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From Women's Health Foundation

Although vaginal dryness can happen at any age, it is common during or after menopause. Vaginal walls are coated with a thin layer of moisture. As estrogen levels decline during menopause, the amount of moisture drops and its consistency changes. As a result, the vaginal walls become thinner and inflamed.

Common symptoms of vaginal dryness include:

    • Itchiness, burning, discomfort, and soreness around vaginal walls
    • Frequent and urgent urination
    • Light bleeding or pain during intercourse
    • Slight vaginal discharge
    • Recurrent urinary tract infections
Influences/Causes
        The main cause of vaginal dryness is a decreased level of estrogen. The following conditions contribute to reduced estrogen levels:
        • Menopause
        • Childbirth
        • Breast-feeding
        • Cigarette smoking
        • Radiation and hormone treatment around pelvic areas
        • Chemotherapy
        • Anti-estrogen medications, such as those used to treat breast cancer

 

      The vagina can be further inflamed or irritated due to:
      • Immune disorders
      • Douching
      • Certain tampons and condoms
Treatments/Remedies
      To minimize vaginal dryness, avoid douching, lotions, perfumes and scented soaps, and try one or more of these strategies:
      • Vaginal moisturizing creams, usually available without a prescription
      • Water-soluble vaginal lubricants (for use during sex)
      • Prescription estrogen, available as a ring, tablet, or cream

 

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Vaginal dryness can happen at any age but is common during or after menopause as estrogen levels decline. Learn more about its symptoms and causes and what you can do to minimize it.

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Vaginal dryness can happen at any age but is common during or after menopause as estrogen levels decline. Learn more about its symptoms and causes and what you can do to minimize it.

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By Jenni Grover

But It's Not "All in Your Head"

If you live with chronic pain you've probably been told "you just need to relax" or "you should stop focusing on the pain" or even "it's all in your head."

Phrases (and attitudes) like that can contribute to feelings of resentment and frustration, and for good reason: Countless generations of women have experienced unnecessary suffering because their symptoms were wrongly attributed to their emotions—or simply dismissed.

But there is a treatment method that focuses on our minds and provides relief from chronic pain: cognitive behavioral therapy (CBT). Chronic pain is a real physical condition, but the reality is that sometimes, health care providers can't relieve the pain medically. That's when CBT can play a significant role.

"The cognitive part is the mental part, or the emotional part, of how we perceive what's going on," explains Robert Jamison, PhD, chief psychologist at Brigham and Women's Hospital Pain Management Center in Chestnut Hill, Mass., and professor, Harvard Medical School. Jamison says many patients fall into a vicious cycle of focusing on the pain and guarding and bracing in a way that, over time, can increase pain.

In CBT, therapists help patients identify negative thoughts, adjust them as much possible, and take meaningful action. Jamison says, "the focus is, how do you help change the cognitive or the thinking part, and also how do you help make an adaptive change in terms of behavioral response to pain?"

Sara Dittoe Barrett, PhD is a health psychologist in private practice in Chicago, focusing on patients with chronic pain, insomnia, anxiety disorders and obsessive-compulsive disorder.

"The pain is real and the suffering is real," she says. "My goal, whether it's physical pain or emotional pain, is to help people figure out ways to suffer less. It's less often about changing the content of [a patient's] thoughts, and more changing how the thoughts influence them and influence their behavior."

Jamison says patients who get caught in a vicious cycle can end up catastrophizing—focusing on all the possible negative outcomes. "These recurrent worried thoughts can actually heighten things and make it worse and can contribute to a stress response," he says. His treatment approach includes finding ways to intervene and teach patients how to identify when they're having those thoughts so they can break the cycle.

Compassion practice

Barrett's practice includes mindfulness-based techniques that help patients identify when they're stuck in negative emotions. And she focuses on compassion. There are two layers of suffering, she explains: One layer is the pain itself, and "the second layer of suffering can be from either not wanting what's happening to us...or fighting against physical or emotional or psychological pain."

When patients struggle, their pain is magnified. Catastrophic thinking, self-blame, or self-criticism can keep patients from making positive changes to their approach. But when they learn how to slow down, to bring some acceptance to their experience, they can begin to make meaningful change, says Barrett. And when patients are kinder to themselves during this difficult process, they build a self-compassion practice that soothes their spirits.

Relaxation strategies can help people with chronic pain stop their stress response, reduce tension, and calm their nervous system. Pacing strategies teach patients how to approach tasks in new ways that cause less pain. Creative problem-solving techniques help patients develop workarounds and fresh methods of achieving their goals. These are all components of CBT.

Jamison adds that technology can help, too; he and his team developed Master My Pain, an app for patients at his clinic (and some other institutions) that helps them track symptoms and create line graphs and charts to share with health care providers. He says any patient can benefit from tracking their experience and sharing it with their health care team. This is especially helpful when patients have to wait weeks or months in between appointments but want providers to see the big picture, he says: "It's a little bit more objective in terms of what's happening, since our memories sometimes get blurred a lot by how we're feeling at the moment."

