Your Health | Mount Sinai Today

What’s Different About the New Cholesterol Guidelines?

Jun 1, 2026 | Your Health

A close up photo of a person eating a hamburger with others also eating.

Cardiovascular disease remains a leading health concern in the United States, and it is becoming more common among younger people.

In response, the American College of Cardiology, the American Heart Association, and nine other leading medical associations recently developed new guidelines for managing your cholesterol.

The new guidelines recommend earlier testing and treatment, assessing risk more broadly, and achieving specific LDL levels—levels of the “bad cholesterol” known as low-density lipoprotein cholesterol.

In this Q&A, Robert S. Rosenson, MD, the Dr. Rony Shimony Distinguished Professor of Cardiovascular Medicine at the Icahn School of Medicine at Mount Sinai, explains some of the most significant changes.

Robert S. Rosenson, MD

“The more information your doctor has about your heart health, the easier it is to develop the best treatment for you,” says Dr. Rosenson, who is also Director of Metabolism and Lipids for the Mount Sinai Health System.

Why are the new guidelines important?

The last set of guidelines came out eight years ago. Since then, there have been major shifts in our society and advances in scientific research. These guidelines take into account these changes and align with recent European standards. They will help keep Americans healthier. But the guidelines can only keep you healthier if you follow them. It is important to get your cholesterol tested regularly and make sure the levels are in a healthy range. If they are not, talk with your health care provider about ways to lower your LDL.

What are the biggest changes to the guidelines?

One of the biggest changes is focusing on the LDL level. Earlier guidelines focused on how much cholesterol medicine patients were taking. The new guidelines emphasize the actual LDL level for people with different levels of risk for cardiovascular disease. For example, if your risk of heart disease is higher, you should aim for a lower LDL level.

The recommended LDL levels are:

For those with a low risk of heart disease: 100 mg/dL (milligrams per deciliter, which is a measure of cholesterol in your blood)

For those with a medium risk: 70 mg/dL or lower. Moderate risk includes people who have:

Calcium buildup in the arteries.
A high-risk condition such as diabetes or high blood pressure.
Family history of heart disease.

For those with a high risk of heart disease: 55 mg/dL or less. This includes people who have:

Already had a heart attack or stroke.
Two or more serious risk factors, such as diabetes and heart disease.
Imaging evidence of coronary artery disease based on a coronary calcium score of 300 or higher or age-adjusted coronary calcium at the 75th percentile.

New Cholesterol Guidelines: Some Key Points

• Nearly one in four American adults has elevated cholesterol levels. This increases your risk of heart attack and stroke.

• The new guidelines are especially important because experts say 80 percent of cardiovascular disease is preventable, and elevated cholesterol is a major risk factor. The revisions are the first in eight years.

• Talk with your doctor if you have specific concerns about how these new guidelines might affect you.

How do the new guidelines assess cardiovascular risk?

The new guidelines take a broader view of heart disease risk than earlier guidelines. They still check bloodwork such as a lipid panel. But they also review family history of heart disease, history of smoking, and body mass index (BMI). The guidelines consider whether you have conditions such as diabetes, chronic kidney disease, or are overweight or obese. And they look at more markers of atherosclerotic cardiovascular risk in your blood. These include:

lipoprotein(a)
apolipoprotein B
high-sensitivity C-reactive protein
elevated triglycerides

Thus, the guidelines officially changed from a cholesterol guideline to a dyslipidemia guideline, which covers cholesterol as well as other lipids (fats) in your blood.

Looking at all these factors gives us a clearer picture of your personal risk of heart disease. HDL, the so-called “good cholesterol,” also may not be as good as a marker of protection as once thought. For instance, if you have insulin resistance, prediabetes, or diabetes, your LDL cholesterol particles are probably smaller and denser. This means LDL cholesterol may not tell the whole story of your heart disease risk. Instead, the guidelines recommend focusing on these markers. This includes non-HDL cholesterol or the difference between total cholesterol and HDL cholesterol and apolipoprotein B (the major structural protein on the “bad” particles”). They also recommend having a coronary calcium scan because those results can also affect your risk level.

Do the new guidelines start at a younger age?

