The pain gap exists. Health-related gaslighting is all too common among women. Almost any woman can tell you about a time her physician failed to take her seriously. For many, getting treatment for pain has always been a key concern, instead, theyve been misdiagnosed, negated, dismissed, or told its anxiety.

Thankfully, there has been a shift in the UK, and officials are beginning to listen. As part of the governments first womens health strategy, a survey of almost 100,000 women revealed that menopause had been cited as the number one health concern for women between the ages of 40 and 59.

Managing symptoms of menopause have not been taken seriously in the UK for some time, with women facing constant challenges in obtaining hormone replacement therapy. Women even reported that some providers were unwilling to prescribe it.As a result, many had to suffer from severe symptoms of menopause, which negatively impacted their daily lives.However, there is now hope of finding relief.

RELATED: Youre Not Crazy, Its Perimenopause Rage: Women Open Up About Their Experiences, And How To Spot It In Yourself

As reported by The Guardian, hormone replacement therapy (HRT) will now be sold over the counter in the UK for the first time. After a safety review, starting in September,the Medicine and Healthcare products Regulatory Agency (MHRA) noted that Gina 10 microgram vaginal tablets (containing estradiol) will be available from pharmacies without a prescription.

Gina HRT tablets are intended for women aged 50 and over who havent had their periods for a least a year. Gina aims to treat vaginal symptoms related to oestrogen deficiency such as dryness, soreness, itching, burning, and uncomfortable sex.

Chief healthcare quality and access officer at MHRA, Dr. Laura Squire, told The Guardian, This is a landmark reclassification for the millions of women in the UK who are going through menopause and experience severe symptoms that negatively impact their everyday life.

Echoing Dr. Squires words, Maria Caulfield, the minister of state for health, told The Guardian, Menopause affects hundreds of thousands of women every year, but for some, its symptoms can be debilitating and for many, they can be misunderstood or ignored. Making Gina available over the counter is a huge step forward in enabling women to access HRT as easily as possible, ensuring they can continue living their life as they navigate menopause.

While we celebrate this milestone for our sisters in the UK, we lament the lack of progress on womens health in the United States. In 1998, the Womens Health Initiative (WHI) conducted a study on the effect of HRT on postmenopausal women. Initial evaluations of the data suggested the risks, namely increased risks of coronary heart disease and breast cancer, outweighed the benefits of using HRT.

Since then, there have been numerous scrutinies of the WHIs methods and analysis, such as the fact that a majority of participants were more than a decade past their final menstrual period. Another limitation of the controversial study included that only one type of HRT and delivery method was tested. Moreover, a lot of the positives of HRT, such as decreasing the risk of diabetes, colon cancer, and osteoporosis never made it into the public narrative.

Despite more recent studies negating the initial findings of the WHI study, this data has not received the same media coverage that has unfairly harbored a negative view of HRT in the publics mind.

Were hopeful that this monumental moment in the UK is the first step of many to reframe the narrative around HRT in treating menopausal symptoms and providing relief to the millions of women out there suffering in silence.

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Hormone Replacement Therapy Will Be Available Over-The-Counter In The UK In SeptemberWe Wish The U.S. Would Follow Suit - Suggest

I am a 60-year-old woman at the end of a five-year regimen of hormone therapy. My doctor has advised me to eventually stop the use of estrogen and progesterone by this summer, as she says women have an advanced risk of breast cancer at this age. Another friend a few years younger than me was told by her doctor that she could continue with hormone-replacement therapy until she is 70. Which doctor is correct? I am experiencing constant hot flashes again and am able to snatch only little bits of sleep each night, along with all of the other issues that come with the loss of estrogen inability to regulate temperature, hair falling out, flaccid skin and vaginal dryness. My other question is, am I able to use other herbal compounds, specifically saw palmetto and/or St. Johns wort, without any risk of breast cancer? Or, are these and other estrogen-mimicking compounds also a contributor to breast cancer?

There is no one-size-fits-all answer to the first question about how long to continue hormone treatment for symptoms of menopause. I disagree with any absolute rule, such as stopping at five years or waiting until 70, because any woman may place a different value on her well-being, and a womans individual risk for breast cancer also needs to be considered.

