“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):

• Menopause Type 1: Women are pre-menopause and starting to see some perimenopausal symptoms with early irregular periods, occasional hot flashes, some (irregular) mood symptoms. For many women PMS gets worse. 
• Menopause Type 2: Women are perimenopausal and starting to experience irregular and spaced periods that are often heavy. Skipping periods is normal during this phase and may continue until periods stop altogether. Women may experience symptoms of hot flashes, night sweats, sleep disturbances, and mood changes. 
• Menopause Type 3: Women in this phase are in early menopause, which lasts approximately 1 to 10 years after last period. Women will still experience some symptoms, but symptoms will wane later in this stage. Vaginal symptoms tend to appear 2 to 3 years after the last period. Women may notice brain, skin, and hair changes more frequently. Mood extremes tend to ease. 
• Menopause Type 4: Women in this phase are in later menopause, which begins approximately eight years after menopause. During this phase, symptoms shift to mental, vaginal, urinary, hair, and skin, as well as more muscle and joint pain.  
• Menopause Type 5: Type 5 menopause defines a woman whose position in the transition is uncertain because she is taking hormones. This reflects women on oral contraceptives or with an IUD that stops menstruation. This category also includes those who have had a hysterectomy or ablation, but have kept their ovaries (as they will hormonally go through menopause, but experience no bleeding signal).

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.

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.

Our telemedicine doctors and coaches have been getting a lot of questions about the COVID vaccine, so Gennev CEO Jill Angelo asked me to share my thoughts on the safety and efficacy of the vaccines which are rolling out.

Normally, vaccines take years to develop; this one took a matter of months, and I know many of you have questions, given how fast these have become available. Let me give you some reassurance on that front.

Are the COVID vaccines safe?

Yes. For the vast majority of us, the vaccines are perfectly safe, and certainly a great deal safer than risking catching the COVID 19 coronavirus. Here are the facts, to help ease your concerns:

• The mRNA technology used has been in development and testing for many years. This is just the first commercially viable vaccine made from it.
• If you think about it, we make a new flu shot each year, in less time, with less testing, and these are very safe.
• Rumors of widespread severe allergic reactions (there have been only a few) and infertility (this is COMPLETELY false) are part of what seems to be a large disinformation campaign. If you see information on the Internet about the vaccine, check the source “” is it coming from a respected medical professional or magazine? Or is it coming from a click baity popular magazine? It’s highly unlikely that a qualified medical journal will have a sensational headline with lots of exclamation points, for example.

Do the COVID vaccines work?

In terms of efficacy (how well it does the job), we have data on the two mRNA vaccines already, the one from Pfizer and the other from Moderna:

• The Pfizer vaccine was tested in a blinded, randomized controlled trial with 43,000 participants. They saw 162 COVID cases in the placebo group and eight cases in the vaccine group. The notes show that there was 95% effectiveness by day 28 after the first shot. They also did a sub-analysis showing 94% efficacy in adults greater than age 65.
• NOTE: just because the vaccine is highly effective after one dose, DO NOT skip the second shot. The series is intended to lengthen the time the vaccine is protective, and one jab may not be sufficient. For the Pfizer vaccine, the second shot should come within 17-21 days after the first.
• The Moderna vaccine was tested in 30,000 individuals, and they reported 185 COVID cases in the placebo group and 11 in the vaccine group. They report 94.1% efficacy, and again two shots are required.
• Both vaccines will reduce the severity of disease, even if you still contract it. Neither has data yet on “passive transmission,” which is to say, if you are vaccinated can you silently pass the virus if you are exposed. The thought is no, but studies continue on this (all 73,000 of these participants get weekly swabs; they deserve a medal!) So when you do get vaccinated, continue wearing your mask, and of course, wash your hands regularly!

Do the COVID vaccines cause side effects?

Regarding side effects, some that have been reported include arm pain, fatigue, and headache. Apparently the second dose hits some people a little harder, with more reporting flu-like symptoms of muscle aches and feeling a bit feverish. This generally lasts 24-48 hours.

Note that these side effects are mild, much more tolerable and short-term than the disease itself, and are actually evidence that the vaccine is working! Your body has recognized a foreign invader and raised its defenses to fight it. That way, if and when it ever sees the “real thing,” it’ll be ready.

I’ve had COVID. Do I still need the shot?

If you’ve had COVID or got passive antibodies in the last 90 days, it is not recommended that you get the vaccine. Studies are showing that having contracted the disease provides protection against reinfection for three months. However, after 90 days have passed, yes, get in line. Having had COVID does not guarantee immunity; there are cases of people who’ve survived COVID contracting it a second time.

Is the COVID vaccine expensive?

The vaccine itself is free, here in the United States, even for those who have no insurance. However, vaccination providers are allowed to charge a fee for administering the shots, so it might be worthwhile to “comparison shop” administrators. You can find more information on costs and reimbursement on the US government’s Health and Human Services website.

What about drug interactions and allergies?

There are no known interactions with other medications, though it’s always good to check with your doctor to be sure no new information has come to light. If you are immune-compromised, your body may not have as robust a response from the vaccine, but you’ll still get some protection and you should definitely take the opportunity to get the shots.

One thing to understand is this vaccine is not “attenuated,” meaning there is NO live, weakened virus in it. This virus cannot give you COVID, only the antibodies to fight it. There is NO live virus in either the Pfizer or the Moderna vaccines.

For those with allergies, if you have severe anaphylactic responses to multiple things (medications or other), tell the doctor when you get the shot. You should be observed for at least 15 minutes after the administration of the vaccine.

Once I get the COVID vaccine, can I visit my grandparents?

Having the vaccine isn’t a get-out-of-quarantine-free card. We still don’t know if those who have been vaccinated can be passive carriers of the disease, we just don’t have enough data yet. So continue to exercise safe practices, and wave at grandma through the window or over Zoom. It’s not ideal, but it does keep you both safer.

Would you get the COVID vaccine, Dr. Rebecca?

YES! In fact, I stood in a very long line of medical health professionals to get my first shot on Friday. This vaccine, plus continuing to wash hands and wear masks, is how we defeat this terrible and deadly virus and get back to normal life.

And it IS deadly; we are losing over 3000 Americans EVERY DAY currently. I HIGHLY recommend getting the vaccine and have no qualms about that recommendation.

Sincerely,

Dr Rebecca

COVID-19. It’s everywhere in the news, and so many of us, even the experts, seem uncertain how serious the risk actually is, especially for otherwise healthy adults.

No matter what, the risk of contagion is high, even for healthy adults, so we brought together our Chief Medical Officer, Dr. Rebecca Dunsmoor-Su, and Gennev Menopause Coach, Sports Dietitian, Exercise Physiologist Stasi Kasianchuk, to talk about the risks and the best ways to minimize them.

One good practice is to minimize your exposure, so Gennev is stepping up its HealthFix and Telemedicine programs to better accommodate the demand. If you have questions about how menopause changes your risks, or if you take medications or have health conditions that concern you, or you need to renew an HRT prescription, you may want to make an appointment with one of our physicians.

For detailed information on how to reduce menopause symptoms and boost your immune system with nutrition, exercise, stress management, sleep hygiene, and supplementation, check out our HealthFix program. Talk with a Menopause Coach to create your personalized plan for better health during the coronavirus outbreak and well beyond.

Watch the video of this COVID-19 and menopause conversation on YouTube.

Read the full transcript:

Gennev:

Welcome to the Gennev podcast. In this series we talk with the experts about women’s lives and health and menopause. Our mission is to empower you with information that puts you in control of your health. We’re glad you’ve joined us. Let’s get started.

Dr. Rebecca Dunsmoor-Su 

Hi, this is Dr. Rebecca Dunsmoor-Su. I’m the Chief Medical Officer here at Gennev, and we’re doing a podcast today to talk a little bit about a coronavirus and what populations we need to take special care in. I’m here today with Stasi. Stasi, you want to introduce yourself?

Coach Stasi 

Yes. Hi, I’m Stasi Kasianchuk and I am a menopause coach at Gennev and also a registered dietitian  nutritionist and exercise physiologist. So I will also bring some insight in terms of lifestyle recommendations that we can do to support our immune system during this time.

Dr. Rebecca 

Excellent. So we wanted to put this podcast together today to talk a little bit about people for whom this virus and this infection is a bit more of a risk. We’ve all seen lots of blogs and podcasts, even from us, about how to protect yourself and how to wash your hands, things like that. And all those things are great and really applicable to the general public, but there are certain aspects of the public for whom that’s just not enough of a precaution. And who really need to think about themselves as being at slightly higher risk and might need to take additional precautions. So in my mind, and the reason I wanted to do this on Gennev, is that one of the things we know about this virus is that it increasingly is more difficult to handle for your body and for your immune system as we age.

