Having the best ob/gyn is important, no matter what stage of life you’re in, but with all the changes and weirdness of midlife likeperimenopause rage and menopause hot flashes, a good gynecologist can be the difference between barely surviving and thriving.

And gynecologists of any kind are getting harder to find. “By 2020, there will be a shortage of OB-GYNs of up to 8,800, according to the American Congress of Obstetricians and Gynecologists. And by 2050, the shortage may grow to 22,000.”

That doesn’t mean you should settle for anything less than the right doctorfor you.

To help you decide if the doc you’ve got is the right OG/GYN for you, we asked the doc who’s perfect for us: Gennev Director of Health and ob/gyn Dr. Rebecca Dunsmoor-Su.

If you are looking for a great OB/GYN, 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.

How do you know when you’ve found the best OG/GYN for you?

According to Dr. Rebecca, the key to finding a beneficial therapeutic relationship is finding the right balance of some key ingredients:

1. Comfort and relatability as are you able to communicate well together?
2. Their knowledge, experience, and credentials as do they have any special training or interest in menopause?
3. Their ability to treat you appropriately as are they open to all the possibilities?

So, says Dr. Rebecca, since they’ll spend plenty of time assessing you, it’s worth your time to take a moment to assess them.

One: Have a “talking” appointment with the doctor

“Go for an appointment and talk with them about your concerns and issues. If you’re in the US, often they’ll only have 15 as 30 minutes to spend with you (thank you, American medical system), but that may be all you need to decide if you relate to them and them to you. Do their explanations make sense and feel genuine?”

Even if a doctor or specialist for menopause is terrific, he or she may not be right for you. If their style is to be abrupt and you prefer someone a bit more nurturing, then it may not be the best connection. You really want someone you can communicate openly with, about some of the most intimate topics in your life, so keep looking until you find a connection that encourages open and frank discussion.

On a side note, says Dr. Rebecca, “Don’t discount a physician just because they’re telling you something you don’t want to hear. Listen to what they’re saying. Sometimes they’ll have an important warning for you, and you need to hear it.”

Two: Check out their ob/gyn credentials

Are they Board Certified and have they maintained that certification? In the US, you can check that your physician is certified on the American Board of Obstetrics and Gynecology website. Do they belong to national and local ob/gyn societies? “There are good medical school and residency programs all over the country,” Dr. Rebecca says, “but that not the only thing you should judge them on. You want a doctor who keeps up with current research and does her or his due diligence. You can also look for a practitioner who is a member of the North American Menopause Society (NAMS) or who has taken their certified menopause practitioner exam.”

(Here’s a handy list of definitions of credentials, from NAMS.)

Do they have a practice focus on women in midlife and menopause? Ob/gyns tend to “age into” a more menopause-focused practice, Dr. Rebecca says. “As ob/gyns start in practice, they tend to do a lot of obstetrics, as that is how women often come into our care. As we age and our patients age with us, we do more and more midlife and menopause care.” That’s not to say that age (or lack of) is an indicator of ability (or lack of), of course.

Three: ask about menopause treatment options

Menopause has a whole range of symptoms and challenges, and a single therapy may not entirely resolve all the discomforts. You want a doc with both a broad range of information and also an open mind about options for menopause treatment.

“Ask them how they evaluate alternative and complementary therapies and how you should navigate them. Most MD practitioners will not prescribe them, but they should be familiar and able to talk about safe and unsafe options. They should definitely know about possible interactions. If you’re already taking any alternative therapies, never hide them, as they impact your traditional medical care. Even if you’re taking “˜natural’ and “˜harmless’ herbs, they can interact with medications.”

Plus, if you don’t feel you can openly discuss all your treatments with your doctor, that may be a red flag that this isn’t the doctor for you.

Ask the doc about his or her approach to hormone therapy (HRT) and the alternatives. There’s a lot of confusion among women as and some among docs as  about the efficacy and safety of hormones. Understand this doctor’s position and how they use hormone therapies, says Dr. Rebecca. “Do they use hormones in everyone? In no one? Do they customize treatment to each individual patient?”

Four: assess the doctor’s office

“How do they run their group?” Dr. Rebecca asks. “Will you be seen mostly by the same doctor? If you need a quick appointment, how easy is it to get in? What call system do they have for emergencies? Do they have mid-level providers like nurse practitioners, midwives, or Physician Assistants who help get urgent visits in, and if so, how are they supervised?” You want a clinic or office that is sufficiently staffed, organized, and clean, so don’t be afraid to extend a few questions to the nurses or other staff.

Finally, Dr. Rebecca says, “Approach your visit with an open mind. Just as you don’t feel happy if you’re not heard by your doctor or other practitioner, we also get frustrated when a patient comes in not able to hear what we have to say. In the end, if it’s not a good match, we won’t be hurt if you go elsewhere.”

“But,” Dr. Rebecca adds, “be introspective. Think about what these practitioners are telling you, even if they are telling you something you don’t want to hear. You can always find someone who will give you what you want without question, but please listen to those who question or warn you as they may be providing important, even life-saving information.”

Tell us about your awesome ob/gyn! How did you find him, how long have you been seeing her, what makes them so amazing? 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.

Unfortunately, given that menopause affects women and people in gender transition, it’s been largely ignored by mainstream medicine. That’s why we recommend you work with a menopause specialist. So doctors receive little to no training specific to the issues of menopause and post-menopause health. This is improving, but the effects of better training are only beginning to be felt and may not have trickled out to your area yet.

In fact, 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.

Do I really need a menopause doctor specialist?

Yes. Just as you need a specialized doctor for pregnancy and childbirth, you really need a specialized doctor for menopause.

The body changes that come with this time in a person’s life are profound and systemic “” because we have estrogen receptors virtually everywhere in our bodies, when that estrogen dips, flows, and recedes, the impacts are felt everywhere.

So, it’s possible your doctor may not know a lot about menopause. According to the CT Mirror, “One recent survey of obstetrics/gynecology residents found that fewer than one in five polled reported receiving any formal training in the topic.” And those are OB/GYN residents! Now imagine how much training your GP has probably had.

This lack of expertise, coupled with the still-pervasive misinformation from the Women’s Health Initiative on the safety of Hormone Replacement Therapy for hot flashes and other menopause symptoms, means many women just aren’t getting the treatment they need and deserve. Doctors who specialize in menopause are still a bit like unicorns, so you may need to search a bit to find one.

What is a menopause specialist?

While the designation “menopause specialist” isn’t recognized by the American Board of Medical Specialties, there are ways to tell if your doctor has a good understanding of menopause care. We encourage anyone needing medical help with menopause symptoms to interview doctors; anyone can call themselves a “menopause doctor specialist” “” be sure yours really is one.

NAMS, or the North American Menopause Society, is the largest non-profit organization devoted specifically to the health of women in midlife and beyond. Their membership is made up of experts in the field, in medicine, nursing, sociology, psychology, nutrition, epidemiology, and so on.

NAMS offers a training and certification that is generally considered to be excellent and reliable, so if your doctor is an NCMP (NAMS Certified Menopause Practitioner), you can rest assured they have had quality training. If your doctor is not an NCMP, that doesn’t mean they aren’t qualified to deal with menopause issues; you may just want to conduct a bit of your own research.

