Why menopause care is still a challenge in Washington state

Menopause is something every woman goes through, but doctors — even OB-GYNs — aren't required to learn much about it.
Why it matters: Millions of women don't get the care they need — and some are getting misinformation at the doctor's office.
Catch up quick: In 2002, research from the Women's Health Initiative found hormone therapy increased a woman's risk of heart disease and breast cancer, upending conventional medical recommendations about the treatment.
But in recent years, the research was put into context: The risks weren't as great as originally thought and the data was weighted toward women 60 and older. The average age of a menopausal woman is 51.
Since then, researchers and health professionals have tried to correct the messaging, noting the benefits of hormone therapy for treating hot flashes and preventing bone loss.
What they're saying: "It's such an uphill battle to not just teach people about it, but to undo all the damage of the last 20-plus years," Deborah Gomez Kwolek of the Mass General Women's Health and Sex and Gender Medicine Program tells Axios.
Stunning stat: Only about 7% of OB-GYN residents reported feeling adequately prepared to manage menopause, according to a 2019 survey published in Mayo Clinic Proceedings.
More than one in five OB-GYN residents (about 20%) reported receiving no menopause lectures during residency.
Symptoms vary widely. Perimenopause, the phase leading up to menopause, can begin six to 10 years earlier and trigger all sorts of hormonal chaos. Menopause is officially marked after a woman has gone one year without a period.
Seattle-based physician Nora Lansen, the chief medical officer for Elektra Health, has a message for perimenopausal patients: "You're not crazy."
"There are so many different symptoms and they manifest in different ways and at different times of life. So it could be: 'I can't remember my kid's teacher's name' this year but then, two years from now, it's, 'My libido's tanking.'"
Zoom in: One way health professionals can signal they've undergone additional menopause training is by passing a certification exam offered by The Menopause Society.
In Washington, about 100 have this credential.
The bottom line: "Women don't have to suffer," says Stephanie Faubion, The Menopause Society's medical director — but they have to find a physician who knows enough to help.

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Los Angeles Times

12-06-2025

• Los Angeles Times

Why REM Sleep Behavior Disorder Is a Warning Sign for Parkinson's and Other Brain Diseases

