Normal oxygen saturation levels (SpO2) are between 95 to 100 percent for both adults and children.
Oxygen saturation levels below 95% are considered abnormal, and the brain may be affected when SpO2 levels drop below 80 to 85 percent. Bluish discoloration of the skin or mucous membranes (cyanosis) occurs when SpO2 levels fall below 67%.
However, older adults usually have slightly lower oxygen saturation levels than younger adults and children. People over 70 years of age may have oxygen levels closer to 95%, which can be normal for that age group, while normal SpO2 rates for infants and children are usually 97% and higher.
Low levels of oxygen in the body’s tissues are called hypoxia. Low levels of oxygen in the blood are called hypoxemia. Both hypoxia and hypoxemia can occur separately, though they often occur together because when blood oxygen levels are low, the blood does not deliver enough oxygen to the body’s tissues. Hypoxia is often used to describe both low oxygen in the body’s tissues as well as low blood oxygen.
Condition
SpO2 Levels
Normal
95% to 100% on both adults and children
Abnormal (the brain may be affected)
80% to 85%
Bluish discoloration of the skin or Cyanosis
Below 67%
What Are Symptoms of Low Oxygen Saturation Levels?
Signs and symptoms of low oxygen saturation levels (hypoxia and/or hypoxemia) include:
Changes in skin color, ranging from blue to cherry red
Blue skin, lips, and fingernails
Confusion
Disorientation
Hypoxia is a medical emergency. If you are experiencing symptoms of hypoxia, call 911 and get to a hospital’s emergency department (do not drive yourself).
What Causes Low Oxygen Saturation Levels?
Oxygen saturation levels can vary based on a person’s underlying health. There are many different conditions that can cause low oxygen saturation levels, which may include:
Low oxygen saturation levels (hypoxia and/or hypoxemia) are diagnosed with a physical examination. A doctor listens to the heart and lungs and will also look to see if the skin, lips, or fingernails have a bluish color.
While tea itself cannot diagnose or treat depression, certain varieties and their components have shown promise in alleviating some symptoms and promoting overall well-being, which can be beneficial for people experiencing depression. We at StudyFinds read through different expert sources to compile a list of the top seven best teas for depression that were recommended most, so you don’t have to.
Important points to remember:
Tea is not a substitute for professional medical care: If you experience symptoms of depression, seek help from a doctor or mental health professional. Tea can be a complementary approach but not a replacement for necessary treatment.
Limited research: While these teas show promise, research on their effectiveness for depression is still ongoing, and results may vary.
Individual responses: People react differently to teas, and what works for one person may not work for another.
Potential side effects: Some teas can interact with medications or have side effects, so research any tea before consuming it and consult your doctor if you have any concerns.
How does tea help with depression?
Certain teas boast mood-boosting properties. Green tea’s L-theanine soothes and focuses, while St. John’s wort’s hypericin tackles mild to moderate depression (check with your doctor first!). Chamomile and lavender gently calm and lull you to sleep, crucial for managing depression.
Finding your perfect brew is key. Feeling anxious? Chamomile, lavender, or lemon balm offer serenity. Need focus? Green tea’s L-theanine can be your ally. Craving a mood boost? Rosehip’s vitamin C invigorates, while peppermint refreshes.
You are not alone, and there are many resources available to help you manage depression aside from trying new teas. If you need a lift, we at StudyFinds have researched across multiple expert sources to bring you today’s list of the top seven best teas for depression. Don’t agree with our suggestions or feel we missed out on a good one? No worries. We would love to hear from you in the comments below!
A cup of tea (Photo by Julian Hochgesang on Unsplash)
The List: Best Tea for Depression, According to Experts
If your morning cup of coffee is making you anxious, you might consider switching to green tea. Green tea is high in caffeine and L-theanine, an amino acid that may reduce anxiety. “Researchers suggest that green tea can exert protective effects against depression by decreasing oxidative stress. Polyphenols present in green tea also have antidepressant effects,” shares Health Match.
StudyFinds’ top pick for the best green tea: Rishi Sencha Organic Green Tea
Green tea is loaded with many health benefits, including aiding in depressive symptoms. “A 2009 study of participants ages 70 and older showed that there was a lower prevalence of depression symptoms with increased green tea consumption,” says Healthline.
A common method for combatting depression is trying to get better sleep. “We all know sleep is incredibly valuable for our mental well-being, but it can be elusive for all too many of us. Insomnia is unfortunately a compounding issue for those with mental health issues. People turn to meditation, sleeping pills, light therapy, etc. to fix the issue. If you are looking for the right type of tea to put you to sleep though, look no further than chamomile tea. It’s an herbal tea and made of dried chamomile flowers, which means no caffeine,” states MHAO.