Questions for your ob/gyn or physician:

1. Are you certified by the North American Menopause Society?
2. What percentage of your practice is with women in midlife and menopause?
3. What is your position on hormone replacement and why?
4. What lifestyle changes do you recommend, if any, and why?
5. How do you treat those in menopause and perimenopause differently than premenopausal patients?
6. What kinds of problems and outcomes have you seen for women dealing with menopause issues?
7. On average, how much time do you spend with these patients during a visit?
8. What society recommendations do you follow when providing menopause care? (The North American Menopause Society or NAMS is a good answer. ACOG or the American College of Obstetricians and Gynecologists is another.)
9. Are you willing to earn an NCMP designation? Why or why not?

Finally, listen to your gut. When dealing with such personal, sensitive issues, you want a doctor you feel comfortable with. You may need to be very open about your sex life, your intimate areas, and things we’ve been culturally conditioned to be embarrassed about (periods, hot flashes, aging, libido). Docs, and particularly OB/GYNs, are ready to talk frankly “” you need to be too.

How do I find doctors who treat menopause near me?

If you are looking for doctors who treat menopause near you, sadly, there probably isn’t one physically close to you. The number of OB/GYNs in most industrial nations is declining. We’re already facing a shortage in the US, and we’re losing more to retirement than we’re gaining from medical schools.

And since menopause management doctors are already thin on the ground, those in need of menopause treatment are already finding it difficult to locate the care they need. Searching on “menopause specialist near me” isn’t likely to find you much.

Fortunately, there are resources.

Menopause care via telemedicine

If there isn’t a menopause-focused doctor in your area, you’re not out of luck. The rapid growth of telemedicine during COVID has made it possible for women to access great menopause care, anywhere their internet connection reaches. Gennev offers [telemedicine access ](https://gennev.com/plans)to menopause specialists. Our team of gynecologists serve patients in all 50 states, so you are assured to find a licensed, experience and often-times NAMs-certified practitioner at the click of a button. You can learn more about Gennev’s team of menopause specialists here .

Technology is filling the gap for many women.

For many of us, prior to COVID, the idea of seeing a doctor virtually was nearly unimaginable. How can they diagnose us via a camera?

It’s very possible, says our own Chief Medical Officer, NCMP and gynecologist Dr. Rebecca Dunsmoor-Su. In fact, she says, most menopause care is based around a conversation between patient and practitioner, and this may actually be better via telemedicine.

“When it’s a telemedicine appointment, I generally have lots of information before we even start talking. That means I have the basics and can jump right into the problem/solution part of the conversation,” says Dr. Dunsmoor-Su. “Often women don’t know what’s going on with them, so by asking questions, I can help them figure out where they are in their journey and what menopause treatment options they have. At Gennev, we’re open to any treatment that shows promise and is medically proven to be safe. All women are different and every menopause journey is unique, so we want to be sure women have access to every possible option.”

And because Gennev has a wide network of menopause focused doctors, if a patient needs to be seen in person, Gennev’s telemedicine doctors can make referrals and help women prepare for their appointments.

COVID revealed a need for more telemedicine access, and Gennev took advantage of modified requirements to bring more states on board and staff them with doctors who specialize in menopause. “Prior to COVID, each state had different requirements for a doctor to practice in their state via telemedcine,” says Gennev CEO Jill Angelo. “COVID proved that some states were lagging behind due to unnecessary barriers. Thanks to a reduction in barriers, we’re now able to provide a truly qualified menopause practitioner in every state in the US.”

Find a menopause specialist

A great way is using the “Find a Menopause Practitioner” feature on the NAMS website. All the doctors listed are NAMS members, and those certified by NAMS are designated as such.

Another tool? Each other. If you’re looking for a great doc, ask your friends; if you have one, share!

So, don’t wait until menopause symptoms make your life difficult. If you’re a woman, it’s never too soon or too late to get informed.

If you’re premenopausal, a doctor or menopause-trained health coach can help you understand how to take care of yourself now to feel great and avoid problems in the future. If you’re in perimenopause or if you’re post-menopausal, get the help you need to relieve symptoms and protect your bones, brain, heart, soul, and body for the many years of vibrant life yet to come.

If your Oooooooos are more Owwwws, you’re not alone. According to Emily Sauer, founder of the Ohnut, painful sex affects up to 75 percent of all women at some point in their lifetime.

Let’s say that again: Up to three-quarters of all women experience painful sex at some point in their lives. For some, the pain is temporary, the result of childbirth or vaginal dryness during certain times in their cycle as for others, it’s chronic. Many women’s pain can be solved with a good vaginal lubricant or intimate moisturizer; some may require a little more help.

Women who have pain or fear pain may start avoiding sex, which can be hard on intimate relationships, and they miss out on all the physical and emotional health benefits of a fulfilling sex life.

Sexual health is part of overall health and well-being, and pleasure during sex or intercourse shouldn’t be considered just a “nice to have.” So why does pain happen, and more importantly, what can we do about it?

What causes pain during sex?

According to pelvic physical therapist Rachel Gelman, “Pain with sex can be due to many factors, and a person usually has several factors at play. They can be anything from hormonal dysfunction to myofascial restrictions. As a pelvic floor physical therapist, I address the musculoskeletal piece that may contribute to pain with sex, but a patient may need other providers on board to address the other elements that may be driving their symptoms. Those providers may include a sex therapist, OBGYN, urologist, naturopath, or acupuncturist. The process can be frustrating but know that there are providers out there who can help!”

So be aware that you may need help both zeroing in on the cause and choosing the right solution.

1. Vaginal dryness is very common among women who are perimenopausal or post-menopausal, breast-feeding, receiving cancer treatment, or taking oral birth control pills, all of which can affect hormone levels. When hormonal changes like estrogen declines, so does vaginal moisture and resiliency. The drier, thinner tissue may tear more easily in penetrative sex or play, causing pain and leaving the vagina more vulnerable to infection. Possible solutions include lubricants and moisturizers, topical estrogen creams or a low-dose vaginal estrogen ring. Or for women who can’t have or don’t want hormones, laser treatments such as the Mona Lisa Touch offer a possible alternative.
2. Vaginal tightness can happen when a woman isn’t feeling relaxed and ready, if she’s nervous or fearful, or if she hasn’t had sex in a while. In many cases, extended foreplay and/or conversation may be all she needs. If the woman is suffering vaginismus, an involuntary tightening of the vaginal muscles, she may need to get outside help from a doctor, pelvic physical therapist, or sex specialist.
3. Vaginal infection or irritation can certainly take the fun out of sex. Yeast infections can cause pain, even without the added friction of penetration, and irritation from contraceptives (foam, “flavored” condoms), lubricants that contain fragrances or “warming” qualities, harsh soaps or detergents, or douching can also make sex uncomfortable. In the case of infections, waiting until the infection is gone is best (and also reduces the risk of transmission); in the case of irritation, identifying and banishing the irritant should take care of the pain.
4. Basic biology. A pain in the lower abdomen could mean your partner is actually bumping up against your cervix, the lower part of your uterus. Or if your uterus is tilted backwards, you can also have pain from too-deep penetration. You can change position to limit thrust; being on top gives the woman greater control. We’re also really excited about the launch of the Ohnut, a customizable wearable that allows you to control penetration depth in any position. Comfortable, interlocking rings placed on the penis determine how far in your fellow can go, so you can relax and enjoy the moment.
5. Endometriosis causes a lot of women a lot of pain, including during sex. In endometriosis, the tissue that should stay inside and line the uterus grows outside as well and can involve the ovaries, Fallopian tubes, and pelvic tissue. When it comes time for the tissue to slough off as it would during a normal menstrual cycle, there’s no exit, and this can cause considerable pain. Treatment for endometriosis may require surgery or pain medication, though some women find relief from hormones such as birth control pills.
6. UTIs. Because urinary tract infections make the area sensitive and painful already, adding intercourse can increase the discomfort. Antibiotics are usually required to clear up a UTI; for recurrent issues, it might be time to consult a urologist or ob/gyn.

