Vaginal Bleeding After Menopause

Imagine you’ve finally weathered the emotional storms and sweats and sleep deprivation of menopause and life has settled down to something resembling pre-menopause normality.  Your kids are out of the house, and you and your husband are getting used to  being a couple again.  Your career is enjoyable and you’re beginning to let yourself think and dream about retirement.

Your health is good and you feel well.  Then one afternoon during a trip to the bathroom you find an unpleasant and unexpected surprise.  Why are you bleeding again?  It’s been 3 years since your last menstrual period, this isn’t supposed to happen anymore!

What do you do?

Since I’m writing about it, it’s a safe bet the right answer is “Call and make an appointment with your doctor.”  There are a number of things that can cause vaginal bleeding after menopause, some of which are benign but a number of which are not.

Any vaginal bleeding after menopause is considered abnormal, even if it’s just a little brownish spotting.  It doesn’t need to be heavy enough to require a pantiliner or pad, it doesn’t even need to be heavy enough to stain your underwear.  Pink or brown discharge on toilet tissue after urinating should have you visiting the doctor to get checked out.

Bleeding from the vagina can come from one of 3 places.  These include the vagina and its outlet, the cervix and the uterus itself.  The patient’s report of symptoms and some testing will help figure out whether the cause is likely to be serious.

As I mentioned in a previous post, after menopause and the loss of the ovaries’ estrogen production, the tissues of the vagina and surrounding areas can become gradually thinner and more fragile.  Trying to have a romantic evening may cause a little trauma and some bleeding.  That’s not generally hard to figure out – a few pertinent questions will usually make that cause obvious.

If there’s no pain or evidence of trauma, we generally need to look at the ovaries and uterus with an ultrasound.  Thickening of the inner lining of the uterus or enlarged ovaries mean a visit to the friendly neighborhood gynecologist is in the near future.

If you or a woman you love has had vaginal bleeding after menopause, I want you to know that it should ALWAYS be checked.  Sometimes it’s just from an infection.  Sometimes it’s from something very serious, like ovarian or uterine cancer.

Please don’t wait.  Don’t panic, but don’t wait, call your doctor and get it checked out right away.

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The Power of Optimism

Do you know anybody who seems to walk around under a black cloud of doom?  Everything is always horrible, nothing good ever happens, and worse, nothing good ever WILL happen.

Are you one of those people?  Do you find yourself assuming there will be a bad outcome?

It turns out that ASSUMING there will be a bad outcome tends to lead to HAVING a bad outcome, in terms of health.  There is a lot of new research that shows pessimism is associated with negative health outcomes.  Studies on such different problems as unplanned C-section, cardiovascular health, quality of life after stroke, and sleep quality in children show an association between health and optimism/pessimism.

So what is optimism?  The dictionary defines optimism as “hopefulness and confidence about the future or the successful outcome of something.”  It is the tendency to look on the bright side, to assume things will work out for the best.

Some people are natural optimists, they seem to have a sunny disposition from childhood.  However, most of us have to consciously choose to look for the silver lining.

Are you a pessimist?  Do you tend to imagine terrible things, to assume things will turn out badly?  If so, you are probably not only living with anxiety and depression but you may also be hurting your health.

How does someone overcome their tendency to be a pessimist?  Is it possible to change?  Turns out the answer is yes!

Shawn Achor, a researcher at Harvard, has devoted his career to the study of happiness and optimism.  His book The Happiness Advantage: The Seven Principles of Positive Psychology That Fuel Success and Performance at Work talks about how optimism leads to success.  More importantly, it also details HOW TO BECOME AN OPTIMIST.

Not only is optimism helpful at work, it improves your life in many other ways.  Most importantly, as shown in Dan Buettner’s book The Blue Zones, Second Edition: 9 Lessons for Living Longer From the People Who’ve Lived the Longest, optimism is one determinant of long life.

Being healthy, living longer and being successful are goals that most of us have.  Optimism helps make achieving these goals more likely.  Get and read these two books, I promise you will be glad you did!

You are important to me, and I want you to be happy, healthy and successful.  Optimism is a choice, a skill that anyone can learn.  Make the choice to learn it, practice it and make it YOUR happiness advantage!

QUESTION:  Are you an optimist or a pessimist?  Why do you say that?

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Hypnotherapy

What do you think of when someone mentions hypnosis?  Do you think of stage hypnotists making audience members do silly things and cluck like chickens?  How about sinister suggestions and gaps in your memory?

I don’t know about these things but I’m pretty sure these are myths.  I DO know that hypnotherapy is a powerful treatment that has been proven to be effective for a wide range of medical problems.

Yesterday (Friday) I spent the day at UH Connor Integrative Health Network’s Heal the Healer symposium.  It’s the first time I was able to go, and I’m SO glad I did!  We focused on rest, rejuvenation and stress relief for those in all sorts of healing roles.