And what we’re seeing from the WHO is that, you know, the death rate in children is exceedingly low if not zero under a certain age. And the death rate is very low as far as we can tell up through middle age. But as we get into late midlife and even older, the death rate starts to climb. And some of that is just that as we age, we have more comorbid conditions. So people with over “¦ who already have cardiovascular disease, people who already have respiratory disease are at higher risk. But there may also be something to do just with how the immune system responds as we age because it does become less robust as we age. But also, you know, this is a population in whom there may be many reasons why the immune system is not as strong. So when I’m talking to my patients, the things that I think about are women especially who are on biologics.

Women are more at risk for rheumatologic disease, for autoimmune diseases, which means they’re much more likely to be on those medications that suppress the immune system. And so, you know, you may feel great and feel great in your life and you know, your biologic medication is keeping you very healthy, but it is suppressing your immune system and that puts you at higher risk. I think about women getting cancer treatment. I think about women who are, who’ve just had surgery and their immune system is busy dealing with that and may not be up to the task of also combating this virus. So it’s certainly something that we need to think about if you’re at higher risk. And I think these are the populations where we need to really address social isolation or quarantining yourself. These people should not be going on vacation right now, not be getting on an airplane right now and really trying to avoid public places as much as possible.

None of us have immunity to this virus. So as it starts to spread through the community, everybody’s going to get it and they’re going to transmit it. So what we’re trying to do as a public health community is not prevent people from getting the virus. Eventually people are most likely going to get the virus unless we managed to invent a vaccine before you get it. What we’re trying to do is make sure we get it in very small staggered stages so we can take good care of those people who get sick when they get sick. What we’re seeing right now in Italy is an overwhelming of the medical system. It’s the same thing that we think we saw in Wu Han, China. So many people got sick all at once. And so many people got so sick, there weren’t the resources or the physicians or the nurses. In Italy, they’re talking even about running out of ventilators for people. There’s just not the resources there to take care of them. So if we, if we practice good social isolation, hopefully we can spread out the spread of this disease such that we can care for you if you do get sick. And then Stasi’s here because we really want to talk about, okay, now those are some risk factors, but what are some things can we do as a general population, even those who might be slightly less immune, to really boost our immunity during this time? And I think you have some great recommendations for that.

Stasi 

Awesome. Thank you, Dr. Rebecca for the, the insight you have there. I think it’s helpful to have reputable information right now. There’s a lot of information out there and I think it’s important that we’re giving information to our listeners and to the women that we work with through Gennev that they can trust. And that’s something that we pride ourselves in doing. So I appreciate you clarifying. And providing evidence-based scientific information around that. So I think from some of the standpoints, you know, going back to the immune system, there’s a lot of things we can do in our life to support our immune system day to day.

And putting a slightly silver lining, positive spin to coronavirus, I’d like to say that it’s highlighting and even some of the women I’m working with are paying more attention to things that, Oh, I should be doing these things. Nothing new. Washing hands, a great example. We know that that works and that’s something that didn’t just come up for a Coronavirus. This is something we should be doing all the time, washing our hands regularly. So that’s a basic one obviously, but looking at things that can really support the immune system’s function, especially from a nutrition standpoint, exercise, stress, I’d like to touch on some of those.

So first, from the nutrition standpoint, this is a great time to focus on how you can increase the nutrient density of your nutrition. So thinking about brightly colored fruits, vegetables, more whole foods, this doesn’t mean, and even increasing these in small amounts can make a difference. Think about every bite that you take with meals that you have as an opportunity to support your immune system. So focusing on incorporating more of these foods into your day, into your week in a way that is convenient for you and realistic for you is a great start to provide additional support.

Another one is exercise. Now this the, this can be a little bit interesting during the coronavirus. I’m working with a lot of women, especially in the Seattle area where they go to group exercise classes. That has actually been something where some of them have decided, I”™m not going to do group exercise class right now. It’s a lot of people, a lot of sweating going on. So maybe I’m not going to go to my group exercise class, but I’m going to go outside. I’m going to get some fresh air. I’m going to walk in a place that maybe there’s not a large crowd, a lot of people. But moving your body and especially if you’re someone that doesn’t need to be in isolation right now, taking advantage of that time to move your body can actually help your immune system. So exercise is something “¦ regular exercise that supports the immune system.

Dr. Rebecca

And I want to just break in here and say that I 100% support that. I find that regular exercise not only itself supports your immune system, but it decreases stress, especially in a time that’s so stressful for us. Getting out of the house and away from the TV and the news and hearing about every new case of coronavirus is huge for supporting the immune system.

Stasi 

Yeah, that’s a great dovetail into just stress management. I think we forget. You know, we live stressful lives. So a lot of times our baseline level of stress might be already elevated. So our body is used to fighting all the time and we don’t want to. And in a situation day to day when there’s not a coronavirus apparent, our immune system may do just fine fighting things we’ve been exposed to. But as you mentioned, none of us are immune to the COVID-19 virus. And so now if your immune system is stressed from day to day family, life, work, and now it’s stressed because you’re concerned about getting the Coronavirus, that can put another, it’s just more taxing. It’s more work for your immune system to do. So taking a deep breath, deep breathing, getting some exercise. And even, you know, meditation apps or mindfulness techniques, taking five minutes, 10 minutes to you know, remind yourself that what it control what you can. I that you can speak more to the statistics right now, Becca. But you know, like you said, most people are not dying from this. It’s unfortunate that there have been some deaths, but we are “¦ generally healthy individuals are able to fight this. Correct?

Dr. Rebecca

Yes. Generally healthy individuals will fight this off. But even some proportion of generally healthy individuals do get very sick. So certainly being able to support your immune system helps to prevent you from becoming one of those people. Most of us who are healthy and don’t have other underlying conditions are probably going to experience it as a fever and a cough that lasts for a while. Some we’re seeing some nausea, some muscle aching. So very much like a flu, but even in 20, 30, 40 year olds who we consider underlying healthy, we are seeing some people get to the point where they need to be hospitalized and/or even in intensive care. And what the difference between those people is we don’t always know. Some of its underlying conditions, but some of it could very well just be the level of stress they”™re under regularly or the state of their immune system. What I will say is, you know, in 60, 70 and 80 year olds, the numbers are much higher for those who get very sick and get critically ill. So really as you work your way up that age spectrum, you need to be thinking more and more about how to avoid a lot of contact right now. Because it’s, you’re at higher risk of getting very sick and therefore at higher risk of dying.

Stasi 

Yeah, that”™s a good point. And for those people too, when you’re thinking, you know, I talked about nutrition being very important and if you’re isolated in your home, it can be hard to find those. But certainly meal deliveries could be options. So things like Sun Basket is a great one that does have a lot of whole foods, fruits, vegetables, colorful antioxidants of immune fighting nutrients. That’s one that I do recommend to clients working on that. But even something like, Hello Fresh, Blue Apron, they all have vegetables. And that’s a way to get those nutrients delivered to you so you don’t have to necessarily go out to the grocery store or areas with a lot of people.

Dr. Rebecca 

And you know, you know, we’re in, we’re in Seattle, which is the hub of everything electronic and delivery. However, you know, I’ve noticed that our local grocery store does delivery service. Whole Foods does delivery service, Amazon Fresh does delivery service. There are ways to get ingredients so that you can eat healthy during this. In most places. We totally understand that some people just don’t have access to those services and you’re going to have to go out. But definitely focusing when you do take those times out on getting the best and most healthy food you can is the best option.

Stasi 

Yeah, that’s a great point. And then the other piece you know, looking at sleep, that’s another thing coming to for supporting our body’s immune system. Immune system function. When we’re sleeping, our body gets to reset and rest, rejuvenate so that it can take on everything we face throughout the day. So that’s something too I work with a lot of clients on. And during menopause it can be hard because those changing hormones change the sleep cycles. With added stress, certainly that can alter things. So working to develop a sleep routine especially, you know, before getting sick so that you can support your body in that and that might have you know, chamomile tea, sleepy time tea is something that really works for a lot of women as a part of their wind-down routine. Also helps with getting more nutrients to you from the, the teas and then also more fluids. So that’s something. And then the meditation apps, a mindfulness practice, those can be helpful for falling asleep, especially for, you know, when you lie down, all you can think about is the coronavirus, maybe having something that’s a little bit distracting but soothing can help to calm things down for you before going to bed so you can get the most out of the sleep as possible.