The only people who should avoid this tea are those with allergies to chamomile and pollen, along with infants and young children. “Chamomile tea is common among those who are struggling with depression or anxiety,” adds Halmari Tea.
Chamomile tea is widely regarded as a mild sleep inducer. It may be beneficial if you have insomnia due to depression or anxiety. Research has also shown that chamomile may reduce anxiety in patients with mild to moderate generalized anxiety disorder,” shares Health Match.
Think about it, just the smell of lavender alone can put your mind at ease. “It’s been used to treat depression and anxiety as an essential oil and extract, and studies from Germany found it to be as effective as other pharmaceuticals for anxiety and depression without the downside of drowsy side effects. Stabilizing the mood and promoting sleep are only some of the benefits of lavender tea. Unless it is mixed with green or black tea though, you won’t get any caffeine,” says MHAO.
Amazon’s Overall Pick: The Tao of Tea, Lavender Herbal Tea
Lavender essential oil has long been used to help treat depression and anxiety in Ayurvedic medicine and other holistic regimens. “In one study of the German lavender supplement known as Silexan, researchers found the lavender oil was just as effective as Lorazepam—a sedative prescribed for anxiety symptoms. The research also found that lavender didn’t have the drowsy side effects associated with many anxiety and depression medications. That means you can enjoy this tea all day long while still being able to focus and work,” adds Sencha Tea Bar.
Along with the amazing benefits for your mind, the flavor is delightful. “Consuming lavender tea can help reduce depression and anxiety scores, as shown in a clinical trial involving older people,” states Health Match.
Drinking this tea can be very beneficial to reduce depression and anxiety in the body. “Gingseng tea reduces the feeling of fatigue which leads to depression and is quite effective against hormonal or office stress. It has a bitter taste that later gives a carrot-like flavor at the end. Gingseng tea has been quite effective in improving mood and boosting cognitive function which improves the problem of depression. You can add a little milk in ginseng tea if you find it bitter and tasteless,” says Only My Health.
Amazon’s Overall Pick: Korean Panax Red Ginseng Tea
You can have this tea anytime in the day. “A randomized, double-blind, placebo-controlled study examined the effects of ginger in 90 subjects with chronic fatigue. Researchers found that ginseng helped improve mood and boosted cognitive performance,” explains Sencha Tea Bar.
Ginseng tea comes from Korea and uses the root of the ginseng plant. “Ginseng has a more bitter taste with a touch of sweetness and has been compared to carrots. Not only will it boost your mood, but it’s also known to help your immune system and cognitive function. Mental fatigue and stress go hand-in-hand, and burnout can really take a toll. Now and then, it’s good to remind yourself that you’re doing just enough and thank your body for all its hard work with rest and kindness; ginseng tea is here to help with that,” offers MHAO.
Lemon balm tea is specific in its taste and flavor. “Lemon Balm tea is extremely beneficial because it has high levels of antioxidants that are known to reduce stress levels in humans. This tea belongs to the mint tea family and offers a great combination of taste and freshness to the person,” says Only My Health.
Amazon’s Overall Pick: FGO Organic Lemon Balm Tea
Lemon balm tea can show its affect in 15 days of regular consumption, it reduces moderate anxiety and depression. “A study published in Neurochemical Research found that lemon balm tea increased GABA levels and decreased corticosterone levels including those of cortisol (4). GABA is a neurotransmitter that induces relaxation while cortisol is known as the human stress hormone. This research shows that drinking lemon balm tea may help treat symptoms of anxiety on a chemical level in the brain,” informs Sencha Tea Bar.
Lemon tea has a calming effect on the person which makes it great to have before going to bed. “A 2014 research article of two small studies, in which participants drank iced tea with lemon balm or ate yogurt with lemon balm, showed positive effects on mood and anxiety level reduction,” adds Healthline.
Ashwagandha tea is recommended by many people and is treated as an herbal medicine as well. “Ashwagandha is known to manage stress levels and other mental health disorders. It helps to improve a variety of functions like boosting brain function, reducing anxiety and depression, and lowering blood sugar levels and cortisol levels in the body,” says Only My Health.
Amazon’s Overall Pick: Herbal Cup Ayurveda Ashwagandha Tea
Ashwagandha tea helps improve immunity which increases dopamine levels in the body and reduces stress hormones and depression symptoms. “Ashwagandha is an ancient medicinal herb. It’s classified as an adaptogen, meaning it can help your body manage stress. This traditional Ayurvedic herb is known for its medicinal properties and has been used for centuries to protect people’s health,” offers Healthline.
Ashwagandha tea is a medicinal herb that is also famous in Ayurveda. “It refreshes your brain and helps in managing body functions as well. It is also helpful in relieving anxiety and depression. Because of its ancient popularity, people have trusted ashwagandha as a natural remedy. It is also helpful for hair as well,” states Halmari Tea.
