In part four of our five-part series featuring Dr. Rebecca’s interview with David Stewart on the SuperAge podcast, “HRT, Estrogen and Menopause, New Scientific Findings with Dr. Rebecca Dunsmoor-Su”, she shares the three typical usage patterns of hormone replacement therapy, dispels the risks of HRT as they relate to breast cancer and cardiovascular disease and discusses why the risk of Alzheimer’s disease is so much higher for women.
David: Is there a time limit that one can be on HRT, or is it a lifetime?
Dr.Rebecca: Interestingly enough, we talked over the years about risks of HRT. So, a lot of women believe that HRT is going to cause them breast cancer or give them heart attacks. These are the two risks that we tend to talk about. I like to dispel those risks.
First of all, the breast cancer risk. I like to talk about the two hormones separately. Estrogen replacement does not cause breast cancer and I shout that from the rooftops. We have many studies that tell us that estrogen replacement does not cause breast cancer, it does not increase the incidence. The Women’s Health Initiative, that big study that came out in 2002 that scared everybody away from hormones – they continued their estrogen only arm and then they actually published the results of the 18-year follow up last year, and they showed no increased risk in breast cancer in the women taking estrogen alone.
Now, obviously, we talked about the fact that women who have a uterus also need progesterone. The Women’s Health Initiative showed that there was a slight increased incidence of breast cancer in progesterone users as or progestin users. They used Provera and they stopped to study for that. They also followed it up last year, 18 years later, and they can still see that slight incidence bump, and I’m talking slight, one additional cases of breast cancer in about a thousand-woman years which is how we study it, but they saw no increased risk in breast cancer mortality. So, the good news is this is low grade. But again, that was Provera. It’s not what we tend to use now. Nowadays, we tend to use micronized progesterone, which is a little more body identical as we like to call it. I use those words because that separates it from the marketing of bioidentical which is generally the marketing of compounds which are less safe. I talked about body identical, which are estradiol and micronized progesterone, which are the molecules that the body used to make, but FDA regulated.
When we use micronized progesterone, we don’t tend to see that bump in breast cancer risk. We have one big study out of France that has looked at 40,000 women on a micronized progesterone prescription up to five years and they saw no increased risk in breast cancer rates on that particular compound. I tell my patients, I can’t say for sure. It doesn’t increase your breast cancer risk. I think there’s more study to be done on this progesterone, but I certainly don’t think it increases significantly. One in eight women get breast cancer-that’s our baseline rate. Some women on hormone replacement therapy are going to get breast cancer. There’s nothing we do about that. If you get it, you have to stop. But I tell people, there’s a difference between association and causation. I think, we’ve assumed a causation that really isn’t there for many years.
Then, we talk about cardiovascular risk. The Women’s Health Initiative also made us worry about cardiovascular risk of stroke and heart attack. What we know from that in other studies is that, the risks of estrogen and progesterone are based on when you start, not how long you use it. So, if you start within five years of that last period, you can use your hormone replacement fairly indefinitely without increasing your risk. The risk of heart attack, stroke, all those things are based on when you start. And women who start hormone replacement therapy within five years of their last period actually reduce their cardiovascular risk, we talked about that. They also slightly reduce their colon cancer risk and they reduce their all-cause mortality over time. The North American Menopause Society is really clear – there is no set stop date for hormone therapy. You can use it as long as it’s functional for you.
Dr.Rebecca: In my practice, I see three different patterns really. Small group of my patients use it just to manage symptoms rather transition to menopause. Two to five years, they taper off, they feel fine, we’re good. Another subset, use it through the age of retirement. They’re very functional women, they don’t like what it does to their brain when they come off their estrogen, they don’t like the hot flashes in the workplace, they want nothing to do with it, they sleep better on it. So, we use it until they’re 65, 70, 75 and then, we taper off and they do fine. And then, I have a small subset of women who feel better on hormone, and they’re going to die with that hormone in their hands, and that’s fine, too. [laughs] I’m happy to continue that journey with them as long as they don’t have any other risk factors. They haven’t developed breast cancer, they haven’t developed heart disease, or anything else that would mean that they need to come off.
David: Do you have an opinion about why Alzheimer’s risk is so much higher with women than with men?
Dr.Rebecca: I have a lot of opinions. I don’t know how based on science they are. I can tell you what we know from the data and what we suspect. I don’t know if we have the full story yet. We mentioned Dr. Mosconi. She’s working on this at Weill Cornell Medical School, and I think, she’s probably on the pathway of discovering exactly what’s going on in the brain. But I think, there are a couple things about estrogen that we need to think about. Like I said, estrogen is an anti-inflammatory molecule, and it’s anti-inflammatory everywhere including in the brain. So, I think, there’s a certain amount of that anti-inflammatory effect that is beneficial for women.I think that sleep has a lot to do with it. When women are transitioning through menopause, we’re talking about five, ten years of disrupted sleep. That’s a lot of impact in the brain and I think that has a lot to do with it.