The highlight for me (other than hearing Dr. Mimi Guarnieri, the president of the Academy of Integrative Health and Medicine, speak), was a hypnotherapy session by Don Mannarino.  I have both observed hypnotherapy and participated in it in the past, but this was a particularly powerful session.

What is hypnotherapy?  Hypnotherapy is a treatment in which a person is guided into a deep state of relaxation and then given suggestions that directly affect that person’s subconscious mind.  Contrary to popular belief, a person under hypnosis is NOT asleep.  As Don says, you can’t hear the therapist if you’re asleep!  You are wide awake and deeply relaxed.  It is a lovely, restful, comforting experience.

The person being hypnotized is an active participant in the therapy.  It’s a bit like being in physical therapy.  The physical therapist can show you exercises and coach you on what to do, but you actually have to DO the therapy.  Same with hypnotherapy.  Your therapist is your coach and guides you, but you have to relax and follow directions.

What sorts of conditions is hypnotherapy helpful for?  A quick PubMed search revealed over 1200 articles published mentioning hypnotherapy in the last 5 years.  That’s a LOT of research!  A quick scan showed research demonstrating effectiveness for menopause symptoms, insomnia, GI disorders like irritable bowel syndrome, fibromyalgia, and in reducing pain and anxiety during labor and childbirth and hospital procedures such as prostate biopsy.

The session yesterday was on hypnotherapy for weight loss.  While I couldn’t find a lot of research about this topic, it makes sense that hypnotherapy would be helpful in a condition like obesity, where subconscious attitudes and patterns of behavior are SO difficult to change.

I’m not going to tell you exactly what happened during yesterday’s hypnotherapy session.  First of all, I don’t think I could describe it very well.  Secondly, it was a large group session, more of a “taste” of hypnotherapy rather than a true therapeutic encounter.

Lastly, I’m not at all sure that MY experience of hypnosis would be the same as YOUR experience.  A bit like explaining what chocolate tastes like, to someone who has never tasted it.  Rich and sweet and very satisfying.  But those words don’t really do it justice.

If you have a condition like anxiety, insomnia, fibromyalgia, irritable bowel syndrome, obesity or other eating disorder, or are curious whether hypnotherapy would be helpful for you, I encourage you to reach out to Don (his phone number and email are on his website).  He will be able to help you decide whether it is likely to help.

How adventurous are you?  How invested are you in feeling better?  I encourage you to step out of your comfort zone and consider hypnotherapy as an effective therapy for many conditions that have a stress-related or behavioral component.

QUESTION:  Have you ever been hypnotized?  Was it helpful for you?

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Why And How To Drink More Water

When I was in Denver last week I was very busy.  Attending lectures all day, trying to keep up with office stuff from a distance, staying in touch with my family.  I was surprised at how hard it was to keep up with my water intake.  I noticed it when I hadn’t had to go to the bathroom through an entire afternoon lecture session and thought, “oops!”

I talk about water intake often with my patients.  Fatigue, constipation, body aches, skin problems and many other physical symptoms can be relieved by making an effort to drink more water.

Here is a comment that I often hear: “But I don’t LIKE water.”  That one makes me want to roll my eyes and come back with “But your BODY does!”  Drinking water ranks right up there with eating fiber as one of the most important and least glamorous things you can do to help your body function right.

Here are three reasons to make an effort to drink more water:

  1. It makes you feel better.  Mild dehydration causes fatigue and body aches, “brain fog,” and lightheadedness with changing positions.
  2. It makes you look better.  Skin texture changes quickly with mild dehydration.  Skin lines and tiny wrinkles are more pronounced when the cells lose fluid.  Your blood plasma is more important to your body than pretty skin, so the body will sacrifice plump healthy skin cells in order to keep blood flowing to the kidneys and brain.
  3. It helps you lose weight.  Dehydration and thirst are often misinterpreted by the brain as hunger, leading you to eat when it’s not food your body wants.  Staying well hydrated also keeps your energy up and makes it easier to exercise.  Have you ever gone to the zoo or an amusement park, or just tried to exercise, on a hot day?  Remember how much more quickly you got tired?  Part of that was likely from dehydration.

How much water does your body need?  Generally for maintenance purposes your body needs 1 ounce of water for every 2 pounds of body weight.  I weigh about 150 pounds which is 75 ounces of water or 4 20-ounce water bottles daily.  Children generally need more, their skin surface area is higher for their weight and they breathe faster.  The body loses water in 3 ways – through urine and stool, through sweat, and as water vapor in the air we exhale.

How do you know if you’re getting enough water?  Generally your kidneys will tell you.  If you’re going to the bathroom to urinate every few hours (the average is 5-6 times per day) and your urine is clear to light yellow, you’re getting enough.

What about those people who don’t like to drink water?  I’m kind of parental with those folks:  it’s sort of like not liking to go to the gas station to fill up your car.  Gotta do it anyway, right?