Jamison says patients need to feel entitled and empowered to be active participants in their care. "Sometimes, what individuals do about their pain can be as important as what the doctors do," he says.

Ready to take action?

The American Pain Society offers educational resources about chronic pain, as well as a directory of award-winning pain treatment centers. The American Chronic Pain Association's website is packed with information about CBT and other treatment options. The 4-Week Insomnia Workbook: A Drug-Free Program to Build Healthy Habits and Achieve Restful Sleep by Sara Dittoe Barrett, PhD, offers a resource on a common comorbid condition with chronic pain. And Learning to Master Your Chronic Pain by Robert Jamison, PhD makes a great addition to your chronic pain resource library.

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By Vivian Manning-Schaffel

You can't watch a pharmaceutical ad without hearing a laundry list of potential side effects—sometimes the kind that can make the hair on the back of your neck stand up. It can be daunting to hear "may cause heart problems, liver cancer and death," just as you're about to fill a prescription for that very same medication.

Those side-effect warnings may be daunting but are completely necessary. "Direct-to-consumer" pharmaceutical ads are a relatively recent development. According to the U.S. Food and Drug Administration (FDA) website, direct-to-consumer advertising began in earnest around the mid-1980s. Before that, detailed information about pharmaceuticals were given to health care professionals who prescribe medications and pharmacists to share with their patients or customers.

Today, pharmaceutical advertising is a multibillion-dollar industry. According to a JAMA Network article, from 1997 through 2016, medical marketing spend skyrocketed to $29.9 billion from $17.7 billion, with direct-to-consumer advertising for prescription drugs and health services leading the growth. That's a lot of money.

To keep consumers aware of potential side effects, the FDA requires direct-to-consumer ads placed by pharmaceutical companies to include a summary of every risk in the product's labeling for three types of regulated advertising:

  • Product Claim Ads
    These ads name the drug they are marketing and are required by the FDA to call out both potential benefits and risks "in a balanced fashion." They are also required to be truthful and easy for consumers to understand.
  • Reminder Ads
    You know those ads that show you how much easier life can be thanks to such-and-such a medication? Reminder ads name the drug they are promoting but not the condition you might take it for. That's why these ads can't be used to promote meds with potentially serious side effects.
  • Help-Seeking Ads
    Focused on a specific health issue or condition, these ads are the reverse of reminder ads in that they shy away from naming a specific medication, though the ad is likely created for and paid for by a pharmaceutical company. According to the FDA, common conditions often seen in these kinds of ads are allergies, asthma and erectile dysfunction.

What should you do if you've been prescribed a medication and are alarmed by the ad warnings?

Selena E. Ortiz, PhD, MPH, assistant professor, Health Policy and Administration & Demography at the College of Health and Human Development, and faculty affiliate, The School of Public Policy at Pennsylvania State University, says your first move is to call your doctor as soon as you can: "I would suggest that patients, without hesitation, should immediately contact their physician to discuss their concerns."

Ideally, your primary care professional should be the one you turn to in any situation where you have questions involving your health, which includes concerns about any medications you are taking as well as questions raised by advertising.

Hair-raising ads aside, what if you learn your medication was recalled? Your first move should be to take it back to the pharmacy to confirm whether your batch is affected by the recall, says Allison Dering-Anderson, PharmD, RP, clinical associate professor at the Department of Pharmacy Practice and Science at the University of Nebraska Medical Center. "Customer-level recalls are actually very rare, but when a prescription drug is recalled, the company will tell pharmacies and patients what to do. Most often, the pharmacy is the place where recalled drugs are collected," she explains.

"If you haven't been notified of a recall directly, you may call the dispensing pharmacy and ask what to do," says Dering-Anderson. "The dispensing pharmacy is the only place that can identify the lot number you received."

Until told otherwise by your primary care professional, keep taking your meds. If you abruptly stop your medication you could put your health at risk for serious side effects—medication-related or otherwise.

And if you hear about a medication recall but aren't sure if your meds are affected, check the FDA Enforcement Report, a weekly post from the FDA of all recalled medications.

The sooner you know, the sooner you can take your next step to keep your meds safe and effective for your health.

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If you ever witnessed a loved one fall or faint from low blood pressure, you know how frightening and potentially dangerous a fall can be. But do you know why a loved one faints or falls?

The problem I have seen so many times is that no one gets to the bottom of why the fall or faint happened. That's where you come in. There is a lot you can do to discover the cause of the fall and help a loved one reduce their risk of having another serious fall or fainting episode.

Although many factors can lead to low blood pressure in the elderly, overly ambitious treatment of high blood pressure is a frequent cause.

For years, a blood pressure reading of 140/90 was the magic number. If your blood pressure was higher, you had high blood pressure. If it was lower, you didn't have high blood pressure. It was as simple as that. Or was it? 

We now know there is no single right blood pressure reading. The closer truth when asked about what is considered high blood pressure is that it depends. It depends on you. There is generally agreement that the lower the blood pressure, the lower the risk for heart and kidney disease, stroke and other complications. But how low and what is the risk for lowering too much? There are always tradeoffs.

