Hello, I am Leslie Greenberg. I am a family physician in Reno, Nevada. I attended Northwestern University in Chicago, then University of Nevada School of Medicine. I relocated back to my hometown in 2015. I trained and practiced medicine in the Midwest (Indiana and Kansas) for 20 years before moving back West. I consider myself a teacher and educator. I have taught 450 + family medicine residents (and countless medical students), over nearly 30 years. I currently teach at the family medicine residency program in Reno and also see private patients. I care for newborns through elderly patients in both the hospital and office. I love to do women’s health (contraception and menopause care) and procedures: skin biopsies, circumcisions, IUD insertion/removals, paps, colposocopies, and toenail removals. I am a Menopause Society certified physician. I invite you to read my blog. If you would like to become a patient, please call 775-982-1000.
Medical Disclaimer
Please remember that medical information provided by myself, in the absence of a visit with a health care professional, must be considered an educational service only. This blog should not be relied upon as a medical judgement and does not replace a physician’s independent judgement about the appropriateness or risks of a procedure or condition for a given patient. I will do my best to provide you with information that may help you make your own health care decisions.
Cervical cancer is one of the most preventable cancers! That is good news. But people still need to get screened.
I teach medical students, and one lesson I share often is this: medicine changes as research results. What we learned years ago may not always be the best way today.
When I was in medical school, Pap smears were done on every woman after she became sexually active and paps were needed EVERY year. Now we know more. Today, Pap smears begin at age 21, no matter when sexual activity starts. This change came from strong research showing that earlier testing did not improve health and could cause harm from unnecessary procedures. Young adults can clear (get rid of) HPV especially when they contract HPV when they are adolescents.
We have also learned how important HPV (human papillomavirus) is. HPV causes almost all cervical cancers. That is why we now recommend the HPV vaccine for both girls and boys starting at age 9. This vaccine helps prevent cancer before it can ever begin.
Even more exciting news arrived this year. The U.S. Department of Health and Human Services now supports self-collected vaginal samples for cervical cancer screening. This means some women can collect their own sample instead of having a pelvic exam. The Health Resources and Services Administration says this option should be offered to women ages 30 to 65 who are at average risk.
Women ages 21 to 29 should still have Pap smears every three years.The new guidelines recommend an HPV test every five years for women ages 30 to 65. Pap smears are still available, but they are no longer the main test for this age group.
These updates matter because they make screening easier, more comfortable, and more affordable. Insurance plans will be required to cover these tests.
Cervical cancer screening saves lives. Staying up to date with research helps us do it better—for our patients today and for the future.
One common question I hear is: What are the benefits of combination hormonal birth control during perimenopause?
Perimenopause is the time before menopause, when hormone levels change and periods can become irregular. Even though fertility is lower, pregnancy can still happen. Combination hormonal contraceptives—birth control that contains both estrogen and progesterone—can be very helpful during this stage of life.
One major benefit is relief from vasomotor symptoms, like hot flashes and night sweats. If you or your loved one is perimenopausal, you can appreciate how disruptive hot flashes and night sweats are. These vasomotor symptoms happen when estrogen levels go up and down. Combination birth control provides steady hormones, which helps calm these symptoms and improve daily comfort.
Another benefit is that combination hormonal contraceptives help make irregular vaginal bleeding regular. Many women in perimenopause have periods that come too often, too far apart, or without warning. Birth control pills can help make periods more predictable and manageable.
Some women experience very heavy bleeding that feels like flooding or gushing. Combination oral contraceptive pills and progesterone-releasing IUDs are both very effective at treating heavy menstrual bleeding. For many women, bleeding becomes much lighter or even stops completely.
Bone health is also very important during perimenopause. Combination oral contraceptive pills can increase bone mineral density in this age group. A large Swedish study found that women who used birth control pills—especially for many years and during their 40s—had a lower risk of hip fractures after menopause. This benefit is long lasting.
Combination oral contraceptives also have important non-birth-control benefits. They significantly lower the risk of endometrial (uterine) cancer and ovarian cancer. The protection against ovarian cancer is especially strong and can last for up to 40 years after stopping the pill.