Don’t endure painful sex or give up intimacy entirely. Devices like the Ohnut can be part of the fun, if you keep minds and lines of communication open. And introducing a toy or vibrator like the smart Lioness Vibrator sex toy can extend foreplay, help you feel more ready (and thus more relaxed and possibly more lubricated), and bring the fun back to a potentially stressful time.

When should I talk to my doctor about painful sex?

Don’t wait. According to Rachel, “If a person is experiencing pain with sex, they should consult their healthcare provider. I know many people report their providers don’t ask about sexual function, and it can be intimidating or embarrassing to bring up, but no one should have to suffer in silence and there are many treatment options for someone experiencing pelvic pain.”

In short: If it hurts, start talking. If your doc doesn’t ask about your sex life, tell her. Because there are so many possible issues, getting properly diagnosed means identifying the right solution and getting your better sex life back that much faster.

If you need support in managing painful sex, a menopause-certified physician can be helpful. Book a visit with a Gennev doctor.

Have you experienced painful sex? What did you do or are you doing to deal with it? We’d love to hear from you, so please share in the comments below, on Gennev’s Facebook page, or in Midlife & Menopause Solutions, Gennev’s 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.

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.

Holiday nutrition? It sounds like an oxymoron to some. From November through January 1, many in the States tend to go a little overboard in the indulgence department. Yet, what if you could breeze your way through these months without allowing sugar, alcohol, and processed foods to potentially intensify your menopause symptoms? 

These tips for the holidays will ensure you get the foods you need to feed your body “” and still enjoy a few holiday sweets!

Tips for the holidays: getting to January with fewer hot flashes

This is not about “perfection.” We get that the holidays are all about overindulgence, and it’s hard to get through two months’ of parties without slipping up here and there. Luckily, it’s not about perfection, just improvement. Curb your holiday cravings by activating a few of these tips.

• Eat a good breakfast with plenty of protein and fiber
• Set a personal goal for water consumption, make it a game
• Journal how different foods make you feel throughout the day
• Take some time each morning to meditate (calm your mood swings) and a few moments each evening for reflection 
• Practice gratitude (it is the season for giving thanks after all!)

Go easy on the eggnog (… or wine… or cocktails)

We hate to say it, but alcohol can be a huge hormone disruptor.

Alcohol can warm you up, make you more sociable and loosen your anxiety. But it can also lead to increased hot flashes, headaches, and irritability. 

If you’re going to indulge in alcoholic sips this season, we recommend no more than two drinks per day. Yes, we do understand that you’re more likely to indulge during the holidays. Just keep your consumption in check and don’t forget to drink lots of water each day.

We also suggest you consider alcoholic beverages with a lower sugar content to keep your sugar consumption in check. Drinks like gin and sparkling water can help you avoid a hangover (when you drink in moderation). The sparkling water offers some hydration and the gin has zero grams of sugar. 

Steer clear of cocktails made with juice, sugary mixers, and heavy cream (e.g. chocolate mudslides and spiked eggnog). 

Drink lots of water

Yes, you hear this advice all the time. Some make it a goal and a game to drink half your body weight in water each day. So, a 150-lb woman may set her intention to drink 75 ounces of fresh, unflavored water every day. 

Alternate between alcoholic beverages and glasses of water. And when you’ve finished that glass of H2O, consider making a mental note about when you’ll drink your next one too.

There’s a reason you’re hearing this tip a lot. It is possibly one of the best pieces of advice we can offer during the holidays. Water can help you avoid a hangover, flush your system, and even keep your skin supple and hydrated. 

If there was ever a “miracle food,” it’s water.

We don’t want to dictate how much water you should drink and when you should drink it, so we’ll just give you a few tips you can pick and choose from, including:

• Try to drink half your body weight in water (in ounces: for 150 pounds, that’s 75 oz)
• After each alcoholic beverage, drink a full 8-ounce glass of water
• Carry a reusable tumbler and eco-straw to remind you to drink enough
• Sip some sodium-free sparkling water (or add it to cocktails, wine, and juice) 
• Snack on oranges, grapes, and other fruits with a high water content
• Contrary to popular belief, tea and coffee don’t dehydrate you, so sip away! (Just make sure to opt for caffeine-free)

Focus on what you should eat “” not what you shouldn’t

If you’re constantly obsessing over what you shouldn’t eat, you won’t be able to enjoy the foods that will fuel your body. Similarly, if you only eat processed foods laden with fat, you’re missing out on a whole gambit of fresh flavors found in unprocessed foods!

Focus on healthy foods you already know you love, and try some new and exotic fruits or veggie recipes. We also recommend:

• Filling your plate with veggies (yes, even a few of the fried ones!)
• Opt for the fish course or vegetarian option over red meat
• Bring a sugar-free dessert to a party (if it’s pre-approved by your host or hostess)
• Drink water when you feel yourself getting tipsy (lowered inhibitions can lead to grazing, snacking, and overeating)
• Opt for a little indulgence over eating tons of low-fat foods (P.S. these are usually made with extra sugar to make up for the decrease in fat)

Holiday events: runs, walks, and plunges

One of the best ways to get a little boost of serotonin is to exercise! Elle Woods said it best when she proclaimed, “Exercise gives you endorphins, endorphins make you happy.” 

When you’re happy, you’re less stressed. When you’re less stressed, you’re less likely to binge your feelings away with pecan pie. You’ll also work up an appetite!

Most cities and towns host holiday running or walking events to help people “work off” a little extra turkey. If you don’t want to dress up and run with your neighbors, you could always go on a solo run. If you live close to a body of water, your city or town may even host something like a “Polar Plunge” around New Year’s Day. 

Just don’t forget to eat a little protein after your workout. You don’t want to find yourself ravenous at the start of the big meal because you worked out so hard earlier in the day. And don’t forget your water bottle.

Plan activities that don’t involve food

The holidays generally revolve around food, drink, and more food and drink. We see people we haven’t seen all year. We want to get warm and cozy inside and enjoy some great conversation. 

But when we’re standing around chitchatting, we’re also more prone to distracted eating. The same goes for sitting at a dinner table talking for hours. 

If you’re going to enjoy a long leisurely meal, do as the French do and plan for small courses to arrive at the table throughout the evening.

Or, plan a few activities that don’t involve food.

If your family loves football, why not play a game of touch football in the afternoon instead of just sitting in front of the TV snacking? Plan a Christmas tree decorating party and ask guests to bring an ornament, string popcorn, and sing songs or carols. While you’re at it, why not get outside and enjoy the sights of some festive lights in your neighborhood?

There’s plenty of fun to be had over the holidays, both indoors and outdoors.

A taste of indulgence

It’s normal to feel a little “left-out” when everyone else is eating your mom’s famous sweet potato casserole (you know, the one loaded with heavy cream and topped with marshmallows?!). 

Food connects us with our family, friends, and heritage. Just because an ingredient is “off-limits” doesn’t mean you must avoid it altogether (unless you have a serious allergy or aversion). 

We recommend indulging in a little of what you absolutely love. Just set a few boundaries with food to keep this copasetic. We recommend:

• Deciding how much of a decadent dessert you’ll enjoy before an event (maybe just half a slice of that pie?)
• Taking a spin around a buffet table and making note of one indulgent treat to eat
• Choosing only one event in the season to let yourself eat without limits (the office holiday party, gift-exchange tea with your girlfriends, or Hanukkah — maybe not all three). 
• Enjoy your food consciously, mindfully; this means placing your fork on the table between bites, stopping when you’re full and paying attention to how that 10-layer dip feels at the bottom of your stomach  

Again, this is not about perfection! We recommend setting a personal goal to make this year’s nutrition goals better than last year’s. And if today you don’t succeed? Try again tomorrow!

