Search Results

If you're in your late 30s to mid-40s and notice changes in your body, you might be entering perimenopause . This stage leads up to menopause, and it can feel unfamiliar. You may experience shifts in your menstrual cycle, sleep, mood, or energy. Experiencing hot flashes, a woman questions if she is entering perimenopause while working from home. Perimenopause is a natural phase that can last from a few months to over a decade. It results from gradual hormonal changes, particularly in estrogen and progesterone. These changes can cause a variety of physical and emotional symptoms. Menopause typically occurs at age 51, though it can happen between 45 and 55. Symptoms of perimenopause can begin as early as 10 years before menopause, meaning you might start experiencing these changes in your mid-30s! Common Symptoms of Perimenopause Marking the dates of her period on a calendar, a woman notices that her periods have become irregular due to perimenopause. 1. Irregular Periods This symptom is often the first and most noticeable. You may find that your cycle lengths become shorter before turning irregular. Many women skip months, and then periods can stop altogether. Some women, however, may experience heavy bleeding. If you have frequent or heavy bleeding, check with your doctor to rule out other causes. 2. Hot Flashes and Night Sweats Hot flashes and night sweats are common symptoms caused by hormonal fluctuations. These can occur during the day (hot flashes) or at night (night sweats), disrupting sleep and leaving you fatigued. Typically, hot flashes start in your face and can last up to 15 minutes. Night sweats often wake women, causing drenched sheets. Don’t hesitate to consult your doctor; treatments are available! A woman lies in bed struggling with insomnia, a common challenge faced during perimenopause. 3. Sleep Disturbances You may find it difficult to fall asleep or stay asleep, even without experiencing night sweats. Hormonal changes can disrupt your sleep cycles, leaving you feeling exhausted, even after a full night’s rest. 4. Mood Changes During perimenopause, mood swings, anxiety, irritability, and even depressive symptoms are quite common. This isn’t just psychological; it’s connected to changes in estrogen, which affects neurotransmitters like serotonin. 5. Vaginal Dryness and Urinary Symptoms Lower estrogen levels can thin and dry vaginal tissues, leading to discomfort during sex and daily irritation. Symptoms such as urinary urgency, an overactive bladder, and frequent UTIs may also occur. This is called genitourinary syndrome of menopause and can often be treated effectively with vaginal estrogen. 6. Brain Fog and Memory Lapses Many women report difficulty concentrating or experiencing forgetfulness during perimenopause. This can be distressing, especially if you are balancing work and family commitments. Some women with ADHD find their medication becomes less effective. Managing weight changes during menopause: Embracing body positivity and self-care throughout transitional phases. 7. Weight Gain and Body Composition Changes Maintaining your usual weight can become challenging. Hormonal shifts can lead to fat storage, especially around the abdomen. You might notice weight gain starting 4-5 years before menopause. This typically amounts to just 1-2 pounds annually, but for some, it can be significantly more. 8. Breast Tenderness Fluctuations in estrogen can lead to sore or swollen breasts, similar to premenstrual syndrome (PMS). 9. Headaches or Migraines If you’ve experienced hormone-related headaches before, they may become more common or intense during perimenopause. Conversely, some women find that hormonal migraines improve as estrogen levels decline. 10. Changes in Hair and Skin You might notice changes such as thinning hair, dry skin, or reduced skin elasticity. These shifts are primarily related to lower estrogen and slower collagen production. 11. Decreased Libido As estrogen and other hormone levels drop, you may also notice a decline in libido. This can be compounded by pain during sex or mood issues. 12. Joint Pain Low estrogen levels can affect your joints and muscles, leading to discomfort. Joint pain is among the lesser-known symptoms of perimenopause and menopause. Treatment Options for Perimenopause You don't have to suffer alone. Many women feel brushed off during this phase, led to believe that they are too young or that this is just "part of life." However, many safe and effective treatment options are available! Low Dose Birth Control Pills : If you don’t have medical conditions that make combination birth control pills unsafe (like migraines with aura or high blood pressure), these can help manage symptoms and prevent pregnancy. They typically contain a higher dose of estrogen than menopausal hormone therapy. Menopausal Hormone Therapy (MHT) : MHT can be safely initiated during perimenopause. It involves a lower dose of estrogen and is an option even for women who cannot take combination birth control. While MHT won’t prevent