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Freeze.

Check your posture. How are you sitting or standing right now? Is your body neatly aligned with your spine, joints stacked squarely on top of one another, head in a neutral position?

Or are your shoulders and back rounded, head jutting forward to see your screen, chest caved in?

One of the most important things we can do to eliminate pain, avoid doing damage to our bodies, and exude a confident, vibrant air is fix our posture.

Back, shoulder, neck, hip, knee, foot, and pelvic pain, plus incontinence and prolapse can all be caused or made worse by chronic poor posture. But fixing it is hard; as soon as we stop being aware of how we’re standing or sitting, we revert back to our slouches, leans, and locked knees.

To learn what proper posture is and how to improve our standing (so to speak), we turned to our awesome DPTs, Brianna from Four Pines Physical Therapy and Meagan of Orthopedic & Spine Therapy.

The posture problem

What does poor posture look like? According to Meagan, the problem starts, literally, from the ground up.

When you’re standing, where are you bearing most of your weight? How you stand translates all the way up, so it’s important to be sure your body is in proper alignment.

“I find a lot of people hang out on their heels, and that sets up a cascade for lazy standing,” Meagan says. “When we do that, we’re not relying on active muscles for support but instead locking our joints. When we stack up locked ankles, knees, hips, and spine, it passes the burden of holding us upright to our ligaments and skeletal structure. At some point, we can’t get away with that anymore, and things start to hurt.”

She went on to describe the posture of someone who isn’t stacking their body correctly: “Typically, the most common crummy posture I see is weight on the heels, knees locked and slightly hyper-extended [bending the wrong way], pelvis thrust forward with hips locked, bum tucked under into what we call a posterior pelvic tilt, and then, because we know we should have good posture, shoulders thrown back. Or they’ve given up on good posture and are hunched in a forward slouch.”

When we try to “fix” our incorrect posture, we tend to do it “from the rib cage up,” she says. “But just squaring our shoulders and keeping our head straight really only contributes to the neck and back pain.”

And posture problems are increasing in younger folks too, thanks to a screen-saturated culture, Bri adds. “I’m working with three teens right now who have that forward-head posture with their chin jutting at their screen, looking at phones or tablets which are down low on a desk or in their lap. Their heads are forward, chest caved in, shoulders rounded. A gentle mid-back cue to push things up and forward is all they need, but pretty soon they get tired and sore and go back to slouching.”

“Of course, when your muscles aren’t used to stabilizing you, they get tired,” she says. “But if you keep at it, they get stronger, just like any muscle you exercise.”

Check you out

A big part of fixing your posture is being aware of how you’re standing and sitting, and correcting what’s wrong.

So, check in with yourself. How?

According to Bri, one great test for those with breasts is to check out your personal “¦ um “¦ trajectory. “Physical Therapist Julie Wiebe suggests you check yourself out in a mirror or a window as you pass by, and notice where your boobs are pointing. Are they pointing at the ground, or up above the horizon? Or are they nicely horizontal, stacked neatly over your ribs, and leading you straight ahead? It’s an easy, quick way to connect with your posture and be aware of how you’re aligned.”

Another check, Meagan says, is to stand with your back against a wall. “Be sure your heels, hiney, the backs of your hands, and back of your head all come in contact with the wall. Keep your nose and “˜headlights’ (for those with headlights) level. If you can’t rest your head against the wall, you might want to talk with a PT for help to get that range of motion back. But this is something you can do several times a day, just to remind yourself what “˜straight’ feels like.”

There’s a sitting version of this too, for those long car commutes: “Don’t be a floating head over the steering wheel,” Meagan says. “Use your headrest, check in with it, press your head against it, use the supports for your back, and get a lumbar roll for longer trips. The support is there for a reason, so use it!”

And speaking of range of motion, when your body is in a healthy “neutral” stance, you should have range of motion available both forward and back. Can you tilt your pelvis forward and backward? It doesn’t have to be a big move, just small shifts, but you should have “room” to go both forward and back. If you can’t move one way, chances are you’re already too far in that direction.

And it’s not just standing and sitting when you need to be aware of your posture, Bri says. When you’re in the gym, take full use of the mirrors around you. Don’t lock your knees, don’t tuck your bottom up, don’t suck your stomach in. Find that nice, neutral position that allows your muscles and joints to do their job as stabilizers and shock absorbers.

OK, my posture needs work. What do I do?

Says Meagan, “When people say they get tired in the correct body position, that’s when I’ll go all the way to the floor. Yes, you’re clinging for dear life above, but if your pelvis is arriving to the room a full minute before your head does, you’re not lined up. Save your muscles by stacking your body correctly: shift your weight forward to the base of your big toe or the front of your foot’s arch. Bring your pubic bone over your shoelaces to unlock the joints below. Lift your sternum, don’t just shove your shoulders back. Open your chest and rib cage to straighten up from the slouch.”

Other suggestions include getting good shoes that fit your feet and your needs (probably NOT high heels). If you’re on your feet all day, consider inserts or custom orthotics, and get shoes that support your feet and ankles (or better yet, work on strengthening your feet and ankles).

Chest-opening exercises can make a big difference, Bri says: “If a motion of a joint is painful, it may take something as simple as fixing your posture to alleviate the pain. If you have shoulder pain, it may be because of a cramped, impinged posture that’s limiting your range of motion. Open up your chest with pectoral stretches. We do an exercise called the “˜open book‘ that helps you rotate and open your spine and stretch your chest muscles, thoracic spine, and pectorals.”

Also, get a good foam roller. Even just lying on it can help open you up and loosen tightness in your chest and thoracic spine (the part of your spine that runs from the base of your neck to your abdomen).

Change your posture periodically. Both PTs like adjustable desks because you can sit for a while, stand for a while. But it’s important to do both correctly and stay in alignment. If you start to shift your weight to one hip, it’s time to sit again.

Just be aware of what your body is doing, what you’re asking from it, Meagan says. Try to be aware that most of us stand with our knees locked, and try not to do that. You don’t have to stand with bent knees, just don’t lock them.

What does good posture look like?

Imagine a little creature that stands on your head and drops a plumb line down the side of your body. The line should run straight from your earhole to the midline of your shoulder (and remember, that’s with the rib cage up and open, not just shoving your shoulders back). From your shoulder, the line should run to the bony part of your hip, to the bony fibular head on the side of your knee, to the bony part of your ankle. Fortunately, your body leaves a sort of topographical map of bony bits to guide you.

Stacking your body properly allows gravity to work for you. Think of cultures where people carry heavy loads on their heads. “If your body is correctly aligned, it’s possible to carry quite a lot of weight safely. Gravity compresses and stabilizes you in a good way,” Meagan says. “But if you’re all out of alignment like a Jenga construction, you’re asking your muscles to take too much of the load.”