You havent told me about any particular risk, but my answer would be very different for a woman with average risk compared with a woman with increased risk due to family history, for example.

About 40% of women will have symptomatic hot flashes until age 65, and continuing estrogen is reasonable in women who are willing to accept the increase in risk.

The risk is not just breast cancer. Women taking combined estrogens and progestins have a small increase in the risk of heart disease, stroke and pulmonary embolism, or blood clot to the lung, but a decreased risk of colon cancer and hip fracture.

That all sounds scary, but the increase in risk of any of these is less than 0.5%. Overall, women on combined hormones were slightly less likely to die than those who were not.

Many women choose to continue taking their hormones when their symptoms are significantly affecting their quality of life. I feel very strongly that its the physicians job to advise so a woman can make the best decision for herself.

Saw palmetto is not commonly used for menopausal symptoms its used very frequently by men with prostate issues and there is inconsistent evidence on its contribution for breast cancer.

Similarly, there is no consensus on the risk of St. Johns wort for breast cancer, and only limited evidence that it helps menopausal symptoms. St. Johns wort can interact with many medicines, so its wise to discuss its use with a pharmacist if you are taking other medication.

Many women ask about phytoestrogens, such as in soy protein or red clover, and other herbs with estrogenic activity, such as black cohosh.

There is a theoretical risk, and although there are some studies suggesting they may be safe, many experts advise against these for women at high risk. That group would include women with a history of an estrogen-sensitive tumor.

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To Your Good Health: Length of hormone treatment depends on the individual - Agri-News

Menopauseis the natural biological process that marks the end of your Menstrual cycle. It is diagnosed after you have gone 12 months without a menstrual period. Menopause can happen in your 40's and 50's, but the average is 51 years in the United States.

Among the physical symptoms of menopause, the most common is hot flashes and emotional symptoms of menopause may disrupt your sleep, lower your energy or affect emotional health. There are many effective treatments available, from lifestyle adjustments to hormone therapy.

Symptoms

In the months or years leading up to menopause (perimenopause),you might experience these signs and symptoms:

1. Hot Flashes

2. Irregular Periods

3. Vaginal Dryness

4. Chills

5. Night sweats

6. Sleep problems

7. Mood changes

8. Weight gain and slowed metabolism

9. Thinning hair and dry skin

10. Loss of breast fullness

Signs and symptoms, including changes in menstruation can vary among women. Most likely, you'll experience some irregularity in your periods before they end. Skipping periods during Perimenopause is common and expected. Often, menstrual periods will skip a month and return, or skip several months and then start monthly cycles again for a few months. Periods also tend to happen on shorter cycles, so they are closer together. Despite irregular periods, pregnancy is possible. If you've skipped a period but aren't sure you've started the menopausal transition, consider a pregnancy test.

When to see a doctor?

Keep up with regular visits with your doctor for preventive health care and any medical concerns. Continue getting these appointments during and after menopause.

Preventive health care as you age may include recommended health screening tests,such as Mammography and Triglyceride screening. Your doctor might recommend other tests and exams, too including thyroid testing if suggested by your history, and breast and pelvic exams. Always seek medical advice if you have bleeding from your vagina after menopause.

Causes

Menopause can result from:

Naturally declining reproductive hormones: As you approach your late 30s, your ovaries start making less estrogen and progesterone the hormones that regulate menstruation and your fertility declines. In your 40s, your menstrual periods may become longer or shorter, heavier or lighter, and more or less frequent, until eventuallyon average, by age 51 your ovaries stop releasing eggs, and you have no more periods.

Surgery that removes the ovaries (oophorectomy): Your ovaries produce hormones, including estrogen and progesterone that regulate the menstrual cycle. Surgery to remove your ovaries causes immediate menopause.

Surgery that removes your uterus but not your ovaries (hysterectomy) usually doesn't cause immediate menopause. Although you no longer have periods, your ovaries still release eggs and produce estrogen and progesterone.

Chemotherapy and Radiation Therapy: These cancer therapies can induce menopause, causing symptoms such as hot flashes during or shortly after the course of treatment.

Primary ovarian insufficiency: About 1percent women experience menopause before age 40 (premature menopause). Premature menopause may result from the failure of your ovaries to produce normal levels of reproductive hormones (primary ovarian insufficiency), which can stem from genetic factors or autoimmune disease.