REM Sleep Behavior Disorder (RBD) might sound like something out of a sleepwalker's nightmare, but it's a very real—and increasingly important—sleep disorder. RBD occurs when the normal muscle paralysis, known as muscle atonia, during REM (rapid eye movement) sleep disappears, allowing individuals to physically act out their dreams during dream sleep. REM sleep is one of several sleep stages, also referred to as paradoxical sleep or active sleep, and is characterized by rapid eye movements and vivid dreaming. This loss of muscle atonia can involve anything from flailing limbs to more aggressive or even violent behaviors, potentially resulting in injury to the sleeper or their bed partner. Once seen as a rare curiosity, RBD is now recognized as both a disruptive parasomnia and a warning sign of more serious neurological conditions—especially neurodegenerative disorders known as synucleinopathies, such as Parkinson's disease, Lewy body dementia, and multiple system atrophy (MSA). This dual significance places RBD at a unique crossroads between sleep medicine and neurology. Pinpointing RBD isn't just about noticing odd behavior at night. While many patients (or more often, their partners) report vivid, sometimes violent dream enactment, true diagnosis requires polysomnography—an overnight sleep study that records brain activity, muscle tone, and eye movements. RBD diagnosis relies on identifying abnormal behaviors during the REM stage of the sleep cycle. Specifically, clinicians look at the REM stage as a specific sleep stage for the presence or absence of muscle atonia—REM sleep without atonia indicates a loss of the muscle paralysis that should naturally occur during this phase. According to a 2017 review in Mayo Clinic Proceedings [1], this diagnostic confirmation is vital—not just to guide treatment, but also to identify those at heightened risk for developing a neurodegenerative disorder. And that risk is real. A 2025 study titled The Many Faces of REM Sleep Behavior Disorder [4] found that individuals with idiopathic RBD (i.e., RBD not linked to medications or other causes) have a significant chance of developing Parkinson's or DLB within a decade. This makes RBD one of the most robust prodromal biomarkers in neurology today. First and foremost, in managing RBD, we need to keep patients and partners safe. That often means adapting the sleep environment—removing sharp objects, padding furniture, or even sleeping separately if necessary. RBD often coexists with other sleep disorders which can complicate management and require a comprehensive approach. But pharmacological treatment can also be very effective. Two drugs are front runners: The 2025 International RBD Study Group consensus [2] also explores new territory, finding potential benefit from cholinesterase inhibitors like rivastigmine and dopamine agonists such as pramipexole. However, these are still under investigation and treatment must be individualized based on symptom severity, age and co-existing conditions. Good sleep hygiene and lifestyle modifications are also important. Avoiding sleep deprivation and ensuring a sufficient sleep period helps promote enough sleep and enough REM sleep which are critical for overall health and RBD management. Perhaps the most exciting—and urgent—aspect of RBD is its predictive value. Multiple studies show RBD isn't just a symptom; it may be an early sign that the brain is already undergoing neurodegenerative changes long before other signs appear. REM sleep plays a crucial role in brain development and maintaining the brain's ability to process information and regulate emotions, making its disruption particularly important in the context of RBD. Advanced neuroimaging and cerebrospinal fluid biomarkers have shown early pathology in many patients with idiopathic RBD. This aligns with broader research on alpha-synuclein accumulation in the brain—key in Parkinson's and DLB development [5]. A 2020 review in Frontiers in Neurology [3] reminds us we need to watch for neurologic signs. Ongoing brain research and sleep research will continue to uncover why REM sleep is important for early detection of neurodegenerative changes. That means screening not only for motor symptoms but for