pregnancy, it can alleviate several symptoms. Vaginal Estrogen : This treatment does not increase blood levels of estrogen but can effectively treat urinary and vaginal symptoms. Most women with a history of breast cancer can safely use this option. Non-hormonal Medications for Vasomotor Symptoms : Many non-hormonal options can help with hot flashes and night sweats. However, these may not address other perimenopausal symptoms like brain fog or joint pain. Testosterone : Transdermal testosterone might assist with low libido. It is safe if levels remain within normal premenopausal limits. Avoid injections and pellets as they can result in dangerously high levels, causing serious side effects. When to Talk to Your Doctor Perimenopause is a natural part of aging, but that doesn’t mean you should suffer. If your symptoms disrupt your quality of life, discuss this with your healthcare provider. Effective treatments, including hormone therapies, non-hormonal medications, and lifestyle changes, can significantly improve your well-being. You should also consult your doctor if: Your periods become unusually heavy or prolonged. You bleed between your periods. You feel persistently sad or anxious. Sleep issues or concentration challenges impact daily functioning. Want to discuss symptoms and treatment options? I would love to help you. If you reside in a state where I am licensed, you can visit my telemedicine clinic for perimenopause consultation. Feel free to contact me or schedule an appointment! Best, Have a question or an idea for my blog? Feel free to reach out! Contact@jackiestonemd.com Dr. Stone, a Board Certified GYN and menopause specialist, leads a concierge telehealth clinic providing expert care for women's health.

What’s the deal with testosterone and menopause? Do we need it? Is it dangerous? Is it the answer to all of our symptoms? Let’s look at the evidence to see what we know and don’t know about testosterone and menopause… Does It HELP? Low libido Hypoactive Sexual Desire Disorder (HSDD), which is part of what is now called Female Sexual Interest and Arousal Disorder (FSIAD), is basically just low libido that is bothersome and is not due to a medical condition, medication, mental health/mood issues, or relationship issue. This has been consistently shown in clinical studies to be successfully treated by transdermal testosterone. Many studies have shown that transdermal testosterone can improve libido (treat HSDD) in postmenopausal women whether or not they are on menopausal hormone therapy (estrogen and/or progesterone). The ADORE study included 272 naturally menopausal women, some of whom were on hormone therapy and some of whom were not. They were given a 300mcg testosterone patch for low libido/HSDD or placebo. The women who used the testosterone patch (both those on hormone therapy and those who were not) reported more satisfying sexual episodes, increased sexual desire, increased arousal, increased sexual pleasure, improved self-image, decreased personal distress, and decreased sexual concerns compared to those receiving placebo. It has also been shown to improve sexual desire and overall sexual functioning in women with surgical menopause (after having their ovaries surgically removed). The Menopause Society and other national professional societies recommend transdermal testosterone for only this indication (treatment of low libido). Fatigue and Mood Although there are fewer studies on the use of testosterone in perimenopausal and postmenopausal women to improve mood and fatigue, there is some evidence that it is helpful for these symptoms. Unlike low libido, however, the studies are mixed. In one study of 510 women in the UK who were being treated with tesosterone for low libido, the women reported improved mood and cognition while on they were on testosterone gel for 4 months compared to when they were estrogen and progesterone but not testosterone. A small study of perimenopausal women in their 40's given transdermal testosterone for libido also reported improvement in mood and overall feelings of wellbeing. However, another study of women with premature menopause did not show any improvement in quality of life, mood, or self-esteem when testosterone was added to estrogen + progesterone therapy. Hot Flashes and Night Sweats Testosterone does not seem to be effective for treating hot flashes and night sweats. Estrogen is the most effective hormone for treatment of hot flashes and night sweats with higher dose of progesterone helping a bit. Is It SAFE? Form of Testosterone & Levels Although the form of testosterone used in the clinical studies was a patch, this did not gain FDA approval (not due to an issue with safety). There is currently no FDA approved form of testosterone for women. The safest form of testosterone is still a transdermal form, either a gel or cream. As the only FDA approved forms of testosterone are for men, these can either be used at 1/10th of the male dose, or a cream can be compounded by a compounding pharmacy. Levels should be checked about 4-6 