Fixing poor posture doesn’t happen overnight, especially when we’ve spent years hunched over our computers, books, or food, but as the PTs tell me, fixing your posture starts a cascade of so many other good things: better breathing, better sleep, less pain, reduced incontinence and prolapse risk, and more. Plus, consider the message your body language is sending into the world ““ do you appear withdrawn, isolated, and unwelcoming? Or confident, open, and ready for anything?

Go stand in front of a mirror and do the plumb line test. Pull your body into the best alignment you can manage. Really feel how straight and confident and strong you can be. Do this anytime during the day when your body hurts, when you’re tired or feeling insecure, or when you’ve just been sitting or standing too long. Then come back here and let us know how the simple act of correcting your posture changed your world ““ even if, for now, it’s just for a few minutes at a time.

Have you had help to improve your posture? How did you do it (other than joining the military…)? We’d love to hear more, so please feel free to comment here, or start a thread in our community forums. You can also reach out to us on Gennev’s public Facebook page or in our closed Facebook group.

 

According to the Spine Health Institute, 72 percent of women wear high heels “at some time.”

Considering this information comes from the Spine Health Institute, you can probably see where we’re going with this.

Yes, high heels can be gorgeous and sexy (see the image above, for example), but they can also be a problem for your posture, spine, and back. And did you know those beautiful, pointy-toed, three-inch wonderpumps you just bought could also contribute to urinary incontinence? Yep.

As ever, our amazing physical therapists, Brianna and Meagan, brought us up to speed on what we need to know about high heels, incontinence, and how to wear those brand-new wonderpumps properly.

How do high heels affect the pelvic floor?

The problem, Bri says, is the change to our posture and everything we have to do to accommodate it. Ideally, we should have a very neutral alignment, with everything stacked appropriately as ribs over hips as to keep us upright.

However, high heels put us in a constant state of falling forward. In order to compensate for that, our normal, gentle “S” curve from the base of our skull down to our tailbone is exaggerated, says Meagan. We have to keep our knees and hips slightly bent to achieve our normal straight up-and-down alignment, which makes our butt stick out. We also have to stick out our chest and pull our shoulders back. All this might sound ideal for accentuating sexy curves, but it could be causing damage to your pelvic floor.

In order to compensate for the falling-forward position of high heels, we do what Bri refers to as “gripping”: we tighten our abdominal muscles and our glutes (butt muscles) to help stabilize us in this forward-leaning posture.

Plus, says Bri, the posture of high heels tends to make our bellies stick out, so we suck those in and hoooooooold. And as we discussed in a previous blog, when our abdominal muscles are held too tightly for too long, we’re actually overtraining our pelvic floor. And that can contribute to incontinence.

What can you do if you’ve been wearing heels for years?

Depending on how much you’ve worn your heels, your calf muscles may be a bit short and tight, says Meagan. Hip flexors, the big muscles surrounding the hip joint, probably also need some attention. The key to regaining your normal posture is gentle stretching.

“You need to regain the flexibility and mobility in your pelvis and lower back in order to restore normal spine and posture,” Bri says, “so we slowly integrate different core exercises to get you back to a neutral, stable position. Then you can relax those abdominals instead of holding them in 24/7 to maintain this idealized posture.”

“We have the false belief that our pelvic floor or our abdominal or back muscles work like ‘isolated pieces,’ but the reality is that they all work in conjunction and are closely related to one another. If your calves are shortening, and you are tightening your butt and lower abdominals to adjust to the new posture, chances are you are also indirectly adding extra pressure to your pelvic floor, and this posture does not favor its correct functioning,” says Estrella Jaramillo, cofounder of B-wom, a digital coach for women’s intimate and pelvic health.

One client Meagan worked with had been in high heels for so many years that flat shoes became uncomfortable, as that’s how foreshortened her calf muscles became. “We met halfway,” Meagan says. “We slowly reduced the heel to 2 inches, then 1 inch, and finally to flats.”

Is there a perfect shoe for humans?

Not really, the PTs agree: there’s just too much variability in human bodies to pick a “perfect” one-kind-fits-all shoe.

“We all have similar skeletal structures deep within us,” Meagan says, “but there’s so much variation in body weight, coordination, strength, and endurance, and they all affect how we use our bodies. Some people’s arches collapse, others have super high arches, and both need very different types of shoes to fit their biomechanics.”

The PTs suggest we “shop like Cinderella” and pick only the shoe that truly fits. “I tell them to buy with their eyes shut,” Meagan says. “Don’t look at the color or the price tag. If the shoes feel magical, buy them, whether they’re athletic shoes or work shoes.”

Do we have to throw our high heels away?

No. While high heels will probably never be “good” for us, we can certainly minimize the damage:

  1. Limit the height, the PTs tell us: go for 1 inch over 2 or 2 instead of 3.
  2. Choose a wedge heel over a stiletto for greater stability.
  3. If you’re wearing heels to be taller, find some that are also thicker at the toe, decreasing the difference from heel to toe while still increasing your stature.
  4. Wear them only a few hours instead of all day.
  5. Stay off your feet as much as you can when wearing them.
  6. If you’re walking to work, throw the heels in your bag and wear tennis shoes or stylish flats to cover the distance.

Finally, the PTs tell us, if you can’t do any of those, if you’re truly stuck wearing those dagger-sharp three-inchers, stretch your calf muscles multiple times a day. And stop sucking in your gut. The clumsiness of menopause doesn’t help here, so do everything you can to combat it.

Do you have issues from wearing fashionable-but-not-very healthy shoes? How did you solve them? We’d love to hear about your experience, so share with us in the comments or on Gennev’s Facebook page or in Midlife & Menopause Solutions, our closed Facebook group.

Want more great advice from Bri and Meagan? Ask and ye shall receive:

If you have scars from surgery or injury, learn how to massage your scars to release adhesions, reduce pain, and free up the tissue again. Think you might be peeing too much or too little? Find out what’s “normal” urination and how to get there. Can a PT improve your sex life? O yes, if you follow their steps for much better sex.

 

“Your Pap test was irregular. We’d like you to come back in for a follow-up.”

It’s not a phone call any woman wants to get, but it’s not uncommon for women to get irregular Pap results in life after menopause. .

Most irregular Pap results turn out to be relatively benign as maybe the doc didn’t get enough cells, or there’s some low-grade inflammation. But it’s worth remembering that rates of deaths from cervical cancer are down significantly over the past 40 years, due in large part to regular screenings, so it’s important to follow up.

Most women have had at least one Pap test, if not a couple dozen, but if you’re like us, you may not be entirely sure how necessary it is, how often we should do this (particularly as we age), or even what the doc is looking for in there.

So we turned to Dr. Jessie Marrs, ob/gyn at Swedish, for more information.

What is a Pap test intended to look for?

Dr. Jessie: A Pap smear is a test every woman needs periodically. It is a test to look for abnormal cells of the cervix. It’s a pretty easy test, your doctor will simply place a speculum and swab your cervix with a small brush to collect a few cells. Frequently the sample from the Pap is also tested for HPV. HPV is a sexually transmitted virus that causes most abnormal Paps. A Pap is actually just a screening test, it gives your doctor information about whether or not you are at risk for abnormal cervical cells.