The new guidelines recommend getting a full lipid profile for children ages 9 to 11. For children who have high LDL cholesterol because of a family history (including a lipid disorder known as hypercholesterolemia), the guidelines suggest screening starting as early as age two. In rare cases, children with this condition have had heart problems even as toddlers. The guidelines recommend getting a one-time check of lipoprotein(a) levels. This is often related to genetic risk. High LDL cholesterol affects your heart risk throughout your life, so the earlier you start keeping low LDL cholesterol levels, the better.

Do the new guidelines discuss treatment options?

Many people take supplements, like fish oil, to improve their heart health. The new guidelines say there is no scientific evidence that supplements can help lower cholesterol or decrease the risk of heart disease. Talk to your doctor about the best approach to improving your heart health.

What do the new guidelines say about making lifestyle changes?

The guidelines emphasize “Life’s Essential Eight,” developed by the American Heart Association. The components are:

1. Eat better: Choose whole foods, fruits and vegetables, lean protein, nuts, and seeds, and cook in non-tropical oils such as olive and canola.

2. Be more active: Adults should aim for 150 minutes of moderate or 75 minutes of vigorous physical activity per week. Kids need 60 minutes of physical activity every day. Walking is good for everyone.

3. Get healthy sleep: Adults need an average of seven to nine hours of sleep, and babies and kids need more, depending on their age.

4. Quit tobacco: This includes smoking traditional cigarettes, e-cigarettes, and vaping.

5. Manage weight: Body mass index (BMI) looks at your weight in relation to your height. Most adults should have a BMI of 18.5 to 25. You can calculate your BMI online or talk to your doctor.

6. Control cholesterol: Monitor your LDL cholesterol, rather than total cholesterol.

7. Manage blood sugar level: The A1c blood test is the best measurement of blood sugar. The ideal level for most adults without diabetes is below 5.7 percent. 8. Manage blood pressure: Try to keep your blood pressure at less than 120/80.

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MyPath: A New Approach to Improve Women’s Health Through Midlife and Beyond

May 28, 2026 | Featured, Women's Health, Your Health

Women’s health is complex—and it doesn’t often fit neatly into one appointment or one specialty. Many women experience distinct symptoms across life stages. They may wonder what’s going on, or where to turn next. Add the demands of work, family, and everyday life, and women may feel stretched thin and unheard.

“At the Carolyn Rowan Center for Women’s Health and Wellness, we offer a unique approach to women’s health called MyPath where care is organized around personalized pathways–integrated, coordinated, and holistic care designed to support your whole body and your whole life. Everything you need is here—guided, connected, and focused on you,” says Anna M. Barbieri, MD, Clinical Strategy Lead at the Carolyn Rowan Center for Women’s Health and Wellness.

“Our care pathways address transitions such as emotional health, sleep, energy, gynecologic health, and other layers of health that cannot be addressed in a single visit,” she adds.

“MyPath supports women through life’s transitions with clarity and empathy,” says Joanne L. Stone, MD, physician-scientist and Chair of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai.

“Each pathway brings together the right specialists at the right time, so your care feels intentional—not overwhelming,” she adds.

The first pathway focuses on one of the most important chapters of women’s health: the midlife transition, featuring perimenopause and menopause.

MyPath Balance 40+: Support for the Midlife Years

Midlife can bring hormonal shifts, sleep disruption, weight gain, stress, and new health concerns. MyPath Balance 40+ is a six-month, personalized care experience created to help women age 40 and over feel stronger, healthier, and more in control of their well-being.

Patients will receive coordinated support for:

Hormonal and metabolic health, including weight management
Heart and bone health
Sleep, mood, and stress
Pelvic and sexual health
Nutrition, movement, and overall vitality

“Your care unfolds step by step—starting with a comprehensive evaluation, followed by personalized treatment and ongoing support. So you always know what’s happening and why,” says Francesco Callipari, MD, Medical Director at the new Carolyn Rowan Center for Women’s Health and Wellness, and Assistant Clinical Professor and Vice Chair of Operations, Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai.

“This approach is different because it’s not rushed, not fragmented, and because it’s designed around how women actually live,” he adds.

Looking Ahead

Additional MyPath programs will include MyPath Moms, MyPath Surgical Recovery, MyPath Healthspan, and MyPath Vitality 60+, each supporting women through different life stages.

