in those women may contribute to an overall improvement in well-being and she won’t need her treatment for depression.”
The guidelines recommend that practitioners who care for women in perimenopause and menopause examine not only standard depressive symptoms, but also menopausal symptoms.
The guidelines are available at www. menopause.org. Download the patient handout by clicking on MenoNote.
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Exercises
Z
umba Gold co-creator Josie Gardiner shares easy-to-do exercises for the workplace. They take less than a minute and can be done throughout the day to keep your body fit and fabulous. Share these videos with your co-workers and turn work into a workout! Click Here to find out more about Josie’s books and videos.
EXERCISE VIDEO 1:
EXERCISE VIDEO 2:
Best Selling Book Offers Yoga for Women
Throughout her Life Cycles Here is what you will find in the book: How to use breathing, postural, and meditation exercises to optimize your health, and how to adapt them into busy schedules.
Specific sections and activities for general female health, menstruation, pregnancy and childbirth, perimenopause and menopause, natural beauty, and self-healing.
Explanations of yoga exercises and meditations accompanied by their benefits.
How to utilize yoga for improved sexuality and intimacy
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Delicious
Dried Plums “Let food be thy medicine and medicine be thy food.” Hippocrates Whether you call them dried plums or prunes, they are good for bones! It’s time to get over the stigma associated with whatever you call them and make them a “regular” part of our diet. A recent study reported that dried plums are an efficacious functional food therapy for preventing bone loss in postmenopausal women. They are rich in nutrient bioactive compounds including dietary fiber, vitamin K, boron, copper, magnesium, and manganese, among others. Your bones will thank you! Here’s a simple and delicious recipe to get you started.
Stewed Dried Plums Dried plums (approximately 30) ½ lemon with rind, cut into small pieces Water cinnamon - optional Place dried plums in a saucepan and cover with cold water Add lemon Bring mixture to a boil then turn heat down to a low simmer Cover saucepan Cook for about 25-30 minutes Serving size 3-5 plums Enjoy hot or cold! Delicious with yogurt, cottage cheese, a drizzle of honey, or alone.
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News From
NAMS
New Bioidentical Estrogen and Progesterone Approved In this video interview with Dr. JoAnn V. Pinkerton, Executive Director of the North American Menopause Society (NAMS), we discuss Bijuva, a newly FDA approved bioidentical estrogen plus progesterone capsule.
Vaginal Laser Safety Update In this video interview with Dr. JoAnn Pinkerton, Executive Director of the NAMS, we address a new FDA warning about vaginal laser therapy.
Test for Perimenopause In this video interview with Dr. JoAnn Pinkerton, Executive Director of the NAMS, we address AMH, a new FDA approved test for perimenopause.
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Is It Menopause at
Age 25 to 40? Menopause is about hormonal transition, not age. Some women experience menopause well before the typical age of 52
I
t’s a fact: 1 in 100 women will experience premature menopause before age 40. Some as young as 20. And 5 percent to 10 percent of women will experience early menopause between ages 40 and 45. Premature menopause can not only sneak up and surprise a young woman, it can also have important health implications if not treated. But it’s not always quick to be diagnosed. According to Dr. Wendy Wolfman, Director of The Premature Ovarian Insufficiency (POI) Unit at Mount Sinai Hospital, University of Toronto, many women report seeing three or more physicians before the diagnosis is made. Symptoms that may be warning signs for premature menopause include: • Periods that get lighter and further apart • Hot Flashes
• Sadness • Anxious and depressed feelings • Loss of sexual desire Because these symptoms can be due to other causes, women often see several doctors before the diagnosis of premature menopause is made. Dr. Wolfman, who spoke on POI at the North American Menopause Society (NAMS) Annual Meeting in San Diego, divided amenorrhea (not getting your period) into two categories, primary and secondary. Primary amenorrhea means you have never had a period. Secondary amenorrhea means you have had periods, but they became irregular, lighter, and stop. Causes of secondary amenorrhea include: • Pregnancy (the most common cause) • Increased estrogen as found in Polycystic Ovary Syndrome
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• Hypothalamic amenorrhea, associated with women who exercise a lot, lose a lot of weight, or experience extreme stress • Premature Ovarian Insufficiency According to Dr. Wolfman, 9 out of 10 times we don’t know what causes POI. Some of the known causes are due to medical treatments, like survivors of childhood cancer treated with radiation or chemotherapy. Childhood cancer survivors will often menstruate afterwards, but their total fertile life is shortened. Another cause of early or premature menopause is surgical menopause. Women may have their ovaries removed for various reasons, and that causes a lack of eggs because the eggs reside in the ovaries, and a lack of estrogen, which is produced from the cells surrounding the eggs. This early lack of estrogen has significant effects on a woman’s body, brain, bones, heart, vagina, mood, and sexual desire. Women may also have their ovaries removed early to lower their risk of breast or ovarian cancer. An example of that is women who have the BrCa or Breast Cancer gene mutation. Genetic causes that specifically increase the risk of early or premature
5 percent to 10 percent of women will experience early menopause between ages 40 and 45 menopause include fragile X syndrome. With that condition, a genetic mutation turns off the ovaries prematurely. Dr. Wolfman told us that, “There are genes on the X chromosome that contribute to egg development. If you’re lacking one of those X chromosomes, sometimes you don’t even go through puberty.” According to Dr. Wolfman, “Probably in 20 to 30% of our patients, there is a family history of premature menopause but when we do the chromosomes, we can’t actually determine the reason.” In fact, according to Dr. Wolfman, “in up to 90% of cases, the cause of premature menopause cannot be found.” Other causes of premature menopause are metabolic, associated with a disorder such as galactosemia, a rare genetic metabolic disorder that affects an individual’s ability to metabolize the sugar galactose properly.