How often should a post-menopausal woman get a Pap test?

Dr. Jessie: How frequently a woman should get a Pap after menopause depends on her age and the results of her recent Pap tests. If a woman has had all normal Paps, she can stop getting Pap tests after the age of 65. Between the ages of 30 and 65 the frequency of Paps depends on the result of her Pap and HPV testing. If the HPV test is negative and the Pap is normal, screening every 3 years is completely appropriate.

 

 

What qualifies as “irregular”? What is my doc seeing?

Dr. Jessie: An irregular Pap is actually something a pathologist finds when she looks at the cells from the Pap. It is not something your doctor finds during the exam. When the pathologist looks at the cells, they are looking for anything that could be a sign of abnormal cells of the cervix.

What could be happening in my body that would result in an irregular Pap test?

Dr. Jessie: There are a couple of possibilities as far as irregular Paps go, especially after menopause. In some cases, there is HPV that is causing actual abnormal cells in the cervix. In other cases, after menopause, thinning of the vaginal and cervical tissue or changes in the vagina like inflammation or cervix related to thinning of those tissues can make the cells on the Pap appear to be abnormal. It will be impossible for your doctor to know which of these scenarios are the case without further testing.

I was told my Pap test was irregular. What happens next?

Dr. Jessie: If your Pap screening test winds up abnormal, it is important to schedule diagnostic testing. The diagnostic test for an abnormal Pap is called a colposcopy. During this procedure, your doctor places a speculum in order to visualize your cervix and coats your cervix in a dilute vinegar solution. Your doctor will then look through a magnifier to look for any areas highlighted by the vinegar. If any possible abnormal areas are found, your doctor will do biopsies of your cervix. This may include biopsies of the external cervix or sampling of the internal cervix. This process can be a little crampy but is generally pretty quick.

How long can I wait before scheduling a follow up?

Dr. Jessie: I usually recommend having your follow-up appointment within 1-2 months after your abnormal Pap smear.

I get “false” irregular results often as when can I stop having follow-up procedures?

Dr. Jessie: Some women do get false irregular results after menopause. If this happens many times, you and your doctor may want to discuss how and when to do follow-up. Depending on the findings and your risk factors, the colposcopies may be able to be performed less often than yearly.

On the other hand, it is always possible that there are actually abnormal cells there, so this needs to be a very careful discussion. In some cases, when the abnormal Pap is thought to be related to atrophy or thinning of the tissues after menopause, a woman can use vaginal estrogen for a couple of weeks prior to her annual exam and Pap, which can normalize the Pap.

I have a teenage daughter. What are your thoughts on the HPV vaccine?

Dr. Jessie: DEFINITELY do get your daughter (and son) the HPV vaccine. The vaccine is FDA-approved for girls and boys between the ages of 9 and 26. It is worth getting your daughter vaccinated to decrease her chances of needing a colposcopy or other procedures on her cervix. Men are carriers of the virus, so vaccinating your son is also a great idea!

Birth control pills don’t cause cervical cancer or HPV; why is my prescription dependent on getting a Pap test?

Ok, good question, this is a common misconception. Actually, your prescription for your pills is not dependent on your Pap, but on your coming in for your annual exam. The Pap is one small part of this yearly appointment.

When you come for your exam, your doctor gets updated by you on any health changes, surgeries and changes to your family’s health throughout the year as well as determining what cancer screening testing is appropriate. The screening that she is tracking includes the Pap smear, but she also determines if you are up-to-date on your mammogram, are you due for a colonoscopy, etc. She also does an exam, which may or may not include a Pap smear.

Getting this information is vital to your health in many cases. I have, more than once, had someone come in for their yearly and found that they were recently diagnosed with a new medical problem and shouldn’t be on birth control pills. Had I just continued to prescribe the pills without seeing the patient, she may have been at risk for complications related to the contraceptives. Some women who take birth control have their menopause delayed.

If you want to be sure you can be prescribed birth control pills, a Gennev menopause-certified gynecologist can give you a trusted opinion and medication for you. They can provide prescription support. Book an appointment with a doctor here.

Now that many women use long-acting forms of perimenopause birth control or need Paps only every 3-5 years, some women are skipping their yearly exams. I don’t recommend this. Even if a pap or a refill isn’t needed, having an annual is important so your doctor can continue to keep track of what screening is necessary and when, stay updated on any new issues and do a thorough exam to look for any changes in your body that need to be addressed.

Can menopause cause an irregular Pap result?

Dr. Jessie: Yes! After menopause a woman’s estrogen levels decrease to very low levels. The vaginal tissues are affected by estrogen. Thinning of the tissues can make the cells appear abnormal on a Pap. The colposcopy will help determine the difference between actual abnormal cells and cells that appear abnormal because of thinning of the tissues.

 

Beating cervical cancer before it starts

While the death rates from cervical cancer have declined, that doesn’t mean incidences of the disease are radically fewer as in fact, as the US population ages, the number of cancer diagnoses generally has actually increased. Cervix cancer pap tests can detect changes that could lead to cancer before the disease develops, making it a very effective preventative tool. And, as more and more young people are vaccinated against HPV, rates of cervical cancer should continue to decline.

Thank you to Dr. Jessie Marrs, ob/gyn at Swedish for her input.

What is your experience with Pap tests? If you’ve had an “irregular” result that caught cancer early or before it became cancer, we would very much like to share your story. You can respond to us at info@gennev.com, and we guarantee to protect your privacy, if you prefer. Or you can share with the community by leaving us a comment below, or talking to us on our Facebook page or in Midlife & Menopause Solutions, our closed Facebook group.

 

Authored by Gennev Chief Medical Officer, ob/gyn Dr. Rebecca Dunsmoor-Su.

“There’s been yet another round of lay-press headlines about how estrogen plus progesterone hormone replacement may increase the breast cancer risk,” says OB/GYN Dr. Rebecca Dunsmoor-Su. 

Headlines don’t tell the full story, and Dr. Dunsmoor-Su, who is an epidemiologist as well as an OB/GYN, helps us separate fact from fiction in this podcast.

If you’re dealing with menopause symptoms and are worried about taking HRT to manage them, you’ll want to give this a listen.

 

TRANSCRIPT:

Hi, this is Dr Rebecca Dunsmore-Su, the Chief Medical Officer here at Gennev. I wanted to put together a podcast today about hormone replacement therapy [HRT] and breast cancer. 

I’m addressing this again because there’s been yet another round of lay-press headlines about how estrogen plus progesterone hormone replacement may increase the breast cancer risk. And that’s because of some data presented at a breast conference recently. 

It’s important to note that this data is not new data. It is the same data from the Women’s Health Initiative that we’ve been talking about for many, many years. And the data from that study has been analyzed multiple times by multiple other investigators, and they all note that the data does not really show an increase of breast cancer in this population. 

When you actually parse the data out and look at the women who started estrogen and progesterone and have had never seen hormone before and therefore likely younger and more close to the time of transition of menopause, there is no difference in breast cancer rate between them and people given a sugar pill in the same group.

