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

Keep Moving With An Indoor Walking Workout 

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

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

Workout 1:  The 30-Minute Treadmill Trio

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

Warm-up (easy to moderate intensity)

Part 1: Steady pace (moderate intensity)

Part 2: Speed intervals (moderate to hard intensity)

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

Cool-down (moderate to easy intensity)

Workout 2:  15-minute High-Energy Indoor Workout

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

Warm-up

1 minute: march in place

Part 1: Fancy Footwork

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

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

Repeat Part 1 one more time

Part 2: Fast Feet

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

Repeat Part 2 one more time

Part 3: Multi-direction Moves

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

Repeat Part 3 one more time

Cool-down

1 minute: march in place

Workout 3:  Add 5 Moves for Total-Body Toning

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

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

For example:

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

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

 

Have you ever heard from your general practitioner that menopause is just “something you’re going to have to deal with”?

Did you feel the brush off?

This week I’m feeling a little punchy. I recently had an appointment with my GP and asked about getting a Mirena IUD to deal with the crazy menstrual cramps I’m having in perimenopause. I’m starting to feel the pangs, and if there’s a solution to the problem you can bet that I’m going to check it out. I run a menopause company, after all.

She wasn’t a fan. In fact, she said that it [the Mirena IUD] would introduce too many hormones into my body and that the Women’s Health Initiative study found risks with all hormone therapies for women entering perimenopause.

You all know how I feel about hormone replacement therapy for menopause, so I won’t belabor the point.

I left that visit feeling dismissed. Even with my work at Gennev, I didn’t have the energy to argue my point.

What I’ve heard from so many of you is that menopause starts with a conversation.

 

 

You want a practitioner who is willing to hear you out as the mood swings, hot flashes, inability to sleep. You want a practitioner who is willing to ask you about your sex life, and actually listen while you bumble through embarrassing details that might not be something to brag about but are the reality of what you’re facing.

In the last few months, menopause has become trendy.

Seriously, there are a number of companies popping up with products, assessments and remedies for women’s health in menopause.

This is good news! Menopause is on the map. People are realizing how underserved women have been for years, and they’re doing something about it.

And yet, I see too many websites and services that are in a hurry to get a product into your hands. Even prescription products that really require a real, live conversation with a practitioner.

At Gennev, we’re grounded in the notion that menopause starts with a conversation. You need a chance to explain what’s going on in your mind, body and spirit as because menopause can touch all three. And that starts with access to experienced menopause practitioners or a community that can empathize with what you’re going through.

I was reminded of the importance of open conversation with regards to menopause yesterday at a meeting I was attending. As 25 of us went around the room introducing ourselves, I mentioned that I run an online clinic for women in menopause.

Immediately a woman shouted from the other side of the room, “where were you 5 years ago?” I love hearing that. It reminds me that we need one another. We need trusted practitioners who will listen. We need to be heard.

So what do you need? Is Gennev filling that void? If not, how can we do a better job? Here’s your chance to speak your mind, freely, to me. Email me at jill@gennev.com. Or, voice your opinions and needs in the anonymity of the Gennev community.

Menopause starts with a conversation as whether that’s with a physician or a friend. Let’s take charge of our health in this journey, together.

genneve CEO Jill Angelo

Jill

 

When it comes to reducing your risk of conditions like osteoporosis, lifestyle changes are usually the first line of defense. They can be effective, are generally very low-risk for side effects, and often have add-on benefits to your health and well-being.

Weight-bearing exercise. Taking vitamin D and calcium together. Maintaining a healthy weight. Not smoking. Eating a healthy, varied (largely Mediterranean) diet. All of these can be helpful in preserving bone health.

However, if these approaches aren’t enough to stop osteopenia  from becoming osteoporosis, or if you’ve suffered an osteopenic fracture, it may be time to discuss osteoporosis medications and treatments with your doctor.

The truth of it is, says the International Osteoporosis Foundation, one in ten women aged 60 are affected by osteoporosis. After age 50, a woman’s risk of death from an osteoporosis hip fracture is equivalent to her risk of death from breast cancer. And yet, up to 80 percent of those at the highest risk as those who have already had at least one osteoporotic fracture as have not been identified, nor are they receiving treatment.

Given the potential impact of osteoporosis on longevity and quality of life, we talked to our doctor about it, Gennev Chief Medical Officer Dr. Rebecca Dunsmoor-Su.

What are our options for osteoporosis medications and treatments?

If lifestyle options are insufficient to halt the progression of osteoporosis, there are treatments that have proven effective. However, not every treatment works the same for every woman, and all come with at least some risk of side effects, so it’s good to discuss the range of options with your doc.

And, of course, you may find that a combination of lifestyle behaviors and medical interventions offer you the best health protection.

 

 

Bisphosphonates

This class of drugs are “anti-resorptive,” Dr. Rebecca tells us, meaning they prevent your body from reabsorbing calcium from your bones and weakening them. Additionally, bisphosphonates can be partly adsorbed onto the bone surface, helping restructure bones to be stronger.

These treatments can be taken orally, by injection, or via an IV, usually on a monthly, bi-annual, or annual basis. For those at low risk of osteoporosis, up to five years of treatments may be necessary. For those at higher risk, particularly those who have already had a fracture, up to 10 years may be necessary.

There are some risks of side effects with bisphosphonates: skin reactions for those receiving injections, stomach upset, heart burn, joint and muscle aches are the most common. For those on high doses, there is an increased risk of osteonecrosis of the jaw (death of bone tissue from lack of blood supply) and atypical femur fractures (the large bone of the thigh). However, the risk is very slight, even among this population.

Long-term studies (up to 10 years) have been done on bisphosphonates and show reduction of bone turnover (less bone loss) without evidence of adverse effects.

Bisphosphonates can be effective in halting the progression of osteoporosis, but not all work the same way or as well for every person taking them, so have a good conversation with your doc and track your progress.