We’d love to hear about your holiday plans for getting nutrition in your body and still feeling you are celebrating the winter season. Let us know what’s going on in the Community. You are always invited.

We doubt that too many women actually look forward to menopause (though we happen to think it’s not a bad idea to start doing so!). Some of the symptoms of menopause you may encounter are: trying to get rid of hot sweats (and cold chills flashes), insomnia, irritability, and weight gain.

Unfortunately, hormonal weight gain symptoms in menopause aren’t the same as other types of weight gain, and can make it harder to lose the excess weight. 

Discover what types of symptoms you should be on the lookout for and a few self-care tips to get you past the hormonal weight gain hump.

Common hormonal weight gain symptoms during menopause

The symptoms of hormonal weight gain during menopause are similar to the symptoms of other types of weight gain, which means this type of weight gain isn’t always easy to diagnose. Some common symptoms of hormonal weight gain include:

• Increased stress
• Insomnia or decreased sleep
• Binge eating/stress eating
• Fatigue and sluggishness
• Increased breakouts (blemishes/blackheads) on the chin
• Decreased estrogen levels

How do I know it’s hormonal weight gain?

In this case, the diagnosis is similar to the treatment – look at the hormonal weight gain symptoms above and ask yourself if you need to employ any of the tips included below. 

Are you getting seven-to-nine hours of sleep each night? Do you wake feeling rested? Are you suffering from symptoms of menopause? How do you manage stress? Do you make exercise and healthy eating a priority?

If you need to up your emotional self-care routine and/or are experiencing other symptoms of menopause, your weight gain might be linked to hormonal imbalances.

Curbing hormonal weight gain symptoms during menopause

The number one thing you can do to curb hormonal weight gain (from both prevention and maintenance perspectives) is to up your self-care game. Since hormonal weight gain during menopause is much different from gaining a few pounds over the holidays, you’ll need to concentrate on hormone-related factors.

Self-care tip #1: exercise 

Yes, this is what we would suggest if your weight gain wasn’t related to hormones, but we also feel that it’s worth mentioning for menopause-related weight gain too.

One of the best ways to regulate your hormones is to excercise. It helps your body produce endorphins, which are hormones that regulate mood and stress “” specifically, they can lower your stress and boost your mood. 

But whatever you do, don’t overdo it with exercise. Overexercising can disrupt your hormones even further. 

Self-care tip #2: eat for your hormones

What we put into our bodies plays a huge role when it comes to hormone regulation and weight management. When we eat foods that help regulate our hormones, we’re supporting our own bodies. 

But if we consistently eat foods that disrupt our hormones and throw us out of whack, we might be facing even more weight gain.

Focus on whole foods, including a variety of veggies and fruits. Avoid any animal products that might contain growth hormones (or any other hormones for that matter!). Buy organic produce to avoid pesticides and wash your produce thoroughly before eating it. If you’re using plastics, always opt for BPA-free. 

Caffeine, some food preservatives and Sugar can affect your hormones. Some women are also sensitive to dairy and soy. Try to eat these products carefully and sparingly. Though we won’t ever fault you for indulging here and there “” especially during the holidays!

Self-care tip #3: make sleep a priority

One of the biggest factors in weight gain (and loss) is sleep. If you don’t get enough shut-eye each night, it can be even harder for your body to shed those pounds or keep them off.  (Read our tips on how to get better sleep during menopause!)

Researchers believe that you need somewhere between seven and nine hours of sleep per night. Getting less sleep than you need? Your metabolism could suffer. Some studies have even shown that cutting back on sleep can affect weight loss up to 55 percent “” without changing any food or exercise habits. 

When you sleep, your body makes a hormone called leptin that can suppress hunger. When you don’t get enough sleep, your body instead makes a hormone called ghrelin, which can trigger hunger. This means that if you don’t get enough sleep, you’ll be hungrier than if you got a full eight hours. 

Self-care tip #4: manage stress

Managing stress also plays a major role in weight management during menopause. This can happen in two ways.

One: Weight gain because of poor stress management – When we’re stressed, we tend to throw all self-care techniques out the door. It’s easier to reach for something unhealthy when we’re busy and stressed than take the time to make a healthy meal. 

Many of us stress eat or binge eat when we’re under pressure. Yet, this is exactly what we shouldn’t do! Alcohol, sugar, salt, caffeine, and additives can negatively affect our stress hormones and make us feel even worse in the long-run “” even though that crunch or sugar fix seemed like a great short-term solution at the time. 

Two: Weight gain because of stress hormones – We humans were built to survive. This means that we share many of the same traits as our prehistoric ancestors “” including fight-or-flight responses. 

When our ancestors needed to run away from a threat (such as a predator), our hormones would kick into action, giving us stamina and strength to get away. Cut to today: when a debt collector sends a threatening email or letter, our bodies react as if the threat were more immediate and triggers our fight-or-flight responses.

Since we’re faced with stressors all day, every day, these stress hormones can send our bodies into overdrive. We don’t need these hormones to run away from debt collectors or texts from an ex; what we need is calm.

Sometimes managing stress can be just as stressful as the original stress itself. Luckily, there are a few tried-and-tested ways to keep stress at bay including: 

• Taking a yoga or meditation class to help with menopausal moodswings.
• Downloading a mindful app
• Going for a walk
• Channeling your stress into a creative project or athletic activity
• Starting a gratitude journal

Self-care tip #5: love your body

No matter where you are physically or hormonally, it’s important to love your body just the way it is. Sometimes your weight will fluctuate — menopause or no menopause. There are often factors out of our control. 

Maybe you just got back from vacation and saw the numbers on the scale inch up. We tend to eat comfort foods around the holidays. Maybe you just wanted to get a bowl of pasta at your favorite restaurant and now you’re holding water weight from all the sodium.

Whatever the reason for your weight gain, don’t let that number define you. Love your body “” all versions of your body “” and the number on the scale won’t matter as much anymore.

Learn more about hormonal weight gain

Combating Menopausal Weight Gain

Intermittent Fasting and Menopause

Belly Fat in Menopause: 5 Ways to Beat It

We can help you manage hormonal weight gain

• If you are can’t seem to lose those added hormonal pounds, a menopause-certified health coach can be helpful. We can create a personalized plan that fits your lifestyle. Book 30 minutes for your personal consultation with a health coach.
• Meet with a Gennev Doctor – our board-certified gynecologists specialize in menopause, and can help you understand your symptoms and create a customized treatment plan.
• Arm your body with our daily supplement specially formulated for women in menopause. Vitality supports mood, energy, stress response, immune health, joint pain, and inflammation.

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 “œjust 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 used to be called the “mask of pregnancy” because it happens so often to women in that condition. But melasma as those darker patches on your skin as isn’t limited to pregnant women. It can first happen, or happen again to many women in menopause.

These changes in pigmentation usually occur on the face, and while they aren’t dangerous, they can impact our self-confidence. To understand the condition, skincare tips, and what concerns it raises, we talked to dermatologist Dr. Keira Barr, author of The Skin Whisperer.

What are the causes of melasma?