Importantly, the only group in which they found a difference between them and the sugar pill is in women who had taken hormones before and stopped. 

Two big issues with that: One, that’s not how we use hormones, and two, the group given a sugar pill in that subgroup actually had a much lower than average rate of breast cancer. So in comparing those two groups, you’re actually comparing to the wrong comparative group. 

If you look at that group of women given estrogen plus progesterone, they really actually don’t have a higher rate of breast cancer than any other E plus P group that we’re not calling significant. 

That’s a lot of statistics talk for saying if you work with your data enough, you can make something look like it causes harm. But really when you look at how we use hormones, estrogen plus progesterone really does not increase the risk of breast cancer.

But again, some studies say it does. Some studies say it doesn’t. Some big studies say it does. Some big studies say it doesn’t. And why are we seeing this back and forth? Why don’t we know the answer by now? 

I think there are two real reasons why that’s true. The first reason is, in anything that may have a very small or no impact, if you do studies you’re going to see studies give you false data on both sides of that true estimate. It’s why we do large studies. It’s a statistical anomaly and so what we’re getting is all of these studies on either side sort of telling us, well maybe the reality is somewhere in the middle or somewhere around zero.

The second reason is probably genetic. Not all women are the same and we know from some studies that there are gene products that probably make it an increased risk to take hormones and with breast cancer and we know from other studies that there are women for whom taking hormones can be protective against breast cancer.

The problem is we just don’t know all of the genes that can impact this yet and so you’re going to see different responses from different women to hormone replacement therapy. The one thing I do know is that no matter which side of that genetic line you fall on, the actual overall impact of hormones on breast cancer is probably exceedingly low. 

So what, you may ask, does that mean for you? Well, here’s how I approach hormone replacement therapy. I approach it by saying, well, what is it good for, and what could the risks be, and how do I balance those for my particular patient? 

Benefits of hormone replacement therapy

So first of all, what is hormone replacement therapy good for? 

Number one, it’s good for symptoms. If you are suffering significantly from hot flashes or night sweats or vaginal dryness or any of those symptoms, hormone replacement therapy is actually very a effective medication for that, and only you know how big the impact of those symptoms are on your life and how much you would value taking a medication that can make them go away.

The second thing we know it’s very good for is your bones. It’s one of the best medicines for preserving bone strength. We don’t typically use it just for that, but we certainly as providers understand that it does one of the best jobs with the least risk for protecting bones. 

The third thing I’ll talk about with people is cardiovascular protection from hormone replacement therapy. The answer to that is very complicated and again, women are genetically very different. So there’s no one answer for each woman. But we do know that women who have estrogen have a different lipid profile and a different cardiac risk in terms of heart attack than women who are menopausal. 

And so there is probably some protective effect from that perspective. But depending on how you use the hormone, it can also be dangerous because if a woman has already developed atherosclerotic plaques in her arteries, adding estrogen back can cause blood clots to form on top of those and could probably increase her heart attack or stroke risk.

So when you’re talking to a doctor about hormone replacement therapy and cardiac risk, you need to be having a very complex discussion about whether it might be beneficial or harmful for you. 

The next thing that we sometimes use hormones for is mood, and in some women it really can be quite beneficial in balancing mood, especially in the perimenopausal time. However, we don’t have great evidence that it helps all women. And again, this is likely because women respond differently both to hormone and have different reasons for having mood symptoms. 

And the last things women often ask me about are more what we typically think of as superficial things like their skin, their hair, their nails, and their weight gain. Hormones can be somewhat beneficial for those things, but I certainly don’t start women on it just for that because really its impact is quite low in those things and there are other things that are safer that we can use for that.

Risks of hormone replacement therapy

So if those are the things hormone replacement therapy can be good for, what are the risks? In my mind, the biggest risk is actually for blood clotting. 

So we know that estrogen increases the risk of forming a blood clot in the body. We know that women who are pregnant have a higher risk of that. We know that women before menopause have a higher risk of that. It is a known risk of estrogen. It is not a huge risk. 

The baseline risk of forming a blood clot if you don’t have a predisposition is quite low and the increase is relatively small from adding estrogen. But we do talk about it because it can be an important risk, especially in people who might be at higher risk of stroke. So it’s important to think about that risk and whether it applies to you.

The second thing we talk about when I counsel patients is breast cancer, and I tell my patients honestly I don’t think that estrogen really, on the whole, increases your risk of breast cancer. I think there are certain people for whom that might be true and there are certain people for whom it’s protective. But on the whole, for most women, it’s probably not a big risk. 

The important thing to keep in mind also is one of the things they show in the Women’s Health Initiative that we don’t talk about a whole lot and in some of these other large studies is that when women do get breast cancer on hormone replacement therapy, it’s often a lower grade or earlier-stage cancer and easier to cure. 

The last thing I always talk to my patients about is that one in eight women will get breast cancer in their lifetime. That’s your baseline risk, so it can be really hard to tell if something is actually increasing that risk when the risk is so common. And while breast cancer is very scary to us as women, we think a lot about it, in reality, it kills very few of us, and those of us who are at highest risk of dying from breast cancer and breast cancer complications or those of us getting it at earlier ages, and there’s a lot of genetic interplay with that. 

The sort of breast cancer that we see as women age that contributes to the large portion of this one-in-eight risk is generally caught fairly early stage — if you’re getting adequate screening — and is curable. 

Many, many, many more women will die of cardiovascular disease and many, many more women will die of hip-fracture related complications. So we need to be thinking and talking much more about cardiovascular disease and bone health in women in menopause.

Taking HRT safely

So I just gave you my counseling session that I give to women in my office for hormone replacement, and many of them after that counseling session say, well, what would you do? Or what should I do? 

And I tell my patients that if you’re going to use hormone replacement therapy, which I often recommend, you need to be using it safely, and the most important thing you can do is know what you are taking. 

I see many women in my office who have been told by other providers that they can be given a special, compounded, just-for-them hormone replacement, that will be better than anything made by an evil pharmaceutical company. 

This is not true. 

First myth: there is no “natural” hormone replacement. Estradiol and progesterone are synthetically made. If you get it compounded, it’s still synthetically made in the same pharmaceutical company that made the pills that I would prescribe you or the patches that I would prescribe you.

Second, no one can match it to the hormones that you had before menopause because those hormones are gone. We can’t predict what those were. So anyone who’s saying they’re making a blend especially for you really isn’t. They’re just making a blend that they’ve been taught to make. 

And the third big thing that I tell people is when you are getting things mixed into creams or rubbing them on your skin, you do not know what dose you are taking. While they try to do their best to get it evenly mixed throughout that compounded cream or lotion or base, it is not evenly mixed and we know it’s not. And when the Lin tests have been done on these products, the variation in the amount of hormone actually in any given dose is quite wide. If you’re going to take something that might have a risk, you need to be taking something where you know what dose you’re getting.