Learn more about MyPath Balance 40+

Learn more about the Carolyn Rowan Center for Women’s Health and Wellness

Thinking of Stopping Your Antidepressant? Talk With Your Doctor First

May 28, 2026 | Psychiatry, Your Health

A stock image of a man looking at a prescription medicine container

Antidepressants are a common treatment for depression. More than one in ten people in the United States take prescription medicine for depression, according to the Centers for Disease Control and Prevention.

These medicines are now in the spotlight amid an ongoing debate over how well they work and their possible side effects.

In this Q&A, Amirhossein Modabbernia, MD, PhD, Assistant Professor of Psychiatry, Icahn School of Medicine at Mount Sinai, explains how antidepressants can help. He also explains what you can do if they do not seem to be working, including how to talk with your doctor about stopping your medication.

“I think people should know that depression is real, common, and treatable, and that needing medication is not a weakness or a moral failure,” he says. “At the same time, antidepressants are not magic, and they are not the right answer for every person or every situation.”

How can antidepressants help people with depression?

Antidepressants can help many people. They may be most helpful when depression is moderate or severe, lasts a long time, or keeps coming back. These medicines can lower symptoms enough so a person can sleep, think clearly, connect with others, work, enjoy life, and start dealing with life’s problems again.

In my work with patients, people often describe the change by saying, “Something has lifted,” “I can think and function again,” or “There is a little more space between me and the depression.” Large studies do show that antidepressants outperform placebo on average, though the benefit varies substantially from person to person. Medication is not the whole answer for everyone. But for many people, it can create the mental and emotional space needed for recovery, therapy, relationships, and meaningful life changes.

Amirhossein Modabbernia, MD, PhD

What if I am taking an antidepressant but do not feel better?

The first thing I would say is: Please talk honestly with your doctor. A poor response does not mean treatment has failed forever. It also does not mean you should stop the medicine suddenly. It is important to have realistic expectations. Antidepressants usually do not create instant happiness. They do not take away all emotional pain. Early signs of improvement can be small. You may sleep better, have more energy, feel less weighed down, think more clearly, feel less irritable, or find it easier to get through the day.

What can I do if my antidepressant does not seem to be working?

If the medicine is not helping enough, that is useful information. It may mean:

The dose is not right.
The medicine needs more time to work.
Side effects are getting in the way.
The diagnosis needs to be looked at again.
Other issues are playing a role, such as sleep problems, substance use, medical problems, trauma, or major life stress.

Sometimes psyhotherapy needs to be added. Sometimes the medicine needs to be changed. Sometimes the whole treatment plan needs to be adjusted. The important point is this: If you are not improving, that is not a dead end. It is a reason to talk with your clinician and decide what to do next. If you feel worse, have side effects you cannot tolerate, or have suicidal thoughts, talk with a clinician right away.

What should I do if I want to stop taking my antidepressant?

Do not stop suddenly unless there is a clear medical reason and a clinician is guiding you. Stopping an antidepressant can be a reasonable choice. But it should be done with care. Before stopping, you and your clinician may want to talk about questions such as:

Why do I want to stop now?
How long have I been feeling well?
How stable is my life right now?
What happened the last time I stopped, if I stopped before?
What symptoms should we watch for?
How slowly should I lower the dose?
What is the plan if depression comes back?

Withdrawal symptoms are real. They can include dizziness, nausea, trouble sleeping, irritability, anxiety, vivid dreams, flu-like symptoms, and sometimes “brain zaps,” which can feel like electric shocks. This does not mean people should be afraid to stop. It means stopping should be planned. It should be done slowly, with a clear follow-up plan.

How do you decide if someone is ready to lower the dose?

I usually want to know if the person has been well—not just a little better—for a steady period of time. I also look at whether the person is functioning well again. I want to know if major stressors are stable, if the person has support, and if there is a plan to prevent depression from returning. That plan might include therapy, steady sleep routines, exercise, social connection, awareness of early warning signs, and a clear plan for what to do if symptoms return.

I also look closely at the person’s history. Someone who had one mild episode of depression is different from someone with depression that keeps coming back, or someone with long-term depression, suicidal thoughts, a history of hospitalization, severe anxiety, trauma, substance use, or possible bipolar disorder. Past attempts to stop medicine also matter.

