TODAY’S DOSE OF HONESTY

On Mother’s Day: What I will share with my daughter about menopause.

First off: To all the moms, moms-to-be, “bonus” moms, grandmoms, daughters who might become moms, fur-baby moms too—may the forces of good health and happiness be with you all! This month, we are celebrated, and celebrate ourselves, for the nurturing roles we play in so many lives. I am, have been, and potentially will be all of these in my lifetime, and there is no accomplishment that makes me prouder. Here’s to us! ❤️

This Mother's Day, I’m turning the tables on the practice of my kids giving me a gift. I’ve often said that I feel like every day is Mother's Day, since I have them as my children. So, in that spirit, I’m going to be the one giving my 24-year-old daughter, Chloe, a gift this year. The gift is what I will tell her about menopause, so that when her time comes, she’s prepared.  

As a gynecologist, of course, I will tell her how and why hormone levels start to drop, even as early as her mid-30s. I will explain the physiology behind the fact that almost every organ system in the female body has estrogen and progesterone receptors—and, as a result, why almost any symptom, head to toe, can be associated with these hormones. I will emphasize that the greatest feat she can achieve is to become an expert in HERSELF, and to pay attention to her baseline, so that if she has any departure from that baseline, she takes notice. 

Some of this is relevant even at the age of 24. For example, with respect to her periods, I’ll explain how she should always track how far apart they are, how long they last, how heavy or painful they are, whether or not there are clots, or if there are associated symptoms. I’ll also counsel her to develop awareness about her sleep, her bowel habits, her skin, her mental health, and her weight and nutritional practices. That medical and physical part is actually the easy part. More challenging is how I hope to help prepare her psyche for menopause—the part I think is essential and doesn’t always get discussed. 

In the end, this is what I will say:

Chloe, fasten your seatbelt! Menopause can range from mildly unpleasant/barely a blip on your radar to truly sucking. The signs and symptoms can and often do run the gamut from thinning hair, dry mouth, sleep disturbances, brain fog, anxiety/depression, angry outbursts, itchiness in your ears, palpitations, midsection weight gain (even though you haven't changed what you’re eating or how you’re exercising), irregular bleeding, vaginal dryness, changes in sexual desire, musculoskeletal pain...and that might not be the end of it.

Chloe, menopause experiences vary from woman to woman, and they’re unpredictable. It can be scary and sad, because it does represent a loss of a past status/condition of sorts. But, my daughter, you are SO much more than a vessel for reproduction. Your value in society is not linked at all to your ability to incubate a human, and your worth is not determined by your wrinkles or sunspots, or your body weight, or your age, or the functionality of your ovaries. Also, even though menopause will feel like the body you have long known is gone or betraying you by feeling and looking and acting completely different, you have the skills, resources, and fortitude to get through this stage in life.

Chloe, you've done it before. You got through puberty, you will get through pregnancy (if you choose to), and you will get through menopause too. You can and will get through it. And by preparing for it (yes, now, even in your mid 20s and 30s), you can increase your chances of having a better experience with perimenopause and menopause. 

Chloe, take advantage of the help at your disposal. Menopause is truly a privilege; the alternative is not being alive, so only the lucky living get to experience it. But don’t be afraid to seek out the help you might need. There are more solutions to the symptoms you may face than ever before. And every single woman who has been through menopause has something to offer that may help guide you before, during, and after this transition. This community is invaluable; we are your femme squad, and we’re here to help.

Finally, Chloe, it’s not all doom and gloom! It’s possible you will have another 45 to 50 years of life after menopause, so don't think of this as an ending. It’s just a transition. For one thing, you can now have tons of sex without worrying about an unplanned pregnancy! You likely have the lived experience, resources, and self-esteem to get you through this hormonal phase that you did NOT have as an awkward teenager slogging through puberty. Celebrate the fact that you have made it to this stage—remember, it's a privilege reserved only for those who are alive!

SYMPTOM SOLUTIONS

5 of my best self-care solutions.

