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From the wellness expert who brought you “sleep hacks: herbs for sleeplessness and anxiety“ comes another video packed to the eyeballs with healthy herbal goodness.

This time, Jovanka is taking on another common menopausal symptom: digestive disruption.

“Your digestion is at the cornerstone of your health.
Without a healthy gut, everything else will start to fall apart eventually.”

As estrogen levels fall in midlife, cortisol levels rise, bumping up both your blood pressure and your blood sugar levels. The hormonal imbalance can slow digestion, causing gas, bloating, constipation, pain, and indigestion.

There are lifestyle changes you can make to help control the problem: eat slowly, drink plenty of water with your food, choose foods in menopause that help with digestion (are high in fiber), get enough sleep, and exercise regularly. But for many women, lifestyle changes don’t provide sufficient relief, and digestive symptoms as and the risk of embarrassment as really cramp their social and professional lives along with their stomachs.

So if bumping up your intake of leafy greens isn’t enough, Jovanka has some great suggestions of herbs that can help regulate your digestion and get your gut back on track. 

 Want more herbal relief? Check out Jovanka’s ebook, 12 Libido-Enhancing Herbs, for even more support of your healthy, fabulous life.

Jovanka is a featured expert at People Magazine, Entertainment Tonight, Whole Foods, Veria Living, Fox News LA, NPR and CBS Radio. She’s also a regular contributor in Spanish-language media outlets like Telemundo and is a contributing guest expert at The Huffington Post, MindBodyGreen, BlogHer and PositivelyPositive. Jovanka gave her first TEDx talk on “Rethinking Failure” in November 2013. Want more Jovanka (and who doesn’t, frankly)? Check out her creation: the Wellness Smackdown , an online wellness & learning community for healthy living, which was featured on the first season of ABC’s “My Diet Is Better Than Yours.” Jovanka also offers lectures, workshops and wellness coaching in both English and Spanish.

 

What if you could relax more easily, decrease anxiety, symptoms of depression, fall asleep easily, improve the quality of your sleep, even signal increased anti-inflammatory and self-regulatory body responses at will? We can.

And…bonus! It’s free and easy to do. 

We almost don’t have to think about it to get the benefits.

While scientific research and verification are still underway, it might be worth attempting to activate the vagus nerve regularly with simple breathing exercises in order to engage the parasympathetic nervous system. This will begin to take us into a “rest and digest” mode, and out of the sympathetic system’s “fight, flight or freeze”.

Chances are good you’re more familiar with your sympathetic nervous system. This system is the one that boosts the body’s heart rate, directs blood flow to key systems and organs, and increases alertness, via rapid hormone release. All of this is in order to prepare the body for the fight, flight, or freeze response in a dangerous or stressful situation. 

Wired, but tired

Feeling wired-but-tired may be an indicator that your sympathetic nervous system is working harder than it needs to, especially if you’ve got that feeling in non-stressful, non-emergency situations. Perhaps you’ve felt it while watching television, or while trying to fall asleep in the comfort and safety of your home. Or maybe you find it challenging to rest or get to a state of relaxation in general.

You’re not alone

Dr. Deepak Chopra, notes that “Our society is on sympatheic overdrive.” Meaning, many of us are in a constant or chronic state of high alert. What else does this mean for our bodies to be in an almost constant state of emergency alert? 

It increases our risks for high blood pressure, inflammation throughout the body, heart disease, cardiac arrhythmias. Getting out of the sympathetic nervous system and into the parasympathetic system takes little effort, and we’re all halfway there by breathing all the time anyway. With a tiny bit of modification, we may reap the benefits of improved health and wellbeing, reduce our risks for heart disease, symptoms of anxiety, and depression.

Fun facts about the vagus nerve

Which is the longest nerve in your body, with a path to almost every organ? It’s the 10th cranial nerve in the body and it wanders from above the mid-brain throughout your body, all the way down to your colon: the vagus nerve. Ta-da!

As a part of the parasympathetic nervous system in our bodies, the vagus nerve influences lung, heart, gut, and diaphragm activity, not to mention facial expressions, speaking and swallowing functions. And it’s possible to activate, support, and bring balance into our bodies regularly by engaging and activating the vagus nerve.

Vagus nerve breathing exercises for engagement

Breathing slowly and deeply is the path to engaging the vagus nerve and improving what’s known as vagal tone. 

Breathing in and out through your nose, inhaling and exhaling to the count of 4. Spend 2-ish minutes and breathe 10 breaths of inhale and exhale at the count of 4 for each, and see how you feel.

Play with it. Perhaps you can slow your number of inhales and exhales per minute even more by inhaling to a count of 5 and then exhaling to a count of 6 or 8 for another series of 10 breaths.

What does this do? 

It provides a balancing effect on your nervous system. When you practice this type of breathing, and other non-invasive methods to activate your vagus nerve, improve your heart rate variability (HRV), so your body can relax faster and easier after a period of stress. This breathing exercise can also help you to relax and fall asleep.

Vagus nerve stimulation

There are medical procedures and devices that have been adopted to stimulate the vagus nerve in order to treat epilepsy and mental health including depression. There was a study done in 2016 for those suffering from rheumatoid arthritis as well. 

Ongoing research is currently underway for inflammatory diseases such as Crohn’s, Parkinson’s, Alzheimer’s, as well as rapid cycling bipolar and anxiety disorders.

More support, not less

How to incorporate a new practice that may ease menopause symptoms, and even help to decrease inflammation, reduce the risk of heart disease? Maybe all you need are a few suggestions to prompt you to engage your parasympathetic nervous system during the day? You could begin to breathe slowly and deeply when you: 

Where else, and what else, might prompt you to take a more conscious, deeper breath?

But wait, there’s more

Additional ways to engage your vagus nerve and your parasympathetic nervous system:

Coaching and additional support may be of help as you navigate through your menopause transition. Make a simple start by slowing and deepening your breathing. The hardest thing about this suggestion may be remembering to do it. 

 

What did you discover when you tried to engage your parasympathetic nervous system via your vagus nerve? We’d love to hear what you’ve experienced in our Community forums. Join, and share.