Complications

After menopause, your risk of certain medical conditions increases. Examples include:

Osteoporosis

Urinary incontinence

Sexual function

Weight gain

What Happens During Menopause?

Natural menopause isnt caused by any type of medical or surgical treatment. Its slow and has three stages:

Perimenopause:This phase usually begins several years before menopause, when your ovaries slowly make less estrogen.

Menopause:This is when it's been a year since you had a period. Your ovaries have stopped releasing eggs and making most of their estrogen.

Postmenopause:These are the years after menopause. Menopausal symptoms such as hot flashes usually ease. But health risks related to the loss of estrogen increase as you get older.

What Conditions Cause Premature Menopause?

Your genes, some immune system disorders, or medical procedures can cause premature menopause. Other causes include:

Premature ovarian failure: When your ovaries prematurely stop releasing eggs, for unknown reasons, your levels of estrogen and progesterone change. When this happens before youre 40, it's called premature ovarian failure. Unlike premature menopause, premature ovarian failure isnt always permanent.

Induced menopause: This happens when your doctor takes out your ovaries for medical reasons, such as uterine cancer or endometriosis. It can also happen when radiation or chemotherapy damages your ovaries.

Diagnosis

You might suspect that youre going into menopause. Or your doctor will say something, based on symptoms you've told them about.

You can keep track of your periods and chart them as they become uneven. The pattern will be another clue to your doctor that youre menopausal.

Your doctor might also test your blood for levels of:

Follicle-stimulating hormone (FSH)

Thyroid hormones

Anti-Mullerian hormone (AMH)

Treatment

Menopause is a natural process. Many symptoms will go away over time. But if theyre causing problems, treatments can help you feel better. Common ones include:

Hormone replacement therapy (HRT):This is also called menopausal hormone therapy. You take medications to replace the hormones that your body isnt making anymore.

Topical hormone therapy:This is an estrogen cream, insert, or gel that you put in your vagina to help with dryness.

Nonhormone medications:The anti-depression drug paroxetine (FDA-approved to treat hot flashes. The nerve drug gabapentin and the blood pressure drug clonidine might also ease them. Medicines called selective estrogen receptor modulators (SERMs) help your body use its estrogen to treat hot flashes and vaginal dryness.

Medications for osteoporosis:You might take medicines or vitamin D supplements to help keep your bones strong.

Lifestyle changes

Lifestyle changes help many women deal with menopause symptoms. Try these steps:

l If youre having hot flashes, drink cold water, sit or sleep near a fan, and dress in layers.

l Use an over-the-counter vaginal moisturizer or lubricant for dryness.

l Exercise regularly to sleep better and prevent conditions like heart disease, diabetes and osteoporosis.

l Strengthen your pelvic floor muscles with Kegel exercises to prevent bladder leaks.

l Stay socially and mentally active to prevent memory problems.

l Dont smoke. Tobacco might cause early menopause and increase hot flashes.

l Limit how much alcohol you drink, to lower your chance of getting breast cancer and help you sleep better.

l Eat a variety of foods and keep a healthy weight to help with hot flashes.

l Practice things like yoga, deep breathing, or massage to help you relax.

Alternative and Complementary Menopause Treatments

Some studies have found that soy products relieve hot flashes, but researchers are still looking into it. There arent many large studies on whether other supplements such as black cohosh or bioidentical hormones work for menopause symptoms. Talk to your doctor before starting any herbal or dietary supplements.

Menopause Complications

The loss of estrogen linked with menopause is tied to a number of health problems that become more common as women age.After menopause, women are more likely to have:

l Bone loss (osteoporosis)

l Heart disease

l Bladder and bowels that dont work like they should

l Higher risk of Alzheimer's disease

l More wrinkles

l Poor muscle power and tone

l Weaker vision

It can be tough to manage the sexual changes that come along with menopause, like vaginal dryness and a loss of sex drive. You might also find that you dont enjoy sex as much and have trouble reaching orgasm. As long as it isnt painful, regular sexual activity may help keep your vagina healthy by promoting blood flow.

