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Breast Health Decoded: Dense Breasts, Risk Factors, and the Screening You Deserve.
Anna Harrelson • December 20, 2024

Breast Cancer Screening: Empowering Women with Knowledge and Choices

Breast cancer screening is a cornerstone of preventive health care, but understanding the options, risks, and guidelines can often feel like navigating a maze. As a physician, I believe it is your job to be educated and armed with the information you need to make the best decisions for your health. My role is to provide the expertise and partnership to support you in that journey. Let’s talk about dense breasts, evolving screening options, and how to take control of your breast health.

What Does It Mean to Have Dense Breasts?
If you’ve been told you have dense breast tissue, you’re not alone. Dense breasts are common and simply mean there is more fibrous and glandular tissue compared to fatty tissue. However, dense tissue can make it harder to detect cancer on a standard mammogram, and it slightly increases the risk of breast cancer. Knowing this information is the first step in advocating for yourself and tailoring a screening plan that works for you.

Screening Options: Navigating What’s Right for You
For women with dense breasts, standard mammograms might not always provide the clearest picture. Fortunately, there are additional options to consider:
  • Digital Breast Tomosynthesis (3D Mammography): Offers detailed imaging by taking multiple angles of the breast, improving cancer detection in dense tissue.
  • Breast MRI: Particularly valuable for women at higher risk of breast cancer, MRIs provide detailed imaging without using radiation.
  • Breast Ultrasound: This can be a helpful supplemental tool, especially for dense breast tissue, as it uses sound waves to capture images.
  • Contrast-Enhanced Mammography (CEM): This advanced technique combines standard mammography with a contrast agent to highlight areas of concern, making it particularly effective for detecting small tumors.
  • QT Ultrasound Imaging: A newer technique, QT Ultrasound provides high-resolution, 3D imaging without the use of radiation or compression. It is particularly promising for women with dense breasts, offering a comfortable and detailed alternative for early detection.
Each of these tools has its strengths, and choosing the right one depends on your unique breast cancer risk and screening goals.

When Should You Start Screening?
The age to begin breast cancer screening and the frequency of tests depends on your personal risk factors:
  • Average Risk: Most guidelines recommend starting annual mammograms around age 40-50. Some suggest biannual screening based on your comfort and risk level.
  • Higher Risk: If you have a strong family history of breast cancer, genetic mutations (like BRCA1/2), or a history of chest radiation, you may need to begin earlier. Additional tools like MRI may be recommended.
Calculating Your Breast Cancer Risk
Understanding your personal risk is empowering. Tools like the Gail Model or Tyrer-Cuzick Model assess factors such as family history, age, and reproductive history to provide a calculated risk of developing breast cancer. Knowing your risk score can help guide your decisions and advocate for a screening plan tailored to you.

Lifestyle and Cancer Risk: What You Can Control
It’s a common misconception that breast cancer risk is purely genetic. In reality, environmental factors, lifestyle choices, and epigenetics—the way your environment and behaviors influence your genes—play a significant role.
Chronic inflammation, often driven by poor lifestyle habits, can create an environment that supports the development and progression of cancer. Here are some actionable steps to reduce inflammation and lower your risk:
  • Nutrition: Focus on a whole-food, plant-forward diet rich in antioxidants and anti-inflammatory foods like fruits, vegetables, nuts, seeds, and fatty fish.
  • Exercise: Regular physical activity helps maintain a healthy weight, reduce inflammation, and support immune function.
  • Stress Management: Chronic stress can fuel inflammation. Practices like mindfulness, meditation, and yoga can improve resilience and overall health.
  • Sleep: Prioritize restorative sleep to allow your body to repair and regulate immune function.
  • Avoid Toxins: Limit exposure to environmental toxins like smoking and excessive alcohol, which are linked to higher cancer risk.
While we can’t control every factor, these lifestyle changes can dramatically shift your cancer risk, empowering you to take charge of your health.

Hormones and Breast Cancer: What’s the Truth?
Let’s clarify an often-misunderstood topic: hormone therapy (HT). For women navigating perimenopause and menopause, HT can be an invaluable tool for quality of life and overall health. Decisions about HT should consider your personal and family health history, but it’s essential to understand that hormone therapy is not an automatic “risk factor” for breast cancer. Instead, the risks and benefits vary by individual, and the conversation should always center on shared decision-making between you and your doctor.

