Why So Many Women Don’t Ask for Help with Menopause — And Why They Should

Posted on November 4, 2025 by drlesliegreenberg

What Is Menopause?

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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Understanding Menopause Health Disparities

Posted on October 23, 2025 by drlesliegreenberg

I am loving the part of my practice where I care for peri- and menopausal women. I am acutely aware that every woman’s menopause experience is different.

While menopause happens to all women, the way it feels can be very different from person to person. Studies show that women of color often start menopause earlier and go through a longer perimenopausal transition. For example, Latina and Black women report more hot flashes, mood changes, and trouble sleeping. Asian women tend to have fewer or milder symptoms. These differences are not only about biology—they also come from things like genetics, where someone lives, culture, and access to healthcare.

Menopause doesn’t happen by itself. It’s part of a woman’s life story. Things like money, stress, culture, and even the air she breathes can all make a difference. Women with lower incomes or less access to good housing, healthy food, and doctors may start menopause earlier and have stronger symptoms. They may also have higher risks for heart problems. Women who speak little English or have trouble understanding health information can also face challenges, since most menopause materials are written only in English.

Being an immigrant can make things harder too. Many immigrant women in the U.S. can’t easily get the care they need. Research shows that the longer they live in the U.S., the more stress, sadness, and sleep problems they may experience. Racism, discrimination, and trauma add to these problems. Black women often face more stress and unfair treatment but are less likely to get help for hot flashes, depression, or high blood pressure.

Habits and environment matter too. Eating a lot of junk food, not getting enough sleep, or smoking can make menopause symptoms worse. Not being active can lead to tiredness and mood changes. People who live in areas with little green space or more pollution often go through menopause earlier and have more health issues. These patterns reflect long-standing inequalities in race, money, and city planning.

A woman’s health and reproductive history also play a role. Starting periods early, having fewer pregnancies, or not breastfeeding can lead to earlier menopause. Getting regular checkups and having insurance can help women get treatments that ease symptoms. Women without insurance often have stronger symptoms and fewer options.

Doctors can help by listening and showing care. Menopause is a chance for women and their doctors to work together—talking openly about symptoms, needs, and choices. Teaching both patients and doctors about menopause, culture, and bias helps make care fairer and more personal.

In the end, menopause care should fit each woman. Understanding how race, culture, environment, and stress affect menopause helps doctors give better, kinder care. Every woman’s story matters, and every doctor visit is a chance to close the gap in menopause health.

I am seeing Menopause patients at our University Health office in Reno, Nevada. Call 775 657 2025 for an appointment with me.

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Testosterone therapy for women: What you should know

Posted on September 17, 2025 by drlesliegreenberg

I am a 30-year board-certified physician and Menopause Society certified physician. A lot of my patients are asking about testosterone…

When people think of testosterone, they often think of it as a “male hormone.” But women also make small amounts of testosterone, and it plays a role in energy, mood, and sexual health. Some doctors and patients wonder if giving testosterone to women could help with certain health problems. The American College of Obstetricians and Gynecologists (ACOG), a group of doctors who are experts in women’s health, has clear rules about when and how testosterone should be used. Let’s break down what they say in a way that is easy to understand.

When is testosterone used for women?

According to ACOG, testosterone therapy should only be used in women who have gone through menopause and who are struggling with something called hypoactive sexual desire disorder (HSDD). HSDD is when a woman has very little or no interest in sex, and it causes her stress or problems in her life. Before starting treatment, women should be carefully checked by a doctor and evaluated for other conditions. Estrogen vaginal cream can help with vaginal dryness and pain with intercourse. Pelvic floor physical therapy can also help with physical sexual issues. Patients are then advised about the risks, since the long-term effects of testosterone therapy in women are not fully known. Some side effects from testosterone are male-pattern hairloss, dark facial hair, cliteromegaly, and anger issues.

Is there an FDA-approved testosterone for women?