early cognitive changes—because acting out dreams today could mean dementia tomorrow. New studies are looking at what might contribute to or worsen RBD risk and severity. These are early days but here are some findings: A full night's sleep typically has four or five cycles of alternating REM and NREM sleep (also called non REM sleep). Each sleep cycle has light sleep, deep sleep and REM (also called paradoxical sleep or desynchronized sleep). During the deep sleep stage of NREM, breathing slows, blood pressure drops and the immune system is boosted. REM sleep (also called active sleep, dream sleep or rapid eye movement REM) is characterized by rapid eye movements, vivid dreaming and variable brain waves. Most people experience REM sleep several times a night. Sleep cycles repeat throughout the night and after each cycle a new sleep cycle begins. Adults need seven to nine hours of sleep to complete enough cycles for optimal health. Sleep deprivation or a shortened sleep period can reduce enough REM sleep and deep sleep leading to negative health sleep apnea and other sleep disorders can disrupt sleep architecture reducing sleep time and quality of both REM and NREM sleep. Daytime naps can supplement nighttime sleep and help those who haven't slept enough at night. Sleep medicine reviews and sleep research have shown the importance of maintaining healthy sleep cycles for the brain to function and overall well-being. These findings support a holistic approach to RBD care—one that considers sleep hygiene, lifestyle and even dietary factors as part of the treatment. REM Sleep Behavior Disorder is no longer just a sleep curiosity—it's a diagnostic warning sign that may sound years before neurodegenerative disease sets in. While traditional treatments like clonazepam and melatonin work for symptom control, newer research points to the possibility of disease interception. As we learn more about sleep, neurobiology and behavior, RBD may become a key entry point for early intervention in Parkinson's, DLB and related conditions. The future of sleep medicine will shape the future of neurology—and for those with RBD that's good news. [1] St Louis, E. K., & Boeve, B. F. (2017). REM Sleep Behavior Disorder: Diagnosis, Clinical Implications, and Future Directions. Mayo Clinic proceedings, 92(11), 1723–1736. [2] During, E. H., Malkani, R., Arnulf, I., Kunz, D., Bes, F., De Cock, V. C., Ratti, P. L., Stefani, A., Schiess, M. C., Provini, F., Schenck, C. H., & Videnovic, A. (2025). Symptomatic treatment of REM sleep behavior disorder (RBD): A consensus from the international RBD study group - Treatment and trials working group. Sleep medicine, 132, 106554. [3] Roguski, A., Rayment, D., Whone, A. L., Jones, M. W., & Rolinski, M. (2020). A Neurologist's Guide to REM Sleep Behavior Disorder. Frontiers in neurology, 11, 610. [4] Arnaldi, D., Mattioli, P., Orso, B., Massa, F., Pardini, M., Morbelli, S., Nobili, F., Figorilli, M., Casaglia, E., Mulas, M., Terzaghi, M., Capriglia, E., Malomo, G., Solbiati, M., Antelmi, E., Pizza, F., Biscarini, F., Puligheddu, M., & Plazzi, G. (2025). The Many Faces of REM Sleep Behavior Disorder. Providing Evidence for a New Lexicon. European journal of neurology, 32(4), e70169. [5] Hu M. T. (2020). REM sleep behavior disorder (RBD). Neurobiology of disease, 143, 104996. [6] Coelho, J., Samalin, L., Yrondi, A., Iftimovici, A., Philip, P., & Micoulaud-Franchi, J. A. (2025). La santé du sommeil comme marqueur et cible d'intervention dans les troubles psychiatriques [Sleep health as a marker and target for health interventions in psychiatric disorders]. Medicine sciences : M/S, 41(5), 477–489. [7] Wang, P., Chen, X., Na, M., Flores-Torres, M. H., Bjornevik, K., Zhang, X., Chen, X., Khandpur, N., Rossato, S. L., Zhang, F. F., Ascherio, A., & Gao, X. (2025). Long-Term Consumption of Ultraprocessed Foods and Prodromal Features of Parkinson Disease. Neurology, 104(11), e213562. [8] Mondino, A., Jadidian, A., Toth, B. A., Hambrecht-Wiedbusch, V. S., Floran-Garduno, L., Li, D., York, A. K., Torterolo, P., Pal, D., Burgess, C. R., Mashour, G. A., & Vanini, G. (2025). Regulation of REM and NREM Sleep by Preoptic Glutamatergic Neurons. Sleep, zsaf141. Advance online publication.