Many guidelines recommend staying on antidepressants for several months after symptoms improve after a first episode. They recommend staying on them longer when depression has come back, lasted a long time, or been severe. So tapering is not only about preference. It is also about timing and safety. Is this a good time to try? And do we have a plan if symptoms get worse?

Are some antidepressants harder to stop than others?

Yes. Some antidepressants are more likely to cause symptoms when they are stopped, especially if they are stopped too quickly. In general, medicines that leave the body quickly can be harder for some people to stop. Examples include paroxetine, brand name Paxil, and venlafaxine, brand name Effexor. Fluoxetine, brand name Prozac, often causes fewer symptoms when stopping because it stays in the body longer. But every person is different. That is why the taper needs to be personalized.

Are there options other than antidepressants?

Yes. Antidepressants are only one part of depression treatment. Therapy can be very helpful. This can include cognitive behavioral therapy, also known as CBT; interpersonal therapy; behavioral activation; psychodynamic therapy; and mindfulness-based approaches. For many people, therapy is as important as medicine, and sometimes it’s more important.

It is also important to look at the full picture. Sleep, substance use, exercise, social isolation, daily routine, trauma, medical issues, and the person’s life circumstances all matter. Depression does not happen in a vacuum. For more severe depression, or depression that has not improved with treatment, other options may be appropriate. These can include transcranial magnetic stimulation, electroconvulsive therapy, or ketamine or esketamine. The right approach depends on the person. It depends on the severity of depression, safety, past treatment response, preferences, access, and what is realistic in that person’s life.

Why should I talk with a clinician?

Good treatment should be a partnership. People should feel able to ask questions and speak honestly about what they are experiencing. Tell your clinician if your medicine is not helping, if side effects are affecting your life, if you feel emotionally numb, or if you want to stop taking the medicine. These are all valid things to discuss. The goal is not just to lower symptoms on a checklist. The goal is to help people return to a life that feels more livable, connected, and meaningful.

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Stroke Risk in Women: What to Know at Every Stage of Life

Updated on May 28, 2026 | Your Health

Stroke is a leading cause of death and long-term disability in the United States, and it affects women in unique ways. Women account for more than half of all strokes nationwide, and one in five women will have a stroke in her lifetime. While stroke risk increases with age, women face additional risk tied to hormonal changes and reproductive events across their lives.

From the onset of menstruation to pregnancy and menopause, shifts in hormones can influence blood pressure, cholesterol, inflammation, and blood clotting. Certain pregnancy complications, such as high blood pressure or gestational diabetes, can raise a woman’s risk for stroke years later, while the transition through menopause is associated with a sharp rise in cardiovascular risk. Despite this, many women are unaware that these life stages play a role in brain health.

In this Q&A, Andrea Lendaris, MD, MS, a stroke neurologist and Assistant Professor of Neurology at the Icahn School of Medicine at Mount Sinai, explains how stroke risk changes across a woman’s life, what warning signs to watch for, and steps women can take to reduce their risk.

Andrea Lendaris, MD, MS

How does stroke risk affect women differently than men?

Women and men share traditional risk factors like high blood pressure, diabetes, smoking, and abnormal heart rhythms such as atrial fibrillation. These risks often have a disproportionately higher stroke risk in women, making prevention and early treatment especially important. Blood pressure is a particularly important example: Stroke risk in women begins to rise at lower thresholds compared to men, especially during midlife, making earlier recognition and control critical. There are three specific examples:

Women experience stroke risk shaped by their hormonal changes throughout their lifespan. Estrogen helps support vascular health, including affecting blood vessel function, cholesterol levels, inflammation, and clotting. As hormone levels change over time, and decline during menopause, these protective effects diminish, and stroke risk increases.
A women’s reproductive history can also provide important insight into a woman’s long-term vascular risk. Pregnancy complications are common, affecting about one in five women, and may reflect underlying vascular biology and signal an increased risk of stroke later in life.
Certain gynecologic conditions such as polycystic ovary syndrome (PCOS) and endometriosis are increasingly recognized as contributors to long-term vascular risk.

How can early life factors, like menstrual patterns or use of contraceptives, be connected to stroke risk?