Right now, there is no FDA-approved testosterone medicine made just for women in the United States. This means that if a woman needs testosterone, medicines made for men can be prescribed in a dose 1/10 the male dose or have a pharmacy make a special version, called a compounded medicine. But these choices can be tricky. The dose may be too high, or the medicine may not absorb well, which can cause side effects. That’s why caution and close follow up is needed.

What about other uses for testosterone?

Some people wonder if testosterone might help with things like stronger bones, sharper thinking, or better energy. But ACOG does not recommend testosterone for these purposes. They also do not support using DHEA (a hormone supplement) for sexual symptoms, except in its approved vaginal form.

How is testosterone given?

Doctors usually recommend a low dose of testosterone, just enough to bring levels back to what they would normally be in younger women. This might look like a compounded cream with a pea-sized amount rubbed into the skin on the ankle.

Oral (pill) forms are not recommended because they can cause bad cholesterol changes and don’t absorb well. The exact dose should be personalized, and doctors adjust it based on lab tests and how the patient feels.

What about lab tests?

Lab tests are an important part of therapy, but ACOG says that a blood testosterone level alone cannot diagnose HSDD. Instead, the diagnosis is based on symptoms and a full evaluation.

  • Testosterone levels are checked at 3–6 weeks after starting treatment.
  • After that, tests are done every 6 months
  • The goal is that testosterone levels stay in a safe range (20–80 ng/dL).

When to stop?

If a woman does not see any benefit after 6 months, or if she has any side effects, therapy should be stopped. The goal is always to use the lowest dose for the shortest time that helps.

The bottom line

Testosterone therapy for women is not a “one-size-fits-all” solution. It is only recommended for certain postmenopausal women with HSDD, and it requires careful monitoring by a doctor. Safety always comes first, and ongoing follow-up is key to making sure the treatment helps without causing harm.

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Kratom: What is it? And, lots of other details….

Posted on September 10, 2025 by drlesliegreenberg

I attended a medical student presentation recently and learned some interesting facts about kratom.

What is it?
Kratom is a natural substance derived from the Mitragyna speciosa tree, native to Southeast Asia. Its main active compound is 7-hydroxymitragynine (7-OH), an opioid. In 2020, about 2.1 million people in the U.S. reported using kratom. It is more commonly used by adults than adolescents, and more by men than women. Some individuals try it to manage opioid withdrawal, and it is sold in smoke shops and convenience stores without a prescription.

Why use kratom?
Kratom has been used for centuries in religious ceremonies, social rituals, and as a visitor gift. At low doses, it can act as a mild stimulant; at higher doses, it produces pain relief and euphoria. Use often escalates over time. A 2020 study reported that 90% of users take it for pain relief, 60% for anxiety, 40% for opioid withdrawal, and 25% for depressive symptoms.

Legal status
Kratom’s legality varies by state. In 2016, the DEA proposed classifying it as a Schedule I substance, but this did not pass. In 2018, the FDA categorized kratom as an opioid. The Kratom Consumer Protection Act (2019) aimed to provide consumer safeguards, but regulations differ widely. In Nevada, buyers must be 18 or older. More than 10 states have no protections, and 6 states have outright bans.

Forms
Kratom is available as powdered leaves, capsules, teas, extracts, gummies, or even ice cream. It contains 25 alkaloids, with four responsible for most effects. Traditionally, leaves were chewed. Red vein kratom has the highest mitragynine content with strong opioid effects. Green strains are more associated with pain relief, while white strains fall in between.

How does it work?
Mitragynine binds to mu-opioid receptors, similar to morphine or heroin but in a slightly different manner. Naloxone (Narcan) may be less effective for kratom overdoses compared to traditional opioids.

How long does it work?
Effects begin within 1–2 hours, and the half-life is about 23 hours, so it may remain in the system for more than a day. Kratom does not appear on routine urine drug screens.

Side effects
Kratom decreases GI motility, leading to constipation and nausea. By affecting serotonin receptors, it can cause euphoria but also dizziness. Reported risks include liver injury, seizures, coma, lung or cardiac complications, and in pregnancy, neonatal withdrawal. Contamination with heavy metals or additives has also been documented. Physicians may be unaware of a patient’s use unless specifically disclosed.