Dr. Keira shared, “Melasma appears on women’s skin much more often than men’s skin. In fact, though over 5 million Americans are affected by melasma, 90% of them are women. “What causes melasma is not yet fully understood, though current theories suggest that hormones, UV exposure, inflammation, and genetics are all major influencers of the disorder.”

“Melasma likely occurs when the pigment producing cells in the skin (melanocytes) produce too much pigment (or melanin),” Dr. Keira explains. “The underlying hormone responsible for triggering the melanocytes is melanocyte stimulating hormone (MSH). This hormone increases the production of melanin, which is responsible for darkening the skin.”  People with darker skin are more prone to melasma because they have more active melanocytes than people with light skin.

“At all stages of women’s lives, hormones can be in flux. When it comes to melasma, research has found that elevated levels of estrogen, and to a lesser degree elevated progesterone levels, are associated with increased skin pigmentation. “This is why melasma is often seen during pregnancy, and in those women using oral contraceptive pills and hormone replacement therapy (HRT) as because hormonal levels are elevated and stimulate melanocytes both directly and indirectly to increase pigment production.”

Hormones + stress: Cortisol is part of the problem, says Dr. Keira, so avoiding stress where possible can help manage the condition. “As you become stressed (whether it be physical, psychological  or emotional), your body produces increasing levels of the hormone cortisol to help cope with the stress.” More cortisol creates an imbalance in estrogen levels, and “these elevated estrogens upregulates MSH levels, which in turn increases the amount of melanin produced. Re-establishing balance in stress and hormonal levels are one of the keys to prevention and management.”  

Hormones + thyroid: Other hormones also have been shown to play a role in melasma, according to Dr. Keira. Studies highlight that individuals with thyroid disorders, specifically autoimmune thyroid conditions, had a higher incidence of melasma as well. 

Exposure to sunlight and heat: “Ultraviolet (UV) light from the sun stimulates your melanocytes. This means that just a small amount of vitamin d or sun exposure can make melasma return after fading,” says Dr. Keira. “This is why melasma often is worse in summer due to higher levels of sun exposure. It also is the main reason why many people with melasma have recurrences…it comes back, again and again.”

Sun exposure can either trigger melasma, or contribute to exacerbation of the skin patches, according to Dr. Keira. “What’s more, the sun’s heat, and heat of any kind, is a common trigger for melasma as it increases vascular dilatation which is a component of this condition. In addition, heat may lead to more inflammation which can also stimulate melanocyte pigment production. What does this mean? Sun screens and other surface protection may not be enough to keep the skin from darkening.”

Genetics:  While women constitute the vast majority of those with melasma, it’s not limited to women alone. In fact, says Dr. Keira, “Recent studies have found that melasma tends to run in families regardless of whether a man or women inherits the condition. In fact, one study showed that 70 percent of Latino men with melasma also had a family member with melasma.” 

Irritation from skin care products:  Be careful of how you treat your skin, says Dr. Keira. “If a product or procedure irritates your skin whether due to heat or friction resulting in trauma, melasma can worsen due to stimulating melanin production. This has been shown in association with intense pulsed light therapy, microdermabrasion and some chemical peels.”

How do you know it’s melasma and not something else?

Dermatologists can diagnose most patients by looking at their skin, Dr. Keira tells us. “What makes melasma a challenge for treatment is how deeply it penetrates the skin. The more deeply it penetrates, the more difficult it may be to treat. To determine how deeply the melasma penetrates the skin, your dermatologist may look at your skin under a device called a Wood’s light. “There are instances when melasma can look like another skin condition. To rule out another skin condition, your dermatologist may need to remove a small bit of skin by performing a skin biopsy. A skin biopsy is a simple procedure that can safely and quickly be performed during an office visit.”

Is melasma dangerous?

Melasma caused by hormone changes is neither painful nor dangerous. However, since melasma can be caused by other conditions, like thyroid disease or allergic reactions, it’s wise to check it out to be sure of the underlying cause.

The pigmentation can fade or go away entirely when the cause is removed as with some time after the baby is born and hormones settle, or if the patient stops taking hormones. However, the patches can last for many years or be permanent.

What are the most effective melasma treatments?

Melasma may, in time, go away on its own, but it can take time and vigilance. These tips, direct from Dr. Keira, can help manage the melasma as well as protect against recurrence.

Limit sun exposure. The best melasma treatment is often prevention. As sun exposure is a leading trigger for melasma, sun protection is at the top of the list for both prevention and management of this condition. When heading outdoors wearing a broad-brimmed hat, sunglasses, and a broad spectrum sunscreen with at least SPF 30 is important. I prefer moisturizers and sunscreens with physical sunscreens like zinc oxide because it is tolerated by most skin types and less prone to cause irritation. It’s important to remember that damaging sun rays penetrate through a car window. 

Protect with good nutrition. Additional sun protection strategies include eating an anti-inflammatory dietrich in antioxidants and phytonutrients which means loading your plate full of colorful fruits, vegetables, healthy fats like olive and avocado oil as well as omega-3 fatty acids like salmon. Supplements to consider before heading outdoors include those that contain polypodium leucotomas, grape seed extract, green tea extract, astanxanthin and omega-3 fatty acids.

Apply topical treatments. Talk with your doctor about the different topical treatments that are available. It’s important to have the right treatment for your skin type and lifestyle, so be sure to discuss all the options with a qualified professional. 

Hydroquinone. Commonly used as first-line treatment for melasma, it works by lightening the skin and is applied on the skin. It comes in varying prescription strengths as well as less-powerful over-the-counter varieties. One caveat: this medicine should be used sparingly and briefly as it can cause a darkening of the skin called ochronosis.

Tretinoin and corticosteroids. Topical tretinoin (aka Retin-A) may be used to enhance skin lightening. Sometimes a combination of three medicines may be used in one “triple” cream: hydroquinone and tretinoin to help with skin lightening, and the corticosteroid to help alleviate any irritation caused by the other two medicines.

Kojic acid. Kojic acid is naturally found in soy and mushrooms and works in melasma by decreasing the amount of pigment within the melanocytes. However, kojic acid has a high rate of contact sensitivity, so be careful to avoid skin irritation that could worsen melasma. 

Azelic acid: Azelaic acid works similarly to hydroquinone and may be paired with tretinoin as well to enhance the effects.

Vitamin C (L-Ascorbic acid): Vitamin C is a natural antioxidant that prevents the absorption of UV radiation and the subsequent formation of free-radicals, so it prevents melanin from forming. It is well tolerated and can be used alone or in combination with other topical therapies.

Niacinamide (Vitamin B3): Studies have shown niacinamide to be effective for melasma. Melanocytes produce melanosomes which give skin its color; niacinamide can block melanin transfer to the outer layers of the skin.

These therapies may work better when combined with a series of chemical peels with either Glycolic, Salicylic, or Trichloroacetic Acid. Peels and topical therapies should be adjusted according to skin type and under the guidance of your dermatologist for best results.

Other treatments include micro needling, laser, microdermabrasion and light-based therapies. Only a dermatologist or highly trained professional under a dermatologist’s supervision should perform these procedures as worsening of melasma or new skin problems may occur when the person who performs the treatment does not tailor it to the patient’s skin type.

What can happen if it’s left untreated?

Treatment isn’t necessary for safety, says Dr. Keira, but there are implications to doing nothing. “As one of the major triggers is UV radiation exposure, continued exposure can lead to darkening of the skin and make melasma patches permanent. While it is a benign condition and treatment is not required, I have found the emotional and psychological impacts of melasma take the biggest toll for many individuals when the condition is left untreated.”

Anything else we need to know?