Your ovaries have stopped sending out eggs once youre in menopause, so you cant get pregnant. But you can still get a sexually transmitted disease. Use safer sex practices if youre not in a relationship with one person.

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Menopause: Symptoms, causes, complications, diagnosis and treatment - Rising Kashmir

Moving homes, new relationships, career prospects and summer holidays. These are some things you might be thinking about when youre in your 20s and 30s. What most people in this age range probably arent likely to be pondering, however, is the big change. It may be the furthest thing from your mind, but the reality is that menopause isnt a sudden condition that hits women once they reach their late 40s. Rather, its a gradual transition (calledperimenopause)and can start 10 years beforemenopause itself.

As many as 5% of the UK population will reach menopause earlier than the average age of 45-55, while 1% experience it earlier than 40. In your 20s, the likelihood is 0.1%. And the longitudinal US study SWAN showed that women from Black and other minoritised ethnic groups might experience menopause earlier than the average.

Theres certainly more awareness now of what can be distressing symptoms of menopause: increased anxiety, osteoporosis, insomnia and a slower metabolism. The earlier you start monitoring and recognising those symptoms, the more empowered you will be to seek advice and start a treatment plan to alleviate them and other long-term effects.

Most of us can usefully integrate diet and fitness tweaks, including more strength training to build muscle mass and bone density, which also helps prevent low hormone-related diseases and symptoms.

Some women have lots of symptoms; some women might only have one symptom and that symptom is enough to really impact the quality of their life, says GP and menopause specialist Dr Louise Newson, explaining there is no blueprint of how women experience perimenopause.

Some people may start feeling worse just before their periods more irritable and tired other people feel those days last longer. Some experiences will involve symptoms coming on very quickly with a sudden onset of mood, memory and sleep issues. Hot flashes and night sweats are commonly cited problems but not all women will experience these. However, some women will feel bad all of the time.

There are more unusual symptoms too, such as urinary symptoms, vaginal dryness, burning mouth, tinnitus, restless legs and itchy or dry skin. Symptoms may vary throughout the days as well.

Theres this misconception that women have to manage the symptoms, says Dr Newson. When women have symptoms, its a sign that their hormone levels are low. And that can be easily treated with hormone replacement therapy (HRT), which Dr Newson says is safe for the majority of women.

Taking HRT earlier can also reduce the risk of disease, says Dr Newson. But, as well as women empowering themselves with information, there should also be a wider acknowledgement that womens choice is largely being dismissed. Women have been refused HRT, for example, and given antidepressants instead.

Women are just being ignored, which has got to stop. Its 2022, says Dr Newson.

Women know their bodies; often, women understand whether their symptoms are due to their hormones or not. And if they think they are, then they absolutely should be taken seriously.

However, while a 1% chance of experiencing menopause before your 40s may seem like good odds, one in 100 women is actually a significant proportion, says Dr Newson: A lot of women are told theyre too young to be menopausal or perimenopausal for which no one is too young.

That is why its so important that women know when to get appropriate guidance from a healthcare professional. You really want to see your GP as early as possible, particularly once symptoms start affecting your quality of life.

But Dr Newson also says that moderating diet and exercise can assist with some of the health-related risks associated with having low hormone levels, as can looking at your sleep and mental wellbeing. Perimenopause is, therefore, a good time to take stock and consider how we live our lives and how it will affect our future selves.

Irina Allport, a personal trainer and nutritional coach, also recognises the benefit of reviewing diet and exercise practices during perimenopause and menopause, something she homed in on after watching her mum have a particularly tough time going through it.

She found that some of the best ways of looking after your health are to incorporate more fish, nuts, veggies, fruit and dairy into your eating plans.

Eat natural foods and stay clear away from anything that elevates your hormones coffee, booze or overconsumption of sugar. We want you to have a balanced body to help out with all the changes taking place, says Allport.

In addition, Allport advocates for eating soy foods, phytoestrogens or plant-based oestrogen that mimics the role of natural oestrogen in the body. Research suggests that eating phytoestrogen-rich foods (soy milk, tempeh, tofu, soy-linseed bread) may ease menopausal symptoms.

Supplements can form part of any regime. Allport says to consider:

Then theres exercise, which many say should include more resistance training and balance not just cardio.