Who to treat for high blood pressure and at what blood pressure reading and how low to get the blood pressure are all a matter of who you are. Let's start with older adults in general. Since it is estimated that half the adult population has high blood pressure and that high blood pressure gets higher as we age, I am talking about most seniors when I discuss treating high blood pressure.

My focus is on both the lack of treatment and the over-treatment of seniors, especially the frail elderly.

You can't talk about treating high blood pressure without knowing more about the recommended guidelines and the studies on which they were based. There have been two major research studies published in the past few years on treating high blood pressure, ACCORD and SPRINT.

The ACCORD study looked at the aggressive treatment of high blood pressure and high blood sugar in people with diabetes over the age of 50. Aggressive treatment meant lowering the blood pressure to under 120 systolic (the top number).

To the surprise of many at the National Institutes of Health, the ACCORD study showed that intensive treatment of both blood sugar and blood pressure did not reduce the number of serious events such as heart attack or death from heart disease. Plus—no surprise—patients who received more intensive treatment had more problems from the lower blood pressure including light-headedness and serious falls.

More recently, the SPRINT study looked at over 9,000 people ages 50 and over without diabetes but who had high blood pressure and at least one other risk factor for heart disease. The results were considered so significant that the trial was stopped early. The researchers concluded that lowering blood pressure to below 120/80 reduced the risk of heart disease (primarily heart failure) and death from heart disease. It did not lower the risk of stroke or heart attack. As you may predict, the intense blood pressure treatment group had many more side effects, including low blood pressure, fainting and blood electrolyte abnormalities.

The American Heart Association (AHA) and the American College of Cardiology (ACC) jointly released new blood pressure guidelines as a result of these findings.

The newest guidelines for blood pressure recommend treating to 130/80 or lower for everyone.

But common sense and a closer look at the study findings tell a different picture. The media, after the SPRINT trial findings were published, failed to pay attention to the potential harm from treating high blood pressure to below 120/80. To emphasize the worrisome findings: People treated to the lower blood pressure of 120/80 had more serious drops in blood pressure, fainting episodes and even kidney injury.

The media also failed to mention the ties to pharmaceutical companies many of the experts at the AHA and ACC had.

It is also noteworthy that the American Academy of Family Practitioners (AAFP ), the American College of Physicians (ACP) and other expert groups failed to endorse the new guidelines and recommended a more common-sense, less rigid approach.

At the end of 2018, JAMA published a lengthy comment article highlighting the hype of the positive findings and the neglect of the potential harm and industry ties.

In my experience as a former ABC Medical contributor, I found that press releases emphasized the positive findings, but the fine print of the research findings was rarely shared or emphasized.

It makes sense that patients may not be experts or have access to a journal article to critique and evaluate findings. Although most physicians are busy in their practices and have little time to thoroughly review the medical literature, they should be trained to be cautious of new studies hyping big positive results with no discussion of the tradeoffs. 

I remember as a general medicine fellow years ago teaching residents how to critically review the medical literature. When reading the results of a research study, important questions to ask are: Does this apply to my patients? Did the study test patients who had circumstances similar to my patients? Were they older or on multiple medications with many different conditions? Did they follow the healthy lifestyle also recommended?

The recent JAMA article emphasized how important it is for practitioners to critically review the medical literature to form their own opinions about evidence-based guidelines and recommendations before adopting them for their patients. 

Back to the common sense and safer approach adopted by the AAFP and the ACP. Both organizations recommend a systolic blood pressure (the higher number) target of 150 mm Hg if you are 60 years of age or older. For patients with very high heart disease risk or a history of stroke or transient ischemic attack they recommend a slightly lower target of 140 mm Hg.

There are many important variables to consider when treating high blood pressure.

First you need to consider the clinical circumstances. This means looking at everything including age, medical conditions such as diabetes and heart or other blood vessel diseases, how frail the patient is, what medications the patient is taking and what symptoms the patient is having. A history of falls and dizziness while standing up after meals or when getting up quickly are important, too.

As we age, our arteries get stiffer, and it is harder for our arteries to adjust to a sudden change in position. For example, when we stand, the blood naturally flows toward our feet. This requires the arteries to constrict or tighten to keep the blood pressure flowing evenly to the brain and prevent us from getting lightheaded.  When arteries get stiff as we age, we can't accommodate to the changed position as quickly or easily. Our blood pressure may briefly drop causing us to get light-headed or dizzy and even pass out. This lowering of blood pressure when standing up quickly is called an orthostatic change in the blood pressure.

Have you ever checked a loved one's blood pressure in the lying, sitting and standing positions? This may be important if your loved one complains of dizziness or is at risk of falling. It is routine for health care professionals to check changes in blood pressure with changes in position when patients complain of falls or dizziness when standing up or after meals.

Do you know if your loved one's blood pressure has been checked in all three positions? Was it much lower after they stood up? In the elderly, blood pressure may also drop after a large meal

Blood pressure in the elderly can also be lower after a drink or two. Parents are not always keen to have their adult children suggest they limit their usual routine of a drink at dinner, but it is important to let them know the risk and your fears. 