Peppermint tea boasts powerful anti-anxiety properties thanks to its invigorating scent. “The tea is made by infusing the leaves of the peppermint plant in hot water. The result is a pale green tea that offers a delightfully refreshing aroma with hints of pine and a tingling flavor,” says Sencha Tea Bar.
Peppermint offers the same effects on the nervous system as other herbal teas, helping to reduce cortisol levels and boost mood. “Peppermint is believed to have an uplifting effect on mood. Its bright, invigorating flavor is an instant boost, especially when blended with green tea,” shares The Whistling Kettle.
The tea boasts anti-inflammatory properties that can help to reduce pain. “Animal model studies have shown that peppermint tea can relax the central and peripheral nervous systems,” adds Health Match.
Researchers say the quality of sleep in younger years can impact memory in older age. Maria Korneeva/Getty Images
Sleep disruptions – waking up and then going back to sleep during the night – may contribute to memory and cognitive problems.
The duration of sleep was not considered in the study.
Researchers reported that cognitive issues showed up 10 years after the end of the study.
People who experience disrupted sleep in their 30s and 40s are more likely to have memory and cognitive problems later in life, according to a study published in Neurology, the journal of the American Academy of Neurology.
Researchers looked at the sleep patterns of 526 people who were followed for 11 years.
To calculate averages, the participants wore a wrist monitor for three consecutive days, one year apart. They also reported bedtimes and wake times in a sleep diary.
In addition, the partcipants completed a sleep quality survey, receiving a score ranging from 0 to 21, with higher scores indicating poorer sleep quality.
The scientists also recorded how long each person slept each night.
Participants also completed a series of memory and thinking tests.
The study included 526 participants with an average age of 40 at baseline who were followed for 11 years. Of these, 239 people, or 46%, reported poor sleep, which was defined as having a sleep score of greater than 5.
The percentage of time not moving for one minute or less
The scientists added the two percentages to determine an average sleep fragmentation score. Overall, the participants had an average sleep fragmentation score of 19%. The researchers then grouped the participants based on their scores.
The researchers reported that of the 175 participants with the most disrupted sleep, 44 had poor cognitive performance 10 years after the study ended, compared to 10 of the 176 with the least disruptive sleep.
The scientists noted that after adjusting for age, gender, race, and education, the people with the most disruptive sleep were more than twice as likely to have poor cognitive performance as those with the least disruptive sleep.
They also found no differences in cognitive performance in the middle group compared to those with the least disruptive sleep.
The length of time people slept and self-reported sleep quality were not associated with cognition in middle age.
“This important work shows how healthy brain aging is a lifelong endeavor,” says Dr. David Merrill, a geriatric psychiatrist and director of the Pacific Neuroscience Institute’s Pacific Brain Health Center in California who was not involved in the study.
“Even in early adulthood, sleep quality results in measurable changes in cognitive performance by mid-life. The study findings support the importance of sleep quality, uninterrupted, or unfragmented sleep in relation to cognitive performance,” Merrill told Medical News Today.
“Undoubtedly, we need a certain minimal quantity of sleep too, but the study wasn’t a sleep lab study, so it wasn’t structured to ask that question,” Merrill added. “Perhaps [discussing sleep patterns with my patients and] encouraging them to use sleep trackers so they can see for themselves how better sleep quality relates to days with improved energy and thinking. There are great direct-to-consumer wearables now that can allow us to know how well we’re doing to get a good quality night’s sleep.”
The researchers reported that the most significant limitation of the study was its small sample size. This prevented the researchers from thoroughly investigating potential race or gender differences.
“This is a very interesting study,” said Dr. Steven Feinsilver, the director of the Center for Sleep Medicine at Northwell Lenox Hill Hospital in New York who was not involved in the study.
“We all know that sleep is good for you and the results of this study are undoubtedly true. But the question is, what came first: Did poor sleep quality cause cognitive dysfunction or did cognitive dysfunction cause poor sleep quality?,” Feinsilver asked.
“Everyone wakes up during the night, but most people don’t remember. We have what is called retrograde amnesia – the last few minutes before falling asleep doesn’t make it into our long-term memory,” Feinsilver told Medical News Today. “This is also true of waking during the night. If we wake up and quickly go back to sleep – which is very common – we don’t remember it.”
“There is still a lot that we don’t know about sleep,” he added. “But the most important aspect is – how do you feel the next day? If you typically feel good during the day, you probably get enough sleep. The average person needs about 7.25 hours, but this is an average. Some may need more; some may need less. People aren’t very good at assessing their own sleep, but they can assess how they feel during the day.”
It is possible that cognitive function is related more to the quality of sleep rather than the length of time spent sleeping.