David: Wow, okay. So, I’m going to paraphrase here and tell me if I got this wrong. But it seems like with HRT, unless you fall into one of these groups where you have a preexisting condition, and you can’t do it – this seems like a really good thing all around. If for nothing else, just the sleep. Like not sleeping for ten years like, oh, my gosh, that’s going to cause all kinds of problems.
Dr.Rebecca: Right. I don’t disagree with you. I think, we have been told a scary story of hormone replacement therapy. Before the Women’sHealth Initiative published, that was not the story we were telling. We were telling women it was great for them. Those of us who’ve been working in this space a long time have gone back to that story for the most part. I think that was the Women’s Health Initiative, and the way it was published, and the way it was recorded was a bit of a blip in that story. The way I’d like to think about it is that, menopause probably had a function when it started. Very few species go through menopause. It’s us and a couple of great whales. That’s pretty much it. There’s a whole sort of grandmother theory about why we would do this. And the theory is that, the grandmothers are the repository of knowledge within these societies, and risking them in childbirth as they age doesn’t make sense, so they stopped being able to reproduce, so they can continue to pass on knowledge. That’s a great theory. There’s no way to prove that. But sounds good. I like it.
But the one thing I do think about is, when menopause is fine and functional, if you’re going to live to be 65, you got 10 years to survive your menopause, you’re going to be okay. We live to 95, 100, 105 now. And that’s a long time. That’s almost half your life without the hormones that sort of keep things going. So, I think that we need to adjust like, I think people have been fed this line that, it’s better to just go through this natural and normal transition. Well, it’s natural normal, but so is dying by 65. We’re in a different place now. So, we need to think about our long-term health, and estrogen may actually help with that long-term health. Not everybody needs it. People do live to 85, 90, 95 without hormone replacement therapy, but it can be beneficial for many women.
David: So, if somebody comes to you and they’re non-symptomatic, they’re not having any of the sort of sleep disorders, mood stuff, weight gain, but they come to you and they say, “Huh, I’ve read this stuff about hormones and long-term brain health. Should I be doing this? Not so much my current status but my longevity, essentially?
Dr.Rebecca: The answer if they’re just talking about brain health is, I don’t know if we know for sure. We have some studies that point at increased exposure to hormone over a woman’s lifetime being protective of her brain and reducing the risk of dementia and Alzheimer’s dementia specifically. In that, we’re talking about a couple of studies. There’s an observational study called The Cache County Study out of Utah, where they just looked at this county and watched everybody age, and one of the publications that they did was they counted up women’s years on estrogen, they counted their pregnancies, their breastfeeding, their hormone use, all those things, and showed that women with more estrogen exposure had a reduced risk of Alzheimer’s disease.
Then, there’s Dr. Mosconi’s study, which was recently published, which looks at women who’ve had exposure to contraceptives, or hormone replacement therapy, things like that, and more exposure showed decreased risk. There are other studies that show that HRT increased the risk of dementia. The Women’s Health Initiative showed an increased risk of dementia. Now, there are some issues with how that study was designed, a lot of those women were 10 or more years into menopause when they were started on hormones, there’s the whole idea of blood clotting and could there be small strokes in the brain, there are a lot of issues. But I have to be honest with these patients and say, there’s data on both sides.
Some data says that, it’s harmful, some data that says, it’s helpful. My take on all that data is, I think, there’s more help than harm if we use it correctly. If you start within five years of that menopause, if you take it continuously, if we use it through the skin rather than orally, because through the skin, there’s a lower risk of blood clots. There are ways that we can do it safely and I am happy to prescribe someone hormone therapy for health benefit as long as they understand that is actually what we consider an off-label use. Hormone therapy is FDA approved to treat hot flashes and protect your bones. That’s it. We know all these other things. So, we can have that conversation and do the prescribing based on that, but definitely, we’re in a somewhat of a gray area.
The menopause journey is different for everyone, but you don’t have to go it alone. Learn more about whether HRT is right for you by tapping into the expertise of our integrated care team. You will access both natural and prescription therapies approved by physicians who specializes in menopause.
Continue to part 5 for Dr. Rebecca’s take on whether intermittent fasting is beneficial, why strength training is key for women, and the importance of supporting your bones starting in your 30s.
Don’t miss the entire series of Dr. Rebecca’s interview with SuperAge on HRT:
And be sure to listen to the full podcast episode at SuperAge.com.
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In part three of five transcripts from Dr.Rebecca Dunsmoor-Su’s interview with David Stewart on the SuperAge podcast, “HRT, Estrogen and Menopause, New Scientific Findings with Dr. Rebecca Dunsmoor-Su”, she reviews the need for quality sleep, and what you need to know about testosterone therapy in menopause. Please listen to the full podcast by visiting SuperAge.com.
David: I know that if you’re not getting deep sleep, your brain’s not being cleared out, and your chances of Alzheimer’s dementia goes through the roof. So, how are you addressing that?