Getting up slowly is always a good idea for the elderly, and especially after a meal, when drinking alcohol or at night when getting up quickly to use the bathroom.

Many medicines can cause episodes of low blood pressure, too. It is important for you to review every medicine your loved one takes and understand all you can about the medicine and its effects. Talk with your love one's health care professional about the medicines.

Common medications includes antihistamines, sleeping pills, tranquilizers and antidepressants. An online search will lead you to many reliable sources from trusted health care institutions including the NIH and National Library of Congress. A popular and easy-to-use website to review medications is www.drugs.com.

The story of my friend who kept fainting

Let me share with you the story of a 72-year-old friend I will call Mr. G. During dinner together a few weeks ago, Mr. G told my physician husband and me that he had a few unexplained falls recently. He felt lucky he wasn't hurt seriously. We both were worried and began to ask him questions. 

Mr. G is generally in good health but does take medication for high blood pressure. He sees a cardiologist who manages his blood pressure, although he has had no known heart disease. His cardiologist advised him that the lower his blood pressure, the better. (Remember, his cardiologist was likely following the stricter guidelines suggesting a target blood pressure of  120 to 130 rather than the 150 or lower followed by the AAFP and ACP.)

Mr. G did his own online search and read the media reports about lowering blood pressure to 120 systolic, even at his age. He didn't read the fine print and ignored or didn't notice the articles that suggested more risks when the blood pressure was lowered too much at his age. 

When we asked him about his medications and blood pressure readings, he proudly reported that his blood pressure was usually very low, in the 110 to 120 systolic range. He has a reliable home blood pressure cuff made by Omron, a popular and usually fairly accurate digital home machine. Home monitoring of blood pressure is important. A blood pressure monitor would be a great gift for a loved one who is on medicine for high blood pressure. 

We told him we thought his falls could be related to his low blood pressure.  We also told him that when he got up after a meal or at night, his blood pressure may even be lower, leading to the unexplained falls.

We suggested he talk to his doctor about lowering the dose of his blood pressure medications to get his resting blood pressure a little higher and avoid the potential orthostatic change.

There are two cardinal things to check after an unexplained fall: the orthostatic blood pressure and a review of all medications.

It turns out Mr. G's cardiologist was not aware of his falls and did not have a comprehensive list of his other medications or his orthostatic blood pressure. In the words of Mr. G, "I have my primary care physician for that."

This makes my case for why a primary care physician or geriatrician must be aware of and play a role in overseeing all of the medications your loved one takes. A primary care physician should serve as the co-captain of the ship. You—the patient or the caregiver—is the other co-captain. In most cases, it is not the specialists who should serve in the co-captain role because they often don't have the complete picture. 

There will never be a hard and fast number to follow when it comes to your blood pressure. Understanding the tradeoffs of treatment is key.

If you are caring for a loved one who has high blood pressure, there is a lot you can do to help lessen the risk of treatment, yet still see the benefit.

Know everything you can about all the medications they take. Which ones treat high blood pressure? Which medications could cause changes in the blood pressure as a side effect or an adverse effect? To help you get started, fill out my helpful daily medications form.

Know what the best and safest blood pressure target is for your loved one's unique circumstances. Is a reading of 160 or lower best? Or a reading of 140 to 130 or lower? Talk with the health care profession who knows the patient best.

Check home blood pressure regularly with a reliable home monitor.  (You can confirm the monitor is reliable at the next doctor visit.) Checking it morning and night is good if you have any symptoms or are starting a new medicine. Checking less often makes sense if you are not having any concerns.

If there are any concerns that the pressure may be too low or the medicines may be too much, check orthostatic blood pressure readings, too (lying, sitting, standing).

Keep a journal of all the medications you take, blood pressure readings and any symptoms you have and show to your health care professional at your next visit.

If you are worried about an aging parent or loved one taking too many medications, I welcome you to join this community of people who are worried about an aging parent or loved one taking too many medications. Together we can share our stories and help a loved one.

Marie Savard, MD, is a trusted voice on women's health, wellness and patient empowerment. She currently writes a blog called Ask Dr. Marie, where this column first appeared. Her blog focuses on the challenges of medication overload in older adults and what caregivers can do to help. Dr. Savard is a former ABC News Medical Contributor and author of four books including her most recent, Ask Dr Marie: What Women Must Know about Hormones, Libido, and the Medical Problems No One Talks About. She lives in Philadelphia with her physician husband and has three grown sons.

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June 10, 2019

As someone who has worked for nearly 30 years to educate researchers, health care providers and consumers about sex differences, I was pleased to be invited to moderate a panel at a meeting convened by AdvaMed on the discrepancies in cardiac care for women. AdvaMed represents the medical device industry. The meeting also served to launch a public education campaign with a unique focus: Improving recruitment and retention of women in cardiovascular device trials. The panel I moderated focused on the lack of women in cardiac device trials and the continued ignorance across the physician community about the number one killer of women: Heart disease.