weeks after starting therapy and after each change in dose. It is important to keep levels within the normal premenopausal female range. When testosterone levels are in this physiologic range, there is no concern about safety (though long term data are not available). A large trial called the APHRODITE trial looked at side effects, and the only side effect common when levels are kept in the normal range is mild facial hair growth. Other forms of testosterone such as injections and pellets are not recommended because they usually result in supraphysiologic (really high) levels. These high levels can result in side effects, some of which can be irriversible -- cystic acne, facial and body hair growth, male pattern hair loss, deepening of the voice, growth of the clitoris, anger and mood changes, and even higher cholesterol levels. Transdermal testosterone in physiologic doses does not affect cholesterol levels. Should I Check My Levels? In general, there is no need to have hormone levels checked before you start menopausal hormone therapy of any kind. We choose to start testosterone therapy to treat symptoms, usually low libido. We choose to start estrogen and progesterone therapy to treat other menopausal symptoms (hot flashes, night sweats, sleep issues, brain fog, joint pain). We do not base hormone therapy on "low" blood levels. If we need to start tesosterone therapy, we may get a baseline level to see where we are starting from. Unlike estrogen and progesterone, testosterone levels do need to be checked during therapy to ensure that the levels are not getting too high! We don't want to turn you into a man! Bottom Line: Testosterone can be a safe and effective treatment for low libido in perimenopause and menopause. It may also help with mood and overall well-being. Safe ways to use testosterone are transdermal gels and creams in 1/10th of the male dose, and levels should be monitored to ensure that they stay within the normal premenopausal female range to avoid side effects. In these physiologic dosages, there are few side effects and no adverse health effects. Do You Need a Rx? Testosterone is a controlled substance, so everyone does not prescribe it, and you often cannot get it online. I am licensed to prescribe testosterone in every state where I see patients. I am happy to help. Have a question for me or an idea for my Blog? Feel free to reach out! contact@jackiestonemd.com Best,

Mood swings and hormone changes tend to go hand in hand. We all know that PMS and pregnancy can cause mood swings, but what about menopause? How does menopause affect mood and mental health? Studies in the medical literature show that the menopausal transition increases the risk of both anxiety and depression. Incidence A large 10-year study showed a 2-4 fold higher risk of depression during the menopausal transition compared to premenopause with rates of a major depressive episode between 11% and 16% and rates of depressive symptoms between 16% and 28%. There is less research on anxiety, but rates of anxiety also seem to be increased during the menopausal transition. Risk Factors While anyone can get anxiety or depression during the menopausal transition, certain things do increase risk. What are the some of the risk factors? Previous history of mood disorders -- especially those related to hormonal factors such as postpartum depression, PMDD (premenstrual dysphoric disorder), or PMS. Vasomotor symptoms -- hot flashes and night sweats are also associated with depression during this time Surgical menopause is more likely to be associated with depression than is natural menopause likely due to a sharper decrease in estrogen. Chronic medical conditions or poor health Adverse perception of menopause Life stressors -- financial stressors, low socio-economic status, and stressful life events Having social and family support is protective against depression and anxiety. Women who have six or more close friends are much less likely to be depressed than those who have fewer close relationships. Treatment For hormone therapy, timing matters. Systemic menopausal hormone therapy has been shown to help treat and prevent anxiety and depression caused by menopause and to elevate mood in women without anxiety and depression when started during the perimenopausal period (< 12 months after the final menstrual period). However, it doesn’t seem to have the same effect on mood when started after menopause (12 or more months after the last menstrual period). Usual treatments should still be used. Depression and anxiety during menopause should still be treated with appropriate medications (antidepressants and anxiety medications). SSRIs (a particular class of antidepressant/anti-anxiety medications) are usually the first line treatment for both anxiety and depression. There is no evidence that any one SSRI works better than another, and sometimes there may be a reason to choose a different medication. Medicine is both a science and an art. So, be sure to choose a doctor who is familiar with menopause when getting treatment