Dr. Rebecca 

Yeah. I’ve also found that there’s an app called Deep Sleep, which tends to be very helpful for people who really struggle to both get to sleep or get back to sleep in the middle of the night. You know, a lot of these things you can find online and they’re not tremendously expensive. Some are free, some are, you know, a few dollars but definitely can be very helpful. The other thing I find is very stress relieving and helps both with relieving stress, supporting the immune system, and sleep, is making sure that while we are not seeing each other face to face, that we’re still having social interaction. So having a conversation with your friends via FaceTime. It’s important not just to talk on the phone. It’s actually important to see people’s faces and look them in the eyes even if it’s online. So if you have access to FaceTime or Zoom or any of those things, make base with your friends and talk with them, you have tea together, you don’t have to be in the same room. Social interaction can be very supportive and really help us to de-stress.

Stasi 

Excellent. Yes, there is such an importance to that around being able to see each other and reassure each other that even if we can’t interact, cause maybe that’s not the safest thing. Hey, I’m okay. Are you okay? That could also bring peace of mind to help decrease that stress. And then like you said, the benefit of the social interaction.

Dr. Rebecca 

Yeah. The one thing I do want to address with you and I want to put out there is that, you know, in times like this, there will always be people who take advantage and want to sell you something new and special and the best, newest, immune-supporting drug, supplement, you know, whatever they want to call it. What I typically tell my patients is if you are eating a well-balanced diet, there are very few supplements that you need. And certainly in terms of immune support you know, there are things, there are herbals out there that claim to be immune supporting. I don’t know how much data we truly have on those. I think there’s some things that are considered harmless such as echinacea, chamomile can be good. But definitely, you know, take any of the recommendations you see right now with a grain of salt.

Dr. Rebecca 

People are out to make money. So my most common warning and you know, I agree with a lot of influencers such as Dr. Jennifer Gunter on this, is don’t buy the thing from the people telling you it works well. Don’t get your advice from the same place that they are selling it. You know, look for your advice elsewhere. They may be telling you the truth. It’s not that they’re necessarily lying to you, but you, they have a vested interest in you purchasing from them. So if you think something might be helpful to you, go somewhere else, look it up, see what the data says, find a reputable source and then maybe go back to it. Yeah. I don’t know if from your nutritionist perspective, or dietitian perspective rather, if there are any things that you generally recommend other than just sort of a well balanced diet and bright, colorful foods in terms of supplements.

Stasi 

That’s going to be the I would say the, the nutrition’s going to be the, the foundation. And what I find works best. Individuals that do have a strong immune system, they have a good foundation in those foods. It doesn’t mean they’re perfect, but it means that those foods, the whole foods, fruits and vegetables, we can all, myself included, eat more vegetables. There’s always potential for that. And then limiting those processed foods, I typically see that those individuals have a generally healthier track. You know, some exceptions there, but that’s the trend I see. And we do see that in the research as well. Individuals from that, that maintain that type of nutrition longterm. So I would say that’s the best foundation.

And then again, like, like you mentioned, you know, things like herbal teas may be supportive. Is it the fluid? Is it because it makes people, you know, stay more hydrated? Is it the actual herbals? We don’t know, but it’s probably not going to harm you if you’re having tea form versus supplements. The body deals with supplements different than whole foods. And we have to keep that in mind that a pill will never be the same thing as a colorful plate. And so I think focusing on the food first right now is your best option and being cognizant of who’s promising you those magic pills. If it’s too good to be true, it probably is.

Dr. Rebecca 

Very true. The things I often see people using in terms of preventing colds and flus are things like zinc, vitamin C. They’re not harmful. If you take huge high doses of vitamin C, most of it exits via your urine. So you’re just paying for very expensive pee, as we like to say in the medical community. So taking, you know, eating an extra orange a day is probably your better bet than taking a large dose of vitamin C. In terms of zinc, the data’s not bad. It’s not great. I don’t think going to hurt you to take a little extra. But I don’t think it’s, you know, it’s not a cure all. It’s not a protect all. So certainly don’t think if you’re, you know, you’re having three zinc lozenges a day, you can go out and, you know kiss people in the community. It’s not gonna, it’s not going to keep you from catching this thing. So while I don’t think it’s going to hurt you, I don’t think, you know, we can count on that to prevent things.

Gennev 

You can now manage your menopause with Gennev. We’ve helped thousands of women take control of their health with our team of doctors, coaches and products. Join our membership program called HealthFix and work with one of our menopause coaches on your personalized menopause plan. Learn more at Gennev.com.

Stasi 

Vitamin D may help in certain ways with immune function, but I think there’s again, mixed research on that. It’s hard to distinguish, does vitamin D exactly, you know, especially when it comes to immune function and something like the coronavirus. There’s a lot of things we don’t know about this right now. But certainly that could be something if you have been, had low vitamin D in the past, which a lot of people in the Pacific Northwest have, making sure that you’re sticking to that supplement routine. Whether it was something that your practitioner provided a recommendation for you. That would, that could be something that you know right now is not going to hurt you to meet your Vitamin D requirements. It may not be the the magic pill though.

Dr. Rebecca 

Right. Well, there is no magic pill. I think that’s the thing we want to make very clear for everybody. You know, there’s no one thing that”™s going to prevent this from happening to you, but doing the right collective things all together to make your immune system as functional as possible is your best protection. I do want to make an important point cause we’ve talked, we’ve talked a little bit about, you know, who is at higher risk in terms of people taking immune modulating medications for a variety of reasons. The one thing I want to make quite clear is I’m not saying that you should stop these medications. You need to continue these medications. They’re important to keeping you healthy longterm. If you have concerns about medications like that or if you think for some reason that it would be better for you to stop, please do not do so.

Go and talk to the doctor who prescribed them and have a genuine conversation or even see if you can talk to them online if, you know, they”™re doing video visits now. But those medications are a long-term health benefit. And so in the, in the short term, fear of coronavirus is not a good idea to stop medications that you really do need.

And then the last thing I wanted to ask Stasi to comment on is, okay, so say you are one of those people at higher risk, you’re getting chemo, you’re on a medication that makes your immune system a little bit less strong and you want to exercise for stress relief, but you really feel like going outside is unsafe. What are some things someone can do at home to really get that the blood moving and get themselves healthier?

Stasi 

Good question. And that’s where, you know, technology does come in place here. We, there are a lot of app options, so things that I like one of ’em can be done on your app or your computer. It”™s called Fitness Blender. It’s a website which has free workout videos and you can do everything from body weight and you can filter through your level of experience. So if you’re just getting started or you’re someone that’s new to exercise, there’s things that are appropriate there, all the way to advanced. So if you have a home gym, you want something new to try out, there could be some different options there. Some other ones that are out there are the Peloton app, you don’t need to have a bike. They have an app that does give you exercises even without the bike or their treadmill. Obviously if you have those resources at home, that can come in handy right now.

Dr. Rebecca:

Yeah, I have to, I have to cut in there cause I actually use that app. I have the bike or the treadmill.

Stasi:

What do you think?

Dr. Rebecca:

I use it actually for outdoor running, because they have audio, outdoor running apps. They have body stretching, they have meditation, they have yoga. I actually think it’s actually a very good app. They have very motivating people on it. And you know, it’s on the more expensive side for some of these apps. But I think they, they do tend to keep up the variety of things. So that is a nice, you can sort of cycle through the variety of different types of exercise. And if you do have a treadmill or even are planning to walk outside, it can be very motivating.

Stasi 

Absolutely, yeah. The variety could be key there. And then there is devices that you can use at home, something like the Excy bike where you are able to, and this can work for individuals that may not be either immune compromised or certainly if you’re having chemo treatment this can be a better option where you can, it’s a little bit less intense. You can increase the intensity but there’s a lot more variation there and it can help with keeping limbs moving so you can use it for your upper body, you can segment to your lower body. You don’t have to be doing a full body workout to be able to use this and that might be helpful for blood flow. Or individuals that may be new to exercise or really can’t get outside right now. It needs something where they’re moving more in, in home and don’t have a stationary bike or treadmill option.

Dr. Rebecca

That’s a great point. Anything, I always, well, we used to use it to learn how to tell the size of babies when I was in obstetric training. But I do know that that a bag of sugar is five pounds. That makes a great weight if you don’t have weights in your house.

Stasi:

Yes, exactly. And even walking around with more, well you know, put a backpack on and walk around, that’s going to be a little bit higher intensity than just walking alone so you can get really creative with what you have in your house. An opportunity to just do an exploration exercise. No one said we have to go to gyms to exercise. That just became the thing we did. So doing that as well. And then the other thing right now, if you’re looking for more support in how to, you know, manage menopause and the coronavirus and how to strengthen your immune system, our HealthFix program is a great option. It’s all remote. So they”™re calls that you take with a menopause coach like myself. and we can talk about menopause symptoms as well as if you have concerns with strengthening your immune system during this time what strategies are going to be specific to you and what you have available in your lifestyle.