Another advantage is flexibility. Women using combination birth control pills can choose when and how often to have a period. Some pill packs are made to allow a period every three months. Others use a standard 28-day pack, and women can skip the placebo pills to skip a period that month. Vaginal contraceptive rings, which also contain estrogen and progesterone, can be used continuously for 28 days without a ring-free week to skip periods as well.
Many women ask how long they can safely stay on combination birth control. If contraception is not needed, such as when a partner is female or has had a vasectomy, pills are often stopped around age 50, and menopausal hormone therapy can be discussed. For women who still need pregnancy prevention, combination birth control can often be continued until age 52 or even 55. By age 55, about 90% of women have reached menopause.
Blood tests are not helpful during perimenopause. Hormone levels change day to day. A test may look high one day and low the next, which can be confusing and misleading. I do not get lab tests if the results are not something that I can address effectively.
Finally, progesterone (levonorgestrel) IUDs are especially helpful during perimenopause. They provide reliable birth control, reduce or stop bleeding, and make it easier to use estrogen safely to treat perimenopausal or postmenopausal symptoms.
Perimenopause can be challenging, but the right treatment can make this time healthier, more comfortable, and easier to manage. I am a Menopause Society–certified provider, and I see patients at 745 West Moana Lane in Reno, Nevada. Call 775 657 2025 for an appointment with me.
I recently attended a lecture about birth control needs for women in perimenopause. Perimenopause is characterized by wide hormone fluctuations and irregular menstrual cycles for 5 or more years preceding and lasts until 12 months of no-bleeding has been achieved. Perimenopause is the time periods may come closer together, farther apart, heavier, lighter, or stop and start again. How frustrating! Even though fertility goes down during this time, pregnancy can still happen.
As women get closer to their final menstrual period, ovulation happens less often. But it does not stop right away. This means pregnancy is still possible until menopause (one year after spontaneous menstrual period) is reached. Studies show that fertility rates change with age. At age 40, about 83% of women can still become pregnant. At age 45, this drops to 45%. By age 50, fertility is lower, but still present, at about 10%.
Pregnancy later in life also carries higher risks. For every 1,000 women age 50 and older who have a live birth, 230 will have an induced abortion. Only teenagers have a higher abortion rate. Women of older reproductive age are also seven times more likely to die from pregnancy-related causes compared to adolescents. Because of these risks, effective birth control is very important during perimenopause.
Many women can safely use combined hormonal birth control, which contains both estrogen and progesterone. This includes combination birth control pills. These are safe for women who do not have certain medical conditions. Examples of conditions where combined birth control should not be used include uncontrolled high blood pressure, history of venous thromboembolism, tobacco use with age 35 or older, or migraines with visual symptoms called aura.
In healthy, nonsmoking women without high-risk conditions, combined hormonal birth control can usually be continued until age 50 to 55.
If a woman has a contraindication to estrogen-containing contraception or heart or blood vessel risk factors, progesterone-only birth control is often a better choice. Options include progesterone-only daily pills, the Depo-Provera shot given every 12 weeks, the Nexplanon implant placed in the arm for up to three years, or an intrauterine device (IUD), which can last up to ten years depending on the type.
It is important to know that combination birth control pills do not increase the risk of breast cancer. They also have added benefits during perimenopause. Because they contain estrogen and progesterone, they can help reduce hot flashes and night sweats, which are common during this stage of life.
Some women in perimenopause have very heavy periods that feel like flooding or gushing. Combination birth control pills and progesterone-releasing IUDs are both very effective at treating heavy menstrual bleeding. Another benefit of combination birth control pills is that they can help maintain or increase bone strength, which becomes more important as women age.
Perimenopause can be a confusing time, but with the right birth control choice, women can protect their health, prevent unplanned pregnancy, and feel better during this transition. Seek out a healthcare professional to help you navigate this journey. If you are in Northern Nevada, I am a Menopause Society certified provider and you can see me at 745 West Moana in Reno! Call 775 657 2025 for an appointment.