Melasma is caused or worsened by irritation, so be aware of everything you do to your skin, Dr. Keira adds. “Choose skin care products that are gentle on your skin. Avoid and discontinue products that sting or burn your skin, as those may worsen melasma. And avoid waxing: Waxing causes acute trauma to your skin and may cause skin inflammation which can worsen melasma, so it’s important to avoid waxing areas of the body affected by the condition. Ask a dermatologist about other types of hair removal that may be right for you.”

We can help you find relief from melasma

• Meet with a Gennev Doctor – our menopause specialists can help you understand fluctuations in your hormones as they relate to melasma along with any other symptoms you may experience, and provide a personalized treatment plan.
• Try Vitality to support your overall health throughout menopause. Gennev’s nutrient-packed multi-vitamin supplement supports inflammation and joint pain, mood, energy, stress response and immune health.
• Are you getting your Omega-3s? Gennev’s Heart & Brain Premium Omega-3 for Women offers care for your heart and brain as well as helps to relieve dry eyes and dry skin.

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 barely an hour past lunch, and you’re hungry. Again. These days it feels like you could eat everything in your refrigerator at one go without even coming up for air.

What is going on? Why do you suddenly have the appetite of a high school track star?

First of all, there’s nothing wrong with eating. No one should feel ashamed or embarrassed about their appetite. 

But if you’re concerned your appetite, nutrition and hormones may be impacting your health, it may be useful to understand why appetite can ramp up in menopause as and how you can stay within healthy limits.

What hormones makes you hungry?

There are a few possibilities to consider, but note that the jury is still out on exactly how hormones, menopause, and appetite interact. So, as always, talk with your doc before making assumptions about your own situation.

1. Increased ghrelin, decreased leptin. In perimenopause, levels of the hunger-stimulating hormone ghrelin increase, a reason why many women find themselves frequently hungry during this phase. Levels of the hormone leptin, which promotes a sense of fullness, reduce throughout peri- and postmenopause.”
2. Increased cortisol. Persistent stress causes a lot of people to overeat as and often, to make some fairly poor choices of foods (high-fat, high-sugar “comfort” foods). So in perimenopause and menopause, when the cortisol-dampening effects of estrogen are diminished, stress-fueled appetite can increase.
3. Decreased estrogen. Like leptin, estrogen serves to dampen appetite. One form of estrogen, estradiol, helps regulate metabolism and body weight. As estrogen declines in perimenopause and menopause, appetite ramps up.
4. Poor sleep. During perimenopause and menopause, hormone weirdness can impact your sleep ( perimenopause night sweats, for example). Insufficient sleep can further elevate sensations of hunger.

So, since hormonal changes in midlife are inevitable as if they haven’t happened sooner as are we stuck struggling to manage our appetite and weight?

Not necessarily.

Before we get to the advice portion, there’s something we want to point out: Many of the articles we found dealing with menopause and appetite are about losing weight. We want to emphasize that we believe achieving and maintaining a healthy weight is the goal. So, we say to societal standards based on unrealistic (and frankly misogynistic) ideas about the female form, there’s the door.

Maintaining a healthy weight in menopause

When it comes to weight, it’s a jungle out there. Lots of folks want you to believe they have the answer, so be sure to do your research and talk to your doc before making radical changes or introducing new supplements or “diet aids” to your daily routine.

As our Chief Medical Officer, Dr. Rebecca, says, “Research into all of these hormones and neurotransmitters (some function as both) is still at the basic and translation science stage. We don’t know what it means clinically, so while it may be nice to understand to an extent how they may impact menopause and the experience of menopause, no practitioner can alter or ‘treat’ these things. If someone is selling you something to do that, they are selling snake oil as the science is, unfortunately, still years away. The only take away is to reduce your stress as best you can (which you didn’t need the science to tell you!)”

Whatever the role hormones have to play in appetite, one thing that’s quite common is the difficulty of losing weight once gained in menopause.

That may be because of our slowed metabolism, it may be due to menopausal fatigue, stress, the effects of night sweats and restless leg syndrome (RLS) on our ability to get a decent night’s sleep. 

All of which is to say: Be aware that maintaining a healthy weight in midlife may require different strategies and be patient with yourself.

Controlling menopause and food cravings

1. Eat more fiber. Since women in midlife frequently experience constipation, this isn’t a bad idea anyway. And since fiber can make you feel fuller longer, it may help curb your appetite.
2. Eat enough protein. Our protein needs may be less than in previous years, but it’s still important to get enough. Protein helps us feel satisfied, which obviously dampens our enthusiasm for snacking.
3. Load up on veggies. Low-calorie, high-fiber, nutrient-dense veggies are ideal for those looking to maintain a healthy weight. They’ll fill you up for a lot fewer calories, and the fiber may benefit your gut biome, further helping with weight management.
4. As Gloria A. Richard-Davis, MD, FACOG, NCMP wrote for the North American Menopause Society, “learn to cope without food.” A lot of us turn to the reliable pleasure and comfort of food under stress, but taking a break to walk the dog or indulge in some non-edible self-care may be a far better option.
5. Move more. Exercise alone doesn’t do a lot for weight loss, if that’s your goal, but its benefits for heart, lungs, brain, and mood are inarguable. Keeping and building muscle after 40 is essential. Mix it up with cardio and strength training to get the biggest boost, and don’t ignore the benefits and feel-good qualities of really good stretching. Exercise can increase appetite, of course; just make sure you refuel with the right foods.
6. Maximize your chances of getting a good night’s sleep by practicing good sleep hygiene. Some women take CBD or sleep better by eating a small snackor before bed.
7. Drink water.  Althought being hydrated can make you pee more often, water is good for you, good for your brain, good for your body. And it can help you feel full. Humans often mistake thirst for hunger. Tired, lightheaded, unable to focus as sounds like you need food, right? Well, it’s also possible that a glass of water is what your body is actually asking for.
8. Allow yourself the pleasure of food. Here’s what Dr. Anna Garrett says about “Vitamin P,” when we take the time to slow down and take pleasure in our food, we may be more in tune with the satiety signals that tell us it’s time to stop eating.

Clearly weight management is more complicated than “calories in, calories out.” Hormones, the stresses of life, and the unique challenges of midlife can all add layers of complication to the way we eat and the way we feel.

But it’s important to understand that weight gain isn’t personal failure. Your body is extraordinarily complex and amazing; it can also be frustratingly unpredictable. Give yourself room to experiment and learn, and don’t forget to include your doctor in major lifestyle changes.

What are your challenges in maintaining a healthy weight, and what’s worked (or hasn’t)? Please share with us by commenting here, or joining the conversation in our community forums. You can also reach out to us on Gennev’s public Facebook page or in our closed Facebook group.

Sleep is a precious commodity. Between menopause and our 24/7 world, getting a good night’s sleep can be tough, and the health consequences of poor sleep keep piling up. Everything from your body weight and mood to your memory and disease risk is influenced by sleep. Even your strong bones may not be immune to the dangers of poor sleep, according to the latest research. That’s why it’s essential to find out if your sleep habits are jeopardizing your sleep in menopause””and your health””and take steps to fix them.

If night sweats, anxiety, or dozens of other unknown factors are keeping you up at night, you probably want to scream every time you hear the recommendation to get seven to eight hours of sleep a night. So, we’re not going to focus on quantity here. Instead, let’s work on improving some sleep habits that may be affecting the quality of your sleep. As you improve those habits, you may naturally get more Zzzzs””bonus!

Here are 10 habits that can negatively impact your sleep and what to do about them.