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Autoimmune diseases like Hashimoto’s thyroiditis, diabetes and celiac disease can also cause early or premature menopause. Dr. Wolfman explained that,“studies from the Mayo Clinic showed that women who were rendered menopausal prematurely had earlier cardiovascular disease, congestive heart failure, and actually a list of 18 different health ramifications if they did not have hormone replacement. However, if they were replaced with hormone therapy, they could prevent the development of those diseases of aging.” This is explained in detail in the book, The Estrogen Fix. And for women who want to experience pregnancy but don’t conceive
before menopause occurs, it is possible to become pregnant through egg donation. As you can see, premature menopause can have a huge impact on a woman’s life, affecting her reproductive health and also her overall health. The good news is that with diagnosis and treatment, you can prevent most of the problems. Dr. Wolfman encourages women to be in tune with their bodies and if they do have these symptoms, to seek medical help. The establishment of clinics to specifically deal with women who experience menopause before the age of 40 is an extremely important addition to our medical care.
The Hot Years Musing
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Mache Seibel, MD
D
o you follow the stock market? Squiggly lines go up and down as the value of a stock fluctuates. Zig zag, zig zag. One minute somebody likes the stock and invests, and the value zigs. Next minute, somebody doesn’t, and the value zags. Perceptions cause the value to trend upwards and downwards all day long, all week long, all year long. The interesting thing about all this fluctuation is that often, the value of the stock has less to do with what the company is really worth, and more to do with what other people think…
Unless you have insider information… Information a person within a company knows that is not available to the investing public. How a stock is valued reminds me of how some people view their own value, their self-worth. An unkind word, a nasty comment, or a negative remark
can send a person’s self-worth spiraling downward. A word of praise, a small success, even a smile can move that person’s squiggly line spiking upwards. Like most stocks on the exchange, way too much of a person’s value is due to what other people think, not the person’s true worth. Sometimes people even cause their own stock to zag by negative self-talk. But there’s a lesson we can learn from most successful companies. They hear what others are saying and if it’s true, they may react to it. But they know their true worth and keep investing in themselves and do what they need to do to succeed. After all, they have insider information. They know how valuable they really are. It keeps their zig going up when others say and do things to make their zag move down. What insider information do you use to keep your zag on the rise?
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A woman is like a tea bag; you can’t tell how strong she is until you put her in hot water. Eleanor Roosevelt
CLICK HERE to hear a Christmas Song written by Dr. Mache called “Merry Christmas.” You can find this song and other health songs at healthrock.com/music/amp-up-your-health-3-cd-set Every effort has been made to ensure that the information contained in this magazine is complete and accurate. However, neither the publisher nor the author(s) is engaged in rendering professional advice or services to the individual reader. The ideas, procedures, and suggestions contained in this magazine are educational and not intended as a substitute for consulting with your physician. All matters regarding health require medical supervision. Neither the authors nor the publisher shall be liable or responsible for any loss, injury, or damage allegedly arising from any information or suggestion in this magazine. The opinions expressed in this magazine represent personal views of the author(s) and are not a substitute for medical care. All content in this magazine is Copyright © HealthRock, LLC
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