Perimenopause

Posted on April 18, 2026 by Patrick Hercules

Perimenopause is the transitional period before menopause. During this time, a woman’s body is preparing to stop having periods.

During this transition, the number of hormones a woman’s ovaries produce varies. Perimenopause can last two to eight years. The average is about four years. The hormone changes can cause symptoms that include:

Irregular periods

Vaginal dryness

Hot flashes

Night sweats

Sleep problems

Mood changes

Trouble finding words and remembering, also known as brain fog

Dry skin, dry eyes, dry mouth

Worsening premenstrual syndrome (PMS)

Breast tenderness

Decreasing fertility

Changes in sexual function

Loss of bone

Changing cholesterol levels

Perimenopause is caused by changes in two key female hormones: estrogen and progesterone. As a woman goes through perimenopause, these hormones fluctuate, and many of the changes they have during perimenopause are caused by lower estrogen.

Menopause can happen earlier in some women than in others, like before the age of 40, or between the ages of 40 and 45. Certain factors may make it more likely for perimenopause to start at an earlier age, such as:

Smoking

Family history

Cancer treatment

Hysterectomy

Some health conditions may make early menopause more likely, such as:

Thyroid disease

Rheumatoid arthritis

Other autoimmune diseases

Perimenopause is a gradual change, and there is no single test or symptom that tells it has started. A healthcare provider looks at many things to diagnose perimenopause, including:

Menstrual history

Noticeable symptoms or body changes

Some healthcare providers may order tests to check hormone levels. However, other than checking the thyroid, which affects hormone levels, hormone testing isn’t usually helpful to know if a woman is in perimenopause. That is because hormone levels in perimenopause change unpredictably.

The treatment for perimenopause usually consists of medicines that treat perimenopausal symptoms, such as:

Hormone therapy

Vaginal estrogen

Antidepressants

Gabapentin

Fezolinetant

Oxybutynin

Birth control pills

If you are experiencing symptoms of perimenopause, call (718) 670 8994 for more information about gynecological services at FHMC’s Center for Obstetrics and Gynecology.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

High-Functioning Depression

Posted on April 15, 2026 by Patrick Hercules

Depression is a common mental health condition that causes a persistent feeling of sadness and loss of interest, and changes how you think, sleep, eat, and act.

There are several types of depression, including:

Clinical depression (major depressive disorder)
Persistent depressive disorder (PDD)
Disruptive mood dysregulation disorder (DMDD)
Premenstrual dysphoric disorder (PMDD)

There are also specific forms of major depressive disorder, including:

Seasonal affective disorder (seasonal depression)
Prenatal depression and postpartum depression
Atypical depression

People with depression often can’t always keep up with the demands of day-to-day life, whether it is keeping a steady job, having significant relationships and friendships, or keeping the house tidy. Their depression can make every task feel daunting.

However, that isn’t always the case. Some people can experience depression in a way that doesn’t appear disruptive from the outside, but it still causes a major disruption inside. This is called high-functioning depression.

Although it isn’t a formal medical diagnosis, high-functioning depression is a helpful way to describe how some people who are living with the symptoms of depression manage to keep up a moderately stable life.

A person with high-functioning depression may have the same symptoms as a person with clinical or major depressive disorder. These symptoms include:

Feeling sad, helpless, or hopeless
Becoming disinterested in things that used to bring them joy
Changes in eating habits, like eating too much or too little
Trouble sleeping or sleeping too much
Difficulty concentrating
Negative thoughts about themselves and others

Unfortunately, some people may feel that they need to hide these depressive symptoms from others because:

They might have come from a family or culture that teaches people not to talk about mental illness
They think they will feel better by powering through on their own
They’re trying to avoid any impact on their job and relationships, hoping the depression lifts
They are someone who isn’t comfortable showing vulnerability or perceived weakness
They think having depression is something to be ashamed of
They feel that their life will fall apart and people will abandon them if they find out about their depression

More women than men are diagnosed with depression, but this may be because women are more likely to seek treatment.