Dr. Rebecca 

I think it does and definitely don’t sell yourself short. You can also help people with sleep issues, with stress issues. You guys are very, you’re just incredible resources for women to have. Telemedicine is good at this time and I won’t recommend just us, although I think our telemedicine program is excellent. We do tend to focus on menopause and menopause symptoms,  we”™re obstetrician-gynecologists with a  menopause focus. We can do some basic medical care too, but certainly if you’re worried about your immune system and you’re about to run out of your hormone, please feel free to call us. We’ll happily give you a refill online. But there are other great telemedicine groups as well that do more primary care if you just have a question and don’t want to go into a doctor’s office. Many doctor’s offices are actually adding video visits as well during this time to keep people out of their offices. So there are a lot of great options out there now.

Stasi

Yeah. And, and we collaborate. So my, the menopause coaches and the healthcare providers that we have, the OB/GYNs with Gennev, we work together. So that’s something also that when I’m working with my clients, if I see that working with an OB/GYN is going to help to benefit you to feel better, I will certainly recommend that and vice versa. So a unique opportunity all from the comfort of your home bedroom, living room, wherever you feel most safe right now. Know that you could get support for menopause symptoms as well as if you have questions on how to best support your immune system.

Dr. Rebecca 

And one last thing I want to bring up because I think it’s a very fearful time for many people right now and fear is not a bonus to your immune system. So as much as you can try to manage that fear, turn off the news at night. You don’t need to know where the last case ended up. You’ll find out tomorrow. So just take a break from the news every day. Take a break to meditate or read a good book or just not think about what’s going on in the world because you need to let your, your stress response system calm down a little bit. If you’re struggling to manage that fear, if you’re feeling anxious all the time, if you’re feeling panicky, please, please reach out. There are providers online who can help talk you through that. And that is while a maybe perhaps a normal response, something that can actually be dealt with and managed. There are therapists online. There are doctors who can prescribe online if necessary. So please don’t feel like that anxiety you have to live with it. It can be helped.

Stasi

Good point. We have all this technology, might as well take advantage of it. And good thing it’s coronavirus in 2020 not 1920.

Dr. Rebecca:

Yeah. So thank you so much for coming to this podcast and/or video. We really enjoyed talking to you today about how to really boost your immune system and how to protect yourself during this time that is, can be fearful but is also a time that we can all manage.

Stasi:

Yes. Thank you so much for listening. Hopefully this information is helpful for you and of course if you have more questions, we’re here to support you.

Dr. Rebecca:

Yep. We have a community, we have chat, and we have HealthFix where you can talk to wonderful coaches like Stasi.

Stasi:

Or our Telemedicine where you can talk to Becca.

Gennev:

Thank you for listening to this episode of the genetic podcast. Remember, you can subscribe on iTunes, Google Play, Spotify, and just about anywhere you get your podcasts. Gennev is your online destination for menopause, doctors, coaches, products, and education. You can find us at Gennev.com. Thanks for joining.

When hormone levels change, it seems like your whole body changes, doesn’t it?

This is especially true for women with diabetes who are entering the beginning stages of menopause, perimenopause. True still and again for pre-diabetic women entering the same life transition. Hormones have a whole lot to do with both menopause and diabetes, and it’s baffling at times to navigate new symptoms and identify what they are in your body, in addition to living your busy, awesome life.

A concern for the undiagnosed

In 2015, of the 30.3 million adults who had diabetes, 23.1 million were diagnosed, and the remaining 7.2 million were undiagnosed. 

What will serve you through this is your awareness and attention to what is going on in your body.

If a new diagnosis of diabetes coincides with the onset of menopause, you may be navigating some similar symptoms. For instance, you may experience a symptom of foggy thinking both menopausally and diabetically. The element to zoom in on might be to determine if and/or when there is a difference in it being a diabetic symptom vs a menopause symptom. So much is new, and not much is fun. 

Still, staying informed and aware of symptoms and changes in your body is where your power lies in making good choices and taking good care of yourself. We do recommend talking with your doctor and getting your blood sugar levels checked, especially if your risk is higher for diabetes.

A few of the main symptoms in common

• Frequent urination: In menopause the frequency for the need to pee can increase. Same with diabetes but for different reasons, mostly having to do with kidney function not being able to reabsorb the glucose normally when blood sugar is up. Instead, more urine is made, thirst increases, and so, more frequent peeing.
• Night sweats: Another common experience in menopause is night sweats. Ugh. In diabetes night sweats may be caused by low blood sugar levels, while in menopause a decline in estrogen to the hypothalamus in the brain can bring those suckers on and wake you up from your sweet sleep. 
• Anxiety, mood swings, depression: Women are twice as likely as men to experience depression, more during menopause, and still more likely for those women with diabetes. The hormone changes and pressures in life a woman experiences are just plain different from men. You deserve good care, excellent attention, and helpful, reliable information.
• Itchy dry skin: As estrogen levels drop in a woman’s body, so does the moisture content in the skin. Here comes the itchy, dry skin. In diabetes, dry skin is often attributed to high blood sugar and/or poor circulation. As skin is the largest organ of the body, it’s significant when it’s uncomfortable: from crackly, crusted feet to rough hands, to that most intimate, delicate vaginal tissue, moisture replenishment yields comfort.
• Urinary tract and vaginal infections: High blood sugar levels (yes, even pre-menopause) can contribute to UTI and vaginal infections. But wait, there’s more”¦ a decline in estrogen makes it easier for bacteria and yeast (yep) to thrive in the vagina and/or urinary tract.

What else will help?

Whether you’ve been diagnosed with pre-diabetes, diabetes, or menopause (or not), there are a few things you can do to help your overall health until you talk with your doctor or check in with our telemed team (but please, do talk with a doc. Soon). What can you do? Self-care, support, processing, and testing.

• Circulate – Some increased blood flow and endorphins from mild exercise can make a world of difference in your blood sugar levels, improve your health and mindset, and aid in managing hot flashes, depression, or anxiety. Even a little regular movement will help you feel better”¦ maybe even good. But don’t take our word for it”¦ give it a go and see.
• Eat the good stuff – Nutrition is a big topic and the fuel you choose has a lot to do with regulating blood sugar, managing symptoms, even sleeping well when it comes to both menopause and diabetes. Where might you make even better choices around refined sugar, alcohol, and processed foods? When are you more willing to drink a little more water? It’ll make a difference.
• Levels? Check! – If your weight is changing, your symptoms are increasing in intensity or frequency, and you’re at a higher risk level for diabetes, it might be time to get blood sugar, cholesterol, and other levels checked with your doctor. Ask also about whether or not an adjustment to any existing medication levels might be needed.

• Menopausal support – Talk with trusted friends, family, and community about what’s going on in your body. What you’re experiencing is real and talking about it can really support you and help you make sense of all the changes. Another option, sign up for some specific menopause coaching support with a Health Coach who is a Registered Dietitian and a menopause expert. It’s a thing.

Your health journey is a precious and vibrant part of your life (and quality of life). The attention and care you take to feel better will serve you in both the long and short run. 

We’d love to hear your experience – both the good and the challenging – around diabetes, pre-diabetes, menopause”¦ life!

Join us in the Community for shared knowledge, wisdom, and support.

Do your jeans irritate you right at the waistband, and not because of the fit? Do you stand at the sink and feel pain or irritation when you lean against the counter?

It could be the scar from that C-section or appendectomy that’s giving you trouble, even if the surgery is years or decades in the past.

Internal and external scars, even long-since healed, can cause sensitivity, pain, and reduced mobility. Knowing the proper way to manage scar tissue can help you reduce or resolve those issues, on any scar, anywhere on your body. Practicing scar massage on new incisions (once healed) can help avoid problems years in the future.

To learn more about “restricted scars” and how to handle them, Gennev turned once again to our fabulous physical therapists, Brianna Droessler-Aschliman PT, DPT, CMTPT and Meagan Peeters-Gebler PT, DPT, CSCS, CMTPT.

How do restricted scars cause problems and why does massage for scar tissue help?

First, it’s important to know a scar is more than just a line on your skin, says Meagan. Our bodies are made of numerous layers, and there may have been several incisions to get to whatever tissue or structure or organ the surgeon was trying to fix. So the “problem” scar may actually lie deep inside.

Second, it helps to understand how scar tissue is formed. “Think of a mud puddle,” Meagan says. “To cover it up, you throw a bunch of straw on it. It covers the hole, but the pieces of straw land every which way and end up lying in different directions. That’s how scars form.”