One important CDC-recommended adult vaccines is Shingrix. Shingles is caused by the same virus that causes chickenpox. After you’ve had chickenpox, the virus stays asleep in your nerves and can “wake up” years later, causing a painful rash, nerve damage, and can cause long-term nerve pain in the distribution the rash was in (even AFTER the rash goes away). This is called postherpetic neuralgia.
The good news is that there’s a safe and highly effective vaccine that was approved by the FDA in 2017. I have seen patients who have zinging pain in the distribution that there rash WAS even years after their rash goes away. I got my Shingrix the week I turned 50. Getting the vaccine lowers the risk of postherpetic neuralgia dramatically—and new research shows it may even protect your brain. That sounds like a win-win to me.
CDC Guidelines: Who Should Get Shingrix?
According to the CDC, almost all adults 50 years and older should receive the shingles vaccine. The schedule is simple:
Two doses, given 2 months or more apart,
Recommended for adults 50 and older, even if you’ve had shingles before or are unsure whether you had chickenpox.
Adults with weakened immune systems may start the vaccine at age 19 and may receive the two doses 1 to 2 months apart. Shingrix is over 90% effective at preventing shingles and long-term nerve pain.
Immunodeficiency and immunosuppression are NOT contraindications to Shingrix. In fact, Shingrix is specifically indicated for adults aged 18 years and older who are or will be at increased risk of herpes zoster due to immunodeficiency or immunosuppression caused by known disease or therapy. In fact, Shingrix differs from the previous shingles vaccine (Zostavax) which is a live attenuated zoster vaccine, which should not be given to immunocompromised patients.
Shingrix may cause side effects for 2-3 days after the administration. These side effects include injection site pain (78%), myalgia (45%), fatigue (45%), headache (38%), injection site redness (38%), shivering (27%), injection site swelling (26%), fever (21%), and gastrointestinal symptoms (17%). Hang in there! It’s better than long-term nerve pain.
New Research: Shingles Vaccine May Lower Dementia Risk
Beyond protecting against shingles, the vaccine may have another surprising benefit: lowering the risk of dementia.
A large study reported earlier this year showed that getting the shingles vaccine reduced the risk of developing dementia by 20% over seven years. This was an exciting finding, but researchers have now gone even further. A major follow-up study published in Cell adds new insight into how the vaccine may help the brain.
Here’s what the scientists discovered:
Cognitively healthy adults who received the vaccine were less likely to develop mild cognitive impairment, a common early warning sign before dementia.
People who already had dementia seemed to benefit as well. Those who received the shingles vaccine were almost 30% less likely to die of dementia over nine years, suggesting the vaccine may help slow the disease’s progression.
While the exact reason isn’t fully understood, the idea is that reducing inflammation from shingles may also reduce harmful inflammation in the brain.
We now know that HPV (human papillomavirus) causes many different cancers. The HPV vaccine which is given to most preteens at 11-12 years of age can be given up to age 45. Studies have shown that patients view HPV vaccine as a vaccine and not as a license to perform risky sexual behavior. HPV is a very common virus that spreads through skin-to-skin contact. Most adults will get HPV at some point.
Approximately 150 HPV types have been identified, with at least 40 infecting the genital area. These are categorized into two main groups based on their clinical manifestations:
Oncogenic (high-risk) HPV types, particularly HPV 16 and 18, cause the majority of:
Cervical cancer and precancers
Penile cancer
Vulvar cancer
Vaginal cancer
Anal cancer
Oropharyngeal cancer
Persistent oncogenic HPV infection is the strongest risk factor for development of these HPV-attributable precancers and cancers. If HPV is contracted when in the teens or early 20s the body often fights it off and this is not considered “persistent.” The vaccine helps the individual patient NOT contract the HPV types that cause cancer.
Low-risk HPV types, particularly HPV 6 and 11, cause:
Genital warts (condylomata acuminata)
Let’s break down what this means in simple terms.
What Did the New Research Show?
Two huge reviews looked at more than 160,000 people in clinical trials and over 132 million people in real-world studies. That is some of the strongest evidence we ever get in medicine. Here is what the studies found:
The HPV vaccine is very safe.
It works extremely well at preventing HPV infections.