Hormonal treatments

Replacing the body’s hormones to slow, stop, or even reverse the progression of osteoporosis is one way doctors are helping women (and men) keep bones stronger, longer. However, Dr. Rebecca reminds us, no hormone is risk-free, so it’s important to discuss benefits and risks with your doc to decide which (if any) hormonal treatment is appropriate for you.

How does Medicare cover osteoporosis? Find out, with this guide from Texas Medicare Plan. 

Hormone Replacement Therapy (HRT)

Some women do get bone benefits from estrogen with systemic hormone replacement therapy, says Dr. Rebecca, potentially even getting some reversal of bone loss. However, given the problematic nature of hormone replacement therapy (possible increased risk of breast cancer and blood clots), most doctors won’t recommend HRT for a single symptom, she tells us. 

If a woman is at risk of osteoporosis or has already had a fracture if she doesn’t have a uterus and therefore doesn’t need progesterone (which is associated with breast cancer), and if she has other symptoms such as hot flashes which hormones can help relieve, she may be a good candidate for HRT.

SERMs (Selective Estrogen Receptor Modulators)

SERMs like Raloxifene (Evista) is a “designer” estrogen which acts like estrogen where bones are concerned (protecting density) but unlike estrogen by not having an effect on the uterine lining (and therefore not causing uterine cancer). You may be familiar with another SERM, Tamoxifen, which is used to prevent the recurrence of breast cancer.

Raloxifene has similar side effects to other hormones, namely a slight but increased risk of blood clots in the leg and lung and increased risk of stroke in women with pre-existing heart disease or risk of heart disease. It can also increase the occurrence of hot flashes.

SERM + estrogen  

Duavee is a SERM + conjugated estrogens treatment that can reduce the effects of osteoporosis while also decreasing hot flashes. The estrogens help with vasomotor symptoms (hot flashes/night sweats) and help prevent osteoporosis; the bazedoxifene (BZA) helps protect the uterus from endometrial hyperplasia as a thickening of the uterine lining that can lead to cancer.

Teriparatide (Forteo)

A synthetic version of the human parathyroid hormone, Forteo helps regulate the metabolism of calcium. Unlike most of the other treatments which slow down the reabsorption of bone, teriparatide actually promotes the growth of new bone.

However, because Forteo is a relatively new treatment on the market, there’s not a lot known about the long-term safety of the drug, which is administered by self-injection. At the moment, it’s only FDA-approved for two years of use. Possible side effects include skin reactions at the injection site, depression, leg cramps, back pain, and heartburn.

Calcitonin

Initially this drug had to be given in an injection because if taken orally, too much was digested in the stomach before it made its way to the blood stream. In response, it was formed into a nasal spray, which is well tolerated by most users. Effectiveness is described as “modest,” but it does seem to increase bone mass, if somewhat less effectively than estrogens and bisphosphonates. However, it does seem to reduce pain from fractures.

Denosumab (Prolia)

Bone removal is, of course, part of the natural process of life, but as we age, bone removal far outpaces replacement, and bones become porous and weaker as a result. Denosumab prevents the development of the cells that remove bone. A Prolia injection every six months has been proven to help some women and men strengthen their bones and reduce their risk of fracture.

Prolia can have immune effects, Dr. Rebecca says, so it’s important to communicate fully with your doctor before starting and during treatment.

Another option to explore

The company OsteoStrong has a unique approach to osteoporosis that may well be worth exploring: non-impact osteogenic loading. Osteogenic loading is putting a high load on the bones in order to force bones to strengthen as this is why impact, weight-bearing exercise can help with bone density.

According to Brent Jordan, co-owner of OsteoStrong Mercer Island, OsteoStrong’s equipment simulates that impact without the danger of hitting the ground wrong. Members spend 10 to 15 minutes, three times a week, at an OsteoStrong facility, where there are four different machines to target different fracture-prone areas: arms between the wrist and shoulder, legs between the hips and ankles, core (ribs), and spine. Members pull or push as hard as possible against immovable parts of the machine, putting pressure on the bones and prompting the body’s inherent response as to increase bone density.

Used properly, the machines can also build muscle and improve balance, Jordan says, which can reduce the potential for falling, another benefit for women with osteoporosis.

Information on the effectiveness of OsteoStrong’s machines on bone density is still being gathered, and there is at this point insufficient evidence to recommend it over regular weight-bearing exercise, says Dr. Rebecca. So we suggest that you consult with your doctor before beginning the therapy, just as you would with any other treatment.

Are you dealing with osteopenia or osteoporosis or concerned about your bone density? What are you doing to manage or avoid the condition? We’d love to hear from you! Please share in our Gennev Community forums!

 

Waking up with perimenopause anxiety in the morning is a common experience for women in midlife. For women who have dealt with it before, it can come roaring back. For women who’ve never experienced it, it can show up for the first time. From annoying to downright debilitating, anxiety can persist for months or years. But anxiety can be treated and managed so you don’t have to live with the swirling brain, pounding heart, and interrupted sleep.

Studies show more than half of women aged 40 to 55 report occasional anxiety (or “nervousness”) and as many as a quarter of women report frequent anxiety.

Researchers haven’t spent much time looking at the relationship between anxiety and perimenopause and menopause, because depression, which can come on the heels of many age-related conditions, has absorbed the lion’s share of time and funds.

Dr Swapna Vaidya

However, with such a large number of people in the perimenopause > menopause transition suffering from disruptive anxiety, we thought it was time to talk with an expert. We asked psychiatrist Swapna Vaidya, MD and Executive Medical Director in the MultiCare Health System, for some answers on hormones, anxiety, and how to stay mentally healthy in a difficult time.

Why does anxiety happen or get worse in perimenopause and menopause?

