Courtesy of Robin Herman

Robin Herman, 60, says it's harder to keep weight off after menopause. But some simple, subtle changes may help.

Robin Herman has always been slender. She eats right, exercises regularly and keeps an eye on her weight. But middle age and menopause have hit her right in the waistband, and she’s frustrated.

“What is this? I used to be able to look straight down at my feet and now there’s this rounded tummy in the way,” Herman says. While she’s still not overweight, Herman, 60, has gained 11 pounds that she just can’t seem to shake. Her problem illustrates what many women are finding in mid-life -- they are putting on pounds despite their best efforts.

“At first I cut back about a quarter of what I was eating. And then I was just eating about half of what I had been eating. Now I don’t take seconds. I don’t eat a lot of bread. I don’t eat potatoes. I don’t eat empty calories. I don’t drink sodas,” said Herman, who recently retired from the Harvard School of Public Health in Boston.

She joined Weight Watchers, a program that’s been clinically proven to work in helping people lose weight. “I kept a food diary. You could eat as many fruits and vegetables as you wanted. I put in a little more exercise,” she says.

“I got nowhere. It just wasn’t doing anything. And it was making me crazy about following every spoonful I ate.”

Herman sounds like thousands of women across the country who are slowly tipping over the point from being normal weight to overweight, or from being overweight to obese. A study published on Tuesday sheds a little light on what may work and why some approaches that help women shed a few pounds in the short term aren’t helping them keep the weight off long-term.

Bethany Barone Gibbs of the University of Pittsburgh Medical Center and colleagues analyzed data from a study of more than 500 overweight women in their 50s and 60s to see what made a difference. They had been randomly assigned to either intensive nutritional and exercise counseling, or to a more general, less weight-loss-focused program. The woman also reported what and where they ate, for four years.

As expected, more of the women who got specific diet and nutrition counseling lost weight. But Gibbs and colleagues wanted to know what worked for any of the women who managed to lose weight, regardless of which group they were in.

Early on, some of the more obvious diet strategies worked -- eating less fried food, staying away from restaurants, avoiding sweets and eating more fish. But these approaches didn’t work for the women in the long term, Gibbs reported in the Journal of the Academy of Nutrition and Dietetics.

 “What we found at four years is that the women who changed their eating behaviors to eat more fruits and vegetables, who ate less desserts, less sugar-sweetened beverages and less meats and cheeses were more likely to have greater weight loss or less weight gain long term,” says Gibbs, an assistant professor in the Department of Health and Physical Activity.

“But on the other hand, something like eating more fruits and vegetables did not predict weight change at six months but was one of the most important predictors for long-term weight change.”

Avoiding restaurants didn’t seem to make a difference long-term, either, she said. Gibbs said the key to keeping weight off long-term may be a little counter-intuitive. “Short term, people are still motivated when they start a weight loss program,” she said. “They are never going to eat another French fry, eat another piece of pie, so you see the pounds coming off.”

But hardly anyone can keep this kind of abstinent behavior up forever. The women who added fruits and vegetable to their diets, using them to replace higher-calorie meats and cheeses, lost more weight over the long-term. “That small change can give you a big, long-term result,” Gibbs said.

How could something so subtle work better than going for the big effect? In part, it’s because weight gain is often subtle and sneaky, too, says Katherine Tallmadge, a personalized nutrition counselor and speaker and immediate past president of the DC Metro Area Dietetic Association. “When people gain weight, it’s usually a pound or a pound and a half a year,” she says. “It is a very small and creeping kind of weight gain.”

The study also illustrates what many middle-aged women complain about. “I recall at age 25 if I wanted to lose five pounds I could do it in a week.  Now, it takes far longer to lose weight,” says Karen Giblin, president of menopause support organization Red Hot Mamas North America, Inc.   

This doesn’t surprise Dr . Domenica Rubino, an endocrinologist who runs the Washington Center for Weight Management and Research. “As we age, the average person has a tendency to gain weight and to gain more fat than muscle,” Rubino says. On top of this, women are undergoing hormonal changes that can disrupt sleep, stress them out and make them tired, three things also associated with weight gain. “Women are getting early morning awakening  and even though they are exhausted, they are not getting back to sleep,” she says.