It stops most precancerous changes in the cervix.
It lowers the chance of getting genital warts.
Girls who got vaccinated before age 16 had an 80% lower chance of cervical cancer later in life.
This is a very big deal. An 80% drop in cancer risk is one of the strongest cancer-prevention results we have seen for any vaccine.
How Does the Vaccine Help With Pap Tests?
The HPV vaccine also lowers the number of abnormal Pap test results. These are the results that make us call you back for more testing. Studies show:
Vaccinated women have 36–64% fewer abnormal Pap tests than unvaccinated women.
Getting all three doses gives the best protection. Of note, only TWO doses needed if the first dose is given BEFORE age 15.
In one U.S. group, women had 52% fewer abnormal Pap tests after one dose and 77% fewer after three doses.
Girls who got vaccinated at ages 11–14 had a 64–73% lower risk of abnormal cells later.
What About Real-World Results in the U.S.?
Since the HPV vaccine became available, the United States has seen a 77% drop in early cervical precancers caused by HPV types 16 and 18 in women ages 20–24. This age group has the highest vaccination rates, and we are seeing huge benefits.
Why I Recommend HPV Vaccination
As your family doctor, I want you and your family to stay healthy for the long run. The HPV vaccine is one of the best tools we have to prevent cancer. It works best when given at ages 11–12, but older teens and young adults can still get it.
Can Probiotics Help Prevent Urinary Tract Infections in Premenopausal Women?
Urinary tract infections, or UTIs, are very common in women. Some women get UTIs over and over, even when they drink plenty of water and try to stay healthy. Because of this, many people ask if probiotics can help. Probiotics are “good bacteria” that can support the body in different ways.
New research gives us some helpful clues, but also shows that we still have more to learn.
What Are Probiotics?
Probiotics are healthy bacteria that can be taken in a pill or placed in the vagina. Many probiotic products contain a type of bacteria called Lactobacillus. This is the same kind of bacteria that normally lives in the vagina and helps keep harmful germs away. Did you know that the vagina has a lower bacterial load and fewer bacterial species compared to the mouth?!
What Recent Studies Show
Some recent high-quality studies found encouraging results:
Probiotics can lower the number of UTIs in premenopausal women.
Women who took vaginal probiotics had fewer UTIs than women who took only oral probiotics.
Using vaginal probiotics alone helped just as much as using both vaginal and oral probiotics together.
Vaginal probiotics may also be less expensive and less invasive overall.
These results suggest that vaginal probiotics may help women who get UTIs often, especially if other methods have not worked.
What We Still Don’t Know
Even though some studies look promising, many others show mixed results. Here is why:
Studies use many different probiotic strains, so it is hard to know which one is best.
Sample sizes are often small.
Doses and schedules vary a lot.
Not all studies agree on how much probiotics help.
Because of these differences, experts say that we cannot make strong, one-size-fits-all recommendations yet.
Are Probiotics Safe?
Yes. Most probiotics are safe and well-tolerated. Side effects are usually mild and rare. But we still do not know the best dose, how long to take them, or which exact strains work best.
Some research also suggests that probiotics may work even better when combined with cranberry or D-mannose, but the evidence for these combinations is not strong enough to be recommended as standard care.
The Bottom Line
Vaginal probiotics may help reduce repeated UTIs in premenopausal women. They seem to work better than oral probiotics alone and may be the simplest and most affordable option. But we still need larger, stronger studies before doctors can give firm recommendations.
If you get frequent UTIs, talk with your doctor before starting probiotics. I hope this helps.
I have some exciting news for women going through menopause: a new medicine called Elinzanetant has just been approved by the FDA to help treat hot flashes and night sweats. It is expected to be available November 2025 with an average wholesale price of $12.50 per pill. We will need to wait for pharmacy pricing and insurance rules for coverage.
This approval was announced right before new safety data were presented, and the audience—mostly doctors and researchers—broke into applause. Why? Because this medicine offers relief for women who can’t or don’t want to take hormones.
What Is Elinzanetant?