Dr.Rebecca: Sleep is really key for women, especially, as we age. It’s not just the Alzheimer’s dementia risk, which is higher in women as we know. But it’s also the fact that if you’re not getting deep sleep, you’re reducing your basal metabolic rate. All women tend to start gaining weight during this time in this transition. It probably has a lot to do with their lack of sleep. You can lose about 400 kilocalories a day in your basal metabolic rate if you’re not sleeping well. It tends to generate a little bit of an insulin resistance from that lack of deep sleep. Your cortisol never really goes all the way down. You don’t get to that really restful place. So, sleep is really key.
How do we address it? Well, I address it in a couple of different ways. I address it with the one proven therapy for sleep that’s been shown in studies to actually work which is cognitive behavioral therapy for insomnia, either using an app, or an online system, or they can even work in person with someone. But the apps in the online versions are actually quite good, and can really help people track their sleep habits, and make changes that helps them to sleep more deeply. Then, sometimes, I address it with hormone therapy, if that’s one of their big symptoms, and they want to try hormone therapy for it.
David: What is cognitive behavioral sleep therapy?
Dr.Rebecca: Cognitive behavioral therapy is a style of therapy that works on behaviors-recognizing behaviors, and changing them is basically the tenant of cognitive behavioral therapy. There’s a specific subset called cognitive behavioral therapy for insomnia. And what that does is, it very specifically tracks behaviors around sleep, about when you go to bed, what you do when you wake in the middle of the night, what things you include in your bedtime ritual, what do you do when you wake in the morning, all these types of things. And then, it works with you on how to adjust those to improve your sleep. And there’s a great app that people can get for free called CBT-I trainer, I believe. It was made at the VA for veterans with PTSD. So, it’s free to everybody. It’s in your app store. You can just download it and give it a try.
David: In my world, I would call this good sleep hygiene.
Dr. Rebecca: It’s a bit more structured than good sleep hygiene. They’re actually things that it recommends in terms of like, if you wake in the middle of the night, you actually get out of bed, don’t check the time, go to a quiet place and actually sit up. It’s a little bit more, but yeah, it starts with good sleep hygiene.
David: So, let’s talk about this other hormone that you mentioned, testosterone. Is it ever a good idea for a woman to be supplementing testosterone?
Dr.Rebecca: I’m glad you’re bringing it up because there’s a lot of what I like to call predatory practice out there – when people are selling women testosterone as a fountain of youth. Testosterone is anabolic steroid. It will make you feel great – and then, it’ll wear off, and you’ll need more, and then, you’ll feel great for a little while, and it’ll wear off, and you need more. So, we end up seeing as women getting into really high levels of testosterone, basically male levels of testosterone, and getting all the joy that comes with that including facial hair and acne. Their voices can deepen, they can grow an Adam’s apple, they can actually grow a small penis from their clitoris. But also on the inside, they’re getting cardiovascular disease on the level of men.
Testosterone is an important female hormone. As I mentioned before, it doesn’t really go down with menopause. It goes at a slow drift throughout our lifetimes, but you haven’t suddenly lost it. People assume as we go through menopause, and there’s often a change in libido, that its testosterone causing that change. In fact, it’s probably a much more complex thing that has to do with psychological factors, how we feel about our bodies, how we feel about our aging, how we feel about our relationships and all those things that are causing that drift down in libido. But there are some small studies that have shown that replacing testosterone at very low female physiologic levels can give a slight boost to libido in women. So, you can increase their sexual satisfying events by about two per month over time.
David: I know you don’t like to say numbers, but can we put a number on that? What’s the dosage?
Dr.Rebecca: We’re having to use male-dosed products at female levels. Because there is no female-dosed testosterone product available in the US that’s FDA approved. So, we’re just struggling with that as physicians. A lot of people are given like compounds or pellets, these are dangerous, very hard to manage, and you can get really high testosterone levels. Those of us who practice in this space typically take a male-dosed product – it comes in little packets of five milligrams each, and for a man, that five milligrams would be a one daily dose. We have women use 1/10th of that a day. So, about 1/10th of five milligrams, 500 micrograms. We’re taking it down and trying to keep it in the female physiologic range. It’s hard for us to do. It’s something that those of us who work in the sexual function space really struggle with because we think there’s some decent data for this, but it’s really hard to safely replace in women. This is not something that should be routinely replaced in women because it is hard to manage, you have to get blood tests regularly to make sure we’re not bumping you too high to the male range, and it’s just something that has a role, but a very restricted role.
Whether you suffer from sleep issues, hot flashes or changes in sexual function, finding the therapies that fit your needs can seem daunting. Skip the endless searches for information, and tap into the proven therapies of our integrated care team. You will access both evidence-based lifestyle strategies and treatments approved by our CBT-trained health coaches and physicians who specialize in menopause.