1. I sleep in on weekends to catch up on sleep

You may feel better, but your body isn’t noticing a difference on a cellular level. Adverse effects of poor sleep like decreased insulin sensitivity, which contributes to diabetes, aren’t improved with a few extra hours of sleep here and there. The more erratic your sleep patterns are, the higher your risk of heart disease. And when you sleep in, it can disrupt your ability to fall asleep that night and reinforce an irregular sleep pattern.

The fix: Keep a consistent wake time. This is one of the most important steps to set yourself up for more and better sleep, according to Andrew Huberman, Ph.D., a neuroscientist at Stanford University School of Medicine. Melatonin is your body’s sleep hormone. It shuts off when you wake up and turns on again at night to prepare you for sleep. A key factor that regulates melatonin’s production cycle is your wake-up time. Melatonin production ramps up 12 to 16 hours after you awaken. 

2. I go to bed after midnight, but I get seven to eight hours of sleep

Quantity isn’t the only factor when it comes to getting quality sleep, according to Michael Breus, Ph.D., a clinical psychologist and sleep expert. Even if you’re getting the recommended number of hours, going to bed after midnight can rob you of precious deep sleep. Deep, restorative sleep happens during the first part of the night, while lighter REM sleep (both are important) happens more during the second part of the night. Turning in after midnight increases heart disease risk. In a five-year study, those burning the midnight oil had a 25 percent greater risk of heart disease than those who were lights out between 10 and 11 o’clock. The risk was 12 percent higher for those who hit the hay between 11 p.m. and midnight. And women seemed to be more susceptible to the dangers of staying up late, according to the research published in the European Heart Journal Digital Health.

The fix: Shift your bedtime before midnight to set yourself up for the best possible sleep. Having a consistent wake-up time (see #1) and getting an early dose of sunlight will help you to be able to fall asleep earlier.

3. I pop on my phone when I wake up in the middle of the night

Stop! New research from Northwestern University found that even a little light when you’re supposed to be snoozing raised heart rate and glucose levels, which can increase risk for heart disease and diabetes.

The fix: Resist the temptation to reach for your phone, even to check the time. The darker your room remains, the easier it will be to fall back to sleep and the better you’ll sleep. Invest in a low-light clock if you want to check the time. Red light doesn’t affect your body clock, waking you up, like blue or white light from your phone. If you struggle to fall back to sleep, check out the strategy in #4.

4. I frequently wake up in the middle of the night and can’t get back to sleep

First, don’t reach for your phone (see #3). Second, don’t panic. The more you stress out about being awake and not getting enough sleep, the harder it will be to fall back to sleep. Instead relax. Even if you don’t fall back to sleep, it’s OK. Early research on non-sleep deep rest (NSDR) shows it can be rejuvenating. NSDR is a hyper-calm state induced through meditation or hypnosis.

The fix: When you panic or stress out because you’re wide awake at 3 a.m., you set off your body’s flight-or-fight reaction, which is not conducive to sleep. Instead, you want to remain or get back into your body’s relaxed, resting state. To help you chill out and improve your chances of falling back to sleep, try yoga nidra, a form of meditation to bring on deep rest. Even if you don’t fall back to sleep, you’ll still be getting some quality rest. You can practice yoga nidra to reduce stress and feel more refreshed any time of the day.

5. I’m a side/belly/back sleeper

Your sleeping position has been blamed for back, neck, and shoulder pain and snoring, but research to back this up is inconclusive.

The fix: Based on preliminary evidence, sleeping on your side with your legs stacked appears to be the safest position unless you have shoulder pain. Try sleeping on the opposite side if you wake up with shoulder pain. The one side position you should avoid is throwing your top leg over your body which twists your back and may contribute to both back and neck pain. Back sleepers may be more prone to snoring and waking up with a stiff, achy back. Sleeping on your belly may also aggravate back and neck pain.

6. I have a glass of wine to help me sleep

You may feel like it’s helping, but alcohol-induced sleep isn’t the best quality. While you may fall asleep faster, alcohol decreases deep sleep and causes you to wake up more throughout the night. It may also contribute to nightmares and snoring, which increases your risk for sleep apnea (see #10). 

The fix: Try a glass of tart cherry juice on the rocks or sip a cup of chamomile tea instead. Both have been found in studies to improve sleep. If you must imbibe, cut yourself off four hours before bedtime.

7. I soak in the hot tub before bed

While this may counteract your body’s natural decline in body temperature that occurs in the evening, some research shows that the dramatic post-soak dip in body temperature may enhance sleep. However, the studies didn’t specifically look at women in midlife, for whom hot water may trigger hot flashes and night sweats.

The fix: If a dip in the hot tub isn’t disrupting your sleep, enjoy! For the best impact on your sleep, time your soak for about 90 minutes before bedtime, so your body temperature has time to lower before you crawl under the covers. If hot water triggers hot flashes for you, try a warm foot bath instead. A 20-minute soak an hour before bedtime not only helped menopausal women sleep better, but it also reduced disruptive menopausal symptoms like hot flashes and night sweats, according to research in the journal Research in Nursing & Health.

8. I get up at least two to three times a night to pee, but I fall back to sleep quickly

Frequent nighttime bathroom visits are a classic sign of an overactive bladder. While it’s great that you’re falling back to sleep, every trip to the bathroom disrupts restful sleep. The fewer bathroom breaks at night, the better

The fix: You can take steps to curb an overactive bladder and improve your sleep. Start by making sure that you’re well-hydrated during the day””yup, it sounds counterintuitive, but it prevents bladder irritation that can send you to the bathroom more frequently. And cut back on other bladder irritants such as caffeine, alcohol, carbonated beverages, citrus, tomatoes and tomato-based foods, and spicy foods.

9. I hit the snooze button three to four times before getting up

This is a wake-up call that you need more sleep. And 15, even 30, minutes of fragmented sleep isn’t going to help. These short bouts of snoozing aren’t restorative and can make you feel more stressed in the morning.

The fix: Get a better night’s sleep by going to bed earlier or improving the quality of your slumber. Or, set your alarm later to enhance the quality of those extra minutes, and then get out of bed when it goes off.

10. I snore

Factors like alcohol, weight gain, sleeping position (see #5), or uncontrollable allergies can contribute to snoring. Declines in estrogen during perimenopause and menopause make women more prone to snoring.

The fix: If addressing these factors doesn’t help, talk to your doctor. Snoring can be a sign of sleep apnea, a breathing disorder that increases your risk of high blood pressure, heart problems, and diabetes.

Now that you know how your habits might be affecting your sleep””and your health””take action! Even small changes can improve your sleep. The result: you’ll have more energy, be more productive, be better able to concentrate, react more quickly, manage your emotions better, and improve your overall health. You may even notice a decline in some menopausal symptoms, such as anxiety, mood swings, irritability, and forgetfulness. A win-win-win!

If you are experiencing changes in your sleep pattern associated with menopause symptoms (especially if body temperature instability is part of the problem), consider an appointment with a Gennev doctor to address the role that hormonal shifts can play in your sleepless nights. 

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 “œjust 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.

How many women experience painful sex at some point in their lives? The number could go as high as 75 percent. And for many women, the condition is chronic. Painful sex can damage our relationships, keep us from enjoying all those health benefits of sex, and generally make our lives a little less rich and joyful.

That’s why Gennev hosted the Painful Sex in Midlife webinar on June 21.

How To Avoid Painful Sex In Midlife Webinar

Our panel of health care professionals, counselors, and innovators in the sexual health space answered questions, offered solutions, provided counsel, and helped attendees understand their options.