A healthcare provider may determine a diagnosis of depression based on:

A physical exam
Lab tests
A psychiatric evaluation
DSM-5

Unfortunately, high-functioning depression can be difficult to recognize. Even though a person may appear to be high functioning, they still should get treatment for their depression. Treatments for depression may include:

Therapies such as cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and mindfulness techniques
Medications
Support groups

To learn more about the mental health services at Flushing Hospital Medical Center, or to schedule a virtual appointment, call (718) 670-5316 to speak with our intake coordinator or call (718) 670-5562 to reach the clinic.

Exercising Outdoors

Posted on April 3, 2026 by Patrick Hercules

Spring has arrived, and the weather is starting to warm up. This means we can spend more time exercising outdoors rather than at the gym or at home.

Outdoor exercise is a great way to work out. It offers many benefits to our physical and mental health, such as:

Reducing stress and anxiety

Improving sleep

Boosting vitamin D levels

Boosting self-esteem

Improving memory

Lowering chronic disease risk

Here are tips that can keep you safe while exercising outdoors:

Drink plenty of water and avoid caffeine and alcohol

Wear clothes that let the air circulate and moisture evaporate

Stay sun safe by wearing sunscreen, sunglasses, and a hat

Know the signs of heat-related illnesses

Wear proper footwear for the activity you are engaging in

If you experience medical problems while exercising, you can schedule an appointment with a doctor at Flushing Hospital Medical Center’s Ambulatory Care Center. To schedule an appointment, please call (718) 670-5486.

IBS vs Lactose Intolerance

Posted on February 25, 2026 by Patrick Hercules

Irritable bowel syndrome (IBS) and lactose intolerance can cause similar symptoms in the digestive system. They include:

Diarrhea

Abdominal pain

Bloating

Although their symptoms overlap, they are separate conditions with differences in how they are diagnosed and treated.

IBS is a common condition that affects the stomach and intestines. It causes various symptoms, including:

Cramping that is related to the urge to poop

Excess gas

Mucus in the poop

Alternating diarrhea and constipation

The feeling of being unable to empty the bowels after pooping

There are three types of irritable bowel syndrome, which are categorized based on how poops look on the days of having symptom flare-ups. They include:

IBS with constipation (IBS-C) causes most poop to be hard and lumpy

IBS with diarrhea (IBS-D) causes most poop to be watery and loose

IBS with mixed bowel habits (IBS-M) causes hard and lumpy, as well as watery and loose bowel movements

Unfortunately, researchers don’t know what causes IBS. However, IBS is classified as a neurogastrointestinal disorder or a gut-brain interaction. A gut-brain interaction means there are problems with how the gut and brain coordinate to help the digestive system work. IBS can also be caused by:

An imbalance in the microbes that normally live in the digestive system

Emotional stress and adverse life events

An infection of the digestive tract, which includes common stomach bugs

Lactose intolerance is a condition that occurs when people lack the enzyme lactase. This makes it difficult to digest lactose, which is the sugar present in milk and milk products.

Lactose malabsorption is the inability to break down and absorb lactose molecules in the digestive system. Lactose malabsorption is common, as about 65% of adults worldwide can’t break down and absorb lactose.

Lactose intolerance symptoms can appear inside and outside of the digestive system. Symptoms include:

Nausea and vomiting

Headaches

Fatigue

Joint pain

Problems concentrating

Mouth ulcers

Primary lactose intolerance is inherited and is more common in certain ethnicities and parts of the world. In the U.S., African Americans, Latinx, Asian Americans, and Native Americans are more likely to suffer from lactose intolerance.

Although it is uncommon, other forms of lactose intolerance are caused by disease or medications.

IBS and lactose intolerance can be diagnosed without testing. A person’s health history is an important part of diagnosing these conditions.

An IBS diagnosis is based on symptoms described in the Rome criteria, the guidelines used to diagnose gut-brain interaction, which includes stool changes, such as diarrhea, constipation, or a combination, and abdominal pain for at least one day each week during the previous three months.