On the one hand, I am gratified to learn that more women are being included in cardiac device clinical trials and to some extent knowledge has increased about the importance of recognizing sex differences. But, on the other hand, I am dismayed by data still showing a continued need for health care provider education about the unique attributes of heart disease in women, and the ongoing need to encourage women to participate in clinical trials focused on devices and medications

A highlight of the panel was the conversation around recently published research, "Sex Disparities in Cardiovascular Device Evaluations: Strategies for Recruitment and Retention of Female Patients." Dr. Cindy Grines, Chair of Cardiology at Hofstra University, and her colleague, Dr. Alexandra Lansky, Professor of Medicine, Cardiovascular Medicine Section, at Yale University.

Examples of the lack of awareness of the unique features of heart disease in women discussed by the panel included:

  • Heart disease remaining the number one killer of women in the U.S. Surprisingly, only eight percent of primary care doctors, 13 percent of gynecologists, and 17 percent of cardiologists are aware of this fact.

  • Women with heart disease often presenting with "atypical" symptoms," resulting in ineffective, delayed or missed treatment opportunities For example, women are more likely to experience stomach, jaw, neck or back pain; chest fullness or pressure; nausea; or shortness of breath.

Other disruptive factors the panel identified that impede effective heart disease-related treatment, research and clinical trial inclusion for women include:

  • A lack of women physicians who treat heart diseases. Only 4.5 percent of interventional cardiologist are women, for example.

  • Biases in the clinical trials system that exclude women from participating.

  • Underrepresentation of women in clinical trials for devices used to diagnose or treat heart conditions because clinicians are less likely to refer women into clinical trials.

  • Fewer women researchers.

  • Reluctance by women to participate in clinical trials because they are more risk adverse than men.

  • The perception by women that clinical trials will take too much time away from their family commitments.

To counter these disparities, these actions steps were identified:

  • Be Assertive and Proactive
    Women should be assertive when talking to their primary care physicians, emergency department clinicians, and even to specialists, like cardiologists about heart disease and heart attack symptoms. And, since women are less likely to be referred to a clinical trial – which may be an option for receiving both standard of care and extensive follow-up – they need to be assertive in asking their clinicians if that option might be appropriate for them.

  • Design Better Education and Awareness for Clinicians about Women and Heart Disease
    Clinicians – particularly those in primary care and emergency medicine – need to be more aware about the signs and symptoms of heart disease in women. Medical school curriculum must improve its focus on the unique health needs of women and clinicians should extend their learning through continuing education classes and their professional societies throughout their practice lives.

  • Industry and the FDA Needs to Be More Aware and Proactive
    Industry and the FDA have been working on how to increase inclusion of women in clinical trials for several years. Those efforts need to continue and to be applied by the operational ranks that design and approval trials, and to the people who conduct the actual recruitment of people into trials – both within companies and at the level of clinicians seeing patients. That is, industry can support clinicians by educating them about the signs and symptoms of women with heart disease and the importance of recruiting women into clinical trials.

To support all groups improving care for women with heart disease and clinical trial recruitment AdvaMed has incorporated many of these recommendations into a "Women in Cardio" campaign. In addition, AdvaMed, the FDA and others are working to support outreach to educational institutions and clinician organizations to increase awareness. For example, HealthyWomen and other organizations will continue and expand social media campaigns to help educate women about heart disease. Key messages will include ways women can improve self-care, collaboration and communication with their clinicians about heart disease, and the importance of participating in clinical trials.

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Late nights, never-ending emails, back-to-back conference calls, looming deadlines. Your job is stressing you out and it's affecting your wellness.

That's likely no surprise to you, but here's what might be: There are simple things your employer could be doing today to support your mental and physical health. 

But why would they want to?

Ask a human resources leader and she'll tell you that employee burnout is a chief concern of hers, fueled by the always-on culture of work today. Study after study finds that high stress can contribute to everything high absenteeism and increased health insurance rates to low morale and employee loyalty.

Believe me when I say, it's a worry.

Of course, we've all seen those snazzy high-tech offices, complete with onsite gyms, treadmill desks and nap rooms. At Google, you can even earn points toward an at-work massage

But as great as those benefits might be, there are six simple ways your employer can impact your wellness for the better right now. Here's how.

Stop late-night emails. Remember the good ol' days when mail arrived only once? Today, it arrives continuously as email, demanding your attention or at least breaking your concentration. In 2012, Volkswagen made headlines when it shut down it email servers after business hours to certain groups of employees. Since then, other employers have followed with similar email policies, stressing the need for employees to find down time. (If there's an urgent issue, you can always call or text.) Try it yourself by using plug-ins like Boomerang, which allow you to pause your in-box as well as schedule emails to send only during business hours.

Encourage (and track) use of sick days. For those with access to them, telecommuting and flexible work can be a godsend, but can also lead to a decline in sick day usage—as in time you actually take off work to recover from illness. A LinkedIn survey found, for example, that employees took an average of 2.5 sick days in 2018 (and I suspect many of us were still checking emails and texts during that time). By tracking sick day use, employers can see whether employees are actually putting their policies to use. Encourage your team to get the rest they need before they return to the productive work you want.