Elinzanetant (brand name Lynkuet) is a non-hormonal pill taken orally once a day. It is approved for women who have moderate to severe hot flashes and night sweats caused by menopause, including those who have had breast cancer or who are on endocrine (hormone-blocking) therapy.
It works in the thermoregulatory zone of the brain—the area that controls body temperature. During menopause, this zone becomes extra sensitive to changes in estrogen. Elinzanetant helps calm those signals.
It does this by blocking two types of receptors in the brain—called neurokinin-1 (NK-1) and neurokinin-3 (NK-3) receptors. Blocking both seems to give stronger, faster relief than blocking one alone.
How Well Does It Work?
In large clinical trials, called OASIS-1 and OASIS-2, women who took 120 mg of Elinzanetant daily had fewer and milder hot flashes within just one week. Improvements continued through six months of use.
Women also slept better and said their quality of life improved. On average, women in the studies had more than 50 hot flashes per week, so the results were meaningful and life-changing.
Studies also show that Elinzanetant may help even more than another non-hormonal option, fezolinetant (Veozah), which blocks only the NK-3 receptor.
Is It Safe?
Elinzanetant has been shown to be well tolerated. The most common side effects were headache (10% of patients), fatigue (7% of patients), and sleepiness (5% of patients). No serious liver problems or hormone-related side effects were reported.
Because it is non-hormonal, this medicine is a great choice for women who cannot use estrogen—such as those with a history of breast cancer or blood clots.
The Bottom Line
Elinzanetant (Lynkuet) is a new, once-daily, non-hormonal pill that offers real relief for hot flashes, night sweats, and poor sleep during menopause.
If you’re struggling with these symptoms, talk to your doctor about whether Lynkuet might be right for you. You don’t have to suffer in silence—help is here, and it’s safe.
In 2002, the Women’s Health Initiative (WHI) study reported increased risks of breast cancer, blood clots, stroke, and heart disease in women taking combined estrogen + progestin. The media coverage was intense, and many women stopped hormone therapy overnight. In response, the FDA issued a boxed (black box) warning in 2003 for all systemic estrogen products (pills, patches, gels, sprays, and rings).For many years, estrogen medicines used for hot flashes and night sweats have carried a black box warning. A black box warning is the strongest safety warning the FDA puts on a medication. This warning caused worry for many women and their physicians, and many avoided treatment even when their symptoms were affecting sleep, mood, work, and quality of life.
November 2025 the FDA announced that it will remove the black box warning from estrogen-containing menopausal hormone therapy products. This includes more than 20 pills, patches, and creams used to help with menopause symptoms such as hot flashes, night sweats, and vaginal dryness.
Why the Warning Is Changing
Newer research has shown something important: Hormone therapy is safest and most helpful when it is started within 10 years of menopause, or before age 60.
Studies show that for many women in this age window, estrogen may actually have long-term health benefits, including:
Better sleep
Fewer hot flashes and night sweats
Improved bone health
Better quality of life
The older warning did not reflect this newer science. It was based on older studies that included many women who were more than 10 years past menopause, which is a time when the risks are higher. The updated labels will give more age-specific guidance to help women and doctors make informed decisions.
What This Means for Women
The removal of the black box warning does not mean hormone therapy is right for everyone. It means:
Decisions should be individualized
Benefits and risks should be discussed based on age, health history and risk factors, and symptoms
Women in early menopause may have more benefit from menopausal hormonal therapy and lower risk from hormone therapy compared to women who start it many years later
Women with a history of breast cancer, blood clots, stroke, or certain other medical conditions will still need careful evaluation.
The Bottom Line
This change is a major step forward in women’s health. It recognizes what many menopause specialists and newer research have shown: For the right woman, at the right time, hormone therapy can be safe, effective, and life-changing. Additionally, there are non-hormonal options for women who have contraindications to systemic estrogen.
If you are struggling with hot flashes, sleep disruption, or other menopause symptoms, please reach out. We can talk together about whether hormone therapy may be a safe and helpful option for you.
As a family doctor I believes that good health starts with the basics—what we eat, how we move, and yes, how we care for our teeth and gums. I ask every patient at their wellness visit who they see for their eye and dental care. The mouth is important. (And, who wants to go blind?!)