A studyTrusted Source completed in 2021 at Washington University Sleep Medicine Center reported that there could potentially be a middle range where cognitive function remained steady.
The scientists found that too little and too much sleep could contribute to cognitive difficulties. Cognitive scores declined in participants who slept less than 4.5 hours or more than 6.5 hours. The association held true even after adjusting for a variety of factors, including age, sex, and levels of Alzheimer’s proteins.
People who wake up feeling rested should not feel compelled to change their sleep habits, experts say.
However, those who do not sleep well might notice they have more difficulty with cognitive tasks. Treating the issue can potentially improve cognition.
When health problems affect your kidneys, they can cause CKD. This is permanent damage that may get worse over time. If they’re so damaged that they stop working, it’s called kidney failure, or end-stage renal disease (ESRD). The treatment is usually either dialysis — when a machine does the work your kidneys normally do, or a transplant — when you get a new healthy kidney from a donor.
Diabetes
2/13
This leading cause of kidney failure damages the organs’ small blood vessels and filters. That makes it difficult for them to clean your blood. Your body holds on to more salt and water than it should, and there’s more waste in your system. Nerve damage caused by the disease can make urine back up and harm your kidneys through pressure or infection.
Anorexia Nervosa
3/13
People who have this have an unrealistic body image, and they don’t eat enough to stay at a healthy weight. (They weigh at least 15% less than they should.) That can lead to a lack of water, electrolytes, and salt in the body, which can cause chronic kidney disease and, eventually, kidney failure. This is especially true for people who binge-eat and purge (vomit or use laxatives) to get rid of calories.
High Blood Pressure
4/13
If the force of blood flow through your body is too high, it can stretch and scar — and weaken — your blood vessels, including the ones in your kidneys. This can keep them from getting rid of waste the way they should, and the extra fluid in your blood vessels can raise your blood pressure even more, leading to a dangerous cycle. It’s treated with medication and changes to things like your diet, exercise habits, and stress level.
High Cholesterol
5/13
If you have too much bad cholesterol, it can build up in the vessels that carry blood into and out of your kidneys, and that can affect how well they work. It also makes you more likely to have high blood pressure and diabetes. A blood test can tell you if your cholesterol level is too high.
Lupus
6/13
This is a disease that makes your immune system attack certain parts of your body. When it affects your kidneys, it’s called lupus nephritis. It causes inflammation and scarring of the small blood vessels that filter waste out of your kidneys, and sometimes in your kidneys as well. It’s treated with different medications: Some affect your immune system, while others help control your blood pressure or get rid of swelling and excess fluid.
Multiple Myeloma
7/13
This kind of cancer involves the white blood cells (plasma) that help you fight infection. The cancer cells build up in your bone marrow, where they crowd out healthy blood cells and make abnormal proteins that can cause kidney problems. More than half the people with multiple myeloma also end up with kidney problems.
Hemolytic Uremic Syndrome
8/13
This happens when small blood vessels in the kidney and other organs get damaged. That can eventually cause kidney failure. It happens after 5 to 10 days of diarrhea, usually brought on by an infection, like from E. coli bacteria. Most people recover if it’s treated quickly. See your doctor if you have several days of diarrhea, aren’t peeing often, and are very tired. You also may get bruises or unusual bleeding.
ANCA Vasculitis
9/13
This is when your own antibodies — which usually fight germs — attack the small blood vessels in your kidneys and other organs. It may lead to blood and protein in your urine and can cause kidney failure. You may have fever, body aches, joint and muscle pain, and brown, tea-colored pee.
Urine Blockage
10/13
If you can’t pee, that can mean urine is backed up, and that can damage your kidneys. It can cause pressure and lead to infection in your kidneys and other parts of your body. An enlarged prostate, prostate cancer, kidney stones, bladder cancer, urinary tract blood clots, and colon cancer are some of the things that can cause this. See your doctor if you’re peeing much less or much more often than usual or if you see blood in your urine.
Blood Clots
11/13
Many conditions can cause blood clots, but a blood disorder — thrombotic thrombocytopenic purpura — is commonly linked to kidney problems. It causes clots in tiny blood vessels that also can affect your brain and heart. Symptoms include fever, bleeding from your nose or gums, diarrhea, chest pain, confusion, headache, bruising, and feeling very tired. It can be serious if it’s not treated quickly, so see a doctor if you have any of these signs.
Scleroderma
12/13
This is a group of rare diseases that make your skin and connective tissues hard and tight. It can sometimes also harm other things, like blood vessels and organs. If it affects your kidneys and they don’t work the way they should, they can let protein escape through your urine. It also can cause a sudden increase in blood pressure that can lead to rapid kidney failure.