for your mental health condition. In women with hot flashes and night sweats, some SSRIs and SNRIs can also help to treat these as well. These include citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil, Brisdelle), venlafaxine (Effexor), and desvenlafaxine (Pristiq). Weight gain and low libido are common complaints during the menopausal transition, and these can also be side effects of certain mental health medications (many SSRIs cause weight gain and both SSRIs and SNRIs can cause decreased libido). These should be considerations when choosing a medication or monitoring treatment. Therapy or counseling is also a great treatment for depression and anxiety, and this should also be considered. Therapy can be used either alone or in conjunction with medication. Medication plus therapy often works better than either alone. Feeling depressed or anxious? Be sure to talk to your doctor about these feelings! Getting closer to menopause? Think this may be tied to your hormones? You could be right! Find a doctor who will listen to you. Find out if you are a candidate for hormonal therapy or get started on the right antidepressant for you, and get back to feeling yourself! Have a question for me or an idea for my blog? You can email me at contact@jackiestonemd.com Best, Jackie Stone, MD

After the WHI (Women's Health Initiative) Study, Menopausal Hormone Therapy (MHT, which is also sometimes called HRT) got a bad rep and was rarely prescribed. We now know many of those initial findings aren't true for all women, and for young women close to menopause (<60 years old or <10 years from their final period), the benefits of hormones typically outweigh any risks. However, there is still a lot of misinformation floating out there, even among healthcare professions. So, you may have been told that you can't take MHT for whatever reason. But, is that really true? There are some reasons you absolutely should not use MHT.... Absolute Contraindications for Hormone Therapy (if you have these, you really shouldn't use MHT): Personal history of breast cancer Personal history of endometrial cancer (high grade or stage 3/4) Previous stroke or TIA ("mini-stroke") Previous heart attack or heart disease (coronary artery disease) Uncontrolled high blood pressure Active liver disease Many reasons that women have been given for not being prescribed MHT, though, aren't actually contraindications to hormones. So, let's break these down.... Family History of Breast Cancer or BRCA gene mutation carrier Estrogen alone therapy does not increase the risk of breast cancer at all. Estrogen + progesterone therapy (which is needed if you haven't had a hysterectomy) can SLIGHTLY increase the risk of breast cancer after 5-7 years of use. The risk is still very small, and studies show the risk of dying from breast cancer is NOT increased. The additional risk of breast cancer with estrogen + progesterone MHT is 9 extra cases diagnosed per 10,000 women every year on MHT compared to those who are not. As all women have a 1 in 8 (or 13%) lifetime risk of being diagnosed with breast cancer, this is really not clinically significant. Per the Menopause Society , women who are at higher risk of breast cancer due to genes or family history can still take MHT as it does not significantly increase their risk of breast cancer over their baseline risk. Migraine with aura Women who have migraine with aura should not use combination birth control pills, patches, or rings because it can increase the risk of stroke. However, the doses of estrogen in MHT are 10-20x lower than what is in hormonal birth control (it is a different type of estrogen, so you can't just look at the mcg or mg and compare those). For this reason, MHT is considered safe for women who have migraine with aura. Using transdermal estradiol as a part of MHT further reduces the risk of stroke and is VERY safe for women with this condition. Family History of Cardiovascular Disease or Heart Attack For young women <60 years old and <10 years from menopause, MHT does not increase the risk of cardiovascular disease and likely decreases the risk. It has also been shown to decrease the risk of dying early from any cause. So, regardless of family history of heart disease, as long as you do not personally have heart disease, you can still take MHT! Family History of Stroke While oral estrogens can increase the risk of stroke, many recent studies show that using non-oral routes of estradiol such as transdermal patches, sprays, gels, or the Femring (vaginal ring for systemic estrogen) has a much lower or possibly no increased risk of blood clots or stroke . So, as long as you have not personally had a stroke or TIA ("mini-stroke"), MHT is still considered safe regardless of this family history if you are otherwise a candidate. Previous blood clot or genetic risk factor for blood clot For women with a prior blood clot in the leg or lungs or those with a genetic mutation that increases clotting risks (such as Factor V Leiden), combination hormonal birth control is not recommended