Continue to part 4 to learn about the three typical usage patterns of HRT, the risks of HRT, plus why the risk of Alzheimer’s disease is so much higher for women.
Did you miss part 1 of this series? Learn about the hormonal journey and why hormone testing is not always helpful.
“In part 2, you’ll learn about the benefits of estrogen, and why some women are not good candidates for HRT.
And be sure to listen to the full podcast episode at SuperAge.com.
Gennev Chief Medical Officer, Dr. Rebecca Dunsmoor-Su was interviewed by David Stewart of the SuperAge podcast for the women’s health episode “HRT, Estrogen and Menopause, New Scientific Findings”.
In part two of five transcripts from the session, Dr. Rebecca shares estrogen’s impact on heart and brain health, as well as why some women are not good candidates for hormone replacement therapy. If you have wondered if hormone replacement therapy is right for you, read on. And please listen to the full podcast by visiting SuperAge.com.
David: As progesterone goes to zero, estrogen goes very, very low, what are the other effects on the body from this?
Dr.Rebecca: That’s a really good question because I think we have lost sight of talking about the benefits of estrogen for a woman over the years with all the fear mongering around cancer, which we should also discuss separately. But estrogen is actually a really healthy hormone for women. So, we know that estrogen is active in basically every part of the body. It’s active in the brain, in the cardiovascular system, the bones, it’s active in the genital region, obviously. And losing estrogen has significant impacts on women as they age. For example, let’s start with the cardiovascular system. So, we for years knew that women didn’t really start having their heart attacks until after menopause. There were a lot of theories by this was, there was this big Framingham nurses’ study that came out looking at many, many nurses, and we’re tracking their progress over the years, and we were seeing that, those women who started hormones, when they went into menopause were also not getting heart attacks. So, it was obviously protecting their hearts. We asked the question, what’s happening there?
What it seems is that, estrogen is an anti-inflammatory molecule. So, at the cardiovascular system in the blood vessels, it’s increasing pliability, reducing plaque. So, it’s keeping those things healthier and younger in that sense, but it also alters the HDL, LDL ratio a little bit. So, women’s HDL is a little bit higher before they go through menopause and actually goes down, and their LDL rises with menopause. So, we switch our lipid profile a little bit to look a little more masculine when we go through menopause. So, it’s a heart healthy hormone if it’s something you’ve had all along and continued. There is some datas showing that if you go through menopause, and then, wait 10 years, and then start estrogen, it’s actually unhealthy for the heart. So, the big important thing there is that you’ve already been made those cardiovascular changes. Your vessels have become less flexible, you’ve built plaque in your vessels, and then, estrogen has the opposite effect because it also slightly increases blood clot risk. So, you can put clots on top of plaques and actually have strokes and heart attacks.
A lot of the benefit of estrogen is continuous estrogen. It doesn’t work, you can’t start later on. At the bone, estrogen helps us keep calcium in our bones. It helps prevent osteoporosis for women. It’s actually a really, really good bone medicine. It’s actually one of the things that the FDA has approved it for is for maintenance of bone health. In terms of the brain, there are a couple of different pathways to go down with brain health. One is just the general symptoms of menopause. A lot of women experience what we call brain fog. So, they just have some word searching difficulty and some memory changes as they start to transition through menopause, that does not last forever.
David: I want to know, why is that? What’s happening there?
Dr.Rebecca: I don’t know that we fully know. There are actually trackable changes in brain function that you can see. Dr. Lisa Mosconi, who’s the head of the Weill Cornell Alzheimer’s research group did a brain function study, which I think they published in the last year. What they did was, they can actually track brain function changes in women going through menopause. The nice thing is they also checked on them a couple years later, and they recovered those brain functions with or without hormone. So, it’s just something about the brain transitioning how it functions. Estrogen is active in the serotonin system, in the norepinephrine system, in the dopamine system, it’s active in the memory centers, it’s active everywhere in the brain. So, there’s something that’s going on as we transition out of the state. Our brain comes to a new steady state. But there’s definitely a lot of women really noticed that.
The other thing that happens during this time is because of the effect on the brain is sleep gets disturbed. So, women get disturbed sleep as they transition through menopause. Usually, what they come to me and tell me is not that they can’t fall asleep, they can all fall asleep. But at 2 or 3 o’clock in the morning, they wake up, they’re up for two or three hours, their minds are racing, and they’re just getting this very scattered sleep. We think that has a little bit more to do with progesterone. Progesterone is a bit of a calming hormone level of the brain. But estrogen, too, because when we’re often waking with hot flashes, and then, they’re up, and they can’t get back to sleep. Sleep has tons of downstream complications including brain health, but also weight, and energy, and all sorts of things.Then, I lost bit for a minute there. Oh, yes. We’ve talked about the brain, we’ve talked about the cardiovascular system and the bones. What else is estrogen good for, what’s good for our skin. It’s good for our hair. It keeps our vaginal tissues young and healthy. There’s a lot of just general benefit for the female body.