Giblin can vouch for what happens next. “My willpower goes down the tube when I'm stressed and I will not do all the good things I should do be doing like eating properly and exercising,” Giblin says.

It all can add up to the muffin top effect: that shift of weight to the abdomen that makes clothes fit poorly, if at all, and that stresses out a woman every time she gets dressed.

“It’s so hard counting calories and keeping food diaries for years and years and years,” Gibbs agreed. “We have a population-sized problem here.” With two-thirds of Americans overweight or obese, she says, people need some simple solutions.  

“I've had to make exercise a lifestyle choice,” says Giblin, who co-authored "Eat to Defeat Menopause" with Dr. Mache Seibel last year. “Never skip a meal,” she advises. “And if you are prone to snacking, grab a piece of fruit or six  to eight almonds.”

Rubino says hormone replacement therapy can help, too, if it helps cut hot flashes and anxiety. “You are sleeping better and not having the hot flashes and your mood is better,” she says.

STOP Obesity Alliance Director Dr. Scott Kahan says managing stress can really help people control weight. “If things are very stressful, things are going on in your life, often stress management techniques can help,” he says.

Kahan and others admit this can be easier said than done. “I think we live in a very difficult time, a toxically busy world,” Tallmadge says. “What really upsets me is when people call themselves lazy or undisciplined when in fact they are running themselves ragged.”

But it’s not exercise.  Many women are busy getting their families ready for the day and then commuting during the very morning hours when they would have been otherwise most likely to exercise.

“It’s a real balancing act.”

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Starting Wednesday, millions of American women will no longer pay for birth control pills, Pap smears or mammograms -- not even a co-pay. Women also have the right to free breast-feeding support, supplies for pregnancy-related diabetes, also known as gestational diabetes, and even screening for domestic violence.

It's not clear how many women will take advantage of the new policy, but the US Health and Human Services Department estimates that 47 million women, ages 15 to 64, have private health insurance plans that will be affected. The 2010 health reform law requires that policies provided by private health insurance companies pay for a list of women’s health preventive services, starting August 1.

However, there may be a delay in services for many women. The law applies to new policies -- women with existing coverage may have to wait for their policies to renew for the requirements to kick in, which could take months. Many health insurers already provide this coverage.

The new rules are based on guidelines from the independent, non-partisan Institute of Medicine, which said paying for these services will save money and lives down the road.

“We want healthy women to have healthy babies,” said Dr. Jennifer Howse, president of the March of Dimes Foundation, a charity that works to prevent birth defects. “Receiving regular medical care greatly increases the likelihood that important messages can be delivered to pregnant women around issues such as nutrition and tobacco cessation, and provides opportunities to detect potentially dangerous conditions like gestational diabetes or high blood pressure.”

There are a few exceptions. Purely religious employers don’t have to provide the services to employees if they object. Related groups, such as Catholic-affiliated universities, have objected so the Obama administration offered what it called an accommodation, forcing the insurance companies themselves to pay for the coverage. But the religious associations still object, as do Republicans in Congress. They have promised to repeal the whole law if they win enough seats in the November election.

On Friday, a federal judge in Colorado ruled that a Catholic-owned heating and air conditioning company in Denver did not have to provide contraception coverage for its workers.

Americans also get refunds starting today from health insurance companies that spent too much on administrative expenses. The law requires health insurance companies to spend at least 80 percent of premiums on actual medical care and not on salaries, office rental and other overheads.

While opponents continue efforts to repeal the health care law, HHS secretary Kathleen Sebelius cheered the the promise of free screening for women's health services. 

"For too long insurance companies have stacked the deck against women, forcing us to pay more for coverage that didn't meet our needs,” Sebelius said Tuesday.

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Shawn Thew / EPA

US Secretary of State Hillary Clinton appeared on a large video screen at the 19th International AIDS Conference this week. Many presentations target women, who make up more than a quarter of new HIV infections in the U.S.