Plus, says Bri, the cells that form a scar matrix are often tougher and more fibrous. This makes the scar tissue less flexible than the tissue around it.

“Scars can even pull on surrounding skin and tissue and form adhesions,” says Bri. The pain, burning sensation, or restricted movement happens when you try to pull or twist against that adhesion.

Scar massage helps by realigning existing scar tissue so the fibers are neatly organized and running parallel and perpendicular to one another, making the matrix of scar tissue much more flexible and elastic. Second, massage helps break up adhesions, freeing up restricted muscles, organs, and fascia for greater range of motion. Finally, massage can help establish a framework so any new tissue that’s created becomes part of this organized pattern. No more jumbled straw!

How do I know my pain is from a scar?

Restricted scar pain can go undiagnosed for years, since people often don’t associate new pain with an old wound. A doctor or physical therapist will likely be able to feel the restricted scar by pushing on the painful area with their fingertips.

A healthy, well-healed scar should feel and move like the skin around it, according to our PTs. “I shouldn’t feel a barrier, no raised ridge, no wad of tissue or puckering. If I pull it one direction or another, it should move easily, without causing pain,” says Meagan. “If it doesn’t, a restricted scar is where I’ll start.”

“Most people aren’t told about the importance of scar massage,” Bri adds, “so we see this problem pretty often. But it’s really avoidable. People can be taught to start massaging their own scars carefully as soon as the incision is healed to keep adhesions from forming in the first place.”

Hands-on healing: how to massage scars

Hang on, before you go diving in: if this is a new incision, is it fully healed? As Meagan says, be sure it’s fully closed, with no draining, oozing or crusting, and no risk of eruption. If you’re not sure, consult with your doc.

Begin by desensitizing the area. Nerves may be flaring and angry from the surgery or injury; you want to calm them so the area can tolerate scar massage a little further down the road. Start the desensitization by rubbing the area lightly with a very smooth, silky fabric. Do that for a few days, then increase the sensory input by moving to cotton, then denim, then wool. Once it can tolerate that level of irritation, you can move on to massage.

According to Bri, most folks are ready for scar massage about 6 weeks after surgery. You’ll want to consult with a physical therapist to learn to do this right. Happily, once you’ve mastered the art of scar massage, you can carry on on your own.

The trick is to find areas of resistance, according to our PTs. When you find one, gently press and hold. You can continue doing this until you feel it start to release. Bri suggests finding a good topical cream to make massage easier and promote healing (oddly, a combination at frankincense and emu oil seems particularly effective, she says).

Fortunately, even very old scars respond to manipulation and massage. And no scars are “off bounds.” Had an episiotomy? Go for it.

Scars and breast cancer awareness month

We wanted to talk about this topic now, in recognition of breast cancer awareness month and the far too many women and men who wear the scars of mastectomies and biopsies.

“Scar massage is really useful for mastectomy and post-radiation healing,” Meagan says. “With mastectomy, women can have challenges with breathing, with ribcage mobility, arm motion, even just reaching overhead. Plus superficial nerves can get entrapped in scar tissue, and that can cause lots of pain and problems. Knowing how to do scar massage can help avoid a lot of issues later on.”

Healing old wounds (and not just old scars)

For many of us, just looking at a scar is difficult, much less touching or massaging it.

This is where working with a PT can really help. “Often we’re the first to touch a new scar, even before the patient,” says Bri. “They want to know that it’s OK to touch it, that they won’t open it or cause themselves more pain. We can show them how to touch it, when it’s OK; we tell them, this is what it’s supposed to feel like, this is what you can expect, this is how it should move. Once they know all that, it’s easier to be open to the massage and to taking over their healing themselves.”

“It makes sense that it’s hard,” says Meagan. “We associate that mark on our body with a traumatic event. Even if it happened during the happy birth of a child, scars change our body and how we view it. But think of it a different way: a scar is proof that your body is healing, and that’s good. When you can’t bring yourself to touch your scar, it’s like you’re an open circuit, and all that good energy is being lost. Once you can touch it, you complete the circuit, allowing the energy to flow through your body. That’s what healing is.”

Have you practiced scar massage, and did it work for you? Tell us EVERYTHING.  Share with the community in the comments below, or fill us in on Gennev’s Facebook page or Midlife & Menopause Solutions, Gennev’s closed Facebook group.

Want more from Meagan and Bri? Well, of course you do, they’re awesome. Check out if you’re peeing normally and what to do if you’re not. Here are some steps to take to improve your sex life (and how to orgasm better! – like, a lot). And be sure to read Brianna’s article on “Managing Scar Tissue” for Nature’s Pathways magazine.

I’ve been thinking about community a lot lately.

How much do we need it? As women, most all of us thrive on connection.

And when we’re going through life’s transitions, connecting with others going through the same thing kind of makes it more palatable.

Personally, I’ve got my community of women to whom I go to with the most personal of things. I’ve got a very small handful of friends (like 3-5 max) that I share life’s ups and downs. Things about my marriage, my family, even shameful mistakes that I’ve made. I’ve learned that I feel better when I share with others that I trust”¦even if there is no amount of advice that can help me recover”¦quickly.

But how about going through menopause? Is it something that you want to share with others?

For menopause and health topics, I broaden my net. I’m willing to share my experiences with other women of all levels of closeness to me, because women’s health is a “sisterhood” type of topic that creates a common bond, even when a personal relationship doesn’t exist.

Menopause levels the playing field. We’re all going to go through it.

I commonly find that my role with Gennev makes me a safe place for women to share all types of gnarly health symptoms including mood swings, painful sex, vaginal dryness, and the all-too-common insomnia that especially nails women in the workplace.

One woman even went so far to call me “the vagina whisperer.”

I’m struggling to land on what our Gennev community needs to be as we grow beyond the thousands of women we serve today. Is it a support group or health Q&A forum?

Do you find comfort in sharing/listening in a closed Facebook group, like the one Gennev hosts called Midlife & Menopause Solutions?

Or would you rather browse a general menopause FAQ forum to seek out questions and answers from health practitioners and like-minded women?

And is a menopause community something you want to bring your friends into, or something that you want to do anonymously?

I want to hear what you want your community to be. Is it simply a place to connect with like-minded women? Or a place to get answers and solutions for feeling better in your body?

Email me at jill@gennev.com

Have a great weekend!

JIll

Gout? Isn’t that something men suffer from? Do woman get gout? 

It is. And more and more women are getting diagnosed with gout as well.

In the last 20 years, cases of women with gout have more than doubled. According to the Arthritis Foundation, “…Two million women as and 6 million men as in the U.S. have this inflammatory form of arthritis that causes joint swelling and telltale pain at the base of the big toe.”

What is gout?

Gout is, as noted, a form of arthritis. Gout occurs when high levels of uric acid increase in the blood and form needle-shaped urate crystals in the joints or a joint’s surrounding tissue.

How does uric acid get produced? 

When your body breaks down purines “” naturally-occurring substances in your body and in some foods “” uric acid is produced. The normal function includes this uric acid being dissolved in the blood, transferring to the kidneys, and then getting eliminated through your urine.

The body could be out of balance and develop gout by producing too much uric acid, or by excreting too little of it in the urine.

What does gout feel like?

A flare-up can swell the joints making it painful to walk or move, and can increase stress and frustration levels, which may then exacerbate other menopause symptoms like insomnia, night sweats, hot flashes, etc. Definitely not the direction to head in if you can possibly avoid it.

Joints may also swell, radiate heat, and flush red in color as well. A gout flare-up may also feel as though a joint is on “on fire,” like a joint-specific, localized hot flash of sorts.

If left untreated, gout pain may worsen and joint damage could ensue. Best to get it checked.

Is gout hereditary? If your family history includes gout, The Mayo Clinic notes you’re more likely to develop this disease. 

In men, gout is often described as a sudden, severe attack, usually in the night, with intense pain in one of the joints, commonly the big toe. But this isn’t always the case with women.

In women, it can be a sudden attack, but it may also develop more slowly over time and in multiple joints. Brian F. Mandell, MD, a rheumatologist at the Cleveland Clinic in Ohio and board member of The Gout & Uric Acid Education Society, shares:

“In women, it seems there is a greater prevalence of the initial episode of gout being in multiple joints. It may not always be the typical swollen great toe. In the hands, this is often misdiagnosed as inflammatory osteoarthritis when it may actually be attacks of gout.”

Women frequently experience gout in the ends of their fingers, wrists, knees, and toes and are more prone to gout after menopause.

Ready to focus on your health in midlife and menopause? Work with a Gennev Menopause Health Coach.