If these symptoms meet the Rome criteria, an IBS diagnosis can be made without the need for an invasive test such as a colonoscopy.

However, further diagnostic testing would be needed if symptoms include blood in the stool, fever, and weight loss to determine if these are symptoms of another condition.

The first steps in diagnosing lactose intolerance include a health history and physical exam. In some cases, a clear connection between a person consuming dairy products and symptoms can suggest a diagnosis of lactose intolerance.

In certain cases, a breath test to diagnose lactose intolerance is available. During this test, a person drinks a solution that contains lactose and breathes to have their breath captured and measured for hydrogen. A higher level of hydrogen in the breath can indicate lactose intolerance.

IBS treatment starts with diet and lifestyle changes, including:

Adopting a low-FODMAP diet, which is a diet that is low in certain carbohydrates such as fermentable oligosaccharides, disaccharides, monosaccharides, and polyols

Eating more fiber

Avoiding caffeine and alcohol

Decreasing and managing stress

Identifying and avoiding foods that cause symptoms

Eating small meals on a regular schedule

Treating mental health conditions

Increasing physical activity

Trying a peppermint oil supplement

If lifestyle and diet changes don’t help, many drugs could help, including:

Antidiarrheals

Antispasmodics

Laxatives

Selective serotonin reuptake inhibitors (SSRIs)

Tricyclic antidepressants (TCAs)

Other prescription drugs

Treating lactose intolerance consists of avoiding foods that cause symptoms, dairy products that have less lactose or are lactose-free, or taking a supplement that breaks down lactose.

If you or a loved one is experiencing symptoms associated with IBS or lactose intolerance, you can receive treatment at Flushing Hospital Medical Center’s Ambulatory Care Center. To schedule an appointment, please call (718) 670-5486.

A.I. Therapy

Posted on February 15, 2026 by Patrick Hercules

During the COVID-19 pandemic, access to healthcare services through telehealth and telemedicine was implemented to help limit the spread of the virus. It was also used for those who were using mental health services, as that time was very lonely and isolated for many people.

A 2020 review published in BMC Public Health concluded that telehealth improved the delivery of healthcare during the pandemic, minimizing COVID-19 transmission and potentially reducing morbidity and deaths.

Telehealth is a way to receive healthcare services remotely through electronic devices such as a computer, tablet, or smartphone. These telehealth services can come in various forms, including:

Live video or audio appointments

Secured text messaging with a healthcare provider

Remote devices that allow a healthcare provider to track blood sugar

Today, many people use telehealth to get support for any mental health challenges they may be experiencing. Unfortunately, obtaining professional mental health support can be challenging as there is a shortage of mental healthcare providers. There is also the daunting task of searching for and finding the right one. This has caused many people to turn to A.I. therapy.

A.I. therapy uses artificial intelligence to support mental health through chatbots, digital therapy apps, and A.I.-driven counseling tools.

Many American adults, 22% in fact, have found some relief by using mental health chatbots as a therapeutic tool.

There are many possible reasons why people are turning to A.I. therapy as a viable option to address their mental health, including:

Accessibility

Affordability

Anonymity

There are many A.I. therapy platforms. They include:

CBT-focused chatbots that use meditation and cognitive behavioral therapy (CBT) techniques that offer personalized recommendations and crisis support

Skill-building apps that teach CBT skills, provide personalized recommendations, and collect user data to improve the experience

Self-guided wellness platforms that combine A.I. chatbots with emotion tracking, journaling, and self-directed therapeutic exercises

Mood tracking apps that allow users to track their moods and symptoms, while sometimes receiving self-care recommendations

Conversational A.I. companions that provide daily support through advanced A.I. and adapt to the user’s needs. It is typically aimed at mild anxiety or overthinking, with CBT-focused conversations

A.I. can be a promising tool for enhancing mental healthcare, but it can’t replace personalized mental healthcare.

Although A.I. therapy can’t replace human therapists, it could be a helpful supplement for those who may need additional support, along with therapy.