David: I’ve interviewed people who’ve said, “Well, I’m not a good candidate for HRT,” or, “It doesn’t work for me.” Because everything you’re telling me is, this seems like a really good thing to do. Why not?
Dr.Rebecca: There are a couple of categories of people for whom hormone replacement therapy is not a good choice. Category number one, women who’ve had breast cancer. So, if you’ve had breast cancer, and that breast cancer often is hormone sensitive, then, we are increasing your risk of recurrence by adding estrogen or progesterone back into the system. So, we just don’t do that. Another category is, people who already have cardiovascular disease.So, if you already have known cardiovascular disease, and then we have this blood clot risk that we add on top, we can actually increase your risk of cardiovascular events. Then, the third category are often women who’ve had ac lotting disorder, or had a blood clot in the past, or have a strong family history, or a genetic reason why they might clot their blood. We’re very hesitant to add estrogen to that system because it does slightly increase blood clot risk.
David: When you’re doing HRT, are you adding both estrogen and progesterone or just estrogen?
Dr.Rebecca: That depends on whether or not a woman still has a uterus. So, as I said back in the beginning, progesterone’s role in the cycling woman is to stabilize the uterine lining to get ready to implant a pregnancy. In hormone replacement therapy, its role is to keep that uterine lining from growing under the influence of estrogen. If you give estrogen alone to a woman with the uterus, her lining will grow and grow and grow, she’ll have a ton of bleeding, but eventually, will also grow into endometrial cancer or uterine lining cancer. Progesterone stops that from happening. So, if a woman has a uterus, we give both. If a woman doesn’t have a uterus, she doesn’t actually need the progesterone arm. We usually start with just the estrogen. In rare cases, I might add progesterone if sleep is a huge issue for her, and we want to try it to see if it really calms the brain. But in general, we start with estrogen and then see if it’s needed.
To find out if hormone replacement therapy is right for you, speak with a physician who specializes in menopause. Together, they can help you weigh the risk versus the benefits, and prescribe the therapies that are right for you.
Continue to part 3 to learn about the need for quality sleep, and what you need to know about testosterone therapy in menopause.
Did you miss part 1? Learn about the hormonal journey and why hormone testing is not always helpful. And be sure to listen to the full podcast episode at SuperAge.com.
“
Gennev Chief Medical Officer, Dr. Rebecca Dunsmoor-Su was recently interviewed by David Stewart, host of the SuperAge podcast. The podcast episode “HRT, Estrogen and Menopause, New Scientific Findings with Dr. Rebecca Dunsmoor-Su” is packed with valuable information on HRT and women’s long-term health.
In part one of five transcripts from the session, Dr. Rebecca provides a thorough view of a woman’s hormonal journey, and offers insight on why hormone testing is not always necessary. Please listen to the full podcast by visiting SuperAge.com.
David: Take me through a woman’s hormonal journey.
Dr.Rebecca: Well, I think, it’s good to frame how we talk about women’s hormones with a background of what are they for. So, this is nota value judgment but our hormonal journey is based on reproduction. We are after all biological animals. So, the transitions that the ovary goes through is all based on reproduction and reproductive potential. When you are born, you’re born with all the eggs you will ever have. In fact, they start to die off immediately. So, in utero, there are millions of eggs. By the time you’re born, they’re hundreds of thousands of eggs. By the time, you get to puberty, they’re about 10,000 viable eggs. At puberty, you start to cycle and release those eggs one by one, and a woman will release approximately three to 500 eggs over her lifetime before they’re all gone, and she starts to go through menopause.
How do hormones play into that? As you start to go through puberty, the brain starts to pulsate with pre-hormones that signal the ovary to develop eggs. Those pulsations tell the ovary to make estrogen, which makes an egg grow and mature, and then, mid-cycle when that egg is matured, and it starts to put out hormones of its own. Then the brain has a pulse of what we call luteinizing hormone, which tells you to release that egg and then, progesterone spikes. So, throughout a woman’s cycling years, she’s getting in the first half of her cycle or the first approximate two weeks getting a sort of a buildup of estrogen, and then, the second two weeks, a build of progesterone, and if she does not fertilize that egg and implant it then, everything drops off at the end, and we get a bleed. So, the drop of estrogen, progesterone at the end of the cycle causes a woman to menstruate.
For the first 20 years or so that a woman is cycling, those eggs are good, they’re viable, they respond to the brain, the hormones are nice, and even for most women, there are conditions where they aren’t. But in general, that’s a nice even cycle. Then, we get to generally, woman’s 40s. This can happen earlier in some women and later in others. The eggs that are being recruited just aren’t discrete, as we like to say. They’re a little older. They don’t listen as well. So, the brain has to pulsate more.The hormone spikes have to be higher to get that egg out. What we often see int his time, which we call perimenopause is that, women are still cycling and having bleeding, but it might not happen exactly right on time. Or, she might have a lot more symptoms surrounding it because the hormone spikes are so much. bigger. And then, as we run out of eggs, once there are no more viable eggs to respond to that brain signaling, then, our hormone stopped being produced by the ovary, progesterone and estrogen that is, and our periods stop. And that’s called menopause.