Early reproductive health can offer important clues about future vascular risk. Irregular menstrual cycles, conditions like polycystic ovary syndrome (PCOS), and early menopause are often associated with underlying metabolic or hormonal imbalances, including insulin resistance, dyslipidemia, and elevated blood pressure. These factors can quietly shape cardiovascular risk decades before any symptoms appear.

Hormonal contraception is another key consideration. Estrogen-containing contraceptives can increase the risk of blood clots and ischemic stroke, particularly in women who have additional risk factors such as migraine with aura, smoking, or high blood pressure. For most healthy young women, these medications remain safe and effective, but individualized counseling is critical. Understanding a patient’s full vascular risk profile helps guide safer contraceptive choices and reinforces the importance of early prevention.

Pregnancy is often described as a “stress test” for the body. What does that mean when it comes to stroke risk?

Pregnancy involves profound changes in hormone levels, in your blood flow, in your body’s metabolism, and even how blood clots. All of these reshape your vascular system, the network of arteries, veins, and capillaries that circulate blood, also known as your circulatory system. Blood pressure, cholesterol levels, inflammation, and coagulation pathways all shift to support the developing fetus and prepare for delivery. For many women, these changes are well tolerated. But when complications arise, such as preeclampsia, gestational hypertension, gestational diabetes, placental abruption, preterm birth, or delivering a small-for-gestational-age infant, they can unmask an underlying susceptibility to vascular disease.

Importantly, this “stress test” does not end at delivery. The postpartum period, sometimes referred to as the “fourth trimester,” extending up to a year after birth, is a critical window for stroke risk. In the early postpartum period, women are at risk of more clotting. During this time, the risk for complications such as stroke increases, including from clots in the brain’s blood vessels or rare tears in neck arteries. These risks highlight that pregnancy-related vascular stress is dynamic and prolonged, not confined to the delivery hospitalization.

There is also encouraging evidence that breastfeeding may help mitigate some of this risk. Observational data suggest that lactation is associated with lower rates of stroke and cardiovascular death, with the greatest benefit seen in the first year of cumulative breastfeeding. This protective effect is thought to be mediated through improvements in blood pressure, insulin resistance, cholesterol, and inflammation.

Pregnancy complications should not be viewed as isolated events but instead as early indicators of long-term vascular health, and can help identify women earlier who may benefit from closer monitoring, risk factor modification, and targeted interventions well beyond the postpartum period.

What happens to stroke risk during and after menopause?

Menopause marks a major turning point in vascular health, driven largely by the loss of estrogen and its effects on the brain and blood vessels. Estrogen plays an important role in maintaining vascular flexibility, regulating cholesterol, and modulating inflammation. As levels decline, blood vessels become stiffer and women begin to experience changes in blood pressure, cholesterol, body fat distribution, and overall vascular function. One common and often overlooked pattern is the slow rise of blood pressure, or “hypertension creep.” Women who previously had normal blood pressure may begin to see increases. Even subtle changes can add up and significantly raise stroke risk. These shifts help explain why heart and stroke risk rises sharply after menopause, particularly in the first decade, when women begin to surpass men in overall stroke burden.

The timing of menopause also matters. Early menopause—whether natural or the result of an intervention such as a hysterectomy—is associated with higher long-term cardiovascular and stroke risk. At the same time, menopausal symptoms themselves are not just a quality-of-life issue. Severe symptoms, such as hot flashes and night sweats, are increasingly recognized as markers of vascular instability and are associated with higher cardiovascular risk. Treating these symptoms appropriately may play a role in improving overall vascular health.

Hormone therapy is an important and often misunderstood part of this conversation. Earlier studies suggested increased risks of stroke and cardiovascular disease with hormone replacement therapy. These findings were largely driven by study populations that were older, further from menopause, or already had underlying cardiovascular disease. More recent data support a “timing hypothesis,” showing that hormone therapy can be used safely for symptom management for appropriately selected women, typically those under age 60 and within 10 years of their final menstrual period.

How hormone therapy is delivered also matters: transdermal (patch) and vaginal estrogen formulations do not appear to increase stroke risk, and vaginal estrogen may even have protective effects.

Taken together, menopause is not just a hormonal milestone but a critical window for identifying and managing stroke risk. It is a time to recognize new diagnoses like hypertension, address symptoms that may signal underlying vascular changes, and take a more individualized, evidence-based approach to prevention.