as it can increase the risk of blood clots to an unacceptable level. However, menopausal hormone therapy may still be appropriate. MHT has a much lower dose of hormones than birth control pills. Additionally, transdermal estradiol is much safer with a lower risk of blood clots than oral estrogen. Many newer studies show that the risk may not be increased at all. Several studies have shown that women with a previous clot or those who are at higher risk of clots due to genetic factors likely have no increased risk of blood clots when placed on transdermal estrogen therapy for menopause. Risks and benefits of any hormone therapy should always be discussed with your doctors. Obesity While women with obesity sometimes have other health issues, obesity itself is not a reason to avoid MHT. Obesity can increase the risk of blood clots, but using non-oral estrogens  like a patch or gel can decrease or eliminate the increased risk of blood clots that comes with MHT. Diabetes Type 2 diabetes without complications is not typically a reason that you cannot use hormone therapy. MHT can actually help improve glycemic control in women without diabetes. In women <60 years old or <10 years from the onset of menopause, MHT can lower the risk of cardiovascular disease as well and can be beneficial. If you are older than this or >10 years from menopause or have other health conditions, the risk to benefit ratio is not as clear and needs to be discussed with your doctor. Older Age We do not see the same health benefits from MHT when it is started or restarted in women >60 and >10 years from menopause. However, this doesn't necessarily mean that you can't start MHT at this point if you are otherwise healthy. If you are having bothersome menopausal symptoms that are interfering with your life, have a discussion with your doctor (who knows about menopause) to discuss the risks versus benefits for you. Risks are generally low. Menopausal Hormone Therapy is safe and effective for most women. Even if you have been told in the past that you are not a candidate, if you are interested in starting MHT for bothersome menopausal symptoms, it may be worth another discussion! Best, Jackie Stone, MD

Weight Gain during the Menopausal Transition What is the deal with weight gain during the menopausal transition? Is this due to aging in general or due to menopause and hormones specifically? Do we really know what causes this phenomenon? While more studies do need to be done, here is what we do know…. Increased Fat and Decreased Muscle– The SWAN study (Study of Women’s Health Across the Nation) showed that during the menopausal transition (2 years prior to the final menstrual period through 4 years after the final period), fat mass (% body fat) increases and lean mass (muscle mass) decreases. Weight also increased throughout the menopausal transition remaining stable in postmenopause (starting about four years after the final period). This is not dependent only on age, but directly related to the decrease in estrogen levels surrounding menopause. Average weight gain – Most women gain about a pound per year during the menopausal transition. However, up to 20% of women gain as much as 10 pounds or more during this time. Meno Belly – This is the term for the fat accumulation around the mid-section that can happen with menopause. Estrogens are generally responsible for fat deposition around the hips and thighs. However, androgens (male-type hormones) are responsible for fat deposition around the mid-sections. When estrogen levels decrease during the menopausal transition, there is a tendency for women to start storing fat around the mid-section, and this can also be associated with a higher risk of cardiovascular disease (especially when waist circumference exceeds 35 inches). Less Fidgeting – One study showed that women during the menopausal transition do not consume considerably more calories, but spontaneous activity (not intentional activity such as exercise, but spontaneous activity such as fidgeting) dramatically decreased when estrogen levels fell around menopause. This resulted in increased weight and increased body fat percentages. Can Weight Gain and Meno Belly Be Prevented? Is there anything we can do to prevent our bodies from turning into something we don’t recognize as we age or is menopause just dooming us to fat around the mid-section and inevitable weight gain? The good news is that there are things we can do to help! Preventative Lifestyle Changes – One study showed that women who started a diet and exercise program during perimenopause successfully prevented weight gain during the menopausal transition. This lifestyle intervention consisted of a reduced calorie diet and moderate exercise. Increase Protein Intake – While you don’t need to eat keto (and that is often not sustainable and cuts out many healthy foods like fruits), studies do show that adequate protein intake can prevent muscle loss and help maintain better body composition. Some researchers think that our bodies need extra protein during the