And so I tell my patients, I only use the pharmaceutically generated and regulated products such as estradiol pills, estradiol patches, and progesterone pills and things like that. And that’s just for safety’s sake. If there might be a risk associated with this thing, I at least want to know what I’m giving you. 

The second thing you can do is get your breast screening, get your mammograms, get your breast exams at the doctor. People don’t enjoy getting mammograms. Trust me, I don’t enjoy getting them either, but they are our best method of screening for early-stage cancer, and if we catch breast cancer early, it can be cured. 

The third thing you can do is when these articles come out in the lay press, read them with a critical eye. Many headlines are generated to scare so that you’ll read the article. So just be aware there may be no new data behind this. They may just be rehashing the same data that we’ve heard over and over again, trying to get a new article out of it. 

The fourth thing I tell people is, help us to understand better how genetics play into breast cancer risk and hormone. Go to an organization like MiraKind.org, and there’ll be a link on our website for this. That is a nonprofit organization that’s doing genetic research on how different gene factors play into the breast cancer risk in women. And it’d be great to sign up for one of their studies if you qualify. 

And finally, when you’re thinking about using hormone replacement, find someone with genuine credentials, find a physician who has some training in menopause and really understands the issues behind this and doesn’t automatically do the same thing for every woman. 

This should always be a discussion between you and your doctor and they should have a good understanding of the risks and benefits of hormones and be able to explain that to you and make a tailored decision for you. 

Thank you so much for listening. I know this is a constant question and issue for us here at Gennev. And our goal, as always, is to give you the best, medically valid and evidence-based information we can find.

 

Join the conversation that continues on about HRT, breast cancer, all things midlife and menopause, and more in our Community forums. You are always invited.

 

The winter holiday season can quickly twist into a tangle of emotions, logistics, dates, delights, and indulgences. This forthcoming season of gathering and giving comes with a long list of additional chores for an already-busy life for a woman in midlife and perimenopause.

Before your stress-levels shift up to the next gear, take a big breath, and scan for ideas that will help you take all the season has to offer in stride. Why? Stress can exacerbate and intensify the most inconvenient and least-fun of the current menopause symptoms you’ve been experiencing in your regular life. A few ideas to get your “scan started”: 

How will I remember to… drink water during the busy times… or at least get more uncaffeinated, non-caloric liquids in my body?

How can I get my best… sleep? I’m going to want to experience that during the holidays too.

Lately, it’s been difficult to… find time for lunch (or whatever meal or task that feels good to accomplish). What would make getting this done easier?

Let’s jump in for more ideas and get you set up, rather than stressed out.

A quick debrief: how did last year shake out?

Checking in so you can make a plan

What are the top 5 things (yes, small things) that could give you more energy, focus, peace, and presence?

What subjects are lately igniting your system to insta-rage? 

The more specific you can be, the better you can make a plan to minimize or avoid your triggers. 

It doesn’t matter what it is”¦ but what is it? And hey, irrational is okay. Awareness of what triggers you to anger can only help you to make a good plan for the holiday at hand.

Making your plan

Once identified, stay with it, and ask, “What would help?” or, “What would be easier?”

How about, “What would be more fun, or more natural, and still accomplish what I’m going for?”

Here are a few options to help minimize the frantic feels and manage your stress for the long season of good cheer.

Instead of doing it all…

In place of buying it all”¦

Rather than being it all”¦

Have you traditionally been the “point person” for a holiday? Or, the hostess? Who can you loop in, in the group of loved ones, to lend more help? How about a co-host? Collaboration can be fun, though it may come with a bit of release of control”¦ and pressure”¦ and responsibility. #justsayin.

What’s this time of year all about, again?

Remember what you’re doing all this for”¦ and reassess.

Where can you lower the bar of expectations, take a breath, and have the best winter holiday season ever? The one that is best for you, your body, your mental and emotional frame of mind, and the ones you hold most dear.

Heightened stress and more frequent or intense menopause symptoms aren’t going to help you spread any kind of good cheer this year. Make a plan for less stress with an informed approach, a few boundaries, and a smart intention for fun and enjoyment for all, including yourself.

 

We’d love to hear what this brings up for you, as well as the brilliant ideas and strategies you and your loved ones will enjoy in the coming weeks. Consider joining and sharing with all of us in the Gennev community forums.

 

To keep hormonal health as balanced and symptom-free as possible, functional nutritionist Nicole Negron starts with the HPA (hypothalamic, pituitary, adrenal) Axis.

This axis is what regulates our stress response system, says Nicole; so if you’re lying in bed at night, unable to sleep because of bills, worries about kids or aging parents, etc., your HPA is responding to that stress.

Your brain (hypothalamus) sends stress signals to the pituitary, which in term triggers the adrenal gland to produce and release more cortisol into the bloodstream.

Cortisol, says Nicole, triggers an inflammatory immune response via inflammatory cytokines. These travel back up and talk to the brain, setting the cycle off again. And inflammation equals heat.

So what can trigger the inflammatory response that can lead to hot flashes?

Stress. This is probably the biggest trigger, Nicole says. Stress starts in the brain, firing off the cycle; it’s also the point where there’s the best opportunity for intervention, because our stressors are often things we have control over.

Controlling triggers in your life

We need to keep the body calm and satiated, Nicole says; this is how we start managing the signals that can set off the hot flash cycle.

Work. Are you where you want to be and doing what you want to be doing? Are you fulfilling your life’s passions and purpose? If not, can you change or find a way to redirect your current job to be closer to your goals?

Family. If you have aging parents or younger kids who need care, are you asking for help when you need it? Says Nicole, many women, including her clients, are wonderful at everything except two critical skills: asking for help, and saying no. Learn to do both of these to make life so much simpler and less stressful.

Partner. Are things good with your spouse or partner, if you have one? Are all your many loads as financial, physical, emotional as being divided equally, or are you taking on more than your share? Can you have a conversation or get therapy to make this relationship a source of strength and not more stress?

Before you turn to a medical intervention, be sure you’re maximizing what Nicole calls the “in-house remedies.” You know what stresses you out; it’s time to do the work to reduce those stressors in favor of reducing hot flashes and supporting long-term good health.

Nutrition and hot flashes, the “no’s”

“People hate me for saying this,” Nicole says, laughing, “but you have to get rid of alcohol, all sugars, and caffeine.”

“It’s about survival. Women wake up in the morning, they don’t have much energy even though they’ve been “˜resting’ for the last several hours. They’re short on time, they’re stressed. But if we’re talking about calming the HPA Axis, you can’t start your day with coffee. One, it’s dehydrating, and two, it’s activating your stress response. Wine is the same, so no wine at night! Alcohol, sugar, and definitely caffeine all can increase the frequency, duration, and intensity of hot flashes.”

Nutrition and hot flashes, the “yes”

Really the question should be, what buffers the stress response? Micronutrients are great, especially if you also have a thyroid condition to consider, says Nicole. Leafy greens are great; cooked if you have difficult digesting or absorbing the nutrients, raw if not. A digestive enzyme might also make the goodness more bio-available.