In 2019, my book, The Self-Care Solution, was published. I got this idea to give myself one personal challenge per month for a full year; I would write about my journey and offer my insights to readers based on my experience as a doctor, a nutritionist, an obesity medicine specialist, a lifetime fitness enthusiast, and a person who doesn’t have enough time in my life for all I need/want to do. I apparently touched a nerve for a lot of women, because it was a hit! The major takeaway was this: You can do ANYTHING for a month—and once you do it for a month, it’s more likely to become a hard-and-fast (good) habit.

But right now, I want to focus on another important point, so important that I put it in the title of my book: self-care. In our roles as mothers but also as friends, lovers, employees, managers, caregivers, volunteers, etc.—to ALL of which we bring our time and our nurturing natures—we often neglect the people who need our nurturing the most: ourselves! Well, I’m here to give you a gentle push in the self-care direction, with a few of my personal self-care tools (read: things I do myself to help ME get the self-care I need). For the rest of the month (or for the next 30 days, if you are up for the challenge), give back to YOURSELF by following these tips from my own “self-care toolkit.” It’s my Mother’s Day gift to all of you!

❤️ Drink enough water every day. Proper hydration doesn’t just quench thirst—it’s absolutely essential to nearly every function in your body. In fact, DEHYDRATION can interfere with heart, brain, metabolic, and liver function; it makes your blood thicker; it ages your skin; and it can cause everything from kidney stones and headaches to nausea, fatigue, bad breath, weight gain, mental confusion, and even seizures. Unfortunately, like many people in the U.S., you might not be drinking enough water: A study at New York-Presbyterian/Weill Cornell Medical Center found that as many as 75 percent of us are chronically dehydrated—in other words, not getting, for women, approximately 2.7 liters daily, which is 90 ounces or 11½ 8-ounce cups. (For men, it’s 3.7 liters.) Sounds like a lot, and it is a lot. Here are a few things that helped make drinking enough water easier for me:

• Find your personal water preference. Experiment with different temperatures, flavors, and types—tap, sparkling, filtered, or bottled—until you find your sweet spot. Just make sure your choice is calorie-free.

• Get a big, beautiful refillable water bottle. I recommend one that accommodates at least 20 ounces. Fill it frequently and use it every day.

• Drink water with every meal. Mealtime offers the perfect way to boost your daily water intake, and it also aids digestion and increases feelings of fullness and satisfaction.

• Invest in a filter. Filtering your own tap water cuts down on the cost and waste of plastic bottles.

• Drink while you wait—for coffee to brew, for shower water to get warm, for toast to pop up. Pairing your water consumption with morning activities will help make it a routine.

• Remind yourself how good it is for your body. Hydration is a tiny investment with huge health benefits: It’s fueling your brain and your heart, flushing out your kidneys, revving your metabolism, and keeping every other organ and physical function in top form.

❤️ Give yourself 5 quiet minutes in the morning. I’m talking about meditation, once considered a hallmark of “crunchy” alternative life stylers and now accepted by many physicians as a bonafide treatment for conditions like depression, insomnia, and even weight gain. The body of evidence that supports meditation’s curative effects is undeniable and growing; it’s so good that I have actually written prescriptions for it. The best part? The equipment is free—all you need is a comfortable place to sit and relative quiet. The following exercise takes just 5 minutes; try doing it once a day, slowly increasing your time.

1. Sit in a manner that’s relaxing—in a chair, on the floor, on the grass, etc. Keep your back straight without being rigid. You can keep your eyes open or close them. (I prefer mine closed.)

2. Take note of your body—how are your arms, legs, feet, back, and sit-bones feel.

3. Focus on your breath as you inhale, filling your chest with air, and then how your chest shrinks as it empties.

4. Your mind will wander—that’s normal. Just notice that it’s happening, without judgment, then return your focus to your breath.

5. Try to maintain that focus on your breath for 5 minutes the first few times. Set a timer so you won’t have the distraction of checking a clock. Work up to 10-minute sessions, but at your own pace.

I have found that meditating first thing in the morning is best for me—it sets the tone for my day, and I get it done before life crashes in with time sucks. I’ve also found that apps, such as Calm and Insight Timer, can be helpful, offering guided meditations, timers, and calming background music and sounds.