How do stroke symptoms sometimes look different in women, and when should women seek emergency care?

Many classic stroke symptoms, such as sudden weakness on one side of the body, difficulty speaking, or vision loss, occur in both women and men. Women, however, are somewhat more likely to report additional, less specific symptoms such as fatigue, confusion, dizziness, headache, or nausea. These symptoms can be more easily overlooked or attributed to other causes, which may delay recognition and treatment.

Despite this variability, the key message is urgency. Any sudden neurologic change should be treated as a medical emergency. The acronym BEFAST (Balance disturbance, Eyes/vision changes, Face drooping, Arm weakness, Speech difficulty, Time to call 911) is a helpful tool to recognize common stroke symptoms, but it should not limit action if something feels wrong. If symptoms are abrupt and new, it’s time to call 911. Rapid evaluation is critical, as timely treatment can significantly reduce disability and improve outcomes.

What are the most important things women can do at any age to reduce their risk of stroke?

Stroke prevention in women starts with understanding risk across the lifespan. In addition to traditional risk factors—such as high blood pressure, diabetes, high cholesterol, smoking, sleep, and weight—women should also know their reproductive and gynecologic history, including pregnancy complications and timing of menopause. These events offer important insight into underlying vascular health and help identify women who may benefit from earlier or more aggressive prevention strategies.

Blood pressure control is especially important, as stroke risk in women rises at lower thresholds and often increases gradually over time. Recognizing patterns like this “creep” and addressing them early can have a major impact. For women with specific risk factors—such as migraine with aura, a history of pregnancy complications, or conditions like endometriosis or PCOS—more tailored management may be needed.

Equally important are lifestyle strategies that support vascular health, including regular physical activity, a heart-healthy diet, good sleep, and stress management. The most effective approach is proactive and continuous. Stroke prevention is not tied to a single stage of life, but to recognizing risk early and managing it consistently over time.

How to Spot Celiac Disease in Kids and Other Family Members

May 21, 2026 | Your Health

A photo of a young child and a doctor who is examining their belly.

Celiac disease does not always produce common stomach or digestive symptoms. In fact, it can hide behind symptoms that seem to be completely unrelated to the digestive system and can be surprisingly subtle.

Celiac disease is a disorder in your immune system that occurs when gluten (a protein in wheat, barley, and rye) causes your body to attack and damage the lining of the small intestine.

In this Q&A, Juliana Kennedy, MD, Director of Mount Sinai’s Pediatric Celiac Disease Program, explains how knowing the signs of celiac disease can help families and pediatricians find it early and prevent complications, even among people, including adult family members, who may show no symptoms at all. Dr. Kennedy is also Assistant Professor of Pediatrics (Gastroenterology) at the Icahn School of Medicine at Mount Sinai.

How can I spot celiac disease in my kids and teenagers?

Symptoms often vary by age. While some children show classic signs, others may have no digestive symptoms. Some may have non-digestive symptoms such as skin or dental problems. Some may have no symptoms at all.

The classic gastrointestinal symptoms of celiac disease include:

Chronic diarrhea
Belly pain
Belly bloating
Nausea or vomiting
Weight loss or weight faltering, which is a term that pediatricians use to describe a child whose weight gain is significantly lower than expected
Constipation

The atypical symptoms of celiac disease can vary widely and include:

Growth: Short stature or delayed puberty
Dental: Pitting or discoloration of permanent tooth enamel
Neurological: “Brain fog,” headaches, or irritability
Skin: An intensely itchy, blistering rash called dermatitis herpetiformis
Certain gastrointestinal symptoms such as gastroesophageal reflux disease (GERD) or liver inflammation (hepatitis)

Why is screening family members for celiac disease important?

Celiac disease occurs in people with certain genetics. Close family members often share similar genes, so the rate of celiac disease among first-degree relatives—typically your parents, siblings and children—is about 7 percent to 20 percent. This compares to 1 percent for the general population. This is why we focus heavily on the “first-degree” circle. We recommend screening first degree relatives when their family member is diagnosed. They are at a much higher risk than the general population, even if they aren’t currently showing symptoms. By diagnosing them early, we can prevent future complications.