There are several reasons why A.I. therapy might be helpful, including:

24/7 availability due to A.I. chatbots being able to provide additional support outside of therapy sessions and holidays

Affordability of A.I. therapy provides a low-cost way to get support outside of sessions

Discretion of A.I. therapy helping people explore mental health support in a low- pressure, judgment-free way

While A.I. therapy may have some benefits for those seeking support with their mental health, it also poses several potential risks, including:

It can cause A.I.-induced psychosis

It can give unsafe advice and misinformation

It engages in sycophantic behavior by validating a user’s emotions, which can be dangerous if they have suicidal ideation, delusions, mania, or hallucinations

There is a lack of human connection and empathy: A user might take a self-assessment without human input that can lead to false reassurance or dangerous delays in getting help. A.I. can miss nonverbal cues, and a user may take its output as definitive

A.I. therapy can offer those who are seeking support with their mental health a convenient way to do so. However, effective mental healthcare should be safe and provided by trained, human mental health professionals.

If you or a loved one needs the assistance and support of a mental health professional at Jamaica Hospital Medical Center, please call 718-206-5575 to schedule an appointment.

When is The Best Time to Drink Coffee? And How Late is Too Late?

Posted on February 13, 2026 by Patrick Hercules

Many people wake up and have a cup of coffee to start their day. And some people drink several cups of coffee throughout the day.

Depending on the type of coffee grounds and how they are brewed, an 8-ounce cup of coffee can contain close to 100 milligrams of caffeine. Caffeine is a stimulant, and it helps wake you up by increasing the amount of cortisol, the stress hormone, in your body.

Cortisol levels usually peak between 7 a.m. and 8 a.m. and gradually drop throughout the day, reaching their lowest point in the middle of the night while you’re sleeping. Cortisol helps the body maintain its sleep-wake cycle.

However, drinking caffeinated coffee first thing in the morning can increase cortisol production.

If you drink coffee later in the day or at night, it could affect your sleep. Depending on your metabolism, it may take two to ten hours to get rid of half the caffeine from one cup of coffee.

Certain people have a “coffee gene”, CYP1A2, that helps the body break down and get rid of caffeine, and some people have two copies of this gene, which helps them break down caffeine faster than those with one copy of the gene. If a person has two copies of the gene, they may not be affected after drinking a late-night cup of coffee.

There is no scientific evidence that supports a “best time” to drink coffee. However, drinking a mid- to late-morning cup of coffee between 9:30 a.m. and 11 a.m. may help you receive the most benefits from coffee. This is the range of time when cortisol levels begin to drop, and the caffeine in a cup of coffee may be most effective.

The best time to drink coffee is ultimately determined by your metabolism and how the caffeine in coffee affects your body.

If you would like to learn more about how caffeine may affect your body, you can schedule an appointment at Flushing Hospital Medical Center’s Ambulatory Care Center. Please call (718) 670-5486.

Dealing with Depression During the Holiday Season

Posted on December 4, 2025 by Patrick Hercules

The holidays are a time when we spend joyous and happy moments with friends and family. However, for some, the holidays can bring a lot of sadness, loneliness, and even depression. This is called holiday depression.

Holiday depression can feel a lot like regular depression; however, it is triggered by the onset of the holidays, large family gatherings, and attending or hosting social events. Holiday depression is like the “winter blues”, but it may come and go in quick bursts as one event ends and another begins, or it can linger for days or weeks leading up to and beyond the holiday season.

Holiday depression can disrupt relationships, mental health, and the ability to manage everything that comes with the holiday season.