❤️ Instead of full “meals,” try “snack bites” of exercise. When I was moving through my challenges for The Self Care Solution, I learned that you can accomplish a lot with and for your body in just 20 minutes. And that anything, even just 5 minutes of cardio, is better than nothing at all. When you’re time-crunched or unmotivated, setting low expectations is one of the easiest ways to get and stay moving.

So, you don’t have time to spend an hour at the gym? Or just don’t have the gumption to spend that hour working out? Try a 5-minute walk around the block. Or hold a plank for just 10 seconds. Or do a couple push-ups. That will keep your activity level on your mind’s radar, and who knows? You might find yourself walking a little farther or eking out a couple more planks or push-ups.

❤️ Go meatless once a day. Getting more plants into your diet—in the form of fruits, vegetables, and whole grains—is such a great step toward better overall health. Enough said. But sometimes the whole magilla can be just too hard to swallow. So, don’t. Try planning one meatless meal into your day for a month. Here are a few things that helped when I was challenging myself to follow a plant-based eating plan:

• Focus on adding, not eliminating. Remind yourself that you are ADDING foods to your diet instead of fixating on what you can’t have. Think about all the delicious foods you CAN eat—creamy sweet potatoes, crunchy almonds and cashews, roasted corn, sumptuous cheeses, crusty multigrain bread, juicy watermelon, luscious berries…the list is endless!

• Plan ahead. Don’t be caught racing to a drive-through because (insert excuse here). Make sure you have plenty of meatless options in your kitchen, so you have plenty of options for every meal.

• Don’t obsess about the scale. By swapping out calorie-dense meats for more plants, you’re likely to drop pounds. But to sustain weight loss, it’s more important to pay attention to how your body feels than what the scale tells you.

• Search online for meal ideas. The internet is a vast and wonderful resource for vegetarian and plant-based recipes and meal planning. Use it!

• Eat breakfast for dinner. Eggs are superfoods in my book. One egg packs a whopping 7 grams of protein in a package of just 70-75 calories, making them one of the most protein-rich foods. They’re also a source of good fats, which will help you stay full when you’re not eating meat.

❤️ Use a large wall calendar to record important self-care progress. This is old-school, no-tech stuff, but crossing off days or making notes on a paper calendar can rev up your commitment regularly—especially when it involves a personal challenge. When I was doing my first Dry January, for instance, I hung a giant calendar in my office at ABC and used fat, fluorescent markers to X out the days. It was super motivating!

Find a calendar that speaks to you—maybe it’s images of horses, or gardens, or beautiful food, or the splendor of national parks or sights around the globe. Place it in a spot where it will remind you, constantly, of your own personal challenge (such as, let’s say, drinking 2.7 liters of water or meditating 5 minutes every morning. 😊) Then start crossing off those days! Before you know it, you will have reached your goal-and can re-up it or start a new one!

❤️ And because I appreciate you SO much…

The first 5 people to share TODAY’S AJENDA with 10 friends who confirm their subscriptions will get a signed copy of my book!

To celebrate self-care this Mother’s Day, I am offering both a challenge and a potential reward: Get 10 friends to successfully subscribe to TODAY’S AJENDA. If you are one of the first five to do so, you’ll receive a FREE signed copy of my best-selling book, The Self-Care Solution!

It’s easy: Just click on the link below and provide your friend’s email address. They’ll receive a message inviting them to subscribe by confirming their email address. Once they do that, you’ve got a bonafide referral. Get nine more, and you could be one of those five lucky winners!

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COMMUNITY

“I’m considering plastic surgery. What questions should I ask?”

You’ve come to the right place for answers: My brother, Dr. Evan Garfein, is a plastic surgeon and cofounder of one of the premier practices in New York City, so I am privy to a lot of “insider baseball” info on this medical specialty. That said, I’ll let the true expert tell you what should know even before setting foot in a surgeon’s office for the first time.

Plastic surgery is an amazing field. It includes treatments for problems large and small, affecting the young and the old, the healthy and the sick. Whether you need a surgeon for breast reconstruction after cancer surgery or for a facelift to combat the effects of normal aging, there are certain guidelines I find useful and, most importantly, that will keep you safe. When my sister Jen asked me to share questions to ask a plastic surgeon before considering surgery, I thought the best place to start was, well, at the beginning. 