Medscape

11-06-2025

• Medscape

Supplements Boost Postmenopausal Serum Biomarkers

Postmenopausal women who took vitamin B 12 , fish oil, or flaxseed oil as dietary supplements had significantly higher levels of accompanying serum biomarkers than those who did not use these supplements, based on new data presented at American Society for Nutrition (ASN) 2025 Annual Meeting. Dietary supplement use in the US is common among older adults, but data on the health effects of dietary supplements remain relatively mixed, said presenting author Hannah T. Baillie, MS, RD, in an interview. Hannah T. Baillie, MS, RD 'One way to measure whether or not supplements could be getting to the intended targets in the body is to measure the amount of the supplement's nutrients in the blood. This could inform whether the supplements have their intended health effects in an objective manner,' said Baillie, a PhD student at the University of Washington, Seattle. To examine the associations between dietary supplements and higher serum concentrations of corresponding biomarkers, Baillie and colleagues enrolled 153 participants in the Women's Health Initiative in a 2-week controlled feeding study. The participants consumed an individualized menu, including a habitual diet, and continued use of their usual dietary supplements. After 2 weeks, the researchers measured serum vitamin B 12 , lutein plus zeaxanthin, and phospholipid fatty acids. In a multiple linear regression analysis, the geometric mean serum concentration of vitamin B 12 was 58% higher among women who used any type of vitamin B 12 dietary supplement than among nonusers ( P < .001). In addition, the geometric mean serum concentrations of phospholipid docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) ranged from 38% to 46% higher among users of fish oil or flaxseed oil supplements than among nonusers ( P < .0001). Use of dietary supplements containing lutein plus zeaxanthin had no significant impact on serum concentrations ( P = .72). However, individuals who used two sources of a dietary supplement containing vitamin B 12 as well as two different sources of supplementation with lutein plus zeaxanthin had significantly higher serum biomarker levels than either individuals who took a single multivitamin containing B 12 and lutein plus zeaxanthin or individuals who took neither ( P < .0001 for both). 'I was surprised by how many different supplements participants were taking; I expected it to be high, but one participant was taking 18 supplements per day,' Baillie told Medscape Medical News . 'I was also surprised by the lack of association between use of lutein + zeaxanthin-containing supplements and serum lutein + zeaxanthin concentrations,' she said. The negligible increases in serum concentrations with supplement use point to potential issues with absorbing or utilizing these nutrients from supplemental sources, she noted. The study findings highlight the need for clinicians to ask patients not only about the use of dietary supplements but also about the dose of those supplements, said Baillie. The researchers also looked at serum concentrations in response to different doses of vitamin B 12 . 'We looked to see if those taking individual vitamin B 12 , just a multivitamin containing B 12 , both those supplements, or neither had different serum concentrations of vitamin B 12 ,' Baillie said. The researchers found that individuals taking > 1000 mcg in a supplement (an average amount in single B 12 supplements) did not have significantly higher serum concentrations than those taking both supplements (which would represent a larger dose). The unreliable and inadequate labeling of nutrient content on dietary supplement packaging was a main study limitation, Baillie told Medscape Medical News . 'Although the contents from labels of each dietary supplement were recorded into our database, prior research has shown there may be discrepancies in what is reported on labels and what each supplement contains,' she said. 'Additionally, labels are not consistent in how nutrient information is reported; for example, for fish oil supplements, omega-3 fatty acids are sometimes displayed as total omega-3 fatty acids, sometimes as EPA and DHA, and on other labels as total EPA + DHA,' Baillie said. This discrepancy makes consistent assessment of total nutrient intake a challenge and limits what conclusions that can be drawn from the data, she noted. Raising Awareness, Examining Intake 'Additional research investigating best practices for assessing nutrient intake from dietary supplements is needed, and this may require changes in the requirements around dietary supplement labeling,' Baillie told Medscape Medical News . Future research also should address assessing serum response among a more heterogeneous population, she added. Older women often take supplements without knowing their full effect, and the current study is important to help alert clinicians to ask patients about type, timing, and dose, said Christine M. Sager, MD, an assistant professor in the Department of Obstetrics and Gynecology at East Tennessee State University, Johnson City, Tennessee, in an interview. The findings were not unexpected, said Sager, who was not involved in the study. 'In clinical practice, we see similar elevations in B 12 when patients are taking B vitamins,' she said. The current study is too short and too small to make global recommendations on supplement intake, but the results suggest that the type, dose, and time of day matter for many supplements, just as with medications, although research on this topic is limited, Sager said. 'Also, serum levels do not always correlate with goals of therapy,' she noted. Looking ahead, the safety and efficacy of intravenous vitamins and supplements is an important question for additional research, Sager added.

Yahoo

10-06-2025

• Yahoo

Could This Diet Help With Your Hot Flashes?