Gout in women. What’s estrogen got to do with gout?

Estrogen in premenopausal women and those on estrogen replacement therapy helps to flush the uric acid out of the system, according to the Arthritis Foundation. After menopause, uric acid levels tend to rise. 

If a person with a uterus develops gout before going through menopause, it’s usually due to other conditions such as having a history of taking diuretics, high blood pressure, diabetes, kidney disease, and obesity.

What about nutrition? Can diet manage gout and minimize flare-ups?

When it comes to diet, gout, and overall health, definitely get into your doctor’s office to talk about your health specifically. Especially if you have other health conditions.

Foods to avoid, limit, or moderate regarding gout

Some of the foods recommended to moderate or minimize may have health benefits that outweigh the risk for gout (like the omega 3s in sardines may be more important to brain health than sardines’ risk of gout). Knowing your levels, getting screenings, and having regular conversations about your health with your doctor or nutritionist will be your best way forward.

• Avoid gland or organ meats such as liver, kidney, and sweetbreads.
• Limit serving sizes of beef, lamb, and pork.
• Note and understand that some seafood including anchovies, shellfish, sardines, and tuna do have higher purine levels than other kinds of seafood.
• Limit or avoid sugar-sweetened foods (cereals, baked goods, candies, even some salad dressings), and limit the consumption of naturally-sweetened juices, like fresh-squeezed fruit juices.

On alcohol and gout

The topic offoods to avoid in menopause like alcohol comes up regularly in our content since it can spike the intensity and frequency of symptoms such as”¦ hot flashes, headaches or migraines, and mood swings (well, rage, really). It’s especially important to note for those prone to developing or who are actively managing gout.

Researchers out of the Boston University School of Medicine examined data on 2,476 female and 1,951 male participants in the ongoing Framingham Heart Study, which has followed residents of Framingham, Massachusetts, since the late 1940s. Over an average of three decades of follow-up, 304 cases of gout were reported, with one-third of those cases occurring in women.

Further reporting from the Framingham Heart Study shared that:

“Drinking 7 or more ounces of spirits a week — roughly five drinks — doubled the gout risk in men and tripled it in women. Heavy beer drinking was associated with a doubling of risk among men and a sevenfold increase in risk among women.” [emphasis ours]

Foods to include

We recommend weight loss,if you need it, for healthy menopause weight management. “Being overweight increases the risk of developing gout, and losing weight lowers the risk of it. Research suggests that reducing the number of calories and losing weight “” even without a purine-restricted diet “” lower uric acid levels and reduce the number of gout attacks. Losing weight also lessens the overall stress on joints.”

Recommended eats & drinks:

• Complex carbs. Eat more fruits, vegetables, and whole grains. Avoid foods and beverages with high-fructose corn syrup, and limit consumption of naturally sweet fruit juices.
• Water. Stay well-hydrated in menopause by drinking water.
• Fats. Skip or cut back on saturated fats from red meat, fatty poultry, and high-fat dairy products.
• Proteins. Focus on lean meat and poultry, low-fat dairy, and lentils as sources of protein.

Talk with your doctor, or one of our doctors, and your menopause health coach, about specific concerns about gout, joint pain, and other forms of arthritis. Talk with them sooner rather than later if obesity, high blood pressure, diabetes figures into your current state of health and well being.

Your health, mobility, and well being are worth it.

Join the Gennev Community Forums to weigh in on this topic, ask questions, and understand more about menopause with others on the path.

Does using birth control delay menopause? Does it increase the risk of breast cancer or heart disease in menopausal or perimenopausal women? After many years on the Pill, how will I know it’s safe to go off it?

Birth control and menopause: what do we need to know?

For answers to our birth-control-and-menopause questions, we turned to Dr. Sherry Ross, award-winning OBGYN and author of the book >She-ology, a look into women’s health beyond the doctor’s office.

Dr. Sherry Ross

For those in perimenopause, should we stop taking the Pill?

“First,” Dr. Sherry told us, “be sure you understand this: until you’ve had no periods for a year, you can still get pregnant.

“Part of the confusion is around definitions: The true definition of “˜menopause’ is when you don’t have a period for one full year, but many women suffer from disruptive symptoms for a few years leading up to full cessation of periods””that’s called “˜perimenopause.’ As I said, until you are officially in menopause””meaning no periods for a full year””you can potentially get pregnant, so be sure to use some form of contraception. If you are single and dating while in menopause, you may not have to worry about getting pregnant, but you do have to protect yourself against sexually transmitted infections, so make sure your partner wears a condom.”

So, re: birth control, keep on keeping on until one year with no periods, and re: condoms, always always always outside of committed, monogamous relationships. Check.

Do birth control pills or using a hormonal IUD help with perimenopause?

” Oral contraceptives and an IUD like Mirenacan mask some of the symptoms of perimenopause and menopause,” Dr. Sherry told us. “That’s one of the benefits. Women on the Pill may have fewer, less-intense hot flashes, more “˜normal’ periods when other women are all over the menstrual map, and they might have more modulated emotional swings, which can be a huge benefit in their personal and professional lives. That’s why many doctors””myself included””prescribe low-estrogen birth control pills women having a rough menopause and don’t smoke or to make the transition into menopause easier.”

Does birth control delay menopause?

Short answer: No. Here’s why:

“Menopause is a time when your ovaries stop producing estrogen and your female hormone reserves are depleted. Known factors that can affect what age you enter menopause include your genetic predisposition, knowing when your mom went through the change, chromosomal abnormalities such as Turner Syndrome, very thin or obese women, long smoking history, needing chemotherapy or radiation therapy, those with autoimmune diseases and epilepsy.

“It’s clear that short- and long-term stress, such as extreme weight loss and weight gain, can offset your hormones, causing irregular periods. The extent this type of significant stress has on your endocrine system, causing hormone adrenal depletion and possibly affecting menopause, is not as clear.

“There is an association between extreme and long-standing exercising causing weight loss which can offset your hormones and cause early menopause. Excessive exercising creates a hormonal imbalance, causing irregular ovulations. It’s less likely short-term exercising mixed in with months of not exercising could cause a cascade of events leading to an early hormonal depletion.

“So there are some things that can bring on early menopause, but being on the birth control pill does not affect when you begin menopause. The Pill can mask the symptoms of menopause and, as I said, many women depend on it to help ease the transition into menopause.”

If we’ve been taking oral contraceptives for 20+ years, how will we know if perimenopause has started?

“The best way to know if you are in menopause while taking the birth control pill is to check your hormonal levels at the end of the pill-free week. Some women may even notice hot flashes during the pill-free/placebo week since they are not taking estrogen that’s normally in the active pills. Your doctor can conduct a simple blood menopause test that determines if your follicle-stimulating hormone level (FSH) has reached menopausal levels.”

If you need a trusted opinion, determine if medication is right for you, and possible prescription support. Book an appointment with one our Gennev menopause-certified gynecologist doctors here.

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Are there health risks to continuing to take the Pill?

Says Dr. Sherry: “As long as you’re not a smoker over the age of 35, and you don’t have any contraindications of being on the Pill (high blood pressure, a history of blood clots, liver disease, breast or uterine cancer, strokes or migraine headaches), there are no health risks to taking the Pill during the first couple of years of menopause. The birth control pill stabilizes your hormones and keeps you physically and mentally balanced.”

And, according to Dr. Sherry, there’s even more good news.

Wait. There’s good news? About menopause?

“There’s evidence that taking birth control pills reduces the risk the risk of ovarian and uterine cancers. It may also help with rheumatoid arthritis.”

OK, that’s all terrific, but there have to be drawbacks.

What are the risks?

Said Dr. Sherry: “As I said, hormonal birth control is not for women who smoke, particularly if they’re 35 or older. Birth control pills may increase your risk of strokes and blood clots, and that risk is exponentially higher for smokers over 35. Yet another reason to quit!”

We completely agree. Anything else?

“Studies are still being conducted into hormonal birth control and breast cancer. But unless a woman has a history of breast cancer or other factors that make her high risk, she should feel comfortable taking low-dose birth control pills to control perimenopausal or menopausal symptoms,” Dr. Sherry told us.

“The best first step is to have a frank and open discussion with your menopause doctor. And don’t be embarrassed or shy””I can tell you from personal experience that almost nothing shocks a doc! Menopause is a normal, natural process and part of life, though women may experience it differently. Your doctor is here to help you understand what’s happening and alleviate symptoms that are interfering with your quality of life. There are solutions. You can feel better. And that’s the best news of all.”