Selenium is great for supporting your system, so eat a couple of Brazil nuts every day. Many women report feeling better with an increase in foods containing vitamins D and E and Zinc, or adding ashwaganda to their diet.

Phytonutrients: if you have lower estrogen, estrogenic foods can be helpful. Soy foods like tofu, edamame; flax seeds, sweet potatoes as these may have a positive effect.

 

What else can we do to reduce hot flashes?

Gentle yoga before bed is great for those with night sweats, Nicole says. Think about breathing from the diaphragm, which soothes and calms. Qigong, a type of tai chi, done an hour or so before bed can be very calming to the central nervous system, making it easier to sleep deeply.

Turn off screens, reduce activity and do things that relax the body and mind. No answering emails, no watching TV that hypes up adrenaline. In the two hours before bed, you need to ready your mind and body for rest, so activity, food, and drink all need to support that goal.

If you follow a religious or spiritual practice, that can be very calming. Touch is very nourishing and healthy as well, particularly as we age, so getting a foot or shoulder massage from a loving partner as you discuss your day (the good, calm parts of your day, anyway) may actually reduce night sweats. For those who aren’t partnered, schedule regular massages. Your insurance might even cover it. Finally, as long as you’re not drained all day, every day, an orgasm before bed is great, says Nicole. “And you don’t need anyone else for that.”

Hot flashes can be disruptive to such a level that women even consider leaving their jobs or drastically reduce their social lives to avoid embarrassment. At Gennev we believe there should be no embarrassment around the body’s natural functions, but we understand society hasn’t quite caught up with this notion yet. We also believe women don’t need to suffer in silence as there are remedies that help. You may just have to keep experimenting with different options until you find the solution or combination of solutions that work for you.

Just please, always keep in touch with your doctor about any new lifestyle change, supplement, medication, or practice that could potentially interact with medications or conditions.

If lifestyle and/or nutritional choices have helped you with hot flashes, we’d love to hear what worked for you. Share in the comments below, join the conversation in our community forums, fill us in on Facebook or in Midlife & Menopause Solutions, our closed Facebook group. 

 

That’s what I’m doing this week “” hanging out with 1,200 menopause doctors “” and I’m loving it!

Some of the Gennev menopause team and I are attending the North American Menopause Society (NAMS) Annual Meeting.

It’s a time of the year when certified menopause practitioners gather for continuing education on how to better help women like you through menopause.

You can read more about Gennev’s involvement in NAMS here.

I’m not a doctor, so I basically hang out in the exhibition hall for companies like Gennev, but nonetheless, I’m getting to hear what practitioners are hearing from their patients. I’m hearing what their needs are. I’m seeing the products and solutions pushed at the docs, just like they’re pushed at women”¦and like women, doctors just want clear answers, no BS.

Why are we at a conference for physicians?

We built Gennev for women. That’s always been our goal.

But we also built Gennev as a companion-solution for doctors. We’re here for them as a trusted platform. We can provide menopause health and wellness education when they don’t have enough time with patients as or they can’t get to all the email requests for questions they may receive from their patients.

Our own Chief Medical Officer, Dr Rebecca Dunsmoor-Su, says, “I don’t get to spend as much time with each of my patients as I’d like to, so Gennev is a trusted resource I can send them to without worrying they’re going to hear something I don’t agree with.”

And guess what, other doctors agree. In our first day at the conference, we’ve given away hundreds of referral cards and scanned hundreds of badges. Just as women are hungry for trusted health and wellness information and products, physicians are too.

So, that’s why we’re here. We’re promoting Gennev to ob/gyns, nurse practitioners and internal medicine doctors who attend conferences like NAMS.

If you think Gennev would be beneficial for your doctor, send them our way. They can email us at info@gennev.com and request Gennev informational materials to place in their office as an added extension of the services they offer to their patients.

It takes a village to address menopause, and our village is starting to come together.

Fighting off osteoporosis with chocolate mousse

Boredom Baker here! What if I told you that today you can, nay, should eat dessert? Today is the greatest day of the year: It’s National Dessert Day! It would be almost criminal if we didn’t celebrate, right?

Now, I know what you’re thinking. Eating copious amounts of sugary deliciousness is just not good for my hormonal health! And that might be true, which is why I went ahead and adapted my all-time favorite dessert, chocolate mousse, and made it just a tad healthier. In fact, this recipe is a great source of calcium for bone density, tryptophan for a mood lift, and manganese to help fight off osteoporosis.

Bon appetit!

Chocolate mousse

Ingredients:

Directions: 

Serves: 4

Calories: 150

Carbs: 12g Protein: 6.7g Fat: 8g Fiber: 0.5g Sugar: 5.6g

Manganese: 50%, Calcium: 11%, Copper: 3%

If you’re a woman with a personal or family history of heart disease, don’t assume your heart health is completely out of your hands.

And don’t assume you don’t need to worry about heart disease because you’re a woman with no family or personal history.

In this podcast, Gennev Chief Medical Officer, ob/gyn Dr. Rebecca Dunsmoor-Su, interviews one of Seattle’s leading cardiologists, Dr. Sarah Speck, on ways to improve your heart health, starting right now, today.

Know your risk factors (preeclampsia can be a risk factor for future heart disease as who knew?) and how to manage them (losing 10% of your body weight if you’re overweight can substantially reduce impacts on heart health). 

Also, if you’re considering HRT to manage perimenopause and menopause symptoms, what are the implications for your heart? 

Take 15 minutes to listen; it could change your life.

Are you concerned about your risk of heart disease? Or are you already taking steps to reduce your risk and be healthier overall? Share your strategies with us and the Gennev community; join the conversation thread on heart health in Gennev’s community forums; chat with us on the Gennev Facebook page, or join Midlife & Menopause Solutions, our closed Facebook group!

It may feel like your heart is fluttering, racing, even skipping a beat””and it’s not because someone sexy walked by. Heart palpitations and irregular heartbeats called arrhythmia can be symptoms of perimenopause or menopause, but they aren’t talked about much so when they strike it can be terrifying.

According to research in the Journal of Women’s Health, nearly 50 percent of women, ages 42 to 62, who were in the study, reported heart palpitations during a two-week period. Some women experience them along with a hot flash, but many get them separately when they’re sleeping, when they’re sitting on the couch or in their car, or when they’re up and moving.

What causes heart palpitations in menopause?

As with most things menopausal, estrogen is believed to play a role in heart palpitations. Before menopause, estrogen may have heart-protective qualities including keeping arteries flexible. When levels decline that protection declines, too, and reduced blood flow can cause arrhythmia (abnormal heart rhythm). Lower levels of estrogen can also lead to an overstimulation of the heart. More commonly the palpitations are a normal rhythm, just fast, and are associated with mild anxiety, a hot flash, or just all by themselves.

Unfortunately, little is known about menopause-related heart irregularities, but research like the Menopause StrategiesasFinding Lasting Answers for Symptoms and Health (MsFLASH) multi-center study is beginning to offer some clues.