Strength train. This is the best thing to do as we get older, says Allport. Strength training exercises will help to build bone and muscle strength, and rev up your metabolism. At home, opt for dumbbells and resistance bands.

Being more attentive to your diet and exercise can improve mood, balance hormones, sleep and energy levels and lower heart disease, diabetes and osteoporosis risks, says Allport, which are linked to low hormone levels. In addition, professionals say the younger you start these exercises, the more beneficial it is.

Equipment: set of dumbbells/1.5 litre water bottles

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How to eat and exercise for menopause: why you should prep now - Stylist Magazine

Melasma is a skin condition that frequently affects pregnant women and anyone who has spent too much time in the sun. Melasma can appear anywhere on your body where the skin is exposed to sunlight. In addition, hormonal imbalances in pregnant women or those taking hormonal birth control frequently cause melasma, which manifests as dark spots and colored patches of skin. This is sometimes referred to as the pregnant mask.

Melasma may occasionally be a symptom of malnutrition and poor liver health. Brown to gray spots on the neck, forearms, chin, above the upper lip, cheeks, forehead, or on the bridge of the nose are symptoms of this skin condition, which are challenging to treat. Melasma is more prevalent in women and might last even after giving birth.

Like other skin conditions, melasma can be treated with chemical peels, exterior lotions, laser therapy, skin protection, hormone replacement therapy, and dietary balancing. Before treating your melasma, speak with a dermatologist or medical professional. The following four simple steps include advice on improving and preventing melasma.

Consult a dermatologist or medical professional about your melasma. You will likely be recommended to take a blood test to look for nutritional deficiencies and impaired liver function that could be the root of this condition. Melasma could also be a negative side effect of your medication. Confirm this with your doctor.

Eat folate-rich foods. Melasma may result from folate or folic acid deficiency. Women on birth control, pregnant, or who consume an inadequate diet may have low B vitamin levels. Among the foods high in folate are whole grains, nuts, citrus fruits, and green leafy vegetables. Your doctor may also recommend you start taking a folic acid supplement.

Your diet should have a healthy balance of copper. Copper encourages the skins melanin production. Therefore, high levels of this mineral can result in excessive skin pigmentation. Copper should not be consumed separately if it is present in your multivitamin. Never exceed the daily copper recommendations of:

Consume foods high in vitamin C and iron, or take supplements of these nutrients to lower excessive copper levels.

Start eating more foods high in vitamins C and E. These antioxidant-rich foods aid in repairing skin damage from the UV rays, which can result in melasma. These vitamins are present in foods such as kiwis, blueberries, citrus fruits, nuts, vibrantly colored veggies, and fish. Before self-treating, have your melasma diagnosed by a professional.

Increase the number of raw fruits and vegetables in your diet to ensure you get enough vitamins and minerals. Avoid packaged and processed foods that have artificial chemicals and preservatives. Food sensitivities and allergic reactions can also cause inflammation in the skin, which can result in pigmented areas such as dark patches. It is also recommended to avoid inflammatory foods that can also contribute to skin inflammation.

Melasma, sun damage, and even skin cancer can be prevented by wearing sunscreen and avoiding damaging UV rays. You must visit your dermatologist or primary care physician if you detect melasma anywhere on your body.

Avoid taking too many nutrient supplements because they may have adverse side effects. Finally, dont discontinue taking prescription medications without consulting your doctor.

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How to Treat and Prevent Melasma with Nutrition - Intelligent Living

Main findings

Our results suggest that reproductive age (reflecting the menopausal transition) does not independently influence change in sub-clinical atherosclerosis (CIMT) or risk factors (e.g. SBP, non-HDL-cholesterol and triglycerides) strongly associated with atherosclerosis, as shown in randomised trials and/or Mendelian randomisation studies to causally influence coronary heart disease [17, 27, 28]. By contrast reproductive age may increase adiposity and risk of diabetes, albeit modestly, as suggested by stronger positive linear associations with reproductive age than chronological age for BMI, fat mass, and fasting glucose. HRT may not identically reflect endogenous hormonal and other changes associated with a natural menopause. However, it is notable that our findings have some consistency with randomised controlled trials of HRT, which have shown no protection, or a possible increased risk for coronary heart disease and reduced risk for type 2 diabetes [29].