Polycystic Kidney Disease
13/13
This causes cysts — small sores often filled with fluid — to grow inside your kidneys. That makes them much larger than they should be and damages their tissue. It’s caused by problem genes you get from one of your parents. If it’s not diagnosed and managed soon enough, it can lead to chronic kidney disease and, eventually, to end-stage renal disease.
Quality — not quantity — of sleep may matter most, research suggests
People who had fragmented sleep in their 30s and 40s were more likely to have worse cognition a decade later, longitudinal data showed.
Those in the highest versus the lowest tertile of the sleep fragmentation index had over twice the odds of performing poorly on three types of cognitive tests 11 years later, said Yue Leng, PhD, of the University of California San Francisco, and co-authors.
Cognitive performance was worse on the Montreal Cognitive Assessment (MoCA) test of global cognitive function (OR 2.29, 95% CI 1.06-4.94), Letter Fluency and Category Fluency tests (OR 2.42, 95% CI 1.17-5.02), and the Digit Symbol Substitution Test (DSST) of processing speed, executive function, and working memory (OR 2.97, 95% CI 1.34-6.56), the researchers reported in Neurologyopens in a new tab or window.
Neither objective sleep duration nor subjective sleep quality was associated with cognition.
“Since Alzheimer’s disease pathology begins to accumulate in the brain many years before symptoms onset, it’s possible that sleep disturbances identified in late life — close to the time when memory loss becomes apparent — is actually the consequence of this pathology that has been developing silently over the years,” Leng said in a statement.
“Given the long, symptom-free window of Alzheimer’s disease and the high prevalence of sleep problems, the understanding of midlife sleep disturbances has significant public health implications,” she added.
Leng and colleagues studied 526 participants in the CARDIAopens in a new tab or window cohort. Mean baseline age was 40.1; 58% were women, and 44% were Black.
From 2003 to 2005, the researchers assessed sleep duration objectively using wrist actigraphy and sleep quality subjectively using the Pittsburgh Sleep Quality Index (PSQI). Actigraphy was measured for 3 consecutive days on two occasions approximately 1 year apart.
Mean sleep duration was 6.1 hours, and 45.6% of participants indicated they had poor sleep quality, defined as a PSQI global score greater than 5.
The sleep fragmentation index — a measure of restlessness during sleep — was based on the percentage of time participants were moving and the percentage of time they were immobile. A higher fragmentation index indicated more disrupted sleep.
The mean sleep fragmentation index in the study was 19.2. The highest tertile of participants had an index greater than 20.6, and the lowest tertile had an index less than 15.3.
Cognitive testing occurred from 2015 to 2016, and poor cognitive performance was defined as a score one or more standard deviations below the mean.
The association between sleep fragmentation and cognition did not differ by race or sex. On two other cognitive tests that were administered — the Rey Auditory Verbal Learning Test and the Stroop test — sleep fragmentation did not have a statistically significant relationship with cognitive performance.
“Although we examined sleep in the mid-30s to late 40s and cognition 11 years later, we were unable to control for cognition at baseline or study the link between sleep and cognition beyond this period of life,” Leng and co-authors acknowledged.
“We also could not assess whether cognition improved with an improvement in sleep quality,” they added. “Future studies are needed to determine the impact of sleep on cognition even earlier in life and clarify the direction of this relationship.”
Although three-quarters of women experience menopausal symptoms, a subset of more than a third of women have moderate to severe symptoms that are frequently debilitating. Hallmark symptoms include hot flushes and night sweats that persist for about 40% of women into their 60s, disturbed sleep, anxiety and low mood, and vulvovaginal atrophy.
Large randomised controlled trials have shown that MHT reduces fractures (even in the absence of osteoporosis), colon cancer, endometrial cancer, and diabetes risk, and that oestrogen-only MHT reduces cardiovascular disease events.
Randomised controlled trials have also shown increased venous thrombosis and gall bladder disease risk with oral oestrogen, and a small increase in breast cancer with oestrogen plus medroxyprogesterone acetate (MPA) or norethisterone (NETA). Hence MHT has shifted to predominantly non-oral oestradiol and, when indicated, progesterone or dydrogesterone.
has triggered a global shockwave of fear among women that MHT causes breast cancer, similar to that generated previously by the sensational reporting of the first publication of the Women’s Health Initiative (WHI) study. The false perception that resulted from misreporting of the WHI findings led to thousands of women discontinuing or never commencing therapy. Australian data published in 2015 suggest that only about 11% of perimenopausal and postmenopausal women aged 40–65 years use MHT despite high symptom prevalence.