How to slow the palpitations

Early research shows that stress, insomnia, and depression may be contributing factors. So, making changes to reduce stress, sleep better, and treat depression may help. Here are some more steps to take at home.

Get a baseline. Find out what your normal pulse rate during exercise and at rest. This will help you calculate how much faster your heart is beating during palpitations. Menopause heart palpitations may increase heart rate by eight to 16 beats per minute; a larger increase may indicate a more serious issue.

The easiest way to check your heart rate is with a fitness tracker like a FitBit or Apple watch or a chest strap monitor like Polar. Sometimes an episode can feel worse than it really is and seeing that your heart rate isn’t as elevated as it feels can be reassuring. It is also helpful information to share with your doctor.

Limit caffeine. It’s stimulant that may contribute to heart palpitations. Remember, coffee isn’t the only source of caffeine. Non-herbal teas, including green tea, contain the stimulant. Even decaf teas have a little caffeine. Chocolate, energy drinks, and soda are other sources.

Read drug labels. Over-the-counter medications, such as antihistamines, decongestants, allergy remedies, and diet pills, often contain ingredients that are stimulants, which may affect your heart. If you’re taking any of these or any prescription meds and experiencing irregular heartbeats, check with your doctor to find out if they may be related.

Pay attention. When your heart starts to race or skip, take note (write it down so you don’t forget) if you feel lightheaded, out of breath, or have pain. What were you doing when it happened””exercising, on medications, working, or sleeping? This is valuable information to help your doctor narrow down possible causes. It will also help you to recognize any warning signs that need immediate attention (see below).

Stop smoking. There are dozens of reasons to quit and here’s another one. Smoking increases your risk of experiencing heart arrythmias. If you’re having trouble quitting, a health coach might help.

Reset your heartbeat. Most episodes last a few seconds or minutes, but it often feels longer. When your heart is a flutter, here are three strategies to get it back in rhythm more quickly.

There are other techniques like the valsalva maneuver, but you should talk to your doctor first to find out if they are appropriate for you and how to properly perform them.

When to get help for heart palpitations

Heart palpitations can have many causes beyond menopause, such as thyroid imbalances, anemia, diabetes, some infections, low blood pressure, and heart problems. While these flutters are usually not serious, when it comes to heart issues, you don’t want to mess around. Heart disease is the leading cause of death in women, and your risk increases after menopause.  So, it’s wise to talk to your doctor about this symptom when you start to notice it.

You should also familiarize yourself with symptoms of a heart attack. Heart palpitations aren’t one of the common symptoms, but heart attacks often present themselves differently in women than men. Many women don’t always experience the classic symptoms and delay treatment so it’s important to be proactive when it comes to one of your biggest health risks.

How we can help you manage heart palpitations

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. 

It’s like your menstrual cycle is going out with a bang. For many women, their periods get more erratic and heavier before they stop entirely. During a time that is already stressful, concerns about leaking and excessive bleeding can negatively impact the quality of your life. You’re not alone.

Occasional heavy periods, called menorrhagia, are common in perimenopause. One study of more than 1,300 middle-aged women reported that 91 percent of them experienced at least one occurrence of heavy flow lasting three or more days during a three-year timeframe. Twenty five percent reported up to three episodes of heavy bleeding for 10 or more days during a six-month time period.

Heavy periods in perimenopause: What’s happening?

During a normal menstrual cycle, levels of follicle stimulating hormone (FSH) rise, causing eggs in the ovaries to mature. These egg follicles produce more estrogen, which stimulates the endometrium, the lining of the uterus, to thicken in preparation for a fertilized egg. When you ovulate, or release a mature egg, more progesterone is created which stops the lining growth. If the egg isn’t fertilized, the drop in progesterone signals your body to slough off the endometrium, and you get your period.

To understand how things change during perimenopause, some menopause doctors describe it like maintaining your lawn. The endometrium is the grass. Estrogen is the fertilizer, which causes the grass to grow. And progesterone is the lawnmower that cuts the grass. You sometimes over fertilize the lawn and get really good growth. Some months the lawnmower is broken (the egg is no good and fails to release despite all that estrogen) and the grass keeps growing, longer and longer until you get a chance to mow.

What exactly heavier means varies from woman to woman. Some notice a slight increase in flow or duration of their period; others are unwilling to leave their homes for fear of leaking. If you need to change your tampon or pad more often than you used to, then it’s heavier. You may also see blood clots, especially during the heaviest part of your cycle. As long as the clots are smaller than a quarter, no worries.

What to do about heavy periods

Heavy bleeding isn’t only annoying and inconvenient, it can have some negative effects on your health. Here are steps to take to minimize bleeding and its effects.

Up your fluid intake. Blood loss can result in a lower blood volume. Tell-tale signs are dizziness, heart pounding, or lightheadedness when you get up from lying or sitting. To prevent a drop in blood volume, bump up your fluid intake by four to six cups a day. If you notice any of these symptoms, include some salty fluids like tomato juice and broths.

Eat more iron-rich foods. Repeated heavy cycles could deplete your iron stores, resulting in anemia. Good sources of iron include fortified, whole-grain cereals, beef, shellfish, spinach and other dark leafy greens, dried fruits, and mushrooms. Since the iron in plant sources is harder to absorb, combining these foods with foods high in vitamin C (strawberries, peppers, oranges) increases absorption. You might also want to talk to your doctor about an iron supplement, but don’t supplement on your own since too much iron can be problematic.

Manage your weight. Fat tissue produces estrogen, which, as explained above, thickens the uterine lining, and the thicker lining results in a heavier period. If you’re carrying around some extra pounds, making some sensible diet and exercise changes could be a win-win.

Take NSAIDs. Nonsteroidal anti-inflammatories like ibuprofen (Advil, Motrin IB) or Aleve can help reduce blood loss.

Consider other options. There are medications that can reduce heavy bleeding in perimenopause, including some hormones (low-dose birth control pills, progestin-releasing IUDs), and tranexamic acid (a non-hormonal drug). In severe cases, you might want to consider endometrial ablation, a surgical destruction of the lining of the uterus that can slow or stop menstrual flow, or a hysterectomy. If polyps or fibroids are causing the heavy bleeding, they can be surgically removed. Talk to your doctor about the best options for you.

When to see a doctor about excess bleeding or abnormal menstrual periods

As always, you know your body best, and you should never hesitate to get professional help if you think you need it. If you experience any of the following, you should consult your doctor right away:

  1. Bleeding that soaks a maxi-pad or tampon in an hour and lasts for more than four hours
  2. Clots larger than a quarter
  3. Accompanying dizziness, breathlessness, or fatigue
  4. Bleeding that lasts more than two weeks
  5. Bleeding after menopause
  6. Bleeding after sex
  7. If you are having periods less than every three months and they are heavy

In addition, menorrhagia can have other causes that require different treatments, such as uterine fibroids, endometrial polyps, infections, thyroid problems, even cancer. Sometimes, medications that you’re taking may contribute. If you have concerns, talk to your doctor.