To our knowledge, this is the largest prospective study to date with two repeat CIMT measures and up to four repeated cardiovascular risk factor measures that spans the late reproductive period, from menopausal transition into post menopause. The average 5-year follow-up period with up to four repeat measures in women of different baseline ages allowed the description of associations from 4years before to 16years after the menopause, a longer postmenopausal period than described in previous studies.

We used multilevel models, which allow all women with at least one measurement occasion to be included in the analysis under the MAR assumption, i.e. missingness depends on observed data and therefore associations do not differ in women (with the same characteristics) who have fewer repeat measures. Furthermore, sensitivity analysis restricted to women who had three or four repeat measures showed similar results to those with at least one repeat measure. We had to restrict our main analyses to women in whom we could calculate their FMP, meaning only those who has at least 12months since their last period could be included. This could introduce selection bias. However, consistency of our main analysis findings with those of the associations of change in outcome with chronological age by strata of menopausal status suggests our findings are not substantially biased by selection. We do however note that a womans menopausal stage will reflect her chronological age (i.e. at the time of baseline assessment, women who are pre-menopausal will be on average younger than those who are postmenopausal). We therefore need to be cautious in our interpretation and in the magnitude of associations which are likely to be driven by differences in the age distribution across the groups.

We fit models which included time since FMP and chronological age to separate the influence of both chronological and reproductive age. However, given that chronological age is the sum of age at menopause and time since FMP, we could have instead analysed time since FMP and age at menopause only, a reparameterisation of time since FMP and chronological age. As such, in mutually adjusted models, the coefficients of chronological age are equivalent to that of age at menopause, whilst time since FMP in the model including age at menopause is the sum of time since FMP in the model including chronological age and additionally the coefficient of chronological age.

As reproductive age is a self-reported measure and measured with more error than chronological age, it may be that this causes some bias towards the null for reproductive age, and correspondingly away from the null for chronological age.

Distributions of outcomes and confounders were similar between women included and excluded from the main analysis (Additional file 3: Tables S9S10).

Our study is predominantly of White European origin women, and previous studies have shown ethnic differences in cardiovascular risk factors [30], so our findings might not be generalisable to women of other race/ethnic groups. As our study recruited women during an index pregnancy and only followed those with a live birth from that pregnancy, all participants had at least one live birth and we cannot assume that our findings would generalise to women with no previous pregnancies or live births. As we know the risk of cardiovascular disease increases with an increase in live births [31], the association between reproductive age and cardiovascular health may differ in studies that also include nulliparous women. Vasomotor symptom severity and duration arealso known to associate with HRT use (the most effective treatment for these symptoms) and CVD risk. Censoring those who use exogenous hormones because we could not determine age at a natural menopause could induce some collider bias [32] if there is residual confounding between HRT and CVD. However, given the key confounders of HRT-CVD effects are the same as those for time to FMP and CVD (e.g. age, BMI, education) which we already adjust for, we anticipate that any bias would be small.

When restricting our sample to women with a time since FMP greater than 0, 71% of the sample, the median time (IQR) since FMP was 5.7years (4.28.8). We believe this time is long enough to observe any differences in CVD risks possibly related to the menopause. However, it may be possible that the longer women are followed up after menopause, evidence of associations become apparent, or the observed associations become larger in magnitude. Furthermore, given only 12% (203/1702) of the sample experienced early menopause, it is possible that women at the very low end of the age at menopause distribution are indeed at increased risk and we were not able to pick this up. These analyses are in unselected women in mid-life and only 20 (1.2%) had evidence of plaque or atherosclerosis, highlighting the need for further follow-up into older ages.

We were able to identify ten papers published up to December 2021 that either explored change in cardiovascular outcomes by reproductive age [8, 12, 15, 16, 33,34,35] or change with chronological age within strata of menopausal status [18, 36, 37]. We have summarised these in Additional file 4: Table S11 [8, 12, 15, 16, 18, 33,34,35,36,37] including number of women, number of repeated measures, sample characteristics and key results. With one exception, these included fewer than 500 women [18, 36, 37]. The one exception was the SWAN which included between 249 to 2659 women in different publications [8, 12, 15, 16, 18, 33, 35].