 

Casey, age 53, woke up chilled. At 4 am this morning. 

Had she actually slept through a hot flash? Miracle of miracles, she could only hope. 

Still groggy, she managed to register some gratitude and relief that it wasn’t 1 am, which it had been for the last several weeks. She sighed, turned to her other side, and touched her cheek down to a fresher spot on her pillow. Another sigh. 

She counted 6.5 hours of glorious, uninterrupted, deep sleep. “At last,” she thought, “Maybe I’m getting the hang of”¦ wait. What was that?” A warm liquid flood released with her new sleep position. She tentatively touched the mattress behind her back, and the backside of her underwear and sure enough. Evidence”¦ bold, red, and wet was there. “Noooo”¦ no, no, no”¦ I thought I was done with periods.” 

It had been 6 months since her last cycle”¦ and there was no mistake that she was having one now.

Not sure where you are in the menopause transition? Take our Menopause Assessment.

Annoying but normal

If you haven’t experienced skipped (or extra) periods in perimenopause, allow us to assure you, it can be a normal (and annoying) part of the process.

As hormone levels change, menstrual cycles may go from reliable and familiar to whose-period-is-this? Changes may include: 

What’s going on? 

In order to illustrate, let’s do a comparison of what goes on during a regular period and a perimenopausal irregular period. 

Most periods until perimenopause

An egg matures in the ovaries during a period with the help of an increased level of FSH (follicle-stimulating hormone). It’s the follicles that produce estrogen, and the estrogen, in turn, causes the lining of the uterus (the endometrium) to thicken, to prepare to receive a fertilized egg. 

Ovulation, the release of the mature egg, creates progesterone. Most eggs aren’t fertilized. What happens next is, the progesterone goes away and the endometrium is sloughed off. This is what we know as a period.

Perimenopause periods

During perimenopause periods, there aren’t as many follicles to stimulate, so the body really increases the FSH, resulting in more estrogen being created. More estrogen means the uterine lining becomes even thicker as causing heavier bleeding and perimenopause periods lasting longer. This whole process can take longer, too, resulting in longer gaps between periods.  

What about ovulation in perimenopause? Is that a thing?

Yes, indeed it can happen more often than not. In some cycles, the endometrium continues to thicken until it has to be shed as resulting in a very heavy flow.

A word about abnormal bleeding

During a cycle that has a heavier flow than you’re familiar with, it can feel surprising, baffling, even a little scary to see more blood and clots than you are used to. 

Bear in mind, you may experience feelings of disappointment, exasperation, weariness, all in addition to increased or intensified cycle symptoms. Be easy on yourself and ramp your self-care if you can. Your body and mind are going through a significant transformation.

This being said, a regular period can release between 2 tablespoons over the course of 4-6 days, or more, for more days or fewer. We’ve also seen reports of regular or normal period bleeding as being 2-3 tablespoons over 3-5 days.

Abnormal bleeding, specifically may look like very heavy bleeding or bleeding that:
 

In order to really dial into your own health and body, consider a check-in with one of our Telemedicine doctors. This is for assurance, guidance, support, and it will keep your files noted with new data and insights.

Be prepared, stay prepared

No, not hyper-vigilance. Just simple awareness. Here are a few ways to be and stay prepared for an unexpected period:

Keep count.

 When was your last period? How many months have you gone without a cycle?

Bring supplies.

 Menstrual cup, tampons, or pads, have something on-hand until you’re sure you’ve gone 12 months without a period. Desk, car, bag, duffel, wherever. And it doesn’t have to be a lot of supplies, just the right one for you to get you through a few hours.

Practice awareness of body changes and any other symptoms.

If you’re experiencing multiple perimenopause symptoms, it’ll make more sense and may feel more normal to have irregular periods at this time. Journal about them, keep a record on Post-it notes at your bedside, record them in a notes-application on your mobile device. They may prove useful and paint a bigger picture when you”¦

Check-in with your doctor or other health  support systems.

Let your doctor or professional know what’s going on with you and your body. Support, education, and care will really help you navigate through perimenopause to menopause by making informed choices about your options.

Was this one my last one?

We have no idea when or which one our last period is. There’s no indicator that we’re on the final countdown, tallying 12 full months of no menstrual cycle to achieve and unlock the menopause level. 

Best you can do is to be aware, consult your doctor (or speak with one of ours), practice some extra self-care, and know that this could be the last or at least one of the last, periods you’ll go through. You’ll be closer, if not finished. Regardless, transformation is, indeed, happening. 

 

What have you experienced around irregular periods in perimenopause? And”¦ what are your questions about period reoccurrence during perimenopause? Check-in and chat in our Gennev Community Forums.

 

Guest blog from Anne M

What it means to go into menopause early

Going into menopause early means you need to love yourself more and get the medical attention you need, now.

Thirty is the new 20, 40 is the new 30″¦. until it’s not. My 40th birthday was to be the beginning of fertility treatments and the excitement of planning to be a single mom after years of dating that had proven fruitless. Forty had another surprise in store for me, however, with the abrupt stop of my menses.

There was nothing in my family history that would have predicted this. My mom and aunts had gone into menopause in their late 40s, early 50s, “like normal.” Having started at age 11 and never once missed a month since, I naively, secretly, and happily thought I might have been pregnant from a relationship that had ended the month before when my period stopped.

The next month I had a very light period, however, so I scratched that idea but thought I should see my ob-gyn when the month after that was extremely light (spotty almost) as well.

Hard to forget that day. The ob-gyn came in, did an exam, ran a menopause test, and left. And then came back in. I can still see her face as she told me, somewhat glibly, that I was in menopause. I asked””dumbfounded and shocked”””so, wait, you mean I can’t have babies?” No. “Well, what about having eggs harvested?” “Nope. Too late.” And she left.

Nope, too late

I numbly got dressed, walked out and didn’t go to an ob-gyn doctor again for five years. Denial and rebellion ensued.

My period pretty much stopped immediately, and the menopause hot flashes and urinary tract infections (UTIs) began. The mental head games weren’t fun either, as I dated and battled with how I would tell my boyfriends (another post, another day).