Why Education and Advocacy Matter
Breast cancer screening is not a one-size-fits-all process. It is a journey that evolves with your age, risk factors, and personal preferences. I encourage you to take an active role in your health by asking questions, knowing your breast density, calculating your risk, and advocating for the screening tools that are best for you. You have the power to be your own best advocate, and my job is to sit beside you, guiding and empowering you every step of the way.

A Personalized Plan for Lifelong Health
My ultimate goal is to help you preserve your healthspan—the years you spend active, independent, and free from chronic illness. Breast cancer screening is just one piece of that puzzle, but it’s a critical one. By staying informed and proactive, you’re setting yourself up for the best possible outcomes, not just for today but for the years ahead.
Remember, no question is too small, and no concern is too trivial when it comes to your health. Together, we can navigate this journey with clarity and confidence, ensuring that you feel empowered and supported at every turn.


WonderCreek Health Blog

By Anna Harrelson March 30, 2025
Let’s start with this: there is nothing shameful or trivial about wanting a healthy sex life. If you're in your 30s, 40s, 50s, or beyond and wondering where your libido went, why sex feels different (or uncomfortable), or why no one ever warned you about vaginal dryness, you’re not alone. And you’re not imagining it. At Wondercreek Health, I talk to people every week who feel confused, dismissed, or ashamed about the sexual changes happening in their bodies. Many are thriving in every other area of life—careers, caregiving, health—but when it comes to intimacy, they feel stuck or unseen. So let’s say this together: sexual health is part of whole-person health. And pleasure is not optional . It’s a reflection of nervous system safety, hormonal balance, connection, and self-awareness. It belongs to you. What Happens to Sexual Health in Midlife and Beyond? Hormonal shifts during perimenopause and menopause can affect every part of your sexual experience. But so can chronic stress, birth control, antidepressants, trauma, and the weight of daily responsibilities. This is never just one thing. Common symptoms include: Vaginal dryness, burning, or itching (genitourinary syndrome of menopause, or GSM) Pain with sex (dyspareunia) Loss of libido or arousal Less intense or harder-to-reach orgasms Urinary urgency or UTIs Pelvic floor tension or dysfunction These changes aren’t "just in your head" and they’re not a moral failure. They reflect real shifts in tissue, blood flow, hormones, and brain chemistry. Sex Isn’t Just for Someone Else’s Benefit Let’s say the quiet part out loud: many of us were raised to believe that sex was about someone else's pleasure. That we should be desirable, responsive, available—regardless of how we felt. That conditioning runs deep. But sex isn’t about performance. It’s about connection, intimacy, and pleasure—for you. Pleasure is your birthright. Intimacy can be tender, playful, spiritual, or wild— but it should never feel like pressure. Your desire may look different than someone else's, and that’s okay. This is true whether your partner is male, female, nonbinary, or you're navigating intimacy solo. There is no one-size-fits-all experience. Why Your Desire Might Feel "Off" Sexual changes can happen at any age. Oral contraceptives (OCPs) can suppress libido by lowering free testosterone. SSRIs and other antidepressants are well known to impact arousal and orgasm. Perimenopause often starts in the mid-30s, long before you notice hot flashes. Chronic stress and the mental load of caregiving, multitasking, and decision fatigue can leave no room for desire. Because here’s the reality: desire doesn’t live in your genitals. It starts in your brain . And when your brain is overloaded with to-dos, responsibilities, or unspoken resentment, it’s nearly impossible to shift into a space of curiosity, connection, and arousal. Unwinding the mind can be hard. For some of us, it means learning to use tools like mindfulness, breathwork, somatic practices, therapy, or just having space and time away from the demands of the world. Creating room for desire isn’t selfish. It’s a form of self-trust and reclamation. The Good News: This Is Treatable Sexual health doesn’t have to decline just because estrogen does. There are safe, effective, empowering ways to reconnect with your body and reclaim your pleasure. 