Only two of these explored associations with CIMT [16, 18]. El Khoudary et al. [18] included 249 participants, (122 premenopausal, 115 early peri-menopausal, 4 late peri-menopausal and 8 postmenopausal at baseline) and in line with our results found that CIMT increased in post-menopause (0.024mm/year, p-value 0.03) compared to pre-menopause, adjusting for age at baseline and ethnicity. Similarly, the recent SWAN paper [16] included 890 women with CIMT measures and suggested that older age at menopause was associated with an increase in CIMT.

Consistent with our results, Greendale et al., in a sub study of SWAN with N=1246 [15], found an independent association between reproductive ageing and gain in fat mass and loss of lean mass until 2years after the FMP in women who had an average age at FMP of 52years. Our findings, with larger numbers, add to this evidence in suggesting that reproductive age, independent of chronological age, increases body fat.

Unlike our findings, Derby et al. [8] found increases in triglycerides with reproductive age, having adjusted for chronological age; however, this change was small. As in our study, Matthews et al. [12] found increases in triglycerides in midlife were small and largely related to chronological age rather than reproductive age or menopausal status. A weak positive linear change in non-HDL-c with reproductive age, consistent with our results, was also shown in that study. In a previous analysis of the same cohort (ALSPAC) using a metabolomic and largely lipids platform, Wang et al. found important changes in many lipids across the menopausal transition, taking into account chronological age [11], however, data were available for only two time points.

Reproductive and chronological age were weakly positively associated with fasting glucose in our study whilst the SWAN studies found neither or a negative association [12, 33, 37]. However, our study was considerably larger than the others. Furthermore, the decrease with reproductive or chronological age would be surprising given in general populations diabetes increases with age [14].

Some studies have looked specifically at the association of early or premature menopause as a risk factor for CVD [38,39,40]. Daan et al. compared 83 women previously diagnosed with POI (i.e. loss of ovarian function before 40years of age) to 266 premenopausal women, all aged >45years, and found an association of POI with higher adiposity and higher CRP levels [40]. Similarly, Honigberg et al. in a study with 144260 postmenopausal women (natural or surgical menopause) found that premature menopause was associated with a small but increased risk for a composite of different CVD [38]. Our study, whilst analysing different parameters, has some consistency with those findings in suggesting that reproductive age associates with intermediate risk factors of CVD, such as adiposity and higher CRP and glucose levels, which could be relevant for later CVD.

Our findings are broadly in line with the narrative review behind the recently published American Heart Association (AHA) statement on menopausal transition and CVD [41]. In that review consistent with our findings, they do not find strong evidence that menopausal transition influences blood pressure or CIMT beyond chronological age and that there is evidence of an increase in fat mass through the menopausal transition, independent of chronological age, as well as fasting glucose, as we also find. They note that non-HDL-c increases across the menopause transition, which we also observed. Notably, they do not discuss in detail magnitudes of change and our review of key papers for this study suggest that these are modest (as in our study). They conclude that guidelines for CVD prevention should have specific reference to the menopause. They highlight the importance of early age at menopause as a risk factor for CVD and that those with surgical menopause, early menopause, and vasomotor symptoms should be considered for exogenous hormone replacement therapy. Previous cohort studies show that premature menopause is associated with CVD after adjustment for age and other CVD risk factors such as high blood pressure [38, 39]. The main aim of our paper adds to this work by using detailed repeat measures of established risk traits to show how these vary in relation to chronological and reproductive age. Whilst we show that chronological age seems to be more important for some risk factors, it is possible that the impact of reproductive age is influenced by those with premature menopause or early menopause. The previous studies were very large (N=144,000 and 301,000) to have power to compare risk of different cardiovascular diseases between premature menopause and menopause aged 5051 [39] or postmenopausal women without premature menopause [38]. Though the cited studies have much bigger sample sizes, we have repeat data and are able to separate the influence of both chronological and reproductive age. Furthermore, we did not find any evidence of non-linearity between reproductive or chronological age and many outcomes, suggesting that those with an earlier menopause did not appear to over influence our results. We do however note that it may not have been possible to pick this up in our sample. Furthermore, previous studies have found that changes in CVD risk factors over time were similar in women with natural and surgical menopause [34, 35], which supports our findings that chronological age might influence CVD risk more than reproductive age. In relation to the menopausal transition, they note that firm conclusions are difficult to make on the basis of current evidence but suggest supporting women to make behavioural changes (e.g. diet and physical activity) to maintain a healthy weight across mid-life would be potentially beneficial.