Lead by example. Earned vacation policies are not enough if your employees don't see their managers taking advantage of them. Indeed, too many Americans leave paid time off on the books, believing we just can't get away. Model the behavior you wish for your employees, whether it's working out, taking a quiet day away or encouraging "walking meetings" that get people moving. If you do it, so will they.

Encourage calendar (and time) management. Here's a simple rule to consider: No more back-to-back meetings. Just because a slot is open on your calendar, doesn't mean it needs to be filled. Stacking meetings one on top of each other means you and your employees have no time to prepare, pivot or produce. Instead, overbooked employees will (rightfully) try to multitask during their meetings, just to keep up with their overpacked schedule. Set fewer meetings and make them count.

Don't bother us on Monday morning. One of my favorite time management tips comes from productivity expert Laura Vanderkam in her book, Off the Clock: Feel Less Busy While Getting More Done. Vanderkam suggests setting aside time at the beginning of the week to work on long-term projects and big ideas rather than waiting until Friday, which tends to become everyone's catch-up day.

Ask about our wellness as well as our deadlines. While wellness should be baked into your company's ongoing employee engagement surveys, here's an even easier way to underscore its importance: Ask how your team is feeling, how they are supporting their wellness today and, even, how the company might serve their health goals. You might be surprised to find that simple changes—say, like starting the workday 30 minutes later to allow time for an exercise class—can go a long way in putting wellness back on someone's to-do list.

Wellness doesn't have to be an all-or-nothing affair. Instead, make it a habit that is easy to keep and your company will reap the benefits of increased productivity, higher morale and better engagement. 

Please join me on our HealthiHer Facebook page to share how you're pulling wellness to work at work—and taking time for yourself to be #BeHealthiHer.

Because, as always, we're stronger together.

Jennifer Owens is senior vice president of digital strategy for HealthyWomen. Previously, she launched Spring.St, served as editorial director of WorkingMother.com and founded the Working Mother Research Institute, where she published more than a dozen studies on the intersection of gender and work and led the Working Mother 100 Best Companies, among other initiatives.

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Everyone is talking about the dangers of the sun. You already know that, but still, you refuse to hide away in a dark house. We can't blame you.

But you need to be wary and informed to be safe.

We're giving you ways to have your sun and enjoy it, too, without the fear of burning yourself.

For when you want the very best sunscreen

Sunscreen, as you know, is a simple way to avoid sunburn, which puts you at an increased risk of melanoma, a potentially fatal skin cancer (not to mention other things like dry or wrinkled skin, dark spots and more). There are so many on the market—how to choose? Consumer Reports just came out with its list of best for summer 2019 and among them are Hawaiian Tropic Sheer Touch (my personal fave!) and LaRoche-Posay (another fave). Want more? Here's Consumer Reports' Sunscreen Buying Guide.

Read about 10 Things You Must Know to Practice Safe Sun.

For when you want to dive in

It's hot, and what better way to cool off than to submerge your steamy body in some cool water? But remember even though the water offers relief, it doesn't offer protection from the damaging rays of the sun. Coolibar offers lots of stylish choices for swimming safe including shirts, capris and turbans so you can look stylish and stay protected from the sun while doing the backstroke.

For when you want to cover your head and frame your face

Hats off, er, on, to the Wallaroo Hat Company for making finding a hat to suit your face easy. Their UPF 50-plus hats are made to block 97 percent of the sun's rays and come in a variety of cool styles and colors to suit any face shape and any occasion. They're even packable so you can tote them along wherever your travels may take you.

For when you want to cover up

When you want to stay outside but you need to put something between you and the sun, slip on one of these cover-ups from Summersalt. The company, founded by females, offers styles to fit any body in recycled materials with no-middleman pricing (read: affordable).

For when you need some shades

Sunglasses, along with sunscreen, are a must, even on cloudy days when UV light can still penetrate. And since conditions like macular degeneration and cataracts have been linked to the sun, you need to protect your eyes with sunglasses like these from Sunski. They're polarized, light, flexible and giving, too—the company donates 1 percent of its annual revenue to environmental nonprofits.

For when you want to protect from the top down

Don't forget about your scalp and hair, which are not immune to sun damage and are often neglected. The sun's rays can be drying to hair and can burn an exposed scalp, too. Coola Organic Scalp & Hair Mist with SPF 30 does more than protect—it also feeds your hair some pretty cool ingredients like monoi oil and kola extract.

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by Mina Samuels

Have you ever been taunted that you "run like a girl"? Even now, telling a girl or woman that she does something "like a girl" (throw, hit, ski, weightlift, kick, ride, drive … you get the picture) is more often insulting than not. I was talking with a radio host recently, who told me that he had been teased for running like a girl when he was young. An insult that haunted him into adulthood.

But here's the thing—running like a girl is empowering! Running like a girl is an everyday experience. Running like a girl happens on the road and off. Running like a girl invites us to engage with the world. Running like a girl means challenging our bodies and minds to be stronger and happier, and accessing our ageless girl-spirit, where the clean-slate optimism of "let's go" meets the seasoned wisdom of "I can."