Sheryl A. Ross, M.D., “Dr. Sherry,” is an award-winning OBGYN, author, entrepreneur and women’s health expert. The Hollywood Reporter named her as one of the best doctors in Los Angeles, Castle Connolly named her as a Top Doctor in the specialty of Obstetrics & Gynecology, and she was selected as a 2017 Southern California Super Doctor. Dr. Sherry continues the conversation of women’s health and wellness in her monthly newsletters and on DrSherry.com.  

Dr. Sherry Ross blogs for Huffington Post, Maria Shriver, Greatist, SheKnows, HelloFlo, Today Show, All Things Menopause, and Gurl, and we are thrilled to welcome her to the Gennev community!

We can help you get your questions answered about menopause

• Meet with a Gennev board-certified gynecologist who is a menopause specialist – they are used to having frank and open discussions about menopause, and can offer a trusted opinion, determine if medication is right for you, and provide prescription support.  
• Try Vitality, our #1 daily multi-vitamin supplement is packed with nutrients that support your whole body including mood, energy, stress response, immune health, joint pain, and inflammation. 96% of women report having more energy after just 2-weeks with Vitality.

 The information on the Gennev site is never meant to replace the care of a qualified medical professional.  Hormonal shifts throughout menopause can prompt a lot of changes in your body, and simply assuming something is “just menopause” can leave you vulnerable to other possible causes. Always consult with your physician or schedule an appointment with one of Gennev’s telemedicine doctors before beginning any new treatment or therapy.

The red cup is back at Starbucks, and you know what that means: the holidays are just around the corner.

Finding gifts for everyone on your list can be enough to put even the most seasoned shopaholic in a bad mood.

And if you traditionally use Thanksgiving as your cue to start shopping, we have bad news: there are only 26 shopping days between Thanksgiving and Christmas in 2019.

And Hanukkah starts on December 22 this year.

Don’t: stress

Hooray! “˜Tis the season for an extra layer of emotion slathered over everything. It may be your first December without a loved one or the annual reminder of rough times with your ex. Family expectations are high, and your mother-in-law still hasn’t forgiven you for marrying her favorite child.Staying relaxed is easier said than done, but stress is both no fun and a big trigger for hot flashes.

If listening to music calms you, bring your headphones while you shop. Take a break for self-care: get a massage, soak in the tub, or go for a long walk before you start to feel burnout.

Doctor’s orders.

We’re hoping this list helps, as well.

Do: prioritize Cyber Monday over Black Friday

Who really wants to wake up at 4 a.m. to beat the Black Friday (November 29) crowds? Cyber Monday (December 2) has become a solid alternative. You’ll get great deals, save gas, and you can do it in your PJs with a cup of (decaf) coffee.

And you don’t need to wait: many retailers already have their Black Friday discounts listed online. For example, Cnet has curated a few ideas from favorite retailers like Walmart and Amazon, and TechRadar has predictions about upcoming Cyber Monday bargains.

Fear not, procrastinators: even if you snooze on the post-Thanksgiving deals, you can take advantage of Free Shipping Day on December 14.

Do: plan out your brick-and-mortar shopping routes

Online shopping makes it easier than ever to cross off everyone on your holiday list without leaving the house.

But when your partner or kids have prying eyes, you want a one-of-a-kind gift that can only be bought in a brick-and-mortar location, or you’re desperate for a new outfit to wear to the office holiday party, you need to put on your big girl pants and get out there.

Whether you’re hitting the mall or the mom-and-pop shops on Main Street on Small Business Saturday (November 30), write out what you want from each store and in which order to visit them to save time, gas, and stress.

Don’t: forget your comfortable shoes and your FitBit!

Hitting the mall can be a great way to get in your steps. Exercise during menopause is important for bone health, weight management, and to lower your risk of breast cancer. Make shopping work to your advantage!

Take the stairs or walk up the escalator. To really get a workout when shopping during the day, park as far from the entrance as you can, or on the opposite end of the side that you’re planning on visiting.

But”¦

Do: be safe

Safety first, always! Law enforcement professionals remind you to park in well-lit areas, keep your hands free and keys and cellphone easily accessible, roll your windows all the way up when parking, store gifts and bags in your trunk, and always lock your car.

Cybersecurity experts remind you to use trusted websites, make sure the site is SSL encrypted (you’ll know because the URL will start with “˜https’ and you’ll see a locked padlock in the address bar), and other best practices when shopping online.

Don’t: shop hungry, and Do: bring water and healthy snacks

Who can resist the alluring smell of Cinnabon? When that cinnamon-sugary aroma wafts across the food court, it can be hard to resist, especially when you’re stressed. Unfortunately, sugar, caffeine, and other mall delights can lead to hot flashes and midlife weight gain.

Stash a few snacks filled with fiber, protein, vitamins, and healthy fats in your bag: nuts, apple slices, dried fruit, hardboiled eggs, a cup of yogurt or cottage cheese, string cheese, or single-serve hummus and carrots are all portable and healthy.

You’ll feel better and make better shopping decisions.

Don’t forget your water bottle!

Thirst has a funny way of sometimes coming across as hunger, and water is good for your brain, body, and holiday spirit. It’s extra important that you stay hydrated in perimenopause, menopause, and beyond.

Do: play sleuth on social media

You can always count on Santa to let you know what the wee ones want. Teenagers and adults, not so much.

Time to do some sleuthing. Your friends and family members’ “Likes” on Facebook or “Hearts” on Instagram can give you insight into what they would like to find under the tree.

We promise this doesn’t make you a stalker. Well, maybe a little bit, but finding a thoughtful, inspired gift that the recipient will cherish makes it cute, not creepy.

Don’t: gift a DNA testing kit (unless you’re positive the recipient wants one)

Many of us in midlife find ourselves wanting to get in touch with our roots or explore our family tree. DNA tests have become a popular gift in recent years, and the most popular services offer deals around the holidays.

These tests can provide amazing genealogic and health insights but may be problematic as unsolicited gifts.

• Privacy: Many users have concerns about giving their DNA to private companies.
• Family: nonpaternity events are more common than you would think; your gift might be the key to a closet full of skeletons.
• Carrier Status: The tube of spit doesn’t lie, and you can’t unlearn your risk for genetic disease. Not everyone wants or is ready for this truth.

Do: buy gifts that support health

Perhaps your sister is trying to shed a few post-menopausal pounds, or your best friend is getting hit hard by hot flashes. Maybe makeup and nail polish are easy stocking stuffers for your daughter or niece.

We’ve written about how makeup, nail polish, and other cosmetics can be a bummer for breasts. Pick products that are free of parabens, phthalates, phenols, and other potential toxins.

Use this as an opportunity to help your friends swap out bad for better, such as alternatives to plastic (which may be full of cancer-causing chemicals). [A few ideas for reusable gifts]

And browse our gift ideas for women in midlife and menopause or our menopause wish list; from float sessions to cooking classes to smart vibrators (oh my), we’ve got you (and your sister, and your girlfriends) covered.

Don’t: buy gifts at all

What do you get for the person who has everything? Sometimes the answer is nothing””nothing besides memories and experiences.

Sure, you can’t give everyone on your list a vacation or spa day, but there are plenty of experiential options for all budgets, for kids, and for the entire family.

You could also give cold, hard cash, but what’s better than getting $5? Giving $5 to charity. Research shows that the pleasure of receiving money fades, while philanthropic contributions leave a warm and lasting glow. Charity Navigator can help you find reputable non-profits and causes that will resonate with your friends and loved ones’ areas of interest.

And you can’t go wrong with a homemade gift from the heart–even if you aren’t crafty enough to upcycle an apron, you can have a lot of fun putting together a DIY bubble bath set.

Do: get a head start on next year’s shopping

You can score seasonal cheer at a deeply discounted rate after Christmas… while you buy yourself what you really wanted from Santa. If you have the space, stock up on holiday decor and evergreen gifts to save your future self some of the stress you’ve just vanquished.

Don’t: be afraid to say “œno”

While there is some truth behind the idea of retail therapy, don’t shop if you know you aren’t in the right headspace for it. The holidays can be hard, and your mental and physical health needs to come first.

While you’re at it, feel empowered to skip the office holiday party. Unless you found that perfect outfit on your shopping adventures.

If you’ve mastered the art of stress-free holiday shopping, help a buddy out and share it with us in our community forums!

Science is starting to uncover the many ways our gut flora affect our health. While many of us still believe the beneficial bacteria is good for digestion (and it is), it does a whole lot more. 

Dr. Anna Garrett chats about the “Gut-Brain Axis”

In this podcast, metabolic surgeon and gut expert Dr. Erika La Vella talks with Gennev’s Director of Health Coaching Stasi Kasianchuk about the bi-directional relationship between your gut and your brain.