We can help you manage heavy periods

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.

According to ASHA, the American Senior Housing Association, nearly 40 million Americans are providing unpaid care for another adult. The “average” caregiver, says ASHA, is a 49-year-old woman who has a job and also provides 24.4 hours per week of care to a parent, most likely her mother.

More than a quarter of these caregivers still have a minor child at home, more than half are helping financially support a grown child. They probably live within 20 minutes of the person depending on their care, but not always.

It’s National Caregivers’ Month here in the US, and because a large percentage of caregivers are women in midlife, we want to pay special attention to your needs. Too many women suffer physical injury or emotional distress from the extra responsibility, so we would like to offer a bit of help.

We went to our Doctors of Physical Therapy,  Dr. Meagan Peeters-Gebler and Dr. Brianna Droessler-Aschliman, to ask for tips on taking care of the caretakers.

What are the dangers to caregivers?

Back pain

Probably the most common injury they see caregivers suffer, says Bri, is lower back pain from moving the person they’re helping around.

“Transferring someone from wheelchair to a stationary chair, from chair to bed, into or out of the bath, if you’re not using good body mechanics, you can easily hurt your back,” says Bri. “If you’re going to be moving someone a lot, learn how to do it right.”

How do you do that? First, have a wide base of support by keeping your feet planted at least shoulder width. Don’t lock your knees. Lift with your strongest muscles: legs, hips, quads, and glutes, not with your back. Keep the person you’re lifting close to you, and don’t pull on their outstretched arms, which can hurt their arms or shoulders and also keeps you further from their center of mass, making you both unsteady.

Set up yourself up for success, Meagan adds: if you’re moving someone from wheelchair to recliner, get the chairs as close together as possible. And make sure you set the brake on the wheelchair!

Also, says Meagan, there are adaptive devices that can ease the strain on you: a slide board is a highly polished plank of wood or plastic for transferring patients. Position it between the chairs, help them get one butt cheek on it, and let them shimmy their way across as you keep them safe. You take far less of their body weight and can more easily assist if they lose balance.

Pelvic floor strain

Also, we know women in midlife need to be particularly conscious of pelvic floor strength and strain. When you’re putting a lot of extra strain on your pelvic floor by lifting or moving another person, you need to be sure you’re doing it correctly. “Breathe while lifting, Kegel while lifting,” says Meagan.

Also, be conscious of your posture. If you’re talking or reading to someone in bed, it can be easy to twist sideways and stay in that position for too long. “Shift position now and again,” Meagan advises. “Sit facing them straight-on as much as possible.”

Falls

If the person you’re caring for starts to go down, they may just take you with them, so it’s important to minimize the risks of that happening.

When someone starts to fall, our instinct is to grab and catch them. That might be possible, in some cases, but often it isn’t, and trying will only hurt you both. Know what you can realistically do.

If the person is mobile and can walk with aid, consider equipping them with a gait belt. This wide band is worn around the waist and gives you a place to hold for stability while moving or grab if they start to wobble. Because it’s close to their center of mass, you have more control of their balance. Also, it stops you from grabbing an arm that could get wrenched or clothing that can tear and give and not be any help at all. It’s best if you and the person you’re caring for work with a nurse or other professional to learn the best ways to use the gait belt.

“I tell my patients that if they start to fall, I’m probably not able to catch them, but I will do my best to slow their descent and protect their head,” says Meagan. “If they’re bigger than I am, I don’t have the strength to catch them, but I can probably make the fall less impactful.”

Clear your environment, says Bri; remove tripping hazards like cords or rugs, be sure they have traction on slick floors like hardwoods. If you’re physically helping someone, try to convince them not to put their hands around your neck or shoulders, since they can easily pull you off balance.

Emotional burn-out

One of the hardest parts of being a caregiver is the emotional strain. If they’re a loved one like a parent or spouse, of course that gives caregiving an extra layer of emotional stress. Find ways to take a moment for yourself when you need it.

“Take a break,” says Bri. “Go for a walk. Ask for help. You need to understand how impactful this is on your mind as well as your body and respond to your needs as well as theirs. It’s mentally and physically exhausting, and if you’re fatigued, there’s a greater chance you or they can get hurt.”

Make it easier on you

This person needs you, and you want to be there for them as much as you can. We want to help you do that safely. So here are some additional tips from Meagan and Bri:

  1. Get stronger. Strength through the hips and shoulders will make it easier for you to do more with less risk of injury. Squats and bridges mixed with rowing will strengthen hip girdle and shoulder girdle, says Meagan, and those can help protect your spine.
  2. Pec stretches are great for those who spend a lot of time bent over another person (or a computer, or a book, or prepping meals).
  3. Help them help you. If you’re lifting someone from a chair, ask them to scoot as far forward as they can while still feeling safe and supported. Have them push their feet back against the chair, then lean forward to bring their “nose over their toes,” Meagan says. That helps pop their backside up so you’re not pulling them from the back of their chair, which takes a lot more strength from you.
  4. Position yourself wisely. If they’re pretty mobile but need stability help, stay to one side (the non-cane side, if they use one) and put a hand on their gait belt. If they need more help to get up from a chair, position yourself in front and keep your hands at their hips. Make sure their cane or walker is within easy reach when they’re up.
  5. Let them be as independent as possible. If they can order groceries from the store, great! If they’re able to do some errands on their own, terrific! If they can do more, they’ll feel more independent and you’ll have time for other things.
  6. Think two steps ahead. If you’re driving someone who uses a walker, collapse it for travel (rather than wrestling it into the trunk), and retrieve it and set it up before helping your person out of the car.
  7. Get a bed rail. Not the long rail that runs the length of the bed, but a U-shaped handle that extends between the mattress and box springs and gives the person something to grasp for stability when moving in or out of the bed. They can also use it to position themselves while in bed, using their own arm strength. In the bathroom, a hand rail for getting on and off the toilet or in and out of the shower can be a huge help. Stair railings as well as non-slip flooring are really great for preventing bad falls.
  8. Speaking of showers, a shower chair or bench that allows the person to be safely seating during bathing is a great idea. You don’t have to manage their body weight or hold a soap-slippery person, and they get to retain a bit more dignity in an often-challenging situation.
  9. Ask for help. If you need assistance, ask for it. Call in another family member to give you a break, or if possible, hire a part time aide to carry some of the load. If you aren’t comfortable having someone else care for your loved one, hire someone to do laundry, clean, prep meals ““ anything to give you time back.

Finally, Meagan says, check with your local Lion’s Club. Many accept donations of lightly used equipment such as walkers, shower chairs, etc., and you may be able to find one at a more affordable price or free. You can find additional resources from the Caregiver Action Network and the American Nursing Informatics Association.  

This caregivers’ month and all the year “˜round, thank you for the care you give to those in need. We hope you’ll come tell us about your experiences and share even more tips in the Gennev community forums.