Dr. Vaidya: Anxiety can occur due to the estrogen and progesterone imbalance that occurs during perimenopause/menopause. When this hormonal system gets out of balance, symptoms of anxiety, depression, irritability, mood swings, foggy brain, tense muscles, and sleep disturbances can all occur. In the brain, reproductive hormones such as estrogen act via steroid receptors. They also have an effect on different neurotransmitters such as serotonin (a mood regulator), dopamine (active in pleasure and reward centers of the brain), etc. Additionally, studies show estrogen can influence brain areas that regulate mood, behavior, and cognitive abilities. So when estrogen declines, we lose its regulating effect on our brain and central nervous system (CNS).

Who is at the most risk of having more anxiety at perimenopause and menopause?

According to Dr. Vaidya, women with a history of depression or premenstrual dysphoric disorder (PMDD), women with significant caretaking responsibilities, those who experience loss or who have chronic fatigue or other health problems are at a greater risk of anxiety. However, even women without risk factors may develop anxiety during this time of hormonal disruption and fluctuation.

Those who already experience anxiety or have a previous experience with anxiety, depression, PTSD, or panic disorder are also at greater risk of developing more severe symptoms of anxiety during the perimenopause to menopause transition.

What does this sort of anxiety feel like? What signs can tell me it’s probably hormonal (at least in part)?

Says Dr. Vaidya, if you’re experiencing hot flashes followed by sweating and panic, body aches, sexual changes, and/or memory issues as well, your anxiety is likely more a sign of hormonal imbalance than a new case of anxiety or panic disorder.

Will anxiety get worse?

It may for a while, says Dr. Vaidya: Studies of mood and anxiety during menopause have generally revealed an increased risk of depression during perimenopause with a decrease in risk during postmenopausal years. The Penn Ovarian Aging Study, a cohort study, showed depressive symptoms increased during the menopausal transition and decreased after menopause. (“Cohort” studies follow a group of individuals who share a common characteristic over time.)

My anxiety is worst in the mornings. Is that normal? Why does it work that way?

Early morning anxiety is typically seen in the perimenopause-to-menopause period, says Dr. Vaidya. Estrogen helps regulate cortisol production; cortisol is your body’s main stress hormone, responsible for your “fight or flight” response. Decreases in estrogen can cause increases in cortisol levels which can stimulate the nervous system, leading to early morning anxiety.

How do I explain to my partner, children, colleagues, boss, etc., what’s happening to me?

Telling people you’re dealing with perimenopause or menopause symptoms can be really tough in our society, and telling people you’re dealing with mental and emotional symptoms as a result risks a double stigma. Hopefully, as menopause and women’s health issues generally become more normalized, we’ll be able to talk more openly and easily.

As Dr. Vaidya says, “Communication and being transparent with your colleagues and loved ones about the experience of menopause and change, whether physical or emotional, would be the first step.” Telling those around you that your responses may sometimes be influenced by unruly hormones may help them have greater understanding and prompt them to do more to accommodate and support you.

What can others do to help?

It’s a tricky question: those who aren’t going through it (and perhaps never will) often struggle to figure out ways to be supportive and helpful. Dr. Vaidya suggests, “One of the best things loved ones can do for you is to listen and to be empathetic. Often people around you may try to give well-meaning but unsolicited advice, but this can come across as pedantic or judgmental.” Discussing a game plan when you’re not currently dealing with anxiety can be helpful, since in the moment, it can be challenging to think and communicate clearly. Now, when you’re clear and calm, is perhaps a better moment to have the discussion.

What are the solutions? Lifestyle choices, naturopathic solutions, medical interventions, apps?

Dr. Vaidya: There are several modalities, interventions, lifestyle changes, and diets that are available out there; however, the most important thing is to create a program that is easy to use and adapt. We know from studies that lifestyle changes such as having a balanced diet and getting good exercise can have real benefits. Cognitive behavioral therapy as well as mindfulness and relaxation techniques have demonstrated significant improvement in symptoms of anxiety. Supportive groups, whether online or in person, are helpful as well; however, it is important not to overwhelm yourself. Approach treatment at your own pace.

When is it bad enough that I should get some sort of help or intervention? What are the red flags that this is likely beyond my control?

If you’re experiencing anxiety or panic that may be hormonal, it may help to talk with a menopause specialist. Remember, hormonal fluctuations can cause symptoms that mimic panic or anxiety disorder, and treatment may depend on the cause of your symptoms. However, regardless of what causes your anxiety, persistent panic attacks and debilitating anxiety that cause significant impairment in functioning or lead to suicidal thoughts or concerns should be addressed immediately.

I know a lot of younger women; should I talk with them about anxiety?

Thanks to continuing social stigma around women’s bodies, many of “Generation X” and older women entered perimenopause with no real understanding of what was happening or what was to come. Moving to normalize perimenopause and menopause can make it so much easier for younger generations of women to have a smoother, healthier transition.

As Dr. Vaidya says, “It’s important to talk about the natural change of life with women in your group. Very often menopause is culturally viewed as an ‘end of reproductive ability or desirability.’ However, opening dialogue and sharing the challenges and treatments would help transform the way menopause is viewed. This can help dissipate fear as well about a normal change in life.” Our anxiety, says Dr. Vaidya, is made worse when we keep menopause a mystery, so talking and educating ourselves and one another is good for us all.

We can help you find relief for anxiety in menopause

Speak with a Gennev Doctor – our menopause specialists can help you understand fluctuations in your hormones as they relate to changes in your moods and anxiety as well as other menopause symptoms you may experience, and provide a personalized treatment plan.

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.

I’m back after taking a week off for the July 4th holiday here in the U.S. I quietly didn’t post anything and hoped nobody noticed. Instead, I was hanging out on the lake with family and friends and I hope you were doing something awesomely brainless too.

Now for a light topic: menopause at work.

If you need assistance taking care of symptoms during work, a menopause-certified health coach can be helpful. Book 30 minutes for your personal consultation with a health coach.

Managing Menopause At Work

At the risk of boring those of you who do not work outside the home, I want to caveat this post that menopause as at work or at home as can be equally as tough, but in this post, I want to address how we’re doing in the workplace.