Odd things happened as well””my handwriting that had often been praised as beautiful started to become incoherent. I went to a psychiatrist about my mental fog and he gave me Prozac. Never made the connection. Of course it would have helped had I told him. He never suspected, given my “youth.”

Fast forward to 45. I decided it was time to accept my fate and went to an ob-gyn. While I had been “playing” with some herbal remedies, I still was apprehensive. The doctor I saw was lovely. He recommended hormone therapy as a trial for three months to see if it improved my symptoms and scheduled a bone density test for me that afternoon. I left feeling better, optimistic, and had my test.

At 10 the next morning the nurse called and said the doctor wanted to see me back immediately. I was petrified, thinking maybe I had cancer, an STD, anything. The doctor told me that my bone density was extremely low and that my hormone replacement was no longer a trial but permanent and very necessary for me to maintain supple bones as I grew older. I had the bone mass density of a 63-year-old, at 45.

My five-year, self-imposed menopause denial and consequent medical hiatus was a mistake, and it cost me my health in many regards.

Lessons learned from early onset menopause

You cannot control when your body goes into perimenopause or full-on menopause. What you can do is get educated, re-examine the best time for you to have your own biological children if this is important to you, and understand your body and what you can do to best take care of yourself before, during and after.

  1. Realize that not everyone goes through a perimenopause stage. I didn’t. My period was normal the month before it stopped, and no other symptoms were present (that I was aware of) up until the day it stopped.
  2. Continue to have regular checkups. Your doctors, health practitioners, holistic shamans are your friends and ready to help.
  3. Ask questions. While I had been having regular checkups throughout my 30s, I treated them like I did when I was 18. Get educated about perimenopause.
  4. Consider your timeframe for children and plan accordingly””perhaps earlier than you may otherwise have. Even my married friends with kids had trouble conceiving in their 40s. The Hollywood lies we had believed in the 90s weren’t really accurate.
  5. Realize that there are some good things””I was the envy of many friends on numerous trips with no cramps or soiled sheets, and many boyfriends were actually pleasantly surprised to not have to deal with a four-day hiatus in our sex lives. Many boyfriends didn’t want children, and therefore my menopause was a non-issue for them.
  6. Your body has brought you far and deserves to be taken care of””by you. By the time you reach menopause. you have both been through a lot. Perhaps you had kids, or not, or maybe not as many as you desired. Either way, your body is the vehicle that hosts your beautiful soul, and it needs to be taken care of as you age. Not getting the medical attention you need is not the answer.

Feeling alone in your menopause journey? Work with a Menopause Health Coach. Learn more.

 

One of the many reasons we love walking for exercise in midlife and menopause is because it is an easy, accessible way for most women to stay active and get outdoors. But what do you do when hot and humid, cold and rainy, or snowy and icy weather keeps you inside?  Don’t use it as an excuse to skip your workout!

Keep Moving With An Indoor Walking Workout 

Most days, you can make some adjustments, dress appropriately, and weather the storm or the heat. For the days when it’s unsafe or impractical to walk outside, turn to our three indoor workouts that will boost your mood, fight belly fat, give you more energy, and help ease those menopause symptoms. The change of pace will also challenge your body in new ways and add variety to your usual routine. Plus, consistency is the key to seeing results from your exercise efforts.

These three workouts can be done in the comfort of your home (or at the gym) no matter what the weather may be.

Workout 1:  The 30-Minute Treadmill Trio

One of the great things about walking on a treadmill is that you’re in command. You control the climate. You can easily walk a precise distance and track your progress. You can add hills when you want them and get rid of them when you don’t. You can multitask while you walk, watching TV, talking on the phone, scrolling social media, or checking your email. Or you can get focused and crank out a heart-pumping, calorie-blasting walk like this one. Adding speed and incline intervals will rev up the fat-burning power of your walk.

Warm-up (easy to moderate intensity)

Part 1: Steady pace (moderate intensity)

Part 2: Speed intervals (moderate to hard intensity)

Part 3: Hill climb burst (moderate to very hard intensity)

Cool-down (moderate to easy intensity)

Workout 2:  15-minute High-Energy Indoor Workout

You don’t need any equipment or a lot of space to get an indoor, energy-boosting walk. Unlike walking outdoors, you can safely change the direction and ways your moving””going side-to-side and forward and backward and adding moves like kicks and knee lifts””to work more muscles, which prevents muscle imbalances and boosts your calorie burn. So, turn up your favorite tunes and get moving.

Warm-up

1 minute: march in place

Part 1: Fancy Footwork

30 seconds: walk on your heels with your toes off the floor

30 seconds: walk on your toes with your heels off the floor

Repeat Part 1 one more time

Part 2: Fast Feet

1 minute: speed walk around your house, exploring as many rooms as possible

Repeat Part 2 one more time

Part 3: Multi-direction Moves

1 minute: climb stairs (no stairs? Step up and down on a single step, exercise step bench, or sturdy low bench, or speed walk around your house again)

Repeat Part 3 one more time

Cool-down

1 minute: march in place

Workout 3:  Add 5 Moves for Total-Body Toning

Add these moves to either the 30-minute Treadmill Trio or 15-minute High Energy Indoor Workout. You can turn either of those previous walking workouts into a total body, toning workout by adding our strength moves for walkers. These multi-muscle exercises will build strength to protect your joints, preserve muscle to keep you active, and improve your balance.

Here’s how to do it: After each part of the workouts above, including the warm-ups and cool-downs, do one of the moves in our strength moves for walkers video, completing 10 to 12 reps of each.

For example:

Want to get more from your walks? Join the Get Moving Walking Program for Women to receive two 30-day walking programs designed by women for women, support from certified fitness instructors and Gennev menopause specialists, as well as special offers and incentives.

Always check with your physician before beginning any new exercise program.  

 

As a nutrition coach, I frequently field questions from my clients who are concerned about whether or not they are getting adequate amounts of protein in their diets.

While I think the concern is valid, I do believe that the hyper-focus on this food group is a byproduct of a trend that I like to call “Labelmania.” Everyone is talking about what their nutrition label is these days, and many of the labels du jour have a protein-centric approach, from Paleo and Atkins to Ketosis. I feel like I can’t go to a social outing anymore without people asking me what or how I eat!