Holiday depression can affect anyone at any time, and it can be hard on a person’s mental health, as it can be triggered by various things, including:

Stressful schedules

Putting pressure on yourself

Separation from loved ones

Loneliness

Family dynamics

Seasonal depression

Social anxiety

Holiday trauma

There are several signs of holiday depression. They can include:

Feeling depressed and hopeless for more days than not

Loss of interest in things you used to enjoy

Constantly feeling anxious, nervous, or on edge

Trouble sleeping over an extended time

Intrusive thoughts that are difficult to manage on your own

Thoughts of self-harm or suicide

Holiday depression can feel daunting as you navigate the season. However, there are many ways to cope with and find support and emotional stability that can help you get through this difficult time of year. They include:

Remembering a loved one

Setting boundaries

Staying connected with friends and family

Limiting social media use

Sharing happy memories

Setting realistic expectations for the holidays

Taking care of yourself

Seeking support and help

If you are having harmful thoughts, such as thoughts about suicide, or believe you are experiencing a mental health or emotional crisis, you can contact the 988 Suicide & Crisis Lifeline 24/7 through phone, chat, or text, go to the hospital, or call your local 911 hotline and your doctor right away to get the help you need.

No one should face their mental health challenges alone. To learn more about our outpatient mental health services at Flushing Hospital Medical Center or to schedule a virtual appointment, please call (718) 670-5316 to speak with our intake coordinator or (718) 670-5562 to reach the clinic.

How Having a Sedentary Job Contributes to a Higher Risk of Insomnia

Posted on October 9, 2025 by Patrick Hercules

According to a study published on January 7^th, 2025, by the Journal of Occupational Health Psychology, people with sedentary jobs, an estimated 80% of the workforce, have a much higher risk of experiencing insomnia compared with people who are active at work. Insomnia is a common sleep disorder that can make it difficult to fall asleep or stay asleep. A sedentary job is any job that requires an employee to sit for about six hours of an eight-hour workday.

Researchers surveyed nearly 1,300 people twice over a span of ten years, inquiring about their job schedules and physical activity levels while at work. They also asked about the participants’ sleep habits, identifying three sleep health categories: good sleepers, insomnia-like sleepers, and catch-up sleepers.

Good sleepers are people who exhibit optimal sleep patterns, such as regular sleep cycles with low levels of daytime tiredness.

Insomnia-like sleepers are people who experience short sleep cycles and higher levels of daytime fatigue.

Catch-up sleepers fall between both groups and often rely on naps or extra weekend sleep to compensate for irregular sleeping patterns.

Compared to active work, sedentary work was 37% likely to lead to a variety of insomnia symptoms, such as difficulty falling asleep, interrupted sleep, and frequent daytime tiredness. The findings of the study also indicated that workers who fall into a pattern of poor sleep due to their job design (defined as elements such as the amount of technology used at work, levels of physical activity, and work schedules, and specifically the time of day when the employee works) can end up stuck in such unhealthy patterns for many years. Insomnia-like sleepers, for example, reported their symptoms persisted ten years later, at the end of the study.

Those experiencing insomnia may have the following symptoms:

Having a hard time falling asleep at night
Waking up during the night
Waking up too early
Feeling tired or sleepy during the day
Feeling cranky, depressed, or anxious
Having a hard time paying attention, focusing on tasks, or remembering
Making more errors or having more accidents
Having ongoing worries about sleep

If you are experiencing insomnia, there are several ways you can improve your sleep, including:

Taking short breaks throughout the day to move
Unplugging smartphones and computers two hours before bedtime
Using light exposure to readjust your circadian rhythms if you work a night shift

If you are experiencing symptoms of insomnia, you can learn more about our outpatient mental health services at Flushing Hospital Medical Center. To schedule a virtual appointment, please call (718) 670-5316 to speak with our intake coordinator or (718) 670-5562 to reach the clinic.

How Making Lifestyle Changes Can Reduce the Risk of Chronic Diseases

Posted on September 26, 2025 by Patrick Hercules

According to the World Health Organization (WHO), chronic diseases, also known as non-communicable diseases, are conditions that tend to have a long duration and result from a combination of genetic, physiological, environmental, and behavioral factors.