Del’Rosa Winston thought she’d done everything right. She kept herself in steady employment, and waited until she was married to start having children. When her marriage ended, she started having regular HIV tests, just in case. So when she settled into a new, steady relationship, she never dreamed she’d end up infected with the AIDS virus.

“I had a job. I had been in the military. I was educated,"  said Winston, a soft-spoken, well-groomed woman with fashionably cropped red hair. "I just got it from a straight man in a monogamous relationship."

More than a quarter of new infections in the United States every year are in women, and of the 1.1 million Americans with the AIDS virus, 280,000 are women, according to the Centers for Disease Control and Prevention. Black women are especially vulnerable – their infection rate is 15 times the infection rate for white American women.

Winston’s smooth skin and easy smile represent the hidden face of the AIDS epidemic in the United States – the people who don’t look like “typical” HIV patients. The 50-year-old mother of three hopes that speaking out at the 19^th International AIDS Conference, being held in Washington, D.C., will help reduce the stigma and ignorance that fuel the spread of the virus.

 “There are so many people who are getting it because they loved someone,” Winton told NBC News in an interview. Winston couldn’t wait to be in a steady, safe relationship so she could stop using condoms, which she found uncomfortable to use. Her boyfriend, who has since died, told her he had no idea he was infected. But he was, and so was Winston. “We didn’t fit the parameters of what an HIV-positive person looked like,” she said.

She can remember the moment in 1990 when she was told her test came back positive. “The room was gray,” she said. “Like stainless steel. I know there were objects in it but I couldn’t see them. I just flowed like water to the floor.”

Health experts at the conference say they are trying to find new and better ways to reach not only the people at the highest risk – young gay and bisexual men – but others, like Winston, who may not intuitively know how easily and insidiously the virus can move during a moment of passion.  “Everyone’s at risk, whether you have the greatest trust relationship or not,” Winston, who now works as an HIV counselor in Atlanta, said.

Health experts are also trying to figure out some of the factors that make women vulnerable and keep them from protecting themselves even if they do understand the risks. Winston has some ideas – women are often too busy looking after others. “We put everyone else first – kids, school, even the PTA. We get into the mind frame that we don’t have to care for ourselves,” she said.

Another factor may be domestic abuse. A team at the University of California San Francisco published a study on Monday showing that physical and sexual abuse and trauma are major factors affecting which women become infected.

“For a long time we have been looking for clues as to why so many women are becoming infected with HIV and why so many are doing poorly despite the availability of effective treatment,” said Dr. Edward Machtinger, who led the study. “Women who report experiencing trauma often do not have the power or self-confidence to protect themselves from acquiring HIV.”

Their team did a study called a meta-analysis, looking at data from other studies involving 5,900 women. They found 30 percent of women infected with HIV had post-traumatic stress disorder, or PTSD, compared to 5 percent of the general population.  Twice as many women with HIV reported they had been victims of partner violence as women without the virus, they found.

Kat Griffith thinks she knows why. The slender redhead from Peoria, Illinois has been HIV positive for 21 years and she blames a violent boyfriend from high school. “I had a jealous and controlling partner who called me names, demeaned me,” she said. “I had no self-esteem.”

But Griffith went away to college and, she thought, started a fresh new life. “I knew that HIV could affect me and I thought I asked all the right questions,” she said. “But my abuse made me feel I was not worthy of protection." Her college boyfriend infected her.

Women may often put others first but they also lack a good way to protect themselves, Griffith noted.

For years, researchers have been looking for ways to protect women against the virus. There’s been hit-and-miss progress with microbicides – gels or creams that women can use quietly to reduce the chance they’ll become infected during sex. On Tuesday, researchers will announce the start of an advanced, Phase 3 trial of a device called a vaginal ring impregnated with dapivirine, a drug used to treat people with HIV. Researchers will enroll 3,500 women in the two-year study to be conducted in Africa, where half of all HIV patients are women.