How is celiac disease diagnosed?

If you suspect celiac disease, an important step is to not remove gluten from your child’s diet until testing is complete. Doing so can cause false negative results. If your child is already on a gluten-free diet, you should discuss this with your doctor before testing.

Juliana Kennedy, MD

There are two steps to diagnosing the condition:

First, a blood screening checks for specific antibodies.
Next, an endoscopy and biopsy confirm the diagnosis by looking at the lining of the small intestine.

What happens if celiac disease is undiagnosed or not treated?

Early intervention is key. If left untreated, celiac disease can lead to long-term complications including permanent short stature, weakened bones (also known as osteoporosis), and infertility.

What are the treatment options?

The current treatment is a strict, lifelong gluten-free diet. This means more than just avoiding bread. Families need to watch for hidden gluten in sauces, seasonings, and cross-contamination in kitchens. While this may seem difficult, we have the tools and resources to support any family as they navigate life on a gluten-free diet. Treatment is critical because, when celiac disease is caught early, the small intestine can heal completely. This allows children to reach their full growth potential and avoid long-term complications.

Get more information about Mount Sinai's Pediatric Celiac Disease Program

Expert Advice for Navigating Menopause

Updated on May 18, 2026 | Your Health

Candice Fraser, MD, MBA

Menopause is a natural life stage, and while it can bring challenges, there’s encouraging progress in how it’s understood and treated. Awareness is growing, care is improving, and more resources are becoming available to support women through midlife.

“Partnering with a trusted health care provider can help you find the right approach for your needs,” says Candice Fraser, MD, MBA, Menopause Society Certified Practitioner and a board certified obstetrician/gynecologist at the Carolyn Rowan Center for Women’s Health and Wellness at Mount Sinai. “Overall, the outlook for menopause care is brighter than ever.”

In this Q&A, Dr. Fraser explains how care has improved in recent years, such as in hormone therapy and non-hormonal medications, and how experts can help, especially when there is so much information available online, not all of it accurate. Dr. Fraser is also Assistant Professor in the Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai.

What are the biggest gaps in menopause care today?

One ongoing issue is clinician education. Many doctors were once trained to avoid hormone therapy due to safety concerns from older studies, and not all training has caught up with newer evidence. Research is another gap. We still need better data on how treatments address the full range of symptoms. And with so much information online, patient education remains critical to help women sort fact from fiction.

Has menopause care improved in recent years?

Yes, there’s been real momentum. More clinicians are pursuing specialized training, and medical programs are beginning to include menopause-focused education. Health systems are also expanding services. For example, Mount Sinai Health System recently opened the Carolyn Rowan Center for Women’s Health and Wellness, reflecting a broader shift toward comprehensive, whole-person care during midlife. New treatment options are also emerging, including non-hormonal medications for symptoms like hot flashes.

What do many women not realize about perimenopause?

Perimenopause can affect the entire body, not just cause hot flashes. Symptoms may include brain fog, mood changes, joint pain, and urinary issues. Another common misconception is that hormone therapy is a cure-all; in reality, many symptoms have multiple causes. The good news is that lifestyle habits—like regular exercise, a balanced diet, good sleep, and stress management—can have a powerful impact.

Can you highlight a lesser-known symptom and how to manage it?

Pain during sex is common but often under-discussed, and it’s very treatable. A health care provider can help identify the cause. Simple options like lubricants or vaginal moisturizers may be enough. If not, low-dose vaginal estrogen is a safe and effective choice for many women. Other treatments, such as pelvic floor therapy, can also provide relief when appropriate.

Why is there a gap between perceived and actual symptoms?

Awareness is still catching up. Many women, and some clinicians, don’t yet recognize how wide-ranging menopause symptoms can be. At the same time, the flood of online information can create confusion. Encouragingly, as education improves, more women are getting clearer, more reliable guidance.

What’s the key takeaway for women?

Every menopause journey is unique, but no one has to navigate it alone. With better-informed clinicians, growing research, and more dedicated care centers, women have more support and options than ever before. Partnering with a trusted health care provider can help you find the right approach for your needs. Overall, the outlook for menopause care is brighter than ever. With continued progress in education, research, and specialized services, women can approach this transition feeling informed, supported, and empowered.