It’d be nice if that all just happened very smoothly. Of course, it doesn’t. The last couple of years of perimenopause can be very erratic. In terms of bleeding, women can have periods every three to six months, they can be very heavy because of these huge spikes of hormone, and then we label it menopause or the end of cycling when you’ve been 12 months without a period or 12 months without those hormones. What I typically tell my patients is that while your estrogen and progesterone go down with menopause and you’re no longer making those from the ovary, you do continue to make testosterone at the same rate. That does not go down with menopause. Both for women and for men, our testosterone slowly decreases over the course of our lifetime from a peak in our 20s until our 80s. But there’s no sudden change in testosterone at menopause. If anything in fact, we see a little bit more of it as women. That’s why we start to get chin hairs and acne. In the menopausal transition, we’re seeing a little more of our testosterone and that’s because one of the things that having circulating estrogen does is, it makes a molecule in our blood called sex hormone binding globulin go up, and that holds estrogen and testosterone bound in our blood so we can’t read it. When the estrogen goes down, so does the sex hormone binding globulin, but the testosterone doesn’t. So, we actually see more of our testosterone.
David: Okay, and then going forward, these levels stay the same in post menopause for the duration of one’s life?
Dr.Rebecca: Yes. After menopause, basically, there’s a little bit of estrogen floating around because there are other things besides the ovary that make a little bit. So, our fat cells make a little estrogen and our adrenal glands make a little estrogen. We basically have no progesterone after the menopause because there’s no use for it. The whole role of progesterone in a cycling woman is to stabilize the uterine lining to inflate the pregnancy. So, that’s not happening anymore. And then, like I said, the ovaries and the adrenal glands continue to make testosterone at a low level through our menopause.
David: Why would someone go into something like hormone replacement theory? Actually, let’s start with what is HRT?
Dr.Rebecca: Hormone replacement therapy is the replacing of the endocrine factors, the estrogen and progesterone that have gone missing from a woman’s body. What I tell all my patients is that there’s a lot of chatter around hormone replacement therapy. A lot of fear mongering, a lot of only I can do this for you the right way. In reality, hormone replacement therapy can be done very safely for most women with your physician, and it should always involve FDA regulated products because that way we know exactly what dose we’re giving you and can adjust appropriately.
David: Well, let’s talk about dosing. So, are you doing like hormone levels and like somewhere you want to match? How do you do this?
Dr.Rebecca: The answer is no. When a woman comes to me in menopause and she’s symptomatic, I don’t need to do a hormone level test because I know what it is. It’s very, very low. There’s nothing that a blood test is going to tell me that her symptoms don’t tell me. A thorough history and exam is much more cost effective than a whole bunch of lab draws that aren’t going to tell me anything different. So, we treat based on symptoms. We don’t titrate hormone levels to a particular lab draw because for example, in a normally cycling woman who’s pre-menopausal, the normal range of estrogen is between about 12 and 200.
David: Whoa.
Dr.Rebecca: I don’t know where to aim in their replacement. I don’t know when she’s going to feel better. Some women feel better at estrogen of 20 and some people it takes to 100. So, doing a level doesn’t tell me if she’s better. She tells me if she’s better. And that’s how we adjust hormone therapy.
David: Let’s say, for instance, I was a woman and you did a hormone draw on me at 30, and then, I come to you at 48, I’m symptomatic and would having this dot in this data point saying like, “Here, everything was happy at this level,” would that be something you’d aim for?
Dr.Rebecca: No. So, here’s the nifty thing because you’re saying, I got a blood drawn you at 30. But did I get it in the first week of your cycle- –the second week of your cycle, the third week of your cycle, and the fourth week of your cycle? All of which have different hormone levels for women. All of those are different estrogen levels. So, we feel fine throughout it. So, women feel fine in it within a huge range of estrogen.
David: If I have a low vitamin D, I mean, I know like what my vitamin D level is, I know what it should be, and I know how to change it. I got a data point,I got a target, I know what to do. How do you do this?
Dr.Rebecca: I talk to women. I talk to them and ask them how they’re feeling and we treat their symptoms. Because that’s really the only marker of when we’ve gotten to the point where a woman feels better – the marker of us using enough estrogen.
It’s never too soon or too late to be informed about menopause symptoms and treatments. And finding a physician who specializes in menopause can help you find relief as well as identify strategies to protect your bones, brain, heart, and body.
Continue to part 2, and learn about the benefits of estrogen, and if HRT is right for you.
Listen to the full podcast episode at SuperAge.com.