Studies have shown that microbicide gels or creams can work - at the last AIDS conference in Vienna in 2010, researchers reported on one that reduced a woman’s risk of infection by 39 percent. But other studies haven’t done so well and experts fear inconsistent use may be one problem.

A flexible, silicone ring may be easier to use and less intrusive than a gel that must be applied before and after sex, the researchers hope. So does Griffith. “After 30 years, we still do not have a completely female controlled prevention technique,” she said.

The search for the female G-spot -- that supposedly erotic pleasure button somewhere in the vagina -- has become like the search for the Lost City of Atlantis. Some insist it’s real and that they’ve found it; others insist it’s a myth; and still others say it was never lost, it’s just part of an island we’ve known about all along, an extension of the clitoris.

Now a surgeon from Florida is insisting he’s not only solved the mystery, but that he’s held the G-spot in his hands.

Dr. Adam Ostrzenski, a surgeon and retired professor of gynecology, who now practices “cosmetic gynecology” in St. Petersburg, reports in an article in the Journal of Sexual Medicine today that he found the G-spot in an 83-year-old Polish woman. It is, he told msnbc.com, not an extension of the clitoris, as many experts believe, but a discrete structure angling away from the urethra.

He based his search, he says, on previous investigations and readings dating as far back as the third century A.D.

“I incorporated that into my protocol for how to identify where to go” in the vagina, he explains. “I put this together. My entire life has been surgery and developing new surgical techniques…and now, of course, there is the excitement of being the first human being to see and touch this structure.”

The bizarre G-spot controversy that has gone on for nearly 40 years, he says, “should be resolved.”   

The question is: Has the doctor done it?

First, Ostrzenski dissected a cadaver, so there is no way to know how the ropy, bluish structure he displays in his paper functioned other than that it seemed to be erectile. Second, the woman was 83-years-old, about 30 years past menopause and its dramatic hormonal shifts. Third, she is just one woman.

“It’s speculation,” Dr. Amichai Kilchevsky, a Connecticut urological surgeon who has conducted his own investigation into the G-spot, says. “It is almost impossible to say what it is, based on what he describes.”

It could be some sort of gland, an extension of the clitoris as some have long maintained, or something else entirely. Without any functional information or even a sexual history of the woman and whether or not she was orgasmic, nobody can claim much of anything, says the urological surgeon and researcher.

Yet, Ostrzenski told msnbc.com, over 50 reporters from all over the world have called him to prepare stories on his “discovery,” evidence of a kind of G-spot mania. The G-spot (like everything) has even become political, with some women arguing that G-spot denial is an anti-woman slander meant to keep women from fulfilling their sexual potential.

It’s also become a business. A German doctor named Ernst Gränfenberg first described the spot, supposedly an inch or two inside the vagina on the anterior wall (facing the front of a woman, not the back) in 1953. Then, in 1982, a book called The G-Spot: And Other Discoveries about Human Sexuality popularized Gräfenberg's findings. Now, sex toy manufacturers sell G-spot stimulators, publishers offer G-spot how-to books, and surgeons offer “G-spot augmentation” meant to enhance sexual pleasure.

“Certainly, if we can prove there is a G-spot, and we could enhance it, surgeons could benefit,” Kilchevsky says.

But maybe not the patients. The dark side of the mania is that many women who’ve come to believe the G-spot is real say they can’t find it, or that they don’t have it. They worry they’re doing something wrong, or that they are defective in some way, and missing out on sexual pleasure.

As Dr. Rachel Pauls, a uro-gynecologist at Cincinnati’s Good Samaritan Hospital told msnbc.com back in 2008, "I see patients looking for the G-spot, and they come to see the doctor because they are so upset they cannot find it.”

“There is such a huge psychology of this,” argues Kilchevsky. “Women who say they experience vaginal orgasms may be experiencing clitoral stimulation and not the G-spot. Finding a G-spot isn’t going to help women understand their bodies. If anything, it might upset women if they feel they can’t experience it.”

Ostrzenski says he understands that the controversy won’t die based on this one paper. He has plans to return to Poland next month to dissect more, younger cadavers, and to conduct more in-depth analysis of the structure, partly in preparation for “clinical applications.”        