When I say running, I mean it as a proxy for any active physical engagement you fancy, however you choose to move your body and get your heart pounding. Also, when I say running, I mean it as more than a sport. Sports are just one aspect of how we engage with the world as strong women. We have our work, our communities, our families, and our friends; how we are in each of those bits of the world matters. Wherever we meet the world with lightness of spirit, curiosity, strength and a desire for excellence, we are running like girls.

My particular interest is the transformative impact of sports in women's lives. How our physical strength fortifies our psychological and emotional strength; how we find balance; how sports nourishes our life's purpose; and how being active feeds our ability to change how we exist in the world. Our sports are a mirror and microscope. They are where we can test our strength and determination and try out new ways of being. Sports is where we practice taking care of ourselves, making our health and vitality a priority.

When I talk about sports, it gets personal. I have been remade by my sports (running found me in my late 20s). I have felt the way my strength has supported me on a daily basis and through big changes (moving countries, going from being a lawyer to becoming a writer, then, in my 40s, a playwright). At the same time, I struggle with finding the right balance between the supportive potential of my sports and the oversaturation point past which I'm worn out and get injured.

When we run like a girl, we answer a call to be present for hard work and sweat, and for joy and indulgence. Know that transforming yourself is a process that doesn't end (and that's a good thing!). We are constantly growing and changing, glimpsing new possibility. There will be growing pains (and muscle pains). But I promise, you will feel better about yourself from the moment you sign on for a physically active, stronger future. We are in this journey together. And while change may happen quickly, more often it happens over time, even imperceptibly; until one day we realize we are skimming along, legs flying, shoes barely touching the ground.

MINA SAMUELS is a writer, playwright and performer, and in a previous incarnation, a litigation lawyer and human rights advocate. Her books include, "Run Like A Girl 365 Days: A Practical, Personal, Inspirational Guide for Women Athletes" (Skyhorse Press; June 2019), "Run Like a Girl: How Strong Women Make Happy Lives" (for which she appeared on The Today Show); a novel, The Queen of Cups; and The Think Big Manifesto, co-authored with Michael Port.

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By Tamar Thompson, Chair, HealthyWomen Board of Directors

Marketers know that when it comes to purchasing power, women generally make 80 percent of the decisions for their families. Who hasn't spent an hour or more going down a rabbit hole of product reviews and price comparisons in an attempt to find the "right" product?

Now, think about trying that with health care. It's almost an impossibility.

Too often we lack the information necessary to make the right health care choices for ourselves and our families. In looking for quality and costs savings, many times we are faced with barriers to getting the information we need.

As someone who has spent more than 25 years working in the health care sector, I am very familiar with the administrative burden and challenges of the U.S. health care system.

Even so, my unique experience and knowledge did not prevent me from receiving my own surprise medical bills after having a planned medical procedure. The anesthesiologist who treated me was out of my insurance network and despite the countless number of forms and releases I had to sign on the day of the surgery (prior to receiving anesthesia, of course), no one said, "Oh, by the way, although this hospital is in network and so is your OB/GYN, the anesthesiologist is not, so be prepared to get a bill for an extra $3,000 for his care."

In this case, fortunately for me, I am a certified medical coder and work in health policy. Once I received the bill, I contacted my insurance provider and asked them to waive the out-of-network fees. And after a transfer to the customer service manager and maybe a threat to contact the state insurance department, the charges were removed. And while most people would not have done what I did or have known it was an option, the point is that they shouldn't have to.

That is why at HealthyWomen, we are working to increase awareness of the health care costs burden on women—and to find ways to empower women through knowledge.

Lack of access due to insufficient coverage is one of the most significant factors impacting women's health care burden; however, it is not the only one. Billing practices, out-of-pocket costs and provider network adequacy and availability are all factors that help shape the patient experience for women. I want women to be armed with as much information as possible before making health care choices for themselves and their families.

Education alone will not solve all the challenges in our country's health care system, but it is a crucial place to start.

Three Key Things to Know About the Cost of Care

Always begin with your health insurance provider. Contact your insurance company to learn about your benefits, your deductibles and any limitations of your plan. Your insurance company will send out a manual every year. It can be confusing and complex, but there is information in the manual that you need to know, whether you are the patient or the caregiver.

Ask three important questions. First, find out if the medical issue you are being treated for is covered by your plan. Next, find out what the deductibles, copayments or coinsurance fees are for the medical service or procedure. Also, if the procedure is scheduled during the first quarter of the new year, make sure that your coverage did not change. Remember that each year, health plans offer open enrollment in October. This is the only time of year that you are allowed to change your insurance coverage (unless a life event such as birth, marriage, divorce or death occurs).

Do not be afraid to talk to or challenge your provider. There is a reason that it is called "shared decision making." Yes, your health care professionals understand the services they provide, but only you can understand what you or your family is going through. Don't be afraid to ask questions about why a particular test is recommended, ask for a referral to a specialist or ask if your care plan includes access to innovative treatment options. The best way to ensure that you and your family are receiving the best care possible, is to ask for it!