1. Local vaginal estrogen (or DHEA or testosterone): Restores tissue health, lubrication, and blood flow Improves comfort, arousal, and pelvic health Safe for most people, even those with a history of breast cancer (with appropriate guidance) 2. Systemic hormone therapy: Can improve libido, mood, sleep, and confidence Testosterone therapy (when indicated) can support arousal and orgasm 3. Pelvic floor physical therapy: Addresses pain, tension, and coordination issues Supports better sensation and comfort 4. Nervous system regulation: Practices like breathwork, somatic therapy, or trauma-informed care help shift from "fight or flight" into connection When the nervous system feels safe, desire can return 5. Sex therapy or coaching: Helps explore personal blocks, relationship dynamics, and pleasure mapping Let’s Talk About Desire You might notice you don’t feel spontaneous desire anymore— but that doesn’t mean you’re broken . For many people, responsive desire (desire that follows arousal) becomes the norm in midlife. And it’s perfectly valid. Touch, connection, and intimacy may need more warming up. But your ability to experience pleasure is still intact—and it can grow deeper, richer, and more grounded as you reconnect with your body on your own terms. Final Thoughts You don’t need to be fixed. You deserve to be heard. You deserve to feel good in your body. Sexual health is not about keeping up with anyone else’s timeline or expectations. It’s about reclaiming what intimacy and connection mean to you in this season of life. At Wondercreek Health, I’m here to help you connect the dots, reduce shame, and support you with science-backed, judgment-free options that honor your experience. Because this is not the end of your sexual story. It might just be the beginning of the most powerful chapter yet.
By Anna Harrelson March 30, 2025
Let’s be honest: midlife can feel like your body is changing the rules without warning. You’re doing what used to work, but the results aren’t the same. The scale doesn’t budge, your sleep is disrupted, your energy is inconsistent, and your moods might feel like a rollercoaster you didn’t sign up for. And while hormone therapy, supplements, and nutrition are powerful tools for navigating perimenopause and menopause, movement—especially strength training and nervous system-aware exercise—is one of the most underutilized forms of medicine. As a lifestyle medicine physician and menopause specialist, I talk about this daily with my patients. Movement isn’t just about burning calories. It’s about retraining your stress response, building metabolic resilience, preserving muscle, and improving insulin sensitivity. Why Movement and Muscle Matter in Midlife During perimenopause and menopause, we experience natural declines and fluctuations in estrogen, progesterone, and testosterone. These shifts impact far more than reproduction—they affect how we regulate blood sugar, manage stress, build muscle, sleep, and recover from daily life. In this stage of life: Muscle mass declines more rapidly if not actively maintained Insulin sensitivity drops, raising the risk for metabolic syndrome and weight gain Cortisol levels rise and become harder to regulate, especially in women with high stress or trauma histories Nervous system resilience weakens, making it harder to bounce back from emotional or physical stressors Movement is the antidote to all of this. What the Research Shows Muscle is a metabolic organ. It stores glucose, improves insulin sensitivity, regulates inflammation, and even contributes to hormone production and detoxification. Building and maintaining muscle in midlife is one of the most powerful ways to protect against: Type 2 diabetes and insulin resistance Cognitive decline Cardiovascular disease Falls, fractures, and osteoporosis And beyond the physical? Movement is critical for regulating the autonomic nervous system, which influences: Your ability to sleep Your mood and anxiety levels Your response to daily stressors Your digestive and immune function Not Just Any Movement This isn’t about hitting the gym for 90 minutes or going hard every day. It’s about intentional movement that supports your biology. Here’s what I recommend: 1. Prioritize strength training. 2–3 times per week of bodyweight, resistance bands, dumbbells, or machines Focus on form, tempo, and functional movement—not just reps or weight 2. Include low-impact, nervous-system regulating movement. Walking, mobility flows, Pilates, yoga, or tai chi Think of this as your recovery and resilience training 3. Move throughout the day. Break up sedentary time with stretching, light movement, or standing tasks Movement snacks matter for metabolic health 4. Don’t overtrain. Too much high-intensity exercise can increase cortisol, disrupt sleep, and worsen hormonal symptoms Listen to your body and focus on consistency over intensity It’s Not About Looking Fit. It’s About Feeling Well. This phase of life isn’t just about managing symptoms—it’s about building your future resilience. Every time you lift something heavy, take a walk, or stretch with intention, you are: Supporting your insulin and glucose balance Reinforcing your bone, brain, and cardiovascular health Regulating your nervous system Building muscle that keeps you independent and active for decades to come Movement is medicine, & muscle is your midlife superpower. Final Thoughts If you feel like your metabolism has shifted, your sleep is off, or your body feels unfamiliar—you’re not alone. But you’re not broken. You’re evolving. And your body is still responsive to thoughtful support. Start small. Lift something. Go for a walk. Move in a way that honors your nervous system, builds strength, and reminds you that this phase of life is not a decline—it’s a recalibration.
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