How many of you work outside the home?

And how many of you have missed a day of work because of a menopause symptom-related issue, including heavy and painful periods, foggy brain, extreme fatigue or anxiety?

Or, should I ask, how many of you have masked one of those symptoms at work, because a) you were embarrassed and/or b) you don’t want others to think your performance is challenged?

My guess is that there are more than a few of you. In the U.S., 20% of our workforce are women of menopause age. That same percentage holds true in other countries too. We’re a powerful group, and I’d like to see us contributing at the top-notch level we know we’re capable of.

Managing Menopause Symptoms At Work

There has been great progress in workplace benefits for pregnancy, post-partum health, and fertility. But we have yet to see any support for women in perimenopause and post menopause in the workplace”¦let alone health and wellness benefits coverage for services (e.g. acupuncture, pelvic-floor therapy, sex therapy, vaginal pain treatment, menopause telehealth) effective for menopause-induced symptoms.

Beyond the benefits, it starts with managers and supervisors in the workplace. Menopause is a mum topic, so it’s likely that your manager as especially if male or a younger woman as will not understand what you’re dealing with on a regular basis.

And, it’s not up to women in the workplace to be the educators as because that doesn’t set you up for success.

So what does a “menopause optimized” workplace look like? We recorded a podcast with workplace and executive coach Lauren Chiren who has advised companies in the UK, Europe and the U.S. on how to support women in perimenopause and post menopause in the workplace.

Recently, I was listening to a webinar for workplace benefits leaders on women’s health and wellness. The focus of the presentation was on fertility, pregnancy, post-partum care and depression. When a question was asked about supporting women in menopause in the workplace, the response narrowly broached the topic with a simple response, “at that point, it’s all about women’s bone and cardiovascular health.”

That’s not enough.

While Gennev is focused on helping all women wherever they’re at, we are keenly aware of the gap in care in the workplace and in employer-provided benefits.

If you have ideas for how you’d like to be supported in your workplace wellness and benefits, please send me an email. jill@gennev.com.

 

 

How do you discuss a “taboo” topic like menopause on a public forum like a podcast? With humor, insight, wisdom, and patience!

Meet Colleen Ricci Rosenblum and Bridgett Biagi Garratt, the forces behind the hit podcast for midlife women: Hot Flashes & Cool Topics.

A year and 60-or-so episodes out from their launch, and Colleen and Bridgett have a genuine hit on their hands.

They’ve talked about the things you might imagine, given their title: peri/menopause, being empty nesters and relationships with adult children, etc. 

But they’ve taken on some tougher topics as well, including Colleen’s daughter’s history with an eating disorder, difficult pregnancies, divorce, and suicide.

Initially, they reached out to Gennev to feature Gennev CEO Jill Angelo on a podcast; they were so delightful and informed and fun, we asked them to return the favor.

What follows is a great conversation about midlife, menopause, the (glacially slow) changing attitudes towards women’s health, and what it’s like to go in the public eye and share intimate information.

 

TRANSCRIPT TO FOLLOW

What do you think? Is it easier to talk about menopause with friends, family, maybe even at work? Do you agree it’s important that health topics such as menopause be discussed openly? We’d love to know your thoughts, so please join the conversation in the Gennev Community forums. 

Menopause and sexuality is one of the many challenges of midlife that can take a toll on romantic relationships. If libido is not as robust as it used to be (or is non-existent), or sex is painful due to hormonal changes, or your relationship is on the brink of divorce for whatever reason(s), intimacy is suddenly a whole lot less attractive.

And midlife comes with plenty of “reasons”: caring for teenage children and/or aging parents, increased responsibilities at work, concerns about financial security in retirement, health worries “” who has the energy to even think about sex, much less engage in it?

Jessa Zimmerman

But if you want a more active sex life, you should have it. Sex and intimacy are actually really good for physical and mental health. So we engaged Jessa Zimmerman, licensed couples’ counselor and nationally certified sex therapist, to give us some quick tips to help re-engage your sex drive.

And it’s not just about sex. There are lots of ways to have intimate and supportive relationships, so if you’re looking for suggestions to help navigate uncertain relationship waters, we got that too.

But wait. At this point, we often lose those readers who are unpartnered and assume content about sex and love aren’t for them. This is for you, too. Masturbation and self-love “count,” “” YOU count “” so stick with us.

Sexuality and Menopause: Partnered  

It’s Valentime, which means lots and lots of articles about revving up your romance. But what if one (or both) of you is in menopause, and frankly, sex just isn’t all that appealing right now?

First, let’s all agree on one thing: this is not a “shaming” situation. No one should be shamed for wanting sex, for not wanting sex, or for being conflicted on the subject.

Generally, a woman’s sexual response is more complicated than a man’s, and penetrative sex may not be enough as and at this time of life, thanks to the vaginal dryness of estrogen loss, it may actually be quite painful.

Jessa’s advice for partners of menopausal women:

  1. Let her “warm up.” Give her time. Quite literally, you need to give her time to get the juices flowing. Extended foreplay is a great idea. Letting her set the pace and determine how far things go is awesome.
  2. Be physically affectionate, even if it doesn’t result in sex. If, for example, every backrub is just a prelude to intercourse, and intercourse is painful, suddenly backrubs aren’t all that pleasant. Be prepared to touch and cuddle without expectations.
  3. Buy lube. She may be embarrassed by the changes in her body, or she may want to have sex but fears the pain, bleeding, even infection from vaginal tearing that can result. Buy some lube for sex, have it handy, check in regularly to see if more is needed. Make it sexy or playful so it’s part of the experience.
  4. Talk. This is a tough topic, even with someone you share a bed with. Talk about sex when you’re not having it, and talk about it when you are as what works or doesn’t, what gets her excited or doesn’t, how you can both find pleasure.
  5. Get educated about a woman’s body and sexual response. Very few women of any age experience orgasm from penetrative sex alone. Learn with the clitoris is and how it works, be open to toys like the lioness vibrator to help her along.