Patterns of use
A local Reno physician notes that typical users are 20–40-year-old white males self-treating fentanyl or heroin dependence. Many spend large sums on kratom and may dose every hour to control symptoms.

Kratom use disorder and withdrawal
Stopping kratom can be difficult. Withdrawal begins 12–48 hours after cessation and lasts 1–3 days. Symptoms include aggression, irritability, restlessness, nervousness, mood swings, delusions, lethargy, insomnia, hot flashes, GI upset, hepatitis, and cardiac arrhythmias. Some patients require hospital admission for safe withdrawal. Always tell your doctor if you use kratom—include the dose, frequency, and duration.

Important note
Kratom should not be used to treat opioid withdrawal. Far safer and more effective medications exist to support recovery from opioid use disorder.

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Posted on September 3, 2025 by drlesliegreenberg

Sometimes I am asked by patients “What should I do with medication that I no longer need?” I tell them that pharmacies have specific days that they accept medications back.

That time is soon! National Prescription Fall Take Back Day Announced

When? On October 25, 2025 the DEA and its federal partners will team up for the 19th bi-annual National Prescription Drug Take Back Day!

How? Find a pharmacy near you at https://www.dea.gov/takebackday

Why is this important? National Prescription Drug Take Back Day is a vital opportunity to safely dispose of unused or expired medications. Keeping leftover prescriptions at home increases the risk of accidental ingestion, misuse, or abuse, especially among children and teens. Flushing medications or throwing them in the trash can harm the environment, contaminating water supplies and wildlife. Returning drugs to a pharmacy or official collection site ensures they are destroyed responsibly, protecting your family and community. By participating, you help reduce the opioid crisis, prevent accidental poisonings, and keep our environment healthier. Safe disposal truly saves lives.

I hope this helps.

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Breast Cancer Screening: What you need to know

Posted on August 19, 2025 by drlesliegreenberg

Breast Cancer Screening: What You Need to KnowBreast cancer is one of the most common cancers in women. Finding it early can save lives. A mammogram is a special kind of X-ray that can show changes in breast tissue before you or your doctor can feel them.

https:flickr.com/photos/seniwati/3179821198

When to Get a Mammogram

The American Family Physician guidelines say most women who are at average risk for breast cancer should start talking to their doctor about mammograms between ages 40 and 50. For many women, screening every two years from ages 50 to 74 is recommended. If you are younger but have a higher risk, your doctor may suggest starting sooner or having mammograms more often.

Why Screening Matters

A mammogram can find breast cancer early, when it is small and easier to treat. Early treatment often means less aggressive care and a better chance of recovery. Mammograms can sometimes find changes that are not cancer, so follow-up tests may be needed.

Who Is at Higher Risk?

You may have a higher risk for breast cancer if:

  • You have a close family member (mother, sister, or daughter) who had breast cancer.
  • You have certain genetic changes, like BRCA1 or BRCA2.
  • You had breast cancer before.

No cost BRCA1 and BRCA2 Genetic Screening in Northern Nevada

The Healthy Nevada Project offers no cost genetic screening for BRCA1 and BRCA2 to patients in Northern Nevada. These genes help protect you from cancer, but if they have harmful mutations/changes, your risk for breast and ovarian cancer is much higher. Knowing your genetic status can help you and your doctor make a plan for screening and prevention.

If you live in Nevada, you can sign up online at https://healthynv.org/  The test is a simple saliva sample or blood test, and your results are confidential.

I hope this helps.

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Colon Cancer Screening: Why starting at age 45 matters…

Posted on August 12, 2025 by drlesliegreenberg

As a family physician, I want to share important news that could save lives. Recent research from the American Cancer Society shows that more people between ages 45 and 49 are getting screened for colon cancer! As a result, more colon cancers are being found early, when they are easiest to treat. I like to tell my patients that colonoscopies find and excise colon polyps. It takes (most people) 10-15 years for a benign polyp to change to cancer. So, get your colonoscopy and have your colon polyps put in a jar!