“What kind of doctor should I look for?” There are lots of different doctors who perform “plastic,” “aesthetic,” or “cosmetic” surgery. Personally, I know of primary care doctors, urologists, dentists, OB-GYNs, ENTs, ophthalmologists, dermatologists, and geriatricians who promote themselves as providers of aesthetic services. Some of these specialists and some of these specialties (ENT, dermatology, ophthalmology) devote significant portions of training to aesthetics within their scope of practice—dermatologists for skin care and laser treatments, ENTs for rhinoplasty, ophthalmologists for eyelid surgery, for example. BUT there are many doctors and some non-doctors out there who perform procedures that are way outside of their training. Dentists should not be performing breast augmentation or facelifts. Primary care physicians should not be performing liposuction. I have seen the disastrous results of both. 

The best place to start your search is with board certification. Every doctor you go to, including your plastic surgeon, should be board-certified in the specialty you are looking for. This is the minimum criterion for ensuring safety and quality. This is not to say that every board-certified plastic surgeon will be great. But you are much less likely to end up with someone who is unqualified to operate on you if you go to a surgeon who, at the very least, has met the standards of the American Board of Plastic Surgery. You can check whether your surgeon is board-certified by abplasticsurgery.org or certificationmatters.org.

“Where/how will the surgery be performed?” Safety is the most important consideration when choosing a surgeon. Find out where they operate, what organization has certified the facility, who will be providing anesthesia (it should be an anesthesiologist or a certified registered nurse anesthetist), and where patients are taken in case of an emergency. No patient likes to think about complications, but make sure your surgeon has. I also recommend that you ask to see the operating facility. Is it neat and clean? Is it outfitted with up-to-date technology?

“What about complications?” Let’s talk about the dreaded issue of complications. First, they happen—to every surgeon. You should ask your surgeon about all the complications that may occur. If a surgeon tells you they’ve never had a certain complication, either they’re lying, or they haven’t done that procedure enough. Hopefully, you won’t experience any, but you should know the possibility exists. I recommend you have insurance that covers medical treatment in case you do have one. We use a service called CosmetAssure. Otherwise, most insurance plans will not cover hospitalization following a complication from cosmetic surgery, and you could get hit with a big bill. 

“Should I get a second opinion?” Yes, and maybe even a third. Make sure they listen to you. Then listen to how each surgeon recommends addressing your concerns. It can be reassuring when two or three doctors say the same thing. The relationship you have with your plastic surgeon should be built on trust and comfort. If something doesn’t feel right, find someone else. And remember, the most expensive surgeon—or your friend’s doctor—may not necessarily be the best or right for you; you may need a different skill set. Ask to speak with former patients—this is more important than looking at before-and-after photos (which can be manipulated or cherry-picked). 

So, choosing a plastic surgeon comes down to three things—board-certification, safety, and trust.

Evan Garfein, M.D., is chief of the Division of Plastic Surgery at Montefiore Medical Center and professor of surgery at Albert Einstein College of Medicine. He is cofounder of Greenwich Street 497, the premier location for aesthetic surgery in Manhattan. Dr. Garfein specializes in breast and body aesthetic surgery with a particular interest in breast augmentation and reduction surgery. He has authored more than 60 peer-reviewed papers on a range of topics, and has been recognized each year by New York magazine’s “Best Doctors” issue for nearly a decade.  @drevangarfein

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ABOUT DR. JEN

In her roles as chief medical correspondent for ABC News and on-air cohost of “GMA3: What You Need to Know,” Dr. Jennifer Ashton—”Dr. Jen”—shares the latest health news and information with millions of viewers nationwide. As an OB-GYN, nutritionist, and board-certified obesity medicine specialist, she is passionate about promoting optimal health for “the whole woman.” She has written several books, including the best-selling The Self-Care Solution: A Year of Becoming Happier, Healthier & Fitter—One Month at a Time. And she has gone through menopause…

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