And remember, sex isn’t the only place where your partner needs additional support during this time, says Jessa. Now is the time to be her ally and her cheerleader. If her self-confidence has taken a hit, boost her up. Show interest in her passions. This can be a powerful time of growth in career, second career, creativity or menopausal zest, so be supportive and join in if she makes a space for you.

Support her physical health by joining her or inviting her out for walks or runs or other physical activity. Encourage healthy eating by cooking some good Mediterranean diet recipes. Be sensitive and never downplay or joke about or call out her symptoms unless you know she’s truly OK with it. Listen. Ask her how she’d prefer you deal with her hot flashes or irritability, then try to accommodate.

This doesn’t mean you give up your life, we promise! But some flexibility and extra sensitivity could go a long way to making life easier for you both.

Jessa’s advice for menopausal women

You’re in menopause, and sometimes life is kind of “¦ miserable. Not only that, but you fear you’re making those around you miserable too.

We get it. Chances are you’re not the ogre you think you are, but we’ve got some suggestions for you too.

  1. Talk about sex. Advocate for what you want and need, Jessa says. If you’re getting what you want, you’re likely to want it more often!
  2. Initiate sex sometimes. Drive can become more responsive over time, Jessa says, so don’t just wait until you’re in the mood.
  3. Prioritize intimacy. Make time for undistracted togetherness. Be sure your partner understands this isn’t a guarantee of intercourse (to take the pressure off) and let what happens, happen.
  4. Get professional support or treatment if you’re struggling. Guilt or worry over whether you’re “normal” aren’t helpful or sexy, so see if a professional can help you get back on track.
  5. Embrace erotica. Suggest to your partner that you watch a sexy movie or read a sexy book together. Even if this doesn’t lead to sex, it can help “keep the embers glowing,” Jessa says.

This can and should be a powerful time for you. You’re probably freer from obligation and more independent than you’ve been in a while, maybe ever. Give yourself time to enjoy that, get to know you if that feels right, take control, set goals, live the life you want. If you want, you and your partner can find new hobbies, ventures, projects to do together.

Or, perhaps this is time to branch out on your own to live new experiences, then come back together to share. Being confident and finding pleasure in life can help you find confidence and pleasure in your relationships as well.

Unpartnered

Notice we didn’t say “alone.” You’re not alone, even if you’re currently not in a romantic relationship. The longest and most important relationship you’ll have in your life is with yourself.

And you’re changing. This transitional time can change our spirits and psyches as well as our bodies, so this is a really good time to get to know yourself (again).

Jessa asks: Are you ready to pursue new things, invest in yourself, leverage your new power at work or in your life? Or maybe it’s time to take a bit of a break, rest, re-energize, focus on self-love and self-care before embarking on your Next Big Thing. Whatever’s right for your next step, this is your time to figure it out, then pursue it. Be your own cheerleader!

And while you’re moving forward, don’t neglect your sexuality, Jessa says. The more you engage your body’s sexual response, the easier it becomes, so keep the fires burning. There are lots of great toys and tools for women’s sexual pleasure that don’t require a partner. You may have a new “body map” for pleasure, so get to know your body and responsiveness. It’ll be even more fun to share when you’re able to define exactly what suits you best!

Want more tips from Jessa Zimmerman? Be sure to check out her awesome book: Sex without Stress: A couple’s guide to overcoming disappointment, avoidance, & pressure.

Got thoughts to share on relationships, intimacy, sex, and love? Join in the conversations happening on the Gennev private Facebook group!

 

Maybe it’s been a few months and you were thinking, “oh, yay, finally no more UTIs,” but on your next trip to the bathroom, the burn and ache say otherwise.

Urinary tract infections (UTIs) are incredibly common among women. Some experts say half or more of all women will have at least one in their lifetime. Let’s discuss what you need to know about menopause and UTIs.

What causes UTIs?

The most common UTIs are caused by the bacteria E. coli. Normally found in the gastrointestinal tract, E. coli can migrate from the anus to the vagina, hitching a ride on thong underwear or toilet paper used improperly (translation: wiping back to front).

Normally the urinary system can keep these invaders from getting a foothold, but if they get in in enough numbers, they can start to colonize and travel up the urethra, causing pain and burning, the urge to urinate, cloudy or bloody urine, and pelvic pain.

UTIs are annoying and painful, and having to get a prescription antibiotic isn’t ideal, but most UTIs are relatively simple to solve. The problems really begin when a woman gets rid of one infection, only to have it come back a few months later.

UTI won’t go away…they keep coming back”¦?

Recurrent UTIs as infections that return as are more than just annoying; they can really disrupt your life. If you’re having several UTIs in a year, it might be time to start looking for other causes.

Recurrent UTIs are very common among perimenopausal and post-menopausal women, so we talked to ob/gyn and Gennev Director of Health Dr. Rebecca Dunsmoor-Su about the causes and treatments of the ones that just won’t go away.

What causes recurrent UTIs?

According to Dr. Rebecca, there are two main reasons women experience recurring UTIs: either the vaginal tissue and flora have changed, or there’s an anatomical issue that needs to be addressed. Both of these happen frequently in women in perimenopause and menopause. So let’s take them in turn:

One: UTIs caused by change in vaginal tissue and flora

A normal, healthy vagina is colonized by lactobacilli. They consume the glycogen our bodies no longer need and produce lactic acid which prevents other, harmful bacteria from invading the vagina.

In perimenopause, estrogen levels start declining. This causes the tissue of the vagina to thin and dry and changes the vaginal pH. Because lactobacilli require a very specific pH to survive and thrive, they may die off during this time in a woman’s life, leaving her much more vulnerable to infections.

 

How do you treat them?

If it’s a flora issue, says Dr. Rebecca, she usually counsels patients to consider estrogen or the MonaLisa Touch laser treatment. Both restore homeostasis, returning vaginal tissue to its pre-menopausal pH and allowing lactobacilli to recolonize.