menopausal transition. When we don’t get this protein, we start craving other things (read: carbs). Eating 0.8-1g of protein per kg of body weight can help prevent weight gain and body composition changes associated with menopause. (Take your weight in pounds and divide by 2.2 to get your weight in kg. That is how many grams of protein your should try to eat per day). Add Resistance Training – Most of us know that we need cardio to burn calories and keep our hearts in shape. But, we also need to add in resistance or strength training at least 2-3 days per week. This keeps our muscles strong, which prevents the lean or muscle mass loss that can come with menopause. It also increases metabolism which keeps us burning calories all day long (even when we’re sleeping!) MHT– While Menopausal Hormone Therapy does not cause weight loss, it may help prevent some of the tendency of fat to accumulate around the mid-section. This effect is small and should not usually be the main reason to start hormones. However, if you are young and healthy and otherwise a good candidate for hormone therapy, it could be something you can discuss with your doctor. What if I am Overweight or Obese Before Menopause? Women who are already overweight or obese before the menopausal transition may have more difficulty preventing weight gain during this time. They may also struggle to lose weight and keep it off. Obesity is a chronic medical condition that is treated as such. If this is you, the good news is that there are medications to treat obesity that are very effective and can be used at any time, including during the menopausal transition! Talk to your doctor if you think you may be a candidate for these. (Anti-obesity medications are generally for women who have a BMI >30 or >27 who also have a medical condition related to their weight AND who have previously tried to lose weight with diet and exercise and have been unable to do so OR have lost weight and have been unable to keep it off.) Have questions or comments? Have an idea for my next blog post? Send me a question or leave me a comment! Best, Jackie Stone, MD

Have you ever gained weight and you just didn’t know why? Your diet and exercise seemed the same, and yet the scale kept climbing up? Sometimes there is an underlying medical condition, so if you have sudden severe unexplained weight gain, you should always see your doctor. However, if you are just struggling to lose some unwanted pounds or slowly seeing your weight creep up, check out these hidden causes of weight gain! You are not getting enough sleep, or your sleep is interrupted. Are you so busy that work and life is causing you to not get enough zzz’s? Are you suffering from insomnia? Waking up frequently in the night? Have poor quality sleep? When we don’t get enough sleep, our stress hormone (cortisol) levels go up. Additionally, leptin (a hormone that helps maintain normal body weight by making us feel full) goes down, and ghrelin (a hormone produced by the gut that that tells you when you are hungry) increases without sufficient sleep. So, with sleep deprivation you tend to be hungrier, eat more, snack more, and pick foods that are higher in fat and carbs. Studies also show that when people diet by restricting calories, those who are sleep deprived lose less fat mass than those who get sufficient amounts of sleep. What can you do? Try to get at least 8 hours of sleep per night, and if you are having trouble sleeping, talk to your doctor. You are anxious or depressed. Increased appetite can be a symptom of anxiety or depression. While some people lose their appetite with anxious or depressed mood, others want to eat everything. (Ever heard the phrase “eat your feelings?”). If you have been eating when you aren’t particularly hungry or eating comfort foods, you may want to ask yourself if you have other symptoms of a mood disorder such as: Anxious, depressed, or irritable mood Sleeping too much or not enough Not wanting to do things that you usually find enjoyable Excessive worrying Feelings of guilt or worthlessness If these describe you, you should talk to your doctor as treating your anxiety and/or depression may help! You are on medications that cause weight gain. Some medications can cause weight gain, so check your medication list. Here are some examples: Beta-blockers –metoprolol, atenolol, labetalol, propranolol SSRIs –paroxetine (Paxil), sertraline (Zoloft), citalopram (Lexapro). mirtazapine (Remeron) Tricyclic antidepressants - amitriptyline (Elavil), imipramine (Tofranil), doxepin. Anti-Psychotics – thioridazine (Thorazine), clozapine (Klonapin), olanzapine (Zyprexa), risperidone (Risperidal) Anti-seizure medications – valproic acid (Depakote), gabapentin (Neurontin), carbamazepine (Tegretol) Corticosteroids – prednisone, prednisolone Diabetes medications – pioglitazone (Actos), rosiglitazone (Avandia), insulin Birth control – Depo-Provera, Nexplanon You should never stop medication without first talking to your doctor. Some medication you may not be able to stop, but sometimes your