Data from observational studies can be hypothesis generating but tend to overestimate treatment effects. Hence, randomised trials are essential to confirm or nullify their findings. Use of routinely collected health data without a priori research aims increases the chance of bias. Much of the data included in the recent Collaborative Group analysis
was collected during routine health delivery, or relied on participants recalling past treatment and duration of use. Specific characteristics of the included populations—nurses in the Nurses’ Health Study
Despite the investigators describing their work as worldwide epidemiological evidence, 67% of the prospective data were from two UK databases (unpublished routinely collected general practice health data and the Million Women Study)
and 24% were from the USA, with only one study from the southern hemisphere included.
With acknowledged limitations, analysis of the WHI trials suggested an increased breast cancer risk with conjugated oestrogen–MPA therapy (hazard ratio [HR] 1·24, 95% CI 1·01–1·53), but no increased risk with oestrogen alone (HR 0·79, 0·61–1·02), with treatment durations of 5–7 years.
These risks are lower than the two-times increased risk for conjugated oestrogen–MPA therapy and 1·33-times increased risk for oestrogen alone estimates reported in the recent Collaborative Group observational analysis
for predominantly similar MHT formulations. This discrepancy is consistent with the expectation that observational findings are tempered by high-quality randomised controlled trials. Follow-up of the 27 347 participants in the WHI trials for 18 years provides the most convincing MHT safety data.
With mortality follow-up available for more than 98% of participants and 7489 deaths, all-cause mortality did not differ from placebo for daily conjugated oestrogen–MPA therapy (HR 1·02, 95% CI 0·96–1·08) or for conjugated oestrogen only (0·94, 0·88–1·01).
Neither oestrogen alone nor oestrogen–MPA were associated with total cancer mortality, or any specific cancer mortality, in the intervention or follow-up phases. For women aged 50–59 years at randomisation, pooled data suggested a significantly reduced all-cause mortality with MHT compared with placebo (HR 0·69, 95%CI 0·51–0·94, p=0·01).
This finding emphasises the precariousness of observational data and of evaluating any single effect of MHT in isolation, whether the outcome be a benefit or a risk, as the effects are a composite and clinical decisions are made on the basis of overall effects, including quality of life.
Notably, recommended MHT is now substantially different from that included in the Collaborative Group analysis.
Nearly all the data for combined oestrogen—progestogen therapy in the analysis pertained to NETA or MPA. The analysis had insufficient power to draw conclusions about the effects of the preferred progestogens, progesterone (only 50 breast cancer cases included) and dydrogesterone (253 cases). The investigators’ conclusion that progesterone was associated with a two-times increased breast cancer risk if used for 5–14 years was based on only 38 breast cancer cases for this duration of use.
A potentially dangerous consequence of misinterpreting observational data in this context is that early (<45 years) or prematurely (<40 years) menopausal women could stop their MHT. 10% of women have early menopause. Thus, the norm for women younger than 45 years is to be premenopausal. Because early or premature menopause is a hormone deficiency state, breast cancer risk is reduced, but the likelihood of osteoporosis, cardiovascular disease, and premature death is increased.
Therefore, for women prematurely menopausal, MHT is physiological therapy that restores overall risks, notably the risk of premature death, back to those of premenopausal woman of the same age.
The findings from the Collaborative Group analysis deserve to be better contextualised. In isolation, such reports offer a unidimensional perspective on a multidimensional issue, disregarding the profoundly detrimental effects of oestrogen deficiency symptoms for many women, the negative bone and cardiometabolic consequences of menopause, and the diverse beneficial effects of MHT. Even with the best estimates of benefits and risks, the art of medicine resides in listening to each woman’s story and providing care tailored to symptom severity and effect, and each individual’s overall benefit-to-risk profile.
Rising demand for menopausal hormone therapy (MHT) in the UK has resulted in shortages of some products, as suppliers struggle to keep up with demand. A consequence of increasing awareness of menopause symptoms and treatment options among women, prescriptions for MHT in England have doubled in the past 5 years to more than 500 000 a month. Used to alleviate distressing vasomotor symptoms, genitourinary syndrome of menopause, and postmenopausal osteoporosis, MHT can also help minimise disruptions to work and quality of life. In response to an outpouring of anger from women affected by the MHT shortages, on April 29, the UK Government announced the formation of a new taskforce to address the supply chain issues.
Although a natural part of reproductive ageing, menopause does not affect all women the same. Duration of the menopause transition, age at onset of natural menopause, and menopausal symptoms—type, severity, and duration—all vary and can be affected by both modifiable (eg, obesity, smoking) and non-modifiable (eg, race, ethnicity, socioeconomic status) factors. In the Study of Women’s Health Across the Nation (SWAN)—a multiethnic cohort of 3302 women in midlife in the USA—80% of women reported vasomotor symptoms, which persisted for a median of 7·4 years. Race and ethnicity strongly influenced the duration of vasomotor symptoms, with Black women reporting the longest duration (10·1 years) compared with Hispanic women (8·9 years), non-Hispanic White women (6·5 years), Japanese-American women (4·8 years), and Chinese-American women (5·4 years). Black women were also more likely to start menopause at a younger age, have a longer transition, and have more severe symptoms than other racial groups.