Here are some tips to ease into drinking more water:

  1. Filter it.  I can’t stand tap water.  Even with a typical water fountain, I can still taste the chemicals and chlorine in the water.  Using a pitcher filter is the most cost-effective way to get lots of clean, great-tasting drinking water.  Check your brand at the Water Quality Association website to see what contaminants it removes.  Here’s the filter I use – it filters twice as much water per filter refill as other brands.
  2. Get a cool water bottle.  I love stainless steel water bottles.  When I carry a water bottle I drink more water.  There are devices that help you keep track of how many bottles you’ve drunk in a day – here’s one I found.  (Not an endorsement, just a mention.)  For me, I try to get two bottles in before lunch, two bottles before dinner.  Remember to stop about 2 hours before bedtime, otherwise you’ll be up at night, LOL!
  3. Flavor it.  You can substitute iced tea and juice for some of your fluid intake, but juice in particular adds a lot of calories.  A squirt of lemon or lime juice is a great choice.  Mix-ins are available and sized for typical water bottles.  Many of those have artificial ingredients.  Using a little to make your water taste better is better than using a lot, and better than not drinking water at all.  Gradually decrease how much you add until you’re used to drinking your water plain.

I challenge you to try a two-week commitment to drinking your recommended amount of water.  See how you feel.  What’s your energy like?  How about bowel and bladder function?  How does your skin look?  I’ll bet you’ll get lots of compliments and feel fantastic.

QUESTION:  Do you struggle with drinking enough water?  What’s your biggest challenge?

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3 Things I Learned In Denver

Hello everyone!  This is Dr. Jen, intrepid girl repoter, checking n from Denver, Colorado.  I’m here for the American Academy of Family Practice annual meeting.

In between collecting over 20 hours of continuing medical education (CME) credits – yes, my brain is full!! – I discovered 3 important things that are NOT necessarily related to medicine.

1. Denver is awesome!

I’ve never been to Denver before and didn’t really know what to expect.  I knew it is at high altitude and that they have a pretty good football team, but that’s about it.

I love it here!  I haven’t been outside of downtown except to drive from the airport, but I’ve been really impressed with the downtown area.  It is clean and very safe, with lots of shopping and restaurants in easy walking distance.  There’s even a yarn shop about 3 blocks from my hotel!

The natives have been friendly and very helpful. Everyone cheerfully ignores crosswalks and crossing lights while walking.  This is understandable because the stoplights and crossing lights make NO sense at all.  Several times I stood at an intersection of two one-way streets, red lights in both directions and do-not-cross lights for the crosswalks.  Complete traffic standstill.  Wait, what?

Denver seems to be very healthy and fitness-oriented.  Obesity rates are low in the state of Colorado.  Healthy food choices including plant based and gluten-free options are easy to find.  Bicycles are available for short-term rental, and cyclists and joggers are everywhere.

Before you ask, YES I’ve seen several recreational marijuana dispensaries.  NO I haven’t seen anyone partaking (it’s illegal to light up in public) and NO I have no interest in trying it myself 🙂

In short, I love Denver and can’t wait to bring my family here.  Wish I had time to get out of downtown and go play in those mountains I can see from my hotel room window!

2. I really AM still shy in large groups

As I mentioned in my last blog post, as a child I was awkward and shy in large groups.  Well guess what, that hasn’t changed.

Here I am in a huge confrerence with thousands of like-minded professionals and I find myself very intimidated.  I’ve been working hard to introduce myself to one new person every day.

Interestingly when I participated in a small focus group with only about 10 people I was much more comfortable.  I have hope that someday I’ll be more confortable in larger groups!

BTW if you can spare a moment for a quick prayer for me on Saturday morning, October 17th, I would much appreciate it.  I have to present a talk on caregiver stress at the Women’s Health Expo.  Want to come listen?  I’d love to see some friendly faces there – click the link to register.  It’s free!

3. Even family doctors aren’t very aware of integrative principles

This week I have been struck over and over that about 95% of the discussions have been “name-it-and-tame-it” lectures.  Basically, diagnose it and then pick a pharmaceutical.

I was pleased that many lecturers did mention diet, exercise and weight loss as being helpful for certain conditions.  I went to every session offered about diet, nutritional supplements and integrative therapies.  On the whole the tone was neutral-to-negative unfortunately.

Even family medicine has a long way to go in bringing proven integrative therapies into the exam room.  Since I haven’t been in practice very long and this was my first major mainstream conference, I have hopes that the trend will be to bring more education to family doctors on these topics in the future.

Shout out to Dr. Amy Locke and Dr. Jill Schneiderhan from the University of Michigan who presented an awesome talk on herbal therapies. It was extremely useful for both integrative docs like me and open-minded family docs who want to be able to advise their patients on commonly used herbal preparations that may or may not be safe.

This trip has been great, even though I miss my family.  I’ve learned a ton and made several connections.  Home Sunday, and back in the office to tackle ICD-10 (yuck!) on Monday.

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