Hot flashes, night sweats and unexpected weight gain—for many women navigating menopause, these symptoms are more than just uncomfortable. They can be disruptive, frustrating and isolating. While hormone replacement therapy (HRT) and other medications are a go-to for some, new research suggests a powerful alternative: a vegan diet. And notably, it works even when processed foods are still on the plate. In a recent study conducted by The Menopause Society and published in the journal Menopause, experts researched how plant-based eating can benefit women in midlife. 'This study highlights the potential positive effects of a plant-based diet rich in soy, regardless of the level of processing, in terms of both hot flash and weight management,' Dr. Stephanie Faubion, medical director for the Menopause Society, said in a statement. More from Flow Space The Surprising Risk Factor for Alzheimer's All Menopausal Women Need to Know Ahead, learn more about how a vegan diet can help manage menopause symptoms and improve your overall health. According to Lisa Schultz, a certified nutritionist, personal trainer and weight loss expert, a vegan diet can support menopausal symptoms like hot flashes and weight gain. Vegan diets are effective because they exclude heavily saturated fats like red and processed meats, deli meats and dairy, which are known contributors to inflammation and are high in calories. Schultz explains that highly inflammatory foods can add to menopause symptoms. 'With that said, the quality of the diet definitely matters,' she adds. 'While even a processed vegan diet may offer some relief due to the absence of animal fats and the inclusion of soy, whole food-based vegan diets are more effective for symptom management and overall health.' Participants in the study were challenged to follow either a vegan diet supplemented with soybeans or an omnivorous diet, and both groups found success in mitigating hot flashes. Should soybeans be a topic of conversation when discussing options for soothing midlife symptoms? 'Soy deserves a redemption arc in the menopause conversation,' says Yaa Boakye, a registered dietitian nutritionist (RDN), personal trainer, nutrition consultant and body data practitioner. 'Despite years of unfounded fears, current research shows that traditional soy foods—think tempeh, tofu, edamame and miso—can be powerful allies during menopause.' Boakye also explains that isoflavones in soy (specifically genistein and daidzein) act as selective estrogen receptor modulators (SERMs). This means they can provide estrogenic effects where beneficial (such as reducing hot flashes) while blocking more potent estrogens where protective, like in breast tissue. But there is a crucial distinction when deciding what version of soy to implement into your diet: Whole soy foods versus isolated soy proteins and ultra-processed soy products. Traditional fermented soy (tempeh, miso, natto) offers enhanced bioavailability—your body can actually use more of the beneficial compounds. While 'soy protein isolates in bars and shakes lack the full spectrum of nutrients and may not provide the same benefits,' Boakye says. Schultz also argues that soy is incredibly beneficial for those experiencing menopause symptoms since it provides a source of protein, calcium and isoflavones without the added sugars, oils or preservatives. But it's not just the vegan aspect of the diet that makes it effective; it's that it's nutrient-dense and balanced. 'When combined with vegetables, legumes, whole grains, and starches, it's a well rounded diet,' Shultz explains. 'Just like with everything, nothing should be overdone.' Start by adding one to two whole soy foods per day in place of processed meats like deli meat, bacon or sausage. From there, increase intake of fiber-rich vegetables, legumes and whole grains. According to Schultz, you should build meals with protein, complex carbs and some healthy fats. 'Gradually reduce highly processed vegan items and read labels carefully to prevent adding high sodium, oily condiments and processed snack foods,' she continues. 'A well-planned, plant-based diet during menopause is like hiring a multitasking assistant —it addresses multiple concerns simultaneously,' Boakye says. 'Plant-based diets can help reduce heart disease risk.' Plant compounds can improve also sleep architecture. 'Tryptophan from seeds and nuts are a precursor to the sleep hormone melatonin,' Boakye shares. Additionally, she notes that prebiotic fibers feed beneficial bacteria, which produce mood-regulating neurotransmitters, such as serotonin (which is 90% produced in the gut). 'B-vitamins from whole grains support cognitive function, especially B6, B12 and folate,' she adds. And stable blood sugar from complex carbs helps emotional regulation. Always work with a healthcare provider familiar with plant-based nutrition during menopause—ideally, a team including your doctor, a registered dietitian and possibly a menopause specialist. 'They can help you navigate potential drug-nutrient interactions, ensure you're meeting all nutritional needs and adjust recommendations based on your individual health markers,' Boakye notes.