Two large studies published in the medical journal JAMA found:

  • From 2004 to 2019, the number of new colon cancer cases in people ages 45 to 49 went up about 1% per year
  • After screening guidelines changed, the increase jumped to 12% per year from 2019 to 2022
  • Screening in this age group rose by 62% between 2019 and 2023

Why this matters:

  • Earlier diagnosis means better chances of a cure. Put that polyp in a jar!
  • According to the American Gastroenterological Association and the American Academy of Family Physicians, finding colon cancer early often means it can be removed before it spreads. After it spreads, this may require chemotherapy or radiation or more extensive surgery.
  • In many cases, doctors can find and remove precancerous polyps during a colonoscopy, stopping cancer before it starts

Common screening options:

  • Colonoscopy: a doctor looks inside your colon with a small camera to check for polyps or cancer
  • Stool-based tests: can be done at home and mailed to a lab; if results are abnormal, a colonoscopy is needed. I prefer my patients get colonoscopies!

Guidelines for screening:

  • Adults at average risk should begin screening at age 45
  • People with higher risk, such as those with a family history of colon cancer or certain genetic conditions, may need to start earlier
  • Screening usually continues until at least age 75

Challenges we still face:

  • People without health insurance are screened at lower rates
  • Those with less access to education are also less likely to be screened
  • Efforts are needed to make screening available to everyone

What you can do:

  • If you are 45 or older and have not been screened, talk to your doctor
  • Choose the screening option that works best for you
  • Remember that screening can prevent colon cancer or catch it early, when treatment works best

I hope this helps.

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Taking care of your heart during menopause: What every woman should know…

Posted on August 5, 2025 by drlesliegreenberg

As a family doctor who is also a Menopause Society Certified Provider, I often talk with perimenopausal and menopausal women. This stage of life brings many changes, and it’s an important time to focus on your heart health. A new study has found that only 1 in 5 women during menopause have ideal heart health, based on the American Heart Association’s Life’s Essential 8 guidelines.

Let’s break this down simply…What are Life’s Essential 8?

These are 8 key things that help keep your heart healthy:

  1. Keep your blood pressure in a healthy range
  2. Eat healthy foods
  3. Be physically active
  4. Don’t use tobacco
  5. Get enough sleep
  6. Maintain a healthy weight
  7. Keep your cholesterol in check
  8. Keep your blood sugar (glucose) under control

Doing well in these areas helps your heart, your brain, and your whole body feel better and work better.

What did the study show?

The study looked at women going through menopause and found that only 21 percent (about 1 in 5) had “ideal” scores for all 8 areas. That means most women had room to improve. The good news? Women with higher scores were less likely to have heart problems, strokes, or diabetes later on.

The study also showed that keeping blood pressure, blood sugar, and staying away from tobacco were especially helpful. Even if your score isn’t perfect right now, making small changes in just a few areas can still make a big difference.

What can you do?

  • Take a walk most days. Even 20 to 30 minutes can help your heart. This can be broken up into smaller time periods during the day.
  • Eat more fruits, vegetables, and whole grains AND cut back on processed foods.
  • Check your blood pressure regularly and take medicine if needed. Goal BP is less than 135/85.
  • If you smoke, quit! Talk to your doctor for support.
  • Try to get 7 to 9 hours of sleep nightly. Good sleep helps your heart and brain.
  • Know your numbers. Ask your doctor to check your weight, cholesterol, and blood sugar.

You’re not alone

Menopause can feel overwhelming, especially with all the changes happening in your body. But this is also a chance to build healthy habits that will support you for years to come. Small changes now can lead to big benefits later.

Remember, you don’t need to be perfect to be healthier. Start with one goal—maybe going for a walk after dinner or swapping soda for water. Every step counts.

Talk to your doctor, get support from family and friends, and take charge of your health. You deserve to feel strong, supported, and cared for during this important stage of life.