Yet beyond the reproductive transition, menopause is also a biopsychosocial turning point in cardiometabolic disease risk for women. Increases in insulin resistance, fat mass, dyslipidaemia, and endothelial dysfunction occur at the menopause transition, contributing to a worsened cardiometabolic profile independent of chronological ageing. Vasomotor symptoms, sleep disorders, and mood changes associated with menopause can also increase cardiometabolic risk. Additionally, a history of some reproductive and gynaecological conditions such as gestational hypertension or diabetes, premature ovarian insufficiency, and functional hypothalamic amenorrhoea can worsen the cardiometabolic profile. As a result, the menopause transition is associated with an increased risk of cardiometabolic diseases such as obesity, diabetes, cardiovascular disease, osteoporosis, dementia, and cancer that can emerge 10–15 years after the onset of menopause. In 2020, a scientific statement on behalf of the American Heart Association included the menopause transition for the first time as a sex-specific event that can profoundly affect future cardiometabolic health in women.
In the June issue of The Lancet Diabetes & Endocrinology, we publish a two-paper Series on menopause. The papers discuss the cardiometabolic changes that occur during the menopause transition and management approaches for menopause with a view to preventing cardiometabolic diseases. The overarching theme of the Series is that the menopause transition is a time of accelerating cardiometabolic disease risk. As such, it presents an important opportunity to raise awareness of the symptoms and downstream health consequences, adopt healthy behaviours and institute early management of traditional cardiovascular disease risk factors, and implement screening and preventive strategies to reduce the risk of chronic cardiometabolic diseases that can occur in later life.
For too long, women’s health-care needs at menopause have been under-recognised and underserved by the health-care profession. Writing in the second Series paper, Roger A Lobo and Anne Gompel concur: “menopause management is poorly practiced and has not been an adequate part of graduate or postgraduate education for health-care providers”. These deficiencies need to be remedied—health care for women approaching menopause, at menopause, and after menopause must be improved. With a demographic of half the world’s population, who spend around a third of their lives after menopause, the unmet need could not be larger. Education, support, and access to treatments for menopausal symptom relief and prevention of later-life chronic diseases must be available to all women irrespective of race, ethnicity, socioeconomic status, or geographical location. With such a foundation in place, women will be able to go through the menopause with confidence, embrace the next chapter of their lives, and lead longer and healthier lives.
Women spend approximately one-third of their lives with menopause, which occurs around 50 years of age. It is now appreciated that several important metabolic and cardiovascular disease risks emerge during the menopausal transition. Many important conditions occur 10–15 years after menopause, including weight gain and obesity, metabolic syndrome, diabetes, osteoporosis, arthritis, cardiovascular disease, dementia, and cancer; therefore, the occurrence of menopause heralds an important opportunity to institute preventative strategies. These strategies will lead to improved quality of life and decreased mortality. Various strategies are presented for treating symptoms of menopause and diseases that are asymptomatic. Among several strategies is the use of hormone therapy, which has efficacy for symptoms and osteoporosis, and can improve metabolic and cardiovascular health. When instituted early, which is key, in younger postmenopausal women (under 60 years) oestrogen has been found to consistently decrease mortality with a favourable risk–benefit profile in low-risk women. Prospective data show that long-term therapy might not be required for this benefit.
Menopause is often a turning point for women’s health worldwide. Increasing knowledge from experimental data and clinical studies indicates that cardiometabolic changes can manifest at the menopausal transition, superimposing the effect of ageing onto the risk of cardiovascular disease. The menopausal transition is associated with an increase in fat mass (predominantly in the truncal region), an increase in insulin resistance, dyslipidaemia, and endothelial dysfunction. Exposure to endogenous oestrogen during the reproductive years provides women with protection against cardiovascular disease, which is lost around 10 years after the onset of menopause. In particular, women with vasomotor symptoms during menopause seem to have an unfavourable cardiometabolic profile. Early management of the traditional risk factors of cardiovascular disease (ie, hypertension, obesity, diabetes, dyslipidaemia, and smoking) is essential; however, it is important to recognise in the reproductive history the female-specific conditions (ie, gestational hypertension or diabetes, premature ovarian insufficiency, some gynaecological diseases such as functional hypothalamic amenorrhoea, and probably others) that could enhance the risk of cardiovascular disease during and after the menopausal transition. In this Review, the first of a Series of two papers, we provide an overview of the literature for understanding cardiometabolic changes and the management of women at midlife (40–65 years) who are at higher risk, focusing on the identification of factors that can predict the occurrence of cardiovascular disease. We also summarise evidence about preventive non-hormonal strategies in the context of cardiometabolic health.