Pushing protein

Speaking of labels, another culprit fueling the protein phenomenon is food marketers who overpromote our need for protein on their packaging. It’s hard to walk down a grocery and avoid being drawn to these colorful, impactful labels.

Power Bar is a perfect example of this. Their Chocolate Peanut Butter Protein Plus Bar boasts a whopping 20-30 grams of protein. Sounds great, right? What they don’t promote on the label is the 12 grams of sugar in the bar and the nearly 20 ingredients it contains, most of which are impossible to pronounce.

These labels and messages around protein are everywhere, from TV commercials to social media. It’s so much information, and it can be completely confusing.

I’m here to help, because I want you to know that this whole protein thing doesn’t need to be complicated. I’ve created a list of four protein pointers that will help you get the protein you need without the stress. They’re easy to follow and will help you cut through the marketing and Labelmania clutter.

1. Know how much protein you really need

It’s easy to make your protein quota! Did you know that the average woman needs approximately 46 grams of protein each day?

It doesn’t take much effort to get to 46 grams; even if you’re a vegetarian. For example, if you consume a 3.5 oz serving of salmon (25 grams) + 2 eggs (12 grams) + 23 almonds (6 grams) + 1/2 cup quinoa (11 grams), you’re at about 54 grams of protein for the day. That’s pretty easy to attain and you didn’t even have to eat a bar!

2. Get protein power from plants

Put plant-based proteins in your portfolio. Protein doesn’t need to mean meat, meat, meat. There are so many nutrient-dense, plant-based proteins to fill your plate with AND satiate your appetite.

Some of my favorite plant proteins are lentils, chickpeas, quinoa, almonds, kale, tofu and broccoli. Animal-based proteins are an important part of your diet, but it’s important to be cognizant that excessive amounts can be detrimental to your health.

Experts agree that if you eat more protein than your body requires, it will simply convert most of those calories to sugar and then fat. Increased blood sugar levels can also feed pathogenic bacteria and yeast, such as Candida albicans (candidiasis), as well as fueling cancer cell growth.

3. Go protein au naturel

Reduce your intake of man-made proteins. I get it, you’re busy, and it’s way easier to grab a bar than it is a piece of chicken breast when you’re starving and on the go.

If you are truly concerned about your health and what you are putting in your tank, then remember the Power Bar I told you about earlier. Sure, you might be getting protein, but you’re also getting a whole lot of other fake ingredients that detract from any “good” you’re doing.

I’m not asking you to quit bars cold turkey, but reduce your intake of on-the-go wrapped protein options, and find some other smart, on-the-go solutions.

Starbucks is doing a great job with their Mercato products; from their sous vide egg bites to their protein boxes with hard boiled eggs and hummus. If you’re going to do a bar, I’m a fan of Kind and RXBAR bars, as they have minimal ingredients.

4. Time it right

On workout days, timing is everything! If you have an intense workout, time your protein intake correctly pre and post workout to avoid the hangries. This is important at any age, but it is especially crucial now when hormones can play such a key role in our moods.

By timing our protein intake around workouts, we can manage through the hangries and the roller coaster effect of feeling food-deprived. On workout days, eat a 3- or 4-to-1 ratio of carbohydrate to protein one hour before and after exercise to ensure your muscles are fueled and replenished. By pairing proteins and carbs, you can slow sugar absorption and help stave off food cravings.

The bottom line is this: protein is a powerhouse that has many powerful effects on your body and mind, but your focus should be a well-rounded diet that also includes lots of vegetables, fruits and healthy carbohydrates.

Try to follow my pointers and try not to get too caught up in Labelmania. It really doesn’t matter what label you’re wearing, it’s how you go about wearing it.

Cheers to your health!
Michelle

More from Michelle:

The holidays are coming round again (canyoubelieveit?). Be ready for the stress “” and the stress eating. Looking for a better way to feed yourself and your family? Be sure to check out how to shop your Farmers’ Market and buy from the bulk aisle!

How are you feeding yourself for optimal health? We’d love to know. Share with the community in the comments below, or hit us up on Gennev’s Facebook page or Midlife & Menopause Solutions, Gennev’s closed Facebook group.

 

Dr. Rebecca Dunsmoor-Su

Friends, I am driven to write this article because of the press release about a large study published in The Lancet, which claims to show that hormone therapy definitively increases the risk of breast cancer.

Having read the study, guidance from the North American Menopause Society, as well as thoughts from Dr. Avrum Bluming, an oncologist and author of Estrogen Matters, I wanted to share with you my concerns about taking these results at face value.

The press loves to put out “scare headlines” even if the results are more complex and muddled than that. This is another example of this type of hype. I have four serious problems with this study and its results:

One: It’s based on observational studies

This is a type of meta-analysis of multiple observational (not randomized) studies run over more than 20 years with different complex regimens. They combine both previously published and some unpublished data (which can not be verified).

For those who do not have a working knowledge of epidemiology, a meta-analysis generally involves taking previously published data and combining it to make a bigger study.

In the epidemiology world, a common joke about meta-analyses is that they represent “garbage in, garbage out.” Unfortunately, this isn’t really a joke. When you bring a bunch of flawed studies together and make the numbers bigger, you magnify their faults.

We have several large randomized trials that, with all their faults, give us better, more reliable data, which do not show an increase in breast cancer on this scale.

Two: It doesn’t reflect current practices

The regimens used in many of the studies that go into this big mash up are, in many cases, higher doses and different types of hormones than are commonly used today.

This mix of past and present practice makes it hard to draw conclusions on what doctors are prescribing today, as different hormones can behave differently in the body.

Three: The study is overly complex

The methodology used to analyze the data from these studies is exceedingly complex and hard to follow, which means it is hard to judge the results.

Dr. Bluming noted in his response to the paper, “In the editorial accompanying this paper, Joanne Katsopoulos, of the Women’s College Research Institute in Toronto, wrote: “˜The complexity of the study design makes it difficult to appraise the results and most of us will take the results on face value.’ What? Meaning: This study is such a mish-mash of complicated analyses that even we professionals can’t make heads or tails of it, and must rely on the investigator’s word of what she found?”