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Just as injury causes inflammation, eating the wrong foods can irritate our bodies and cause oxidative stress and chronic inflammation. Inflammation in our bodies can show up as joint pain, muscle aches, skin irritation and more. And chronic inflammation plays a role in nearly every major illness, including cancer, heart disease, Alzheimer’s disease and depression.
One of the most powerful ways to fight chronic inflammation is by following an anti-inflammatory style of eating. By eating anti-inflammatory foods, you may help reduce inflammation and improve symptoms of some common health conditions.
An anti-inflammatory diet is not a specific diet you will follow. Instead, it’s a way of eating that emphasizes plants for their fiber, vitamins, minerals, and phytochemicals and encourages foods that are closer to their natural state (not processed).
Making even small changes to you diet that you know you will stick to, and building from there will go a long way to helping you practice an anti-inflammatory style of eating.
When you practice an anti-inflammatory lifestyle, you will know it’s paying off when you start feeling better. There are many ways your body may respond, but you may begin by noticing:
Eating a healthy diet supports your body against inflammation and disease as you age. If you need some guidance on how to incorporate these foods into your diet on a regular basis, consider working with our integrated care team who are experts in supporting women in menopause. They will help you create a personalized plan that will optimize your nutrition and other lifestyle factors, as well as offer the support to create healthy habits for the long-term.
What foods should you eat in menopause? This is a common question we get here at Gennev- and for good reason! Let’s face it, nutrition can be confusing. We all come across many different opinions and news from so many sources, so our team of health experts has done some digging for you, and offers our targeted recommendations.
Protein: Our protein needs go up in mid-life as extra support is needed to maintain muscle mass, mobility, metabolism, and our immune system. How much protein should you include each day? This can vary from person to person, but a general guideline is to aim for 20 to 25 grams per meal and 10 to 15 grams per snack.
Chicken, turkey, and fish are all good sources of lean protein, or you may choose legumes, grains and even spinach. Plus, we like Greek yogurt for a high protein breakfast or snack option that has the added benefit of being high in calcium. When selecting Greek yogurt, choose a product that is lower in fat and added sugars. You can add in your own berries for flavor.
Prebiotics & Probiotics: Research is finding that our gut health extends beyond digestion to other areas of our health and wellness including metabolism, nervous system regulation, and endocrine system function. The hormonal changes that occur during menopause have even been found to change the bacterial make-up of the gut microbiome. These shifts make it important to include prebiotic and probiotic foods to support having a diversity of beneficial bacteria within your gut.
You are already adding pre-biotics to your diet when you include more fruits, vegetables such as bananas, onions, garlic, leeks, asparagus, artichokes, beans and whole-grain foods to your meals. And including fermented dairy foods like yogurt, kefir and certain cheeses, often contain live cultures which may act as probiotics. Other fermented foods that may provide benefit (but more studies are needed) include sauerkraut, kimchi, miso and tempeh.
Phytoestrogens: Phytoestrogens, found in flaxseeds and soy-containing foods, may have the potential to support a reduction in menopausal symptoms for some women. However, all women can benefit from the plant-based protein and fiber these foods contain as a way to support heart health, which is an important focus point in menopause as estrogen naturally declines. Aim for 2 to 3 servings of high quality soy foods such as tofu, tempeh, or soy milk and 1 to 2 tbsp. of ground flaxseeds daily: consider adding flax to cereal or yogurt or blending in a smoothie.
Anti-inflammatory foods: An anti-inflammatory diet emphasizes plants for their fiber, vitamins, minerals, and phytochemicals and includes foods that are closer to their natural state (not processed).
To get started with an anti-inflammatory diet, the simplest way is to include a rainbow of colorful fruits and vegetables each day for antioxidant support and protection. You may be surprised that you can find one or two creative ways to get those fruits and veggies into your meals such as adding spinach to your scrambled eggs or kale to a smoothie. You can also try adding cauliflower rice to your regular rice for an added boost of nutrients and fiber.
Calcium-rich foods: Bone health is very important to consider in menopause, and calcium will help protect your bones. The recommendation is to aim for 1200 mg per day, which can sometimes be hard to do through food alone. When you think of calcium-rich foods, dairy products like milk, cheese and yogurt are top choices. Also high in calcium are fortified orange juice, dark leafy greens like kale and spinach, broccoli, soy foods , sardines and trout.
Proper nutrition is key to warding off disease as we age. If you need some guidance on how to incorporate these foods into your diet on a regular basis, consider working with our integrated care team of board certified OB/GYNs and Registered Dietitians who are experts in supporting women in menopause. They can create a personalized plan that addresses your symptoms, optimizes your nutrition and other lifestyle factors, as well as offers the support to create healthy habits for the long-term.
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Hello! I’m Jill Angelo, CEO of Gennev. When I started this company in 2016, my number one goal was to solve women’s health pains in menopause. Sleep, weight, hot flashes, sex, depression, fatigue, brain fog – the list of health pains is long and it’s robbing women of their quality of life and productivity at work. If you’re reading this, you likely identify with that.