You may not realize it, but the health of your mouth can have a major impact on your heart and your blood sugar. Scientists have found strong links between gum disease and serious conditions such as heart disease, stroke, and diabetes.
What the Research Shows
A recent study found that people with gum disease and cavities had an 86 percent higher risk of stroke. Even those with gum disease alone were 44 percent more likely to have a stroke.
Large studies involving millions of people have found the same pattern. People with gum disease have about a 24 percent higher risk of serious heart problems such as heart attack or stroke, and a 31 percent higher chance of dying early from any cause.
These findings tell us that brushing, flossing, and seeing your dentist regularly are not just about keeping a bright smile—they can truly help save your life.
Why Gum Health Matters
Your gums are filled with tiny blood vessels. When gums become infected or swollen, germs and inflammation can enter the bloodstream. This can damage blood vessels, increase blood pressure, and make blood clots more likely—all of which raise the chances of heart attack and stroke.
Gum disease and diabetes also affect each other in both directions. People with diabetes are two to three times more likely to develop gum disease, and gum infections can make blood sugar harder to control. Treating gum disease can even lower blood sugar by about 0.3 to 0.4 percent, which makes a meaningful difference over time.
How to Keep Your Mouth and Body Healthy
Brush twice a day with fluoride toothpaste.
Floss daily to remove plaque between teeth.
Visit your dentist at least twice a year.
Do not smoke or vape; both damage gums and blood vessels.
Eat plenty of fruits, vegetables, and whole grains while limiting sugar.
If you have diabetes, keep your blood sugar under control and tell your dentist.
Menopause is a natural part of aging. It usually happens between ages 45 and 60, when a woman’s ovaries stop making as much estrogen and periods stop. The definition of menopause is one year after the last menstrual period.
This change can bring a lot of body and mood changes — some mild, some pretty uncomfortable.
What a New Study Found
A large study from the Mayo Clinic looked at almost 5,000 women aged 45–60 and asked about their menopause symptoms and whether they got help.
Here’s what they found:
Over 80% (more than 4 out of 5) did not seek medical help.
About one-third said their symptoms were moderate to very bad.
Most common problems were:
Trouble sleeping (55%)
Weight gain (52%)
Changes with sex or vaginal dryness (43%)
Feeling tired or worn out (40%)
Achy joints and muscles (37%)
Even though many women were struggling, only 28% were getting treatment. Most said they were managing on their own (65%), and some were too busy to see a doctor (37%).
Why So Many Women Don’t Seek Care
It’s easy to understand why:
Many think menopause is “just part of life.”
Some feel embarrassed to talk about hot flashes, mood changes, or sex.
Others are busy caring for kids, parents, or work — and put themselves last.
Some have heard confusing or scary stories about hormone therapy.
But here’s the truth: you don’t have to suffer.
What Doctors Can Help With
As your family doctor, I can:
Explain what’s normal and what might need attention.
Offer safe treatments such as lifestyle steps, non-hormonal options, or menopausal hormone treatment if appropriate.
Check for other causes of tiredness, weight changes, or mood shifts. Thyroid labs may be ordered to confirm that it is not the root issue.
Help you sleep better and keep bones and heart healthy.
Simple Ways to Start Feeling Better
Even before seeing a doctor, small steps can help:
Stay active. Walking, stretching, and light weights help energy and bones.
Eat colorful foods. Fruits, vegetables, lean proteins, and whole grains support hormones.
Limit alcohol and caffeine. They can worsen hot flashes.
Sleep hygiene. Go to bed at the same time each night; keep the room cool.
Mind care. Deep breathing, journaling, or talking with friends can reduce stress.
If symptoms still bother you, that’s the time to check in. You deserve to feel good in your body again.
Let’s Change the Story Together
Menopause shouldn’t be a silent struggle. If you are losing sleep, feeling unlike yourself, or just unsure what’s normal, please reach out. You’ve spent years taking care of everyone else — now it’s time to take care of you.
I see patients at University Health 745 West Moana in Reno, NV. To make an appointment call 775 657 2025.
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