“I am close to putting the putting the controversy to rest completely,” he says.

That’s doubtful. But not the end of the world -- or good sex. After all, women and their sexual partners don’t have to pay any attention at all to the G-spot. All they have to do is figure out what feels good, and do it. 

Brian Alexander (www.BrianRAlexander.com) is co-author, with Larry Young PhD., of "The Chemistry Between Us: Love Sex and the Science of Attraction," to be published Sept. 13.

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Women tend to find it harder to quit smoking than men, and a new study suggests why — women's brains respond differently to nicotine, the researchers say.

When a person smokes, the number of nicotine receptors in the brain — which bind to nicotine and reinforce the habit of smoking — are thought to increase in number.

The study found in men, this is true — male smokers had a greater number of nicotine receptors compared to male nonsmokers. But surprisingly, women smokers had about the same number of nicotine receptors as nonsmokers.

"When you look at it by gender, you see this big difference," said study researcher Kelly Cosgrove, an assistant professor of psychiatry at Yale University School of Medicine.

The findings are important because the main treatments for people who want to quit smoking are nicotine-replacement therapies, such as nicotine patches and gums. The study suggests women smokers may benefit more from other types of treatment that don't involve nicotine, including behavioral therapies, such as exercise or relaxation techniques, and non-nicotine containing medications, Cosgrove said.

Elements of smoking not related to nicotine, such as the smell and act of holding a cigarette, may play a greater role in fueling the habit of women smokers, compared with men, Cosgrove said.

Locating nicotine receptors
Cosgrove and colleagues scanned the brains of 52 men and 58 women, about half of whom were smokers. The researchers examined nicotine receptors in the brain by using a radioactive marker that binds specifically to an important group of receptors that are primarily responsible for the body's physical dependence on nicotine, Cosgrove said.

Smokers in the study had abstained from smoking for a week so that their nicotine receptors would be free to bind to the marker used for imaging.

The researchers found that male smokers had about 16 percent more nicotine receptors in an area of their brain known as the striatum, 17 percent more in the cerebellum, and 13 to 17 percent more in the cortical region, or outside layer, of the brain compared with male nonsmokers. Female smokers, on the other hand, had similar numbers of nicotine receptors in these brain regions.

Why are female brains different?
Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in N.Y., agreed more attention should be paid to non-nicotine related smoking therapies.

"You can replace all the nicotine you want, and people might still want to smoke," Horovitz said. For instance, smoking is a big stress reliever for some people. Even the act of deep breathing is a part of the habit, and breathing exercises may help smokers because they mimic puffing a cigarette, Horovitz said.

The reason for the sex difference seen in the study is not known, but it may have something to do with levels of the hormone progesterone. Levels of this hormone fluctuate in females depending on the stage of the menstrual cycle, and are much higher after ovulation. The study found higher levels of progesterone were associated with a lower number of available nicotine receptors, the researchers said, suggesting progesterone may indirectly block these receptors.

The study is published in the April issue of Archives of General Psychiatry.

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Women with heart failure, a condition in which the heart fails to pump enough blood to meet the body's demands, may live longer than their male counterparts, a new study says.

The results are based on an analysis of 31 studies involving 28,000 men and 14,000 women with long-term (chronic) heart failure who were followed for three years.

After taking into account patients' age, men had a 31 percent higher risk of dying over the study compared with women, the researchers said.

However, the absolute difference between men and women's mortality was only slight. Over the three year period, 25.3 percent of the women and 25.7 percent of the men died.

The study is the largest to look at how gender affects risk of death for people with heart failure.

A number of factors could explain the survival advantage in women, said study researcher Manuel Martinez-Selles, of the Gregorio Marañón University Hospital in Madrid. "The female heart appears to respond to injury differently from the male heart," Martinez-Selles said.

For example, women appear to have less detrimental changes in heart function after an injury, and greater protection from irregular heartbeats, Martinez-Selles said.

The study also found that overall women were prescribed fewer recommended treatments for heart failure than men, including angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) and beta blockers.

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