Chronic diseases are the leading cause of death worldwide. These diseases include:

Cancers
Cardiovascular disease, such as heart attacks and strokes
Chronic respiratory diseases, such as chronic obstructive pulmonary disease (COPD) and asthma
Diabetes

A person’s lifestyle and daily habits can increase their risk of developing a chronic disease. About 80% of chronic diseases are driven by a person’s daily habits. These include:

Tobacco use, including the effects of exposure to second-hand smoke
Unhealthy diets, including excess salt, sugar, and fats
Excessive alcohol use
Insufficient physical activity

These habits can contribute to metabolic changes that can increase a person’s risk of chronic disease, including:

Hypertension
Obesity
Diabetes
High cholesterol

Making the following lifestyle changes is one of the best ways to address harmful habits and help prevent chronic diseases.

Dietary changes include eating whole, unrefined, and minimally processed plants. Eating plant-based foods can help reduce diabetes, heart disease, and the risk of cancer
Increasing physical activity by engaging in a recommended 150 minutes of moderate-intensity activity each week
Getting a good, restful night’s sleep of about seven to nine hours. This can be achieved by:
- Having a consistent bedtime and waking up on time, even on weekends
- Being physically active
- Limiting alcohol and caffeine
- Putting digital devices away 90 minutes before bedtime
- Keeping your sleeping area cool, dark, and comfortable
Reducing stress by practicing mindfulness, meditation, and gratitude can help relieve stress and improve your physical and mental health.
Staying socially connected with friends and family can help keep you emotionally and physically healthy.
Quitting smoking, or never starting, lowers the risk of serious health problems, such as heart disease, cancer, Type 2 diabetes, and lung disease, as well as premature death
Limiting alcohol use can reduce health risks that excessive drinking can lead to, such as high blood pressure, various cancers, heart disease, stroke, and liver disease

By avoiding these risks and getting good preventive care, you can improve your chance of staying well, feeling good, and living longer.

For more information on how you can make lifestyle changes, you can schedule an appointment with a doctor at Flushing Hospital Medical Center’s Ambulatory Care Center by calling (718) 670-5486.

The Loneliness Epidemic

Posted on March 12, 2025 by Patrick Hercules

In May 2023, former U.S. Surgeon General Dr. Vivek Murthy issued a report that drew attention to an epidemic that affects half of American adults: loneliness and social isolation.

Dr. Murthy said that loneliness and social isolation are “urgent public health concerns, more widespread than smoking, diabetes, or anxiety”.

Loneliness is feeling lonely or disconnected from others and not having meaningful or close relationships or a sense of belonging. It also describes the negative feelings that can occur when your needs for social connection aren’t met.

Social isolation is when a person doesn’t have relationships or contact with others and has little to no social support. It can pose a health risk to people, even if they don’t feel lonely.

Certain conditions or experiences may increase a person’s risk of social isolation and loneliness, including:

Having a mental or physical challenge, such as:
- Chronic disease or condition
- Psychiatric or depressive condition
- Long-term disability
Being marginalized or discriminated against
Having limited or no access to resources, which may result in:
- Living in rural areas
- Limited transportation
- Language barriers
- Being a victim of violence or abuse
Facing a divorce, unemployment, or the loss of a loved one

Loneliness may impact some groups more than others, including:

Low-income adults
Young adults
Older adults
Adults living alone
Immigrants
People who identify as LGBTQ+

Social isolation and loneliness can increase a person’s risk for:

Heart disease and stroke
Type 2 diabetes
Depression, anxiety, suicide, and self-harm
Dementia
Earlier death

It is important to make meaningful social connections, as those who do experience benefits, including:

Less stress
Better sleep
A longer, healthier life

Making social connections can be hard, especially if you are in poor health, have money problems, or live alone. However, a few small acts of connection can build supportive and meaningful relationships.

You can take various steps to fight against loneliness, including the following:

Talking to family, friends, neighbors, and co-workers
Connecting with others on social media
Volunteering in your community
Being kind to yourself
Learning more about ways to improve social connectedness
Getting help from a professional

To find out more about Flushing Hospital Medical Center’s outpatient mental health services or to schedule a virtual appointment, please call (718) 670-5316 to speak with our intake coordinator or (718) 670-5562 to reach the clinic.