The “Gut-Brain Axis” affects your perception, cognition, your nervous system, your mood, pretty much everything. Given that, and how cattywampus everything can be during menopause anyway, doesn’t it make sense to be sure your gut is getting exactly what it needs?

This is why we bang on about nutrition here at Gennev “” it’s so important to feed yourself well, because it literally affects everything in your body. Good fiber helps the beneficial flora in your gut to thrive so it continues pulling nutrition from the food you eat and sending it where it does the most good. 

Like virtually everything in nature, diversity is best, so eat lots and lots of veggies: 30 different kinds a week, according to Dr. La Vella. The more diverse your vegetable selection, full of vibrant colors and flavors, the better. Because different micronutrients have different functions in the body, “eating the rainbow” really does provide the most comprehensive care.

And if you can’t get them all, supplementation can help fill the gaps, so consider Gennev’s Vitality pack. Thirty veggies is a lot, and if that means you’re bumping up your fiber, you’ll want to take it slowly. While Dr. La Vella assures us that gas is normal and means your gut flora is doing their job, ramping up fiber too fast can cause more than ordinary gas!

TRANSCRIPT TO FOLLOW

Are you taking care of your microbiome? What do you do to keep those good bacteria healthy and thriving? We’d love for you to share your tips for eating the rainbow, getting good probiotics, protecting beneficial gut flora, etc., so please join the conversation on the Gennev Community forums!

A jog on a Hawaiian beach was all it took for Jan, a post-menopausal registered nurse, to fracture a bone in her foot. The sand shifted slightly as she took a step, and she felt the pain.

The vacation that Jan and her husband had anticipated for months? Ruined.

Jan always assumed she got enough calcium to keep her bones strong through her healthy diet and didn’t dwell on taking supplements before she entered menopause. Even her nursing training had only briefly touched upon nutrition.

If she had known the full truth, she might have spent more time in Hawaii outside of her hotel room, catching sun rays, instead of in the emergency room, getting x-rays. At Gennev HQ, we’ll show why you need calcium, where to get it, and how much is enough.

Check out our review of the 10 best vitamins for menopause symptoms.

The low-down on calcium and menopause

Minerals like calcium are vital to a healthy body. Your bones and teeth are home to 99% of your body’s calcium, while the remaining 1% helps your blood clot, your nervous system relay information, your muscles and blood vessels contract, and performs many other functions.

Your bones are constantly remodeling, breaking down and rebuilding to repair injuries and the daily wear and tear from normal activities.

During bone remodeling, your bones release calcium into the bloodstream and reabsorb it back. If your body doesn’t have enough available calcium, it will use the calcium released into your blood to repair nerves, cells, and muscles instead of reabsorbing it into your skeleton.

In childhood, our bodies build more bone than we lose. This is how we grow. From adolescence until our thirties, our bones are the strongest because they build up and break down at an equal pace.

In our mid-thirties, this changes. We start to lose bone mass faster than we can maintain it.

Bone loss speeds up when your body’s estrogen production decreases during perimenopause and menopause, as estrogen aids calcium absorption from food and reabsorption into bones.

This all can lead to osteoporosis, a condition where bones become porous, brittle, and break easily, and its precursor, osteopenia. Forty percent of post-menopausal women in the US will have an osteoporosis-related fracture at some point in their lives. Some women have even died from osteoporosis hip-fractuces . Our friend Jan is one of these women. If your mother or grandmother had osteoporosis, you are at greater risk of developing it.

The calcium that you consumed as a teen and young adult is what shapes your risk of osteoporosis entering menopause.

“˜This is great for my daughter,’ you might say, “˜but how does it help me now?’

You can’t have your teenage body back, including your bones, but keeping adequate levels of calcium in your bloodstream as you enter menopause and beyond can help your bones stay strong.

How much calcium for menopause do I need?

For more than 20 years, the USDA has defined the recommended daily allowance (RDA) of calcium for American women as 1000mg for women 50 and under and 1200mg for women over 50.

Some nutritionists now suggest that as low as 500mg per day may be enough. However, more research is needed to support this conclusion.

The best way to obtain the calcium you need is to…

The foods you eat are the most effective sources of calcium. Great sources of dietary calcium include yogurt (310 mg/serving), cheese (up to 210 mg/serving), sardines (325 mg/serving), cow’s milk (300 mg/serving), fortified soy milk or orange juice (300 mg/serving), tofu (205 mg/serving), and leafy greens (up to 360 mg/serving). [Learn more: A Guide to Calcium-Rich Foods]

You can figure out how much calcium you’re getting from your diet by checking food labels or using a calcium calculator. Note: the “DV” (daily value) for calcium on food labels is based on 1000 mg, so “30% of DV” is 300 mg. If you are over 50, this isn’t 30% of your daily need!

Your doctor may also suggest taking a daily calcium supplement. For best absorption, take calcium supplements in doses smaller than 600mg; if you need more calcium than this, space out your supplement several times throughout the day

Calcium carbonate is the more affordable and available form of calcium supplement. You may already have calcium carbonate in your medicine cabinet as an antacid, like Tums or Rolaids. Take it with food, as stomach acid increases absorption.

Calcium citrate is another form of over-the-counter calcium. You can take it with or without food.

Side effects of calcium supplements may include gas, bloating, and constipation. Calcium carbonate tends to have more side effects than calcium citrate, so if you’re experiencing gastro discomfort, consider making the switch.

How to maximize calcium absorption

• Take calcium with vitamin D. Your body needs vitamin D for optimal calcium absorption. Experts recommend 600 IU daily for women under 70 and 800 IU daily for women 71 and up. We get vitamin D naturally from the sun, but people with darker skin and those who see less sunlight due to location (hello, Seattle!) or limited mobility may need more. A multivitamin with 800-1000 IU vitamin D should be sufficient,
• Take calcium at a different time than iron, zinc, or magnesium supplements or an iron-rich meal. Calcium can affect how your body absorbs these important minerals.
• Add milk to your coffee or tea. Some studies suggest adverse effects of caffeine consumption on calcium metabolism. You can offset this by adding a few tablespoons of milk to your coffee. Or, treat yourself to a latte for even more calcium!
• Avoid alcohol. While you may enjoy a glass of wine with dinner or a celebratory cocktail, alcohol increases calcium loss in your urine. (Alcohol can increase hot flashes, too–another reason to teetotal.)
• Get the right amount of protein. Protein is essential for muscle and bone health, and the body absorbs more calcium when you’re getting your recommended daily allowance of protein. However, too much protein can increase urinary calcium loss. Aim for 46 grams every day.

What to watch out for

The amount of calcium that’s right for you may defer from the norm if”¦

• You are taking other medications: Calcium supplements can interfere with antibiotics, medications to treat osteoporosis, and blood pressure medications. Consult your doctor or pharmacist before adding a calcium supplement to your diet.
• You have a medical condition that interferes with calcium absorption: cancer, thyroid disorders, tuberculosis, and immobilization can impact the levels of calcium in your blood. Talk to your doctor to determine what’s best for you.

How much calcium should a postmenopausal woman take?

Getting more than the RDA value of calcium may increase your risk of kidney stones, heart disease from increased calcification in the arteries, and potentially colon cancer, though more evidence is needed to support these claims.

Preliminary research shows that vitamin K2, which plays an important role in calcium metabolization, can help with heart health if this is a concern for you; be sure to talk to your doctor first.

(Did you know that vitamin K is great for your bones, too? Women who get at least 110 micrograms of vitamin K daily are 30% less likely to break a hip than women who don’t!)

There is no catching up, only moving forward

Studies suggest that exceeding the RDA of calcium doesn’t actually increase bone health in patients with osteoporosis but meeting your daily needs now and taking preventative measures will reduce your risk of fracture in the future.

If you are 65+ or have risk factors for osteoporosis before entering menopause, get a bone mineral density test (BMD) to evaluate your bone health before you break something.

And remember that calcium is only part of the equation for strong bones: if you want toprevent osteoporosis, exercise, a healthy diet, and refraining from smoking.

Jan now maintains her bone strength by eating calcium-rich foods, doing yoga with her husband, and walking to the grocery store instead of driving. She can focus her attention on her book club and adult children knowing that she’s doing everything she can to prevent another fracture.

Are you dealing with or at risk of osteoporosis? We’d love to know what you’re doing to manage your health and keep your bones strong. Please share with us in the Gennev Community Forums!

Meet writer Helen Pitlick! A seasoned communicator with a master’s degree in digital media to back it all up, Helen loves to create content that helps women feel more confident at all stages of their lives. When she’s not in front of her laptop, Helen enjoys pottery, pretending to play soccer, and hanging out with her dog.