“Estrogen” in this context means the topical ESTRACE cream, Dr. Rebecca says; generally for vaginal complaints, estrogen applied directly to the area in question appears to be more effective than estrogen taken orally. However, the estrogen needs to be at a higher dosage to work, so if you still have your uterus, you’ll need progesterone as well. Vagifem tablets and the Estring ring are low-dose, and while they may work fine for some, they may not provide enough estrogen to combat recurring UTIs in all women.

For those who can’t or prefer not to use hormones, there’s the MonaLisa Touch. The laser can rejuvenate vaginal tissue and increase blood flow to the area, bringing tissues back to their pre-menopausal condition. Once the tissues return to normal, the body’s pH returns, as does the glycogen the lactobacilli need to survive.

Hear our podcast with Dr. Rebecca about how the MonaLisa Touch works and why it’s a good option for many women in menopause.

One of these two treatments is generally necessary to handle the problem. According to Dr. Rebecca, taking a probiotic supplement isn’t particularly effective because the bacteria in the supplement don’t make it to the vaginal canal. Even if they did, the pH still wouldn’t be right for them to survive. Cranberry juice or extract may provide some relief, but more clinical studies need to be done to determine if it really does protect the bladder from bad bacteria.

Two: UTIs caused by anatomical issues

The other UTIs, she says, are due to anatomical problems. Prolapse and weakened bladder muscles may stop the bladder from emptying completely in urination, and that can lead to recurrent UTIs.

As we age, tissue can weaken; if the tissue between the bladder and the vagina weakens, the bladder may bulge into the vagina, causing a prolapse or “cystocele.” If the bladder drops enough, it’s no longer in an ideal position for voiding completely. Bulges may form pockets where urine pools and doesn’t make it out.

If bladder muscles are weak, they don’t contract properly anymore, and again, a woman may not be able to empty her bladder completely.

The urine that isn’t expelled becomes a breeding ground for unhealthy bacteria, enough of the bad bacteria build up to overwhelm the good bacteria, and pretty soon, the woman finds herself with another UTI.

How do you treat them?

First, get a diagnosis from an ob/gyn, Dr. Rebecca says, so you know what’s actually happening. Then, if appropriate, a physical therapist may be able to help strengthen weak bladder and pelvic floor muscles. Medication can help you empty your bladder more completely, and if the problem is a prolapse, surgery might be your best bet.

What can I do about recurrent UTIs?

Depending on the reason you have recurrent UTIs, there are a few things you can do to reduce your risk: schedule an appointment with a pelvic physical therapist for help with pelvic floor strengthening; stay hydrated so you’re using the bathroom every 2 as 4 hours; empty your bladder as completely as you can; pee immediately after intercourse; if your doc approves it, try Uqora for UTIs, take one dose of antibiotic before engaging in behavior that often triggers a UTI (like intercourse); and since it doesn’t hurt and might help, drink cranberry juice, if you like it, but watch the sugar.

When should I see a doctor?

Most women get a UTI at some point, and often once they’re over, they’re over. But if you’re suddenly having 3 or 4 UTIs in a year, that’s less common, and it might be time to check with your ob/gyn.

Dr. Rebecca advises you to have a culture done so you know what bacteria you’re dealing with. If it keeps coming back, you might have a resistant strain of bacteria that needs a different treatment, or perhaps you’ve just been taking the wrong medication. UTIs don’t go away on their own, so don’t wait to get help from a medical professional.

If you had or have recurrent UTIs, how did you handle it or how are you handling it? Leave a comment below, or let us know on Facebook or in Midlife & Menopause Solutions, our closed Facebook group.

 

As vaginal tissue and pH change, more frequent UTIs can become a real problem for many women in perimenopause and menopause.

Many women in perimenopause and menopause find themselves repeatedly at the doctor, getting yet another prescription for yet another antibiotic. The problem is solved for maybe a couple of months, then *boom* “” the UTI is back.

Why? They’re doing everything right: staying hydrated, urinating after intercourse, trying new birth control methods, etc. etc. etc., and yet the stinging and cramping while voiding comes back time and again.

Listen to our podcast to learn more about why it happens and about an innovative new product from Uqora to help women of any age ward off the dreaded UTI.

If you prefer to watch the discussion, you can find it on YouTube. Be sure to subscribe to the Gennev channel, so you never miss a video!

 

TRANSCRIPT COMING SOON

 

Increased risk of diabetes, heart disease, osteoporosis, dementia, autoimmune disorders”¦.

Either menopause is Mother Nature trying to kill us, or it’s her way of signaling that it’s time to start taking really good care of ourselves.

Considering Mother Nature also supplies a lot of nutrition for hormones we need to achieve and maintain good health, we’re going with the latter.

Loss of estrogen does, directly and indirectly, increase our risk of developing type 2 diabetes. And since having diabetes increases our risk of other health conditions, we definitely want to reduce any chance of setting some unhealthy wheels in motion.

What does diabetes do to my body?

Nothing good. Type 2 diabetes increases your risk of heart disease and stroke, it can lead to kidney disease, vision problems like menopause cataracts, nerve issues, and more. Because it affects blood vessels and nerves, diabetes can diabetes can impact any part of your body, though some are more vulnerable to its affects than others.

Diabetes is the #6 killer of women aged 45-54 and #4 of women between 55 and 64, so clearly we need to understand and minimize our risk.

How does menopause contribute to diabetes risk?

Both men and women are more vulnerable to metabolic diseases as we age, but it appears losing estrogen can speed up and intensify the process.