If you weren’t able to attend, no problem! We recorded the full, hour-long conversation. You can find links to the resources they discussed below.

Meet the experts who just might help you get your happy, healthy sex life back”¦.

Our Painful Sex webinar panel

Dr. Sheryl Kingsberg

2017/2018 President of the North American Menopause Society (NAMS), Dr. Kingsberg’s expertise in sexual medicine, female sexual disorders, and menopause make her an invaluable resource for women, especially women in midlife. She is the Division Chief for OB/GYN Behavioral Medicine at UH Cleveland Medical Center, and Co-Director of the Sexual Medicine and Vulvovaginal Health Program at UH Cleveland Medical Center.

Dr. Rachel Gelman

Rachel Gelman is a clinician, writer, and educator with a Doctorate in Physical Therapy from Samuel Merritt University. She specializes in treating pelvic floor dysfunction in men and women at the Pelvic Health and Rehabilitation Center in San Francisco where she serves as the Branch Director. She has advised journalists on such varied subjects as depressed vaginas, anal beads, and the squatty potty, and she even schooled Dan Savage on bladder control during intimacy.

Liz Klinger

CEO and co-founder of Lioness, Liz is bringing smart technology to the vibrator. Her unique device captures the strength and intensity of a woman’s orgasm, allowing the user to track her response and understand the factors that affect her sexual pleasure. The Lioness is great for women in midlife and in the menopause transition, as women can control the experience and gain insights into their response as their bodies change over time. Plus, you know, orgasms.

Emily Sauer

Founder and CEO of the recently developed Ohnut, Emily refers to herself as the “Director of Enthusiasm.” The Ohnut is a unique device that allows couples to control the depth of penetration, giving relief to women who experience pain during sex when their partner penetrates too deeply. One man describes it as “like a hug.” And who doesn’t like hugs? 

Jessa Zimmerman

With a Master’s in Psychology and national certification as a sex therapist, Jessa is the couples counselor you want on your team when navigating sexual health issues. She works extensively with individuals and couples and knows the toll sexual dysfunction can have on intimate relationships. If couples are avoiding sex because of physical or emotional pain or both, Jessa can help them communicate more openly, discover new options together, and find their way back to intimacy. 

Resources

Jessa Zimmerman mentioned the book When Sex Hurts. Check out her website for information on couples sex counseling; listen to her podcast, and get updates on her soon-to-be-released book, “Sex without stress; a couple’s guide to overcoming disappointment, avoidance and pressure.”

Rachel Gelman mentioned the book Pelvic Pain Explained, which you can find on her organization’s website. Click here if you’re looking for a physical therapist who specializes in pelvic pain or the pelvic floor. Stay tuned to Gennev for an upcoming blog on what to do if you don’t have a pelvic PT to turn to.

Interested in Vital V yam cream?

If deep, penetrative sex is painful, you can order an Ohnut at Ohnut.co.

Curious about your sexual response? Check out the Lioness smart vibrator.

To order lubricants and moisturizers that are proven effective for many women with vaginal dryness, visit Gennev.

What did you think of the webinar? Is there a topic you’d like us to discuss in a future webinar? Please send any feedback to info@gennev.com. We’ll be doing more of these, so please help us make them as valuable as we can.

What’s your experience with painful sex? Did you find a solution, are you still searching, did you feel you had to give up on sex? Please share in our Gennev Community forums!

So, last night you had popcorn and a Dr. Pepper for dinner.

Not exactly the most balanced meal, but you were hungry, it was too hot to fire up the oven, popcorn has”¦well, at least fiber, right? Could be worse.

Could also be better. But we get it: not every meal is going to be as nutritious as we might hope. And that’s OK. But chronically falling short of nutritional guidelines really isn’t great for your health, and many adults (particularly older women) don’t get enough of some pretty important nutrients.

So maybe you decide to take supplements, just to ensure you’re getting enough of everything you need.

During your weekly grocery shop, you venture into the “vitamins” aisle, take one look at the groaning shelves stocked to bursting with a million options, and back right out again, determined to eat more kale.

So let’s talk about how to buy supplements.

In this blog, we’re not going to discuss which nutrients you need (but you’re getting enough magnesium, right?). For now, we’re more concerned with how you choose supplements for menopause symptoms that are safe and effective.

Why is supplement safety a problem?

In the US, supplements are a multi-billion dollar industry. But because the government considers supplements to be more like food than like medicine, the regulation of supplements is far less rigorous than on drugs.  

Why does it matter? Because safety. Drugs must prove they are safe before they can go on the market as via trials under well-controlled conditions. Supplements are considered “safe” until someone proves the supplement has caused harm.

With so much potential profit and so little regulation, it’s a great opportunity for the unscrupulous to prey on consumers, offering “supplements” that may do nothing as or may cause more problems than they solve.

Potential risks include:

1. Misleading labeling. A studies found that after many herbal supplements were tested, less than half contained the herb claimed on the label.
2. Because the supplements aren’t checked by 3^rd parties, unscrupulous providers may use fillers or allow contaminants into the supplements.
3. “Extra ingredients.” In order for their “supplement” to meet the company’s claims, some have added medications such as steroids or other drugs. These are not generally listed and can cause dangerous interactions or carry health risks of their own.
4. “New ingredients.” Untested ingredients have found their way into supplements, causing “” in the case of DMAA “” several deaths.
5. Just because something is natural doesn’t make it safe. (Box jellyfish are “natural” too, but you wouldn’t give one to your kids as a pet.) Some herbs can interact with medications, either making them less effective or putting your health at risk. If an ingredient isn’t listed, or risks aren’t added to the label, you could unknowingly put yourself in danger.

How do we choose safe supplements?

To figure out how to find credible sources among the vast quantities of supplement providers, we turned to Dr. Wendy Ellis, Naturopathic Physician and educator.

Want safe supplements? First, says Dr. Wendy, check that the supplement’s manufacturer followed the cGMP “” Current Good Manufacturing Processes “” and that they’ve been certified via a third party audit. You should see an endorsement like this one on the supplement label.

The cGMP are set by the Food and Drug Administration (FDA) and are “a set of requirements that ensure the quality and safety, including the testing, manufacturing, preparation, storage, and other quality assurance procedures. This ensures that the dietary supplement is packaged and labeled as specified in the master manufacturing record.”

Next, Dr. Wendy says, be sure the company has and follows specifications for all raw material and finished products. Meaning, they know where their ingredients come from and how they’ve been handled. They should be able and willing to provide documentation of this on request.

Third, be sure the manufacturer tests regularly for potency and to ensure against contaminants. These include solvents used in manufacture, heavy metals or pesticides that can be picked up in when ingredients are being grown, and pesticides and molds, as herbs and other food products can be at high risk for these.

Finally, the manufacturer should be able to guarantee that the product will remain safely stable and potent throughout its shelf-life.

There are several reports that may help you determine some good supplement manufacturers.  

Here’s To Better Vitamin Safety

Obviously, it’s tough to get all this information on the label, so you may have to call the manufacturer or do some research on your own. But it’s worth it to be certain your supplements are safe and of good quality.

The health care world is still undecided about the effectiveness of supplements, but from our own experience and those of the women we work with, we know many supplements have had life changing (and menopause surviving) benefits. If you do decide to add to your diet with supplements, please do so safely, and check with your doctor to be sure supplements won’t interact with your medications.

Do you take supplements to complete your nutrition? How do you choose the ones you take? We’d love to learn more from you, so please comment below or join in the discussion on our community forums!

Thank you to Dr. Wendy Ellis, Naturopathic Physician and educator for her advice on choosing safe supplements.