doctor may be able to switch you to an alternative medication that doesn’t affect your weight. So, ask! Your gut microbiome is off. The microbiome is the variety of good bacteria that naturally live in our intestines (gut) that function as part of our immune and endocrine systems. Many things affect our microbiome including our diet. Studies show that there is an inverse association between the number of strains of bacteria in the gut and BMI. This means that people who struggle with weight tend to have a fewer strains of good bacteria in their gut. While these studies cannot really tell us what came first (chicken or the egg situation), we can do some things to try to improve our microbiome. Eating foods with lots of fiber, taking prebiotics, and taking probiotics can all improve gut health. While additional studies need to be done, early evidence points to the fact that these supplements may help with weight loss and insulin resistance. You are under a lot of stress (and not coping well). Who doesn’t have stress? While we all face stressful situations from time to time (and some of us tend to live in the midst of stress ALL the time!), studies show it is not the amount of stress we have but rather how we handle the stress that matters. Some people tend to be reactive – their body creates a lot of the stress hormone cortisol, which causes an increase in appetite and subsequently weight gain. Other people do not get as much of a spike in cortisol, and they do not have this response. So, what do you do if you are feeling stressed, eating more, and gaining weight? Seek out a therapist to discuss coping strategies. You are consuming artificial sweeteners. Switched to diet soda instead of regular to skip the calories? This seems like a great plan to keep the weight off, but studies show that artificial sweeteners alter glucose metabolism, lead to insulin resistance, and may even cause weight gain. Consuming artificial sweeteners can alter your gut microbiome in a negative way and that may be how it leads to insulin resistance. What can you do if you want to avoid sugar? Natural plant-based sweeteners such as stevia and monk fruit seem to be safer. What Should I Do Now? If you are struggling with weight gain, you should see your doctor. I am accepting patients in my virtual clinic who live in states where I am licensed and would love to see you. Have a question for me or an idea for my blog? Feel free to reach out via email contact@jackiestonemd.com.

Some women get Bacterial Vaginosis (BV) (a vaginal infection that causes vaginal discharge and odor) over and over again. It seems like as soon as it gets better, it comes right back. Why does this happen, and how do you keep it from happening? If this happens to you, read on for the answers… What exactly happens that causes BV? Our vagina has good bacteria called lactobacillus that are normal and keep everything balanced and healthy. Sometimes these good bacteria are replaced by bacteria that are not supposed to be there, and this causes BV. Usually this happens when the pH of our vagina gets “off” or if the good bacteria are washed away. Here are some of the common culprits: Douching: Douching washes away the good bacteria and increases the risk of bacterial infections, especially BV. You should NEVER douche!! Feminine washes, deodorants, and wipes: There is a whole aisle at the store dedicated to selling us on the lie that our vagina should smell like strawberries and bananas or whatever, but vaginas should smell like vaginas. If you do not have an infection, then your own natural smell is normal. Using feminine washes, deodorants, and wipes can also change the pH of your vagina and wash away the good bacteria increasing your risk of infections. It is best to use only water to clean your vaginal/labial area. If you really need to, use a mild soap like Dove, but only on hair bearing areas (not inside the vagina or in between your lips). New sexual partner: Women are more susceptible to BV when they have a new sexual partner. However, some women do report repeated infections related to each time they have sex. This is because semen has a higher pH than our vagina usually has and this change in pH can increase the risk of BV. Same sex female partners: Lesbian women have a two times higher risk of BV than heterosexual women. The reason is not quite understood, but women with same-sex partners who have BV are at higher risk of getting BV. However, studies show that monogamous homosexual women have lower rates of BV after about 6 months with the same partner (by then, most same-sex female partners who are monogamous have similar microbiomes or sets of bacteria in their vaginas that are mostly the normal healthy type). Should my male partner be treated? Although BV may be somewhat sexually transmitted, multiple studies have shown that treating a male partner of a female with BV does increase cure rates (the chance that a medicine will make the infection go away) or reduce recurrence rates (the chance that the infection will come back). Men