I have to agree with this assessment. I have a master’s degree in epidemiology, and I could not make heads or tails of the study methodology.

Four: It focuses on breast cancer to the exclusion of other concerns

This study does not take into account the balance between length of life and quality of life. Breast cancer is just one risk women face as we age, and is not even the leading cause of death.

Estrogen is one of our best and most studied treatments for osteoporosis and may well protect women from heart disease and those at risk of Alzheimer’s disease.

Most importantly, for women with significant symptoms in menopause, estrogen can be life (and sanity) saving. As always, we need to look at the whole woman when making hormone decisions, as she is more than her breasts.

Professor Michael Baum, a leading breast cancer researcher in London, released a long statement about the study. This is a portion of that response, excerpted from Dr. Bluming’s letter on the subject:

“I think the press release put out by The Lancet is irresponsible and will undoubtedly lead to a drop in the use of HRT/ERT, plunging thousands of women into a life of misery and for all we know shorten the lives of millions around the world. Remember there are more important threats to women’s lives than breast cancer, which is now only 7th in the league whilst those higher up the league might increase as a result of the withdrawal of oestrogen replacement therapy. “˜Statistical significance’ does not always translate into “˜clinical significance.'”

As much as the WHI study published in 2017 had flaws in methodology and the conclusions it made, the data from that study are still better and more reliable than the associations made in this more-recent publication.

The WHI, in the end, showed estrogen replacement alone to be protective for breast cancer (even when started late in menopause) and the estrogen and progesterone arm had a slightly higher rate of breast cancer, but not a difference that was statistically significant (which means mathematically it could be a chance or incorrect finding). It is a randomized trial that showed hormones to be overall safe for women if used correctly.

At Gennev we believe every woman has a right to valid data and information when making a personal decision about whether hormones are right for her. We try to provide a balanced interpretation of complex medical studies. We also try to reach out to other experts to see what they have to say.

On balance, this latest publication in The Lancet probably does not add much to the conversation around hormones, except to stoke fear.

Rebecca Dunsmoor-Su, MD MSCE NCMP
Chief Medical Officer, gennev.com

Want to learn more or discuss HRT with other women? Join our community forums and be part of the conversation!

 

Americas future surrounding women’s empowerment and the new presidency

This morning I watched Kate McKinnon’s performance (as Hillary Clinton) of Leonard Cohen’s “Hallelujah”.

And I finally cried.

It’s taken me a while to process last week’s election. As a woman, let alone a CEO of a women-focused business, I knew that I needed to make a statement. Take a stand. Be part of the solution. Not be a victim.

And yet, I couldn’t sift through the disbelief, the anger, the sadness, and the understanding and empathy for the millions of people who believe the outcome is right for them.

So I took some time and just buried myself in life with the reassurance that I indeed will process the outcome and share how I see it with you””women who aspire to be the best versions of themselves.

We started Gennev with the profound belief that women should feel fabulous in their bodies. No matter their age. That comes with taking care of the symptoms life’s aging and processing throws our way. The vast majority of Gennev-ers that we reach everyday with our articles and our healthy products are in the most vibrant years of their lives. They’re at an age where they’ve got confidence, they know what they want in life, they’re financially OK, their kids are relatively self-sufficient, their careers are in a good place, and their relationships are well-grounded or becoming more clear.

For many of us, the outcome of this election threatens the path for women’s empowerment and feeling fabulous. And for others, their lives are not threatened. They either believe that the new president will not impact their day-to-day, because they frankly don’t stand for many of the womanly things that a women-led, democratic administration would have stood for. OR, they’ve risen above it to say, “I’m the boss of me” and are taking action to sustain the path of success, confidence-building and support for other women they believe in.

I’m in the latter camp.

I grew up in North Dakota on a cattle ranch and farm. It was awesome, because there was beauty, peace, fun things to do every day, hard work (which I didn’t mind), and family. The days where we gathered, dirty and tired in the house at 10 p.m. after a long hard day of work for a drink and a late-night snack were blissful. It was a very conservative culture””both morally and politically. I understand it well, because I grew up in it. I don’t share the same conservative views today, but I certainly have empathy and love for the culture of people who do. Conservatives don’t represent all the bad parts of the incoming president””in fact, many have love and compassion for all types of people. But, in this election, many of those people didn’t have a better choice, and when needing to select a candidate that most closely represented what they stood for, Trump was their person. For others filled with hate and anger, I simply don’t understand them and only hope there is a uniting force that brings our country together in a way that I cannot see at this point.

I voted for Hillary. I was with her and still am. Am I ready to band together and work through our differences? I don’t genuinely feel that way””like a kid who’s been instructed to say they’re sorry when indeed they’re not. And yet, I know it’s the right thing to do, and I’ll get there. At my own pace.

The tears I finally shed today were a lot for Hillary. I feel so badly for her. In spite of her short-comings (hell, we’ve all got “˜em), she cares deeply for doing what’s right. She’s had to rise up to levels of strength that most of us will never comprehend in our lives. She’s had to fight back amongst highly public humiliations and allegations. And she’s always done so with confidence. She may not have the charisma of people we love to love””like many celebrities (that’s likely part of why they’re so famous)””but we don’t always need to like people in positions of decision, leadership and power. We just have to believe in their ability to lead on our behalf. We have to be able to respect them.

You may have seen the photo of Hillary hiking the leafy paths of Chappaqua, NY last week. I love how human she looked”¦still with a smile on her face. That’s the image we need to be reminded of and replicate when we’re feeling down in the dumps. I hope she gets more time for hiking in the woods in the coming days. I’m going to follow her lead and keep living my life with confidence, grace and a positive outlook”¦but not let go of all the things I stand for when it comes to women’s development, rights, health, and success.

Hallelujah for women like Hillary who dare to take such a bold stand!

 

As I look back on 2019, it was an amazing year for women in the second half of life.

Everywhere we turned, we saw women owning their lives. From celebrities to politicians; career-focused women to those who have mastered their family needs, we witnessed women taking charge. We also heard from women who were suffering from changes in their health, and from others making huge strides in their well-being.