  1. Estrogen may play a role in managing insulin, says Michael J Breus Ph.D. Certainly many women who have diabetes find it more difficult to regulate blood sugar levels during and after the menopause transition, indicating a hormonal impact.
  2. In perimenopause, hunger hormones fluctuate right along with estrogen and progesterone, often causing a spike in the hunger-causing hormone ghrelin and a reduction of the appetite-dampening hormone leptin. Increased appetite can lead to weight gain, which is a risk factor for developing diabetes.
  3. Speaking of weight gain, many women put on more fat around their stomach at this time, and excess abdominal weight can increase diabetes risk.
  4. Menopause is also frequently a time of increased stress, increased fatigue, and decreased quality sleep, all of which can make you more vulnerable to developing diabetes, especially if you exercise less than previously and your diet is not exactly ideal.

Women who enter menopause early (before age 46) or late (after age 55) may have an even higher risk of developing type 2 diabetes, says a study by National Institute of Health, so if you’re in either of those categories, you really need to prioritize healthy choices.

If you need help making life changes to control your diabetes, a menopause-certified health coach can be helpful. Book 30 minutes for your personal consultation with a health coach.

Speaking of healthy choices “¦

So what should you do to minimize your risk?

According to the North American Menopause Society, you should get tested for diabetes every 3 years beginning at age 45. If you have risk factors such as a family history of the disease, blood pressure above 135/80, or if you are overweight, had gestational diabetes during pregnancy, or have PCOS, you may want to test more frequently. Some ethnicities also have a higher rate of the disease, so if you are Hispanic, African American, Native American, Asian, or Pacific Islander, more frequent testing might also be recommended.

In many cases, type 2 diabetes can be prevented, managed or even reversed with some healthy lifestyle choices. A study by the National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Diseases found that losing a modest amount of weight (7 percent of body weight was the goal), and improving diet and exercise was the most successful at helping people at high risk avoid developing type 2 diabetes. Those who adopted the Modified Lifestyle Change Program reduced risk by 58 percent. And those over 60 fared best of all, reducing their rate by 71 percent! And change really was modest: eat less fat and fewer calories, get women’s fitness motivation, increase exercise to 150 minutes per week.

If you’re interested in joining a program based on the study, you can find the one nearest you at the Diabetes Prevention Support Center website. You can also check out The Diabetes Diet from HelpGuide.org for suggestions on how to improve your food choices.

If you smoke, stop. Or at least reduce your exposure to nicotine as much as you can. According to the Centers for Disease Control and Prevention, smokers are 30 as 40 percent more likely than non-smokers to develop diabetes, so do what you can to avoid the unnecessary risk. If you already have diabetes, smoking can make the disease harder to control. (Smoking intensifies many menopause symptoms as remember: mother nature is trying to get you to take better care of yourself.) Alcohol can also increase risk, so limit intake to one drink a day or less.

Prioritize sleep. A single night of total sleep deprivation was as detrimental to insulin sensitivity as six months of eating a high-fat diet! While most of us aren’t dealing with “total” sleep deprivation, interrupted or poor sleep can cause weight gain and increased risk of diabetes. Getting better sleep during menopause is often really hard, so give yourself every advantage by practicing good sleep hygiene.

So much feels out of our control during this particular phase of life, but much of your diabetes risk can be managed. Eat better. Don’t smoke. Exercise. Not only will you minimize diabetes risk, you’ll likely also have a healthier heart and brain, a trimmer waistline, and reduced menopause symptoms.

Do you have diabetes or are you at high risk of developing the disease? What do you do to manage your health, and is it working? We’d love to know more. You can comment here, find us on Facebook or in Midlife & Menopause Solutions, our Facebook group. You can also join us, anonymously, if you prefer, on our community forums.   

*Menopause is defined as 12 months without a period.

 

Continuing our conversation with Dr. Erika La Vella, in this month’s Microbiome Series, we’re asking the doc about how food affects our microbiome for good or ill, how we can eat to protect beneficial gut flora, and substances that may impact our gut.

The gut microbiome is sometimes referred to as “the second brain.” Why? Because what happens in the gut does NOT stay in the gut. As science explores gut flora, we’re discovering more and more how microbiome health impacts so many other systems and organs of the body.

That means taking care of the gut is pretty critical to feeling good and being healthy. And like every other organism, beneficial bacteria rely on the right food sources for optimal health.

So what do they eat? They eat what we eat, for better or worse. Fortunately, people like Dr. Erika La Vella have a good handle on what food our good gut bacteria thrive on, and she shared that information with us.

Hint: As our bodies change in perimenopause and menopause, so does our digestion and our gut. Even if you’ve been eating “gut healthy” for years, you may notice differences in how your body reacts to food. If that’s the case, it might be time to reevaluate your diet and if it’s truly suited “” still “” for optimal gut health.

 

TRANSCRIPT TO FOLLOW

As a a consulting psychologist, consultant and executive coach to high-achieving women, guest blogger Barbara Mark, PhD, knows something about the storms of midlife. Here she takes on the six conditions of the perfect midlife storm and tells us how to survive the weather.

“Midlife: when the Universe grabs your shoulders and tells you,
“˜I’m not f***ing around, use the gifts you were given.'” “• Brené Brown

If you are a woman in your late thirties to your late fifties you are entering into, are in the middle of, or are coming out of the perfect storm.

Yes, there’s an “out” to this storm, and you’ll get there. I promise.

Not all women experience this storm with the same intensity, as we are all different with different backgrounds and different communities. Your experience may be that of a squall, or you may find yourself holding on for dear life in a Category 5 hurricane. (If that is the case for you, my heart goes out to you!)

The elements that make up this perfect storm are

  1. The Stages of Adult Development
  2. The Happiness U-Curve
  3. The Social and Economic Realities
  4. Perimenopause
  5. The Sandwich Experience
  6. Cultural Beliefs About Midlife

First of all, it is important to know that you are not alone, you’re in good company. All women are subject to these factors to varying degrees, but we all go through it.

If you need help riding the menopause wave, then a Gennev menopause-certified gynecologist can give you a trusted opinion, determine if medication is right for you, and they can provide prescription support. Book an appointment with a doctor here.