cannot get BV, so there is no reason for your male partner to be treated. What can I do to reduce my risk of BV coming back? If you think you may have BV due to vaginal discharge or vaginal odor, be sure to contact your doctor. If your symptoms do not resolve with treatment or resolve and then come back, be sure to let your doctor know! Here are some tips to decrease the chance that your infection will come back: Vulvar/Vaginal Hygiene: Your vagina is meant to clean itself! Use only water in the shower and avoid soaps when cleaning this area. DO NOT DOUCHE! Skip the feminine wash aisle! Use Condoms: If your BV tends to occur in close proximity to intercourse, try using condoms. Although this may not be your or your partner’s favorite, it will keep semen out of the vagina which keeps your pH normal preventing recurrent BV. Think about hormonal birth control: Some women find that they have fewer BV infections when they are on the pill. Probiotics: Studies are mixed on whether or not probiotics decrease the risk of BV infections. However, some women find them helpful. If you choose to try these, be sure you try one that is labeled “for women” or “for vaginal health” as these contain the specific species of lactobacillus that keeps our vagina healthy. I’ve done all of those things, and it is still coming back… Now what? For patients who continue to get BV despite conservative measures, there are preventative medical treatments. This means you take medication even when you don’t have an infection to prevent the infection from coming back. This is successful for most patients. However, some patients still get recurrent infections if they stop therapy. What Should I Do Now? If you are struggling with recurrent vaginal infections, you should see your gynecologist. I am accepting patients in my virtual clinic who live in states where I am licensed and would love to see you. Have a question for me or an idea for my blog? You can email me at drjacquelynstone@gmail.com. Jackie Stone, MD

So, you have a friend who has PCOS or maybe you’ve read about PCOS. You think you may have it too, but… What exactly is PCOS? PCOS stands for polycystic ovarian syndrome. This is a hormonal imbalance in women that causes too many male-type hormones and irregular or absent periods. About 10% of women will be diagnosed with PCOS, but many women struggle to get an accurate diagnosis. Women with PCOS are also at increased risk of other health problems. How is PCOS diagnosed? PCOS can sometimes be diagnosed based upon symptoms alone, but other times lab tests (blood work) and/or an ultrasound of the ovaries may be needed. Symptoms of PCOS include abnormal hair growth (on the face, chest, and/or abdomen), acne, and thinning hair on the head, especially at the crown (top) or hairline. Abnormal periods due to not ovulating (releasing an egg from the ovary) regularly is another major symptom. For most women, periods are very irregular or even absent, but other women may have prolonged or frequent periods. If I have PCOS, what treatment options are available? Many treatments are available for PCOS including medications to regulate menstrual periods such as progesterone, birth control pills, and birth control rings. It isn’t safe to go prolonged periods of time without having a period if you are not on hormonal birth control as this can increase the risk of cancer and precancer in the lining of the uterus. Therefore is you are going long periods of time without a cycle, something may need to be done to protect your uterine lining even if you do not want to be on the pill. There are also medications to treat symptoms of too many male-type hormones such as acne, abnormal hair growth, and hair loss on the head. Birth control pills can help with these symptoms, but sometimes other medications that work to lower testosterone levels are also needed. Is PCOS making me gain weight or making it more difficult for me to lose weight? Between 40 and 85% of women with PCOS are overweight or obese, and most of these women suffer from insulin resistance. Insulin resistance occurs when your body does not respond correctly to the hormone insulin, which is responsible for sugar metabolism. This causes your body to make more and more insulin, which can eventually lead to prediabetes and diabetes. Insulin resistance can cause weight gain or make it very difficult to lose weight. Medications such as metformin can be used to treat insulin resistance and can make it easier to lose weight. Metformin can also make your ovaries work better (regulate periods) and decrease male hormone levels. What should I do now if I still think I may have PCOS? If you have symptoms consistent with PCOS, you should schedule an appointment with your gynecologist. I welcome patients to my virtual clinic in states where I am licensed. I can evaluate for PCOS and treat patients for this condition, including weight loss medications where indicated and desired. Have a question for me or an idea for my blog? You can email me at drjacquelynstone@gmail.com. Jackie Stone, MD