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Cardiovascular health in the menopause transition: a longitudinal study of up to 3892 women with up to four repeated measures of risk factors - BMC...

Although theres a lot that goes into finding the right partner, many find that a primary focal point in dating particularly in the early stages involves physical appearance. So, when you have a condition that can visbily affect your outward appearence, like alopecia, it can affect your self-eestem and confidence in the dating world.

Alopecia is the medical name for a everyday condition: "Alopecia is a general term to describe hair thinning or hair loss," Ken L. Williams Jr., DO, FISHRS, ABHRS, a surgeon and founder of Orange County Hair Restoration in Irvine, California. "The most common form of hair loss is due to genetics." Other causes of alopecia include thyroid issues, autoimmune problems, (known as alopecia areata), or in women, menopause. Men who use hormone replacement therapy may also experience hair loss.

Although hair loss can make you feel self-conscious about dating, the truth is, its incredibly common.

"Up to 50 percent of the adult male population has some type of hair loss," Dr. Williams says. But it's not just men who are affected: According to the Cleveland Clinic, more than 50 percent of women will experience noticeable hair loss as well.

Of course, the amount of hair loss or hair thinning you experience can also factor into your self-image. Some men (and women) have advanced balding to the point where they prefer to shave their heads. But as we age, hair thinning becomes more common, making it less of a stigma.

"Men and women in their fifties and sixties will not have the same type of hair density or frontal hairline as they did in their twenties or even their teenage years, says Williams. "So there is a natural appearance of hair loss as we age."

Even if its common, hair loss can still affect your self-confidence, especially if youre a younger person who is dealing with hair loss earlier than many of your peers. Further, if youre at a stage in your life where youre interested in dating or a starting a relationship, low self-image can become a barrier.

"Someone who is suffering from hair loss may have low self-esteem and might not have the self-confidence to ask an individual on a date, says Williams. It can also be challenging to style your hair or camoflouge the hair loss, which can impact your overall confidence.

These issues can also potentially lead to mood disorders. "Theres a known association between hair loss and anxiety and depression, as well as self-esteem and confidence; however, the subtle nuances have yet to be fully defined in medical literature," says Shani Francis, MD, MBA, a dermatologist and hair loss specialist based in Los Angeles. Dr. Francis has alopecia herself and experienced hair loss as a child. "Alopecias impact on self-esteem and confidence is real, diverse, and uniquely personal," she says.

Alopecia can be especially hard on women, who often face greater scrutiny and pressure about their physical appearance.

"There was a time I didnt want to go out of the house. I didnt want to wear a wig either," says Smriti Tuteja, a content writer in India who lives with alopecia. "Especially with women, when people want you to adhere to a certain standard, you assess your worth with that lens and end up being unkind to yourself," she says.

Hair loss doesnt have to derail your dating life in fact, it can be an opportunity to fully embrace every part of yourself and approach the scene with more confidence. Consider these tips:

If your hair loss bothers you or you want to camoflague it for whatever reason, you can talk to a hair loss specialist, such as a dermatologist, about options. "For some, that could include medical treatment or involve a wig, toupee, or new hairstyle, but for others both men and women it could also mean embracing a new image," says Francis.

If youre interested in exploring surgical options like a hair transplant, Williams recommends visiting the American Board of Hair Restoration Surgeons to find a qualified surgeon.

Above all, remember that youre not alone. "Hair loss affects millions of men and women, and there are countless support groups and professional organizations that advocate, research and support those who have alopecia," says Francis. These include the American Academy of Dermatology and the National Alopecia Areata Foundation.

Your hair loss is unique to you, and so is the way you want to handle it. But keep in mind that hair loss is only one aspect of who you are.

"Just because you've lost your hair doesn't mean you've lost who you are," says Gibson. "No one can duplicate your sensuality and sexuality that comes from within."

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4 Real-Life Dating Tips for People Living with Alopecia - Everyday Health