The Stages of Adult Development

Although it wasn’t until the 1950s, 60s, and 70s that psychologists began to recognize how adults go through stages just as children do, my favorite theorist, Carl Jung, developed his theory of adult development in the 1920s and 30s. Jung experienced a spiritual and intellectual crisis after Freud ended their friendship and professional relationship around 1915. He later identified this time as a spiritual crisis in the middle of life. In 1965, psychologist Elliott Jaques coined the term “mid-life crisis.”

Not everyone experiences a “crisis” as such as it depends on how intense your perfect storm is.

I love this topic and could go on for pages, but let me say simply that the stages of adult psycho/social development that occur in an individual’s 30s, 40s and 50s are the most tumultuous.

Why? Well, we move from a relatively happy young adulthood through deciding that we don’t want to follow anyone else’s rules or meet others’ expectations, to discovering that there is a self to embrace, only then to encounter fears that this self may not be all that our younger self imagined and wanted to be when it grew up. This leaves us feeling, “Is this all there is?” until finally we arrive at a place of self-acceptance in our mid-to-late-50s to mid-60s.

For many women, midlife means an increase in anxiety, depression, and rage. But it is, like adolescence, a transitional (and hormonal!) phase with an ending. The important thing is to find tools (hobbies, exercise, family and friends) that will help you get through to the good stuff on the other side. Trust me as the post-menopausal zest and the last stage of midlife development are awesome! Then adult development goes on to the stages of older adulthood which are pretty cool, too.

The Happiness U-Curve

In the early 2000s, while everyone was looking at happiness, a few theorists developed and evolved the Happiness U-Curve. It is based on a group of longitudinal and multi-cultural studies of life satisfaction, happiness, and contentment. What the results showed was a curve at high levels of happiness in early life that then dives downward to its lowest level in the late 40s, before climbing back up beginning in the late 50s and early 60s.

The nadir of the curve is just at the developmental moment of greatest self-doubt and the search for purpose and meaning. If you’re feeling at the bottom, as unhappy as you can ever remember being, understand that it’s a curve, and there’s an up awaiting you. By this time your hormones have settled down quite a bit and you are feeling the psychological impact of arriving at big self-acceptance!

The Social and Economic Realities

If you are an American woman in your late 30s through your early 50s, you have lived through some difficult times in US history. Many parents’ child rearing practices were pretty hands-off, thus creating a generation of latch-key kids. There were a lot of divorces. The American economy went from OK to boom to bust to OK to a huge recession to a slow recovery. The recession made it more difficult to embrace the typical American Dream of home ownership and wealth-building.

There are big decisions to be made as Marriage? Kids? Kids before or after marriage or without marriage? Intense career development early on and then take time off from work? Try to get back into work or start an entrepreneurial venture? Try to move the Baby Boomers out of the way while dodging the Millennials who are running up behind and past you? And, this is just a cursory review! Wow, I am exhausted just writing this, yet I know that the economy is better and there are lots of resources out there for you.

Perimenopause

While all this is happening, your hormones are having a party at your expense. Many women begin to experience the first stirrings of hormonal fluctuations in their late 30s. This will continue through to menopause, defined as the point at which you have had no period for one year, around 50-52.

The list of perimenopausal symptoms is long and varied. Many women experience hot-flashes, night sweats, insomnia, mind-crushing fatigue, brain fog, anxiety, depression, heart palpitations, migraines, irritability, crying spells, episodes of rage, and lack of impulse control, to name a few.

If you are still young, preparing for this early in your life as your 20s and 30s as will make the transition a whole lot easier. Dedicate yourself to a good diet and lots of exercise. Develop a routine of mindfulness and self-care so that you are not scrambling to create it when you are in the middle of this.

If you are in the middle of this, contact a menopause specialist and assess the options that are right for you. Also, exercise and mind your diet. This doesn’t have to be hellish even if you are on the more “hurricane” end of the spectrum!

Trust me as this is not your new normal! This party ends and you’ll celebrate being past this ritual of maturation physically, emotionally, and psychologically.

The Sandwich Experience

Many if not most women are caretakers, and if kids are in the picture and parents are needing help at the same time, life can be a sandwich of competing needs and demands. For many women, travel is involved as more family members live some distance away from each other. Also, women who grew up at this time period are less likely to have many siblings that can pitch in to take care of aging parents, so the burden can fall to just one or two people. This, too, evolves. Give it time and give yourself a lot of self-care!

Cultural Beliefs about Midlife

Last but not least is the social construct that midlife equals “old.” In our youth-obsessed culture we have gendered ageism, meaning “old women” become marginalized and invisible.

As a result, so many women are doing everything they can to deny that they are aging and are not speaking up for what they need or engaging in appropriate self-care. Women are running around exhausted and dripping with sweat, trying to prove to themselves and everyone else that they’ve got it all covered.

We are living longer and healthier, so people no longer feel “old” in their 40s, 50s, 60s and for many even in their 70s! However, we have not updated our concept of what the middle of our lives is. The important thing is to live your midlife, not the one dictated by myths and outdated societal stereotypes.

There is calm after the storm

There is “calm” after the storm, if calm is what you want. But there’s also so much more: excitement, change, growth, confidence, and empowerment.

We now can have a midlife that is a productive, satisfying, full third of our lives book-ended by youth and older-age. I meet so many women who say that being in this middle third of their lives is the most empowered and vibrant time of their lives so far. If you met me in my late forties I would say that I was running out of time to accomplish all that I wanted to in my life. Now in my late sixties I am on top of the world and loving my work and my life.

Take heart, women! This can be a difficult and challenging time, but we have so much more access to information and community support from organizations like Gennev than we’ve ever had. Your hormones will settle down, you will move to a place of self-awareness and integration developmentally, and you will move up the other side of the U-Curve! Yippee!

For more from Barbara, check out her blogs on Middlescence and having fun (yes, fun) in midlife.

Weathering your own perfect storm? We’d love to hear about it. Leave a comment below or on Gennev’s Facebook page, or join Midlife & Menopause Solutions, Gennev’s closed Facebook group!