This article is dedicated to you. As a community, you grew thirty-percent: 85% of you are from the U.S. and 15% of you are from countries around the world.

You showed us that you’re hungry for information, so we recapped the Top 10 articles most read by this community to bring 2019 to a close.

As the team and I curated this special edition, we were struck by the diversity of what women in midlife must deal with. It’s not just menopause. It’s also aging parents, kids, careers, discerning fact from fiction, feeling appreciated in life and finding gratitude and contentment.

We hope you enjoy “” even share “” this recap of 2019. Here’s to an incredible year for women’s health. The best is yet to come!

Happy New Year!

 

 

 

 

Jill Angelo,

Co-Founder and CEO, Gennev

Compounded bioidentical hormones

Looking for a more “natural” solution for menopause symptoms, many women are choose bioidentical hormone replacement therapy. But what is BHRT? Is it safer than HRT? Get the facts on hormones, compounding, hormone “matching,” and how to be your own best advocate when it comes to your care. Read the full article.

Is this normal?

It’s the question we at Gennev hear most often: I’m experiencing X as is this normal? Chances are, yes. Yes, it is. And we’re so glad you asked. We believe the more women (and others) know about the changes of menopause, the safer we’ll all be. So keep asking, and we’ll keep helping you find answers. Read more on what’s “normal” in perimenopause.

Benefit from a gratitude practice

Gratitude is good for you. It may be hard to come by when you’re waking up and changing PJs for the third time in one night, but gratitude is actually a powerful healer. Find things to be grateful for, and you may find you have more than you imagined. Learn more about the benefits of gratitude.

Helping caregivers take care of themselves 

The “average” caregiver is a 49-year-old woman “” likely also in the throes of the menopause transition. If you’re caring for an elderly parent, ailing partner, young children, etc., you’re at more risk of injury and depression. Find out how to care for you while you’re caring for everyone else.

Internet hygiene in menopause

This term, coined by OB/GYN Dr. Jen Gunter, is about how to parse through all the health “information” you find on the Internet. Our own Chief Medical Officer, Dr. Rebecca Dunsmoor-Su, provides some wisdom around vetting online sources to keep yourself safe and informed.

The right way to get calcium in menopause

Remember when “getting calcium” just meant drinking a glass of milk? As we age, our nutrient needs change, and calcium is a biggie. Be sure you know the best ways and times to get your calcium to maximize its benefits to your body.

I think I had my first hot flash

Gennev CEO Jill Angelo talks about having her first hot flash, and how modern women and companies like Gennev are changing the definition of “menopause as the beginning of the end” to better reflect the truth: that it’s the start of a second chapter that can be just as rewarding as the first. 

Healing from a hysterectomy

About a third of American women will have a hysterectomy by age 60. Because it’s so common, and because it’s serious surgery, our Docs of Physical Therapy took us through ways women can prepare for it, recover from it, and move forward in a healthful way. Read more about how to heal from a hysterectomy.

Practicing safe supplements

You suspect you probably need to take a supplement or two to meet all your nutrient needs. You head for the grocery store vitamin aisle and immediately want to give up. There are just too many choices and not enough information. Until now! Practice safe supplementing.

Flash Count Diary podcast with Darcey Steinke

Writer Darcey Steinke had a hot flash and started identifying with whales “” in a good way. Certain whales experience menopause because their experience and wisdom is more important to their communities than their ability to have babies. Sound familiar? Listen to this fun podcast with a gifted writer on the transformative experience menopause can and should be.

What articles did you get the most from this year? Did you share any articles with friends? If so, which ones? We’d love to know, so please share your thoughts with us on the Gennev community forums!

 

“Every woman that reaches middle age will experience some level of menopause symptoms. Left untreated, these symptoms can lead to a significant reduction in quality of life,” says Gennev Chief Medical Officer, OB/GYN Dr. Rebecca Dunsmoor-Su.

And because none of the 1.3 million American women who enter menopause each year will have exactly the same experience as another “” and because two women can have vastly different experiences “” there’s never been a real attempt to chart the journey through the transition.

Until now.

Recently we crossed a major milestone here at Gennev: 50,000 women have taken our Menopause Assessment! Created in 2017 by Dr. Dunsmoor-Su, the comprehensive Gennev Menopause Assessment asks women for information about their age, menstrual cycles, symptoms, and history.

Based on women’s responses and Dr. Dunsmoor-Su’s 20+ years of expertise as an OB/GYN with special expertise in menopause, we identified five distinct menopause types. From there, Dr. Dunsmoor-Su, along with our CEO Jill Angelo, created the first-of-its-kind Menopause Journey Map.

Why the map for menopause stages matters

Why is the map a big deal? According to Dr. Dunsmoor-Su, “We’re excited to deliver the Menopause Journey Map to help set expectations for women and offer predictive solutions for symptom relief, something that’s never been done before.”

If you’re a Type 1 (periods becoming irregular, occasional hot flashes), it might be very helpful to know what probably lies ahead in Type 2 (skipping periods, heavy periods, some hot flashes, poor sleep). You can start making lifestyle changes now to combat symptoms, and perhaps the first time you experience normal, harmless, hormonal heart palpitations, you’ll know how to distinguish them from something more serious.

Perimenopause is an opportunity to start practicing some serious self-care in terms of diet, exercise, sleep hygiene, and more. But many women miss a lot of this window, not knowing the symptoms they’re experiencing are hormonal. And if your primary physician isn’t well-educated on menopause (as many aren’t), they may not know either.

Too many women spend years being misdiagnosed, or worse, ignored, before getting the answers they need. But because our health in perimenopause can affect our longer-term, post-menopausal health (think brain, bones, and heart), it’s important that we know when we’re in it.

And no, your getting hormone levels tested probably won’t tell you.

Hear more about the map from the creator of the Menopause Assessment, Dr. Rebecca Dunsmoor-Su:

What are the Menopause Types?

Our Menopause Map breaks menopause into 5 types. (A detailed overview of Menopause Types is available here):

Knowing your symptoms and cycles is the best way of pinpointing your place in the journey, but to truly understand your body, it helps to discuss your experience with a menopause expert.