The Future for HealthyWomen

Accessible, quality medical care and information about how to navigate the system bring us closer to health care equity for women and their families. That's why at HealthyWomen we provide accurate information, education and resources for women's empowerment.

More transparency in health care costs and quality will help women gain access to the knowledge needed to choose to be HealthiHer. Indeed, narrowing the gender equity gap must include equipping women with the knowledge and ability to be effective health care CEOs for themselves and their families.

Because if there's one lesson I've learned in my 25 years in the health care industry, it's that when we bridge the equity gap for women, we all win.

Tamar Thompson has served on the board of directors for HealthyWomen for a decade and as chair of the board since 2017. She is also head of Federal Executive Branch Strategy and State Government Affairs at Bristol-Myers Squibb Company.

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SATURDAY, June 1, 2019 (HealthDay News) -- Adding a newer drug to standard hormone therapy lengthens the lives of younger women with advanced breast cancer, a new trial has found.

READ: Living With Breast Cancer

The drug, called Kisqali (ribociclib), is already approved for treating such patients -- based on earlier results showing it can delay the progression of their cancer.

This is the first evidence it can also extend their lives, said senior researcher Dr. Debu Tripathy, chair of the breast medical oncology department at M.D. Anderson Cancer Center in Houston.

After 3.5 years, 70% of patients given hormone therapy plus Kisqali were still alive. That compared with 46% of those given hormone therapy alone.

That proof of a survival advantage hits "a pretty big milestone," Tripathy said.

And, he added, it argues for giving the drug as a "first-line or second-line" treatment to these patients.

The findings were to be presented Tuesday at the American Society of Clinical Oncology annual meeting, in Chicago, and they will also be published in the New England Journal of Medicine.

Kisqali is one of three newer drugs on the market called CDK4/6 inhibitors; the others are Verzenio (abemaciclib) and Ibrance (palbociclib). They work by blocking two proteins that help cancer cells grow and divide.

Kisqali, taken as a tablet, was originally approved as a first-line treatment for postmenopausal women with advanced breast cancer that is hormone receptor-positive -- which means estrogen fuels the cancer's growth. Most breast cancers fall into that category.

Last year, the U.S. Food and Drug Administration extended that approval to include younger, premenopausal women. That was based on earlier findings from the current trial, which showed Kisqali typically doubled the time that patients remained progression-free -- from one year to two.

The new evidence of longer survival is exciting, said Dr. Larry Norton, medical director of the Lauder Breast Center at Memorial Sloan Kettering Cancer Center, in New York City.

"My expectation is that, when faced with these data, it'll be hard for doctors not to include this in the standard of care," said Norton, who was not involved in the trial.

But, he added, the findings also raise "a lot of interesting questions."

One is whether the other two CDK4/6 inhibitors could have the same benefits. "Is this an effect of the drug, or a drug-class effect?" Norton said.

According to Tripathy, "We don't know the answer to that yet." Tripathy has served as a consultant to Kisqali maker Novartis -- which funded the trial.

"There are some biochemical differences between the drugs," he noted. On the other hand, all three have been shown to roughly double the time patients remain progression-free, Tripathy said.

Norton pointed to another, related question: Once a woman on Kisqali sees her cancer progress, can she benefit from another CDK4/6 drug?

Again, the answer is unknown, Tripathy said. But in the "real world," some doctors will likely try that strategy, he noted.

The latest findings are based on 672 women with advanced breast cancer, aged 25 to 58, who were premenopausal or going through menopause. All had cancer that was hormone receptor-positive, but negative for a protein called HER2 -- a common scenario in breast cancer.

All of the women were given standard hormonal therapy -- an aromatase inhibitor or tamoxifen -- plus a medication that shuts down the ovaries' production of estrogen. Half were randomly assigned to also take Kisqali. The other half took inactive placebo tablets.

Kisqali is taken in cycles of three weeks on the drug and one week off.

Norton said it's "relatively non-toxic," versus chemo.

The possible side effects include fatigue, nausea, diarrhea and constipation, and a drop in certain white blood cells that help fight infections.

A small number of women develop what's called a QT prolongation -- a change in the heart's electrical activity that can trigger an abnormal heart rhythm. Novartis says that as a precaution, Kisqali patients should have their heart activity checked before and during treatment.

There's also a steep cost. CDK4/6 inhibitors run several thousand dollars per treatment cycle. Insurance usually covers treatment, Tripathy said, but some women may have trouble affording the co-payments. The drug companies do have financial assistance programs, he noted.

While the drugs are an advance, there's more work to do, Tripathy said.

"Eventually, these patients progress," he said. "We still need to keep developing new therapies."

SOURCES: Debu Tripathy, M.D., chairman, breast medical oncology department, University of Texas M.D. Anderson Cancer Center, Houston; Larry Norton, M.D., medical director, Evelyn H. Lauder Breast Center, and chair, clinical oncology, Memorial Sloan Kettering Cancer Center, New York City; June 4, 2019, presentation, American Society of Clinical Oncology annual meeting, Chicago; June 4, 2019, New England Journal of Medicine, online

Copyright © 2019 HealthDay. All rights reserved.

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