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Eating Eggs May Help decrease your chance of Alzheimer’s

Posted on July 29, 2025 by drlesliegreenberg

A new study shows that eating eggs may be good for your brain. The research looked at over 1,000 adults in the United States and found that people who ate more than one egg a week had a lower chance of getting Alzheimer’s disease.

Alzheimer’s is a condition that causes short-term memory loss and changes how the brain works. It usually affects older adults and can make daily life harder over time for the individual and their family. Scientists are always looking for ways to help prevent this disease—and diet may be one of them.

In this study, people were followed for almost seven years. During that time, 280 people—about 27%—were diagnosed with Alzheimer’s dementia. But the people who ate eggs regularly had a 47% lower risk of getting the disease compared to those who didn’t eat eggs as often.

One of the reasons eggs might help is because of a nutrient called choline. Choline is mostly found in egg yolks and helps with memory and brain function. The study found that 39% of the protective effect of eggs came from choline. This means that choline could play a big role in helping the brain stay healthy.

So, what does this mean for your diet? It’s simple: eating a few eggs each week, especially with the yolk, may be a small step toward protecting your brain. Eggs are also affordable, easy to cook, and packed with other good nutrients like protein and vitamins.

As family doctors, we know that no single food can prevent a disease. But adding healthy foods like eggs to a balanced diet can make a big difference over time. If you’re already eating eggs a few times a week, you’re likely doing your brain a favor!

Of course, everyone’s health is different. If you have high cholesterol or other health concerns, talk to your doctor before making big changes to your diet.

In summary:

  • Eating more than one egg per week may lower your risk of Alzheimer’s disease.
  • Eggs are rich in choline, which helps support memory and brain health.
  • This benefit is linked mostly to the egg yolk, so don’t skip it.
  • A healthy diet, including eggs in moderation, can be part of a brain-smart lifestyle.

This research was published in The Journal of Nutrition and shared by The Hill on July 23, 2025.

Want help building a brain-healthy meal plan? Talk with your family medicine provider—we’re here to support your health at every age.

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When should you take your blood pressure medication?

Posted on July 18, 2025 by drlesliegreenberg

Do you or someone you love take medicine for high blood pressure? A new study says that taking it at bedtime might help even more than taking it in the morning!

This study was shared by HealthDay and published in a science journal called JAMA Network Open. The researchers wanted to learn if the time people take their blood pressure medicine makes a difference. They looked at two groups of people. One group took their medicine in the morning, and the other group took it at bedtime.

Guess what? The group who took their medicine at bedtime had better results!

What Is Blood Pressure?

Blood pressure is how hard your blood pushes against the walls of your blood vessels. If it’s too high, it can cause problems like strokes or heart attacks. People who have high blood pressure often take medicine every day to help keep it safe.

What Did the Study Find?

The study found that the bedtime group had lower blood pressure at night. This is important because our hearts need to rest while we sleep.

Here are some of the results:

  • People who took their medicine at bedtime had a 3.0 mm Hg lower top number (systolic) at night.
  • Their bottom number (diastolic) was also 1.4 mm Hg lower at night.
  • More people in the bedtime group had good blood pressure control at night — about 79% compared to 70% in the morning group.
  • Their body clocks, also called circadian rhythms, were working better too.

What Is a Circadian Rhythm?

A circadian rhythm is like your body’s clock. It helps you feel awake during the day and sleepy at night. It also controls things like heart rate and blood pressure. When your body clock is off, your blood pressure can stay too high while you sleep. That’s not good for your heart.

Taking medicine at night helps match the medicine to your body’s natural rhythm. It works when you really need it — while you’re sleeping!

What Does This Mean?

This study shows that bedtime might be the best time to take blood pressure pills. It could help your heart stay safe and healthy while you sleep.

But don’t change your medicine time without asking your doctor first. Everyone is different, and your doctor knows what’s best for you.

In Summary:

A new study shows taking blood pressure medicine at bedtime helps lower blood pressure better at night. It also helps your body’s natural clock work better. Talk to your doctor if you want to learn more about what time is best for you to take your medicine.

Taking care of your heart is important — even while you sleep!

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