Know where you are in the journey

Cliché or not, knowledge truly is power as the power to take control: To manage perimenopause and menopause symptoms now, and to make good choices to preserve your health, independence, and quality of life for the many decades that come after menopause.

“For too long, women’s health 40+ has been treated as shameful, but with GenX women aging into midlife, demands for menopause information, community, and solutions are on the rise,” says Jill Angelo, co-founder and CEO of Gennev. “The healthcare industry has been stubborn to evolve, but now we have the data, software, diagnostics, products, and services that allow us to tackle menopause symptoms head on. We have the ability to create the What to Expect When You’re Expecting for menopause.”

If you’re ready to find out your Menopause Type and start charting your path on the Menopause Journey Map, the first step is to take the Gennev Menopause Assessment. This free and confidential questionnaire takes less than 10 minutes.

Once your Assessment is complete, you’ll be directed to create a free account on Gennev. From your personal, confidential dashboard, you can learn all about your menopause type, get product recommendations specific to your symptoms, find educational materials tailored for you, and connect with a Health Coach or OB/GYN. Then, with your Gennev menopause team, you can build the plan that’s right for you.

The definition of menopause is actually really simple: it’s just one day. Menopause is the one-year anniversary of your last period. This is perhaps the only thing about menopause that’s “simple.” But menopause doesn’t have to be unpleasant or something to dread. With knowledge and a Menopause Plan, you can survive and thrive through the transition and for many many years beyond.

 

Menopause Journey Map

 

Transitioning into parenthood: what to expect from a first time pregnancy

“All of a sudden, all these medical professionals are like, “˜Have fun with your baby, see ya!’ And the hospital door shuts behind you, and you have no idea what to do.”

This may sound familiar to a lot of first-time parents. The risks are so high, yet many new moms and dads feel like they’re missing vital information that would make adjusting to parenthood easier.

Chris and Josh Gourley had their little girl Michaela 15 months ago. Says Chris, “Having a child””especially a first child””is opening the door to a whole new world where this tiny person hands you grubby things to eat”¦.and you eat them because you want your kid to know it’s good to share. Who knew that was going to happen?!”

“Being a parent is a huge adjustment, especially for women: If you’re a dad, your whole life just changed. If you’re a mom, yep, your life changed, but so did your body, so did your hormones. That has a huge impact. But we don’t talk about it. We talk about pregnancy and the time up to the childbirth, and we talk about going through the birth of the child, but we don’t talk about what comes after. No one prepares you for what’s coming.”

So we asked Chris what she learned that might help others in the transition to parenthood:

  1. Buy the biggest maxi-pads you can find, and buy them in bulk. You’re about to have the worst period of your life. “It makes sense, really; the placenta is, like, 10″ in diameter, so you have this big wound in your uterus that’s going to bleed and slough for a while. You don’t want to wear tampons because you want everything to come out, and a menstrual cup won’t fit because your cervix is all wonky. Be prepared. When they send you home with those funky, one-size-fits-all stretchy panties, that’s why.”
  2. Vaginal dryness is a real thing. You can fix it. “After that six-week period from hell was finally over, all of a sudden it was like sandpaper between my legs. You’re walking around like, oh my god, what’s happening, because you have to figure out what’s going on. I know what a runny nose feels like, or a cold, or when I cut myself, but this”¦I didn’t know vaginal dryness was going to happen and that it was going to be so severe! Just sitting on the couch or stretching hurt. For the first time in my life, I used a vaginal lubricant just for personal reasons, and it made a huge difference. You hear that after a baby sex will be “˜different’ because of your hormones, but the difference is really significant.”
  3. Breastfeeding is hard, but it can be easier than the alternatives. “Apparently, it takes a day or two for the milk to come in, and you feel like you’re starving your baby. No one tells you that’s normal, so you just feel like a failure. Oh, and then when it does start, there’s a period known as the “˜let down’ when the milk comes extremely hard and fast. Suddenly my baby was choking and gurgling, and she cried and cried, and I didn’t know what was wrong. Now I know it’s normal and you can solve it by catching the initial flow in a rag, but you have to know what’s happening to know what to do next. I’ve never known a woman who breastfed who didn’t go through it, but no one told me it was going to happen.”Breastfeeding may be challenging, but there’s one big benefit no one really talks about: “It’s super convenient,” Chris says. “I don’t have to boil anything or prepare anything, it’s milk on-demand! A lot of women tell me they don’t breastfeed or they stopped breastfeeding because it’s so hard. And it is, but there are ways of making it easier on yourself. You can use formula during the day and nurse at bedtime, for example. You have choices, but no one tells you that. I had to just keep asking questions until I had all the information I needed.”
  4. Be prepared for wonky hormones. “Everyone warns you about postpartum depression, which is a real thing that really happens. But it happens differently to different women. For me, it was about four months after Michaela was born. It was pretty mild, but I went to a counselor because it helped to talk about it. For my friend, postpartum depression came out as rage. One day her husband asked, “˜Do you want me to make you some tea?’ and she screamed, “˜Of course you should make me a cup of tea, why wouldn’t I want a cup of tea, but I don’t want peppermint, I want cinnamon!’ Because I was a few months ahead of her, I had told her about my experience and the four-month mark, so she was a little more prepared. And she said she was more willing to go to a counselor because I’d told her how it helped me. That’s why talking about this stuff is so important.”
  5. External support matters. “I’m in a breastfeeding support group, and that’s really helpful. We share breastfeeding stuff, like how your supply can drop when you have your period or if you start back on birth control, and how you might not have that postpartum period until you stop breastfeeding, but then break out the stretchy panties! These are things you might not hear from your doctor. But other new moms will fill you in. Friends and family are great, and you’ll need them, but I also really needed people going through what I was going through.”
  6. Adjustment happens. “When you have a baby, everything is all out of whack for a while. Your hormones show no semblance of normalcy, maybe not until after you stop breastfeeding, but even if you don’t nurse, your body can take weeks to level out. There’s a lot going on in there, and it’ll take time to bounce back. You may never be the person you were before, and that’s OK.”
  7. The most important lesson she learned? Change happens daily. “The best advice I got came from my pediatrician: “˜Don’t get used to anything because tomorrow it’ll change.’ Michaela may sleep tonight, but she might not sleep tomorrow. Today she doesn’t want to eat; tomorrow she will. You just never know. But that’s what makes it fun.”