A whole day of eating right can go down in the swirl of cocktail — with crazy-high calories and weakened willpower. So we’ve put a few drinks on a diet, starting with the Cuban mojito. Instead of using sugar, use a wooden pestle or a big spoon to gently crush cubes of watermelon with fresh mint leaves. Add rum and sparkling water for a sweet mojito with half the usual calories.
Simple Margarita: 170 Calories
2/13
Skip the syrupy mixes in crazy colors and you’ll trim hundreds of calories from this Mexican cocktail. Measure out the basics: one shot of tequila, lime juice to taste, and a splash of triple sec. Shake with ice and serve. Staying within the limits of moderate drinking — one for women and up to two drinks per day for men — is another way to watch your calories and your waistline.
Skinny Piña Colada: 229 Calories
3/13
Rum that’s infused with a coconut flavor can cut about 300 calories from a piña colada. What’s out? The sugary, coconut milk mix. Measure one shot of coconut rum. Then add fresh strawberries, a splash of agave syrup, and blend with ice. You get a tall, 12-ounce tropical cocktail for about the same calories as in a handful of pretzel twists.
Shochu Cosmo: 70 Calories
4/13
Make a super-slim cosmopolitan by replacing the vodka with shochu, a Japanese spirit with a smooth flavor. A 2-ounce serving has only about 35 calories. Add splashes of diet cranberry juice, fresh lime juice, and orange juice, and then toss in a martini shaker. This cosmo shakes out at half the calories of a traditional cosmopolitan.
Slim Berry Daiquiri: 145 Calories
5/13
Simple, unadorned berries can help slim down a strawberry daiquiri. Start with 1 cup of no-sugar-added berries, either fresh or frozen. You get intense berry flavor for just 50 calories, compared with 255 calories in berries frozen with syrup. Add rum, ice, and sweeten the deal with 1 teaspoon of stevia, a sugar substitute. Blend into a slim and delicious frozen concoction.
Slim the Gin and Tonic: 75 Calories
6/13
Did you know that tonic water has nearly as many calories as soda? Switch to diet tonic water for a skinny version of this favorite cocktail. Bubbly seltzer water is another option that can shave calories — although it’s really a different drink without the bitter nip of quinine in the tonic water. In that case, punch up the flavor with a squeeze of lime juice or a flavored seltzer.
Better Bellini: 120 Calories
7/13
Slim down Italy’s festive Bellini by using just 2 ounces of peach nectar, about half the usual amount. Swirl the syrupy nectar together with 4 ounces of champagne and serve in a pretty, fluted glass. Mimosa lovers can try the same trick to cut the calories: use just half of the usual orange juice.
Asian Flavor Fusion: 90 Calories
8/13
Flavor-infused alcohols are a tasty way to limit juice mixes, which can be high calorie. Try ginger vodka and lime sparkling water for a fusion of Asian flavors at just 90 calories. Look for flavored seltzer or mineral waters that have no added calories.
Skinny Vodka Iced Tea: 80 Calories
9/13
The mix of lemonade and sweet iced tea, favored by golfer Arnold Palmer, becomes a popular cocktail when you add a shot of vodka. You can slice off half the calories in this tall, cool drink by using low-calorie lemonade and sweet-tea-flavored vodka. This specialty vodka is lower in calories than traditional types.
Lemongrass Collins: 90 Calories
10/13
Enjoy the tart flavor of a Tom Collins without the syrupy mix, sugar, and other sweeteners that bartenders often swirl into your glass. Our skinny version starts with vanilla vodka, instead of gin. Vanilla carries a sweet flavor with very few calories. Add a splash of lime juice and a zero-calorie sparkling water flavored with lemongrass, mint, and vanilla.
Skinny Cocktail Dos
11/13
Choose fresh 100% juice rather than mixes.
Use zero-calorie bubblers instead of soft drinks. Try flavored seltzer, sparkling water, or club soda.
Fewer ingredients mean fewer calories.
Pay attention. Moderation is key for your waistline and health.
Skinny Cocktail Don’ts
12/13
Don’t add creamed spirits or liqueurs. They double the calories in a cocktail.
Don’t use several shots in one drink. A Long Island iced tea has seven ingredients and 700 calories!
Don’t order an after-dinner drink, which is often sweet.
Don’t sip a sweet dessert wine, which has about 40 calories more than table wine.
Get the Calories Out of Grenadine
13/13
Do you love rosy red cocktails? If they call for grenadine, it’s a red alert that your diet is about to explode. Grenadine is pomegranate juice and simple syrup. To get the same look and a sweet taste with fewer calories, make your own grenadine. Boil down pomegranate juice and sweeten it with stevia.
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