Many thanks to Chris for sharing her experience and learnings from her Adventures in Motherhood. What did you have to learn when you became a parent for the first (or second or third) time? Share your expertise with us in the comments below or on our Facebook page.

 

Can you touch your tongue to the tip of your nose? Bend your thumb to your wrist?

If you are (or used to be) “double-jointed,” get compliments on your soft skin, and experience joint pains, there’s a chance you could have a rare disease and not know it. 

Fans of RuPaul’s Drag Race know that Season 11 winner Yvie Oddly wowed viewers with her fierce looks and jaw-dropping contortions. For many people, this was their first exposure to Ehlers-Danlos Syndrome (EDS).

The disease is rare, so we don’t know a lot about how it works. But there are some interesting ties to perimenopause and beyond.

What is Ehlers-Danlos Syndrome?

EDS is a group of rare disorders affecting the skin, blood vessels, bones, tendons, ligaments, and other connective tissues; faulty collagen, the protein that adds elasticity to this tissue, is to blame. One or two people out of every 10,000 have EDS, though some doctors think this number is actually higher.

There are 13 types of EDS but the two most common (if you can call a rare disease “common”) are the classical type and hypermobility type (hEDS).

Soft, velvety, and extremely stretchy skin that bruises and scars easily is the hallmark of classical EDS.

hEDS symptoms include joint hypermobility, dysautonomia, and musculoskeletal pain, though there’s some overlap: velvety-soft skin, easy bruising, and the ability to extend joints beyond the normal range of motion are present in most types. 

Tiredness, digestive disorders, easy bruising and bleeding due to weaker capillary walls, and anxiety risks can be present in both forms as well. 

Basically, wherever there is connective tissue, you’re more likely to have issues.

Hypermobility leads to hyperextension, dislocation, subluxations (partial dislocation), and overall pain. For many sufferers, this pain can be debilitating, requiring braces, crutches, or even a wheelchair, all while looking “normal.”

EDS, and especially hEDS, often go undiagnosed; most doctors receive very little training on the disorder, even those who specialize in joint and skin conditions. 

Need a trained doctor’s opinion about hEDS? A Gennev menopause-certified gynecologist can give you a trusted opinion, determine if medication is right for you, and they can provide prescription support. Book an appointment with a doctor here.

There’s no genetic test for hEDS, so diagnosis is dependent on clinical criteria, including the Beighton Scoring System (try it yourself!) to assess joint flexibility and self-reported pain. 

The lack of knowledge and diagnostic tests can lead to years of frustration for sufferers, as doctors ignore their issues, tell them it’s all in their heads, or recognize that there’s something wrong but just don’t know enough about EDS to be effective.

The hypermobility-estrogen connection

Women experience hEDS at a much higher rate than men, and the current theory is that estrogen plays a role. 

Estrogen overall has an effect on connective tissue. Women, in general, have looser ligaments than men and people with higher testosterone, which leaves us more prone to joint injury.

Estradiol receptors, proteins in cells activated by estrogen, are present in skin, cartilage, and other connective tissues. Estrogens help regulate the metabolism of these cells.

Research done on a normal population shows that tendon injury is more common in pre-menopausal women, with the highest risk being when estrogen in the menstrual cycle is at its lowest after ovulation.

This hormonal link to loose joints shouldn’t come as a surprise: ligaments relax in pregnancy to allow the birth canal to expand to fit a baby.

Puberty is often the onset of hEDS symptoms, and those who previously had symptoms notice that they worsen after their periods start.

Women with hEDS often have gynecologic difficulties like heavy periods, heavy cramps, and pain with sex, and report more hEDS symptoms with their menstrual cycle. Combined hormonal contraceptives (CHC) and Progestin-only contraceptives (POP) can help symptoms and reduce fatigue in some patients with hEDS.

What does this mean for menopause?

Well”¦ there isn’t a lot of solid scientific information out there about how menopause specifically impacts people with hEDS. Anecdotally in Facebook groups and online forums, many women with EDS report early menopause, but research does not support this. 

However, because of the hormonal involvement, menopause certainly has an impact on hEDS. For starters, connective tissue in the general population changes post-menopause and skin collagen decreases 1-2% each year after menopause.

Joints stiffen with age for all of us, which can be a good thing for people with hEDS, as less supple joints are less prone to overextension. In a study of 386 women with hEDS, 22% of the post-menopausal women reported that their symptoms decrease after menopause. 

However, more than one-third of participants experienced a worsening of symptoms before their periods while in perimenopause. The most rapid shifts in hormone levels happen during this transition, which is why it’s not surprising that the time just before menopause can be when hEDS is first diagnosed. 

As we previously mentioned, women with hEDS have more gynecologic concerns than the rest of the population. They’re more likely to experience incontinence, vaginal dryness, and how to do sex without pain, concerns that increase for all people with uteruses in menopause.

Some studies have found that people with EDS tend to have lower bone density than the regular population, pre-menopause, which makes them more prone to osteoporosis later in life. While this may be because people with EDS limit bone-strengthening exercise due to pain and mobility issues instead of a structural cause, the implications for bone health are the same. 

It’s been thought that hormone replacement therapy (HRT), selective estrogen receptor modulators (SERM), and oral contraceptives could improve diseases of connective tissues. Unfortunately, the amount of estrogen in HRT is not enough to protect joints, and higher doses may increase the risk of breast and other reproductive cancers.

If you’re a woman in midlife who thinks that you might have the hypermobile form of EDS, talk to your doctor or one of ours; because the disorder is so rare, you may need to be persistent and detailed about your symptoms to get the help you need. 

More research clearly needs to be done on how to help women with EDS in menopause, but awareness of the condition “” and better reporting, so we have a better idea of actual numbers “” can help bring greater attention to the issue.

Sign up and chime in about your path in menopause on the Gennev Community Forum. Come join the conversation.