As the CEO of Gennev, I love knowing that 89% of our patients feel relief from their menopause symptoms. But the more important issue weighing on my mind, is that there are so many more women not seeking care. In November 2021, we surveyed Gennev patients and learned that 85% of them regretted not seeking menopause care sooner.
Considering there are 50 million women in the U.S. alone in menopause, and less than 7% seek care, that leaves 47 million women not seeking the care they need. Are you one of them?
What concerns me is that the solution is so simple: get a menopause check-up. It’s as easy as taking the free assessment (2 minutes), and then speaking with a doctor from the comfort of your own home (30 minutes). Internally, we affectionately call this the “M-check”.
In the past 12 months, over 4K women have had the full M-check (assessment + doctor). And over 200,000 women have taken the assessment.
If you’ve taken the assessment, you’re 50% of the way there. You’re informed about where you’re at in the menopause journey and have access to some great education. The remaining 50% of the effort results in relief from sleepless nights, answers to mysterious weight gain, remedies for brain fog, uncomfortable sex, and unexplainable fatigue. Who doesn’t want to feel better from all of that?
As a leader in women’s health, I feel the responsibility to get the 47M women not seeking care, the care they need.
Starting at the age of 45, women need to get their menopause check-up. Just like a mammogram, pap exam, or colonoscopy leads to awareness and treatment, the M-check answers the health pains of menopause and assesses a woman’s risks for rising cholesterol, depression, and self-doubt when it comes to sexual satisfaction. And, with 75% of women in menopause struggling with hypertension, 30% with osteoporosis, and 10% with depression, the menopause check-up addresses that too.
This menopause check-up does not exist in health literature or research. While I appreciate research and guidance for Well-Women visits, perimenopause and post-menopause are afterthoughts in the final paragraph with no explanation for what to check in the patient. Women’s post-reproductive health has been largely underserved for decades, but the longer I’m in this business, I’ve come to learn that the status quo is not working. Results from over 200,000 completed assessments remind me of this daily.
What I hope you take away from this article is that women need to start assessing where they are with menopause at age 45. Just like getting a mammogram at the age of 40, and a colonoscopy at 45. It’s that simple.
If you haven’t had your M-check, start by taking the assessment. Then, speak with a doctor and feel better starting now.
If you’re hesitant, I’d love to better understand your concerns. Please take this 2-minute anonymous survey. Hearing from you is the only way we can make a massive change to how women’s health is treated in this country, not to mention the workplace and by insurance providers.
Many of the changes womens bodies go through in menopause can challenge the strength of their immune system. When we are not sleeping well or eating right, stressing more and working out less, we may be more susceptible to illness. However, even small tweaks to your daily routine can make all the difference for maximizing your health.
Why not start right now? Heres your checklist for supporting your body and boosting your immunity in menopause.
When we dont get enough sleep, it can result in a number of negative impacts on our bodies including lowering our immunity, increased inflammation, poor nutrition choices (caffeine, sugary snacks to keep us going), increased risk of disease, stress and anxiety. Try creating a sleep routine including a set bedtime, and stick to it every night. Unwind with meditation or deep breathing, cool down your room, and be sure to make it a device-free zone.
“Staying hydrated supports the lymphatic system which is linked to the immune system. Being properly hydrated helpswith lymphatic drainage and works to clear out toxins and waste materials. Shoot for drinking a minimum of half your body weight in ounces of water or other non-caloric fluids each day. Exercise regularly A 2019 scientific review in the Journal of Sport and Health Science found that exercise can improve your immune response, lower illness risk, and reduce inflammation. It also helps improve your mood, supports weight management, bone health and reduces risk of heart disease and diabetes.Experts recommend 150 minutes of moderate to intense activity per week.
“Vitamin D is one of the most important vitamins for wellbeing in menopause. Like other hormones, vitamin D participates in a whole lot of bodily processes includingmuscle movement;its involved in carrying messages between the brain and body, and its important for fighting off bacteria and viruses. It helps us maintain our bones by supporting the absorption of calcium in menopause, and it plays a role in reducing inflammation. You can get vitamin D through exposure to sunlight, through a supplement, and through your diet in small quantities. Are you getting enough? You can find out your level of vitamin D with a simple blood test done by your doctor.
“Consuming a variety of brightly colored fruits and veggies provides various health benefits. Plant foods are low calorie and include vitamins, minerals and antioxidants we need, and may protect against cancer, heart disease, vision loss, hypertension and other diseases. Try for a total of 4 cups(2 cups veggies/2 cups fruit) a day. This sounds like a lot, but if you plan for two cup servings at each meal, you will quickly crush that goal.
Protein provides amino acids that the body uses to build and repair tissue. Amino acids also form antibodies, which play an important role in immune response. How much protein you need each day depends on how much you weigh. For women over 50, experts recommend1 to 1.5 grams of protein per 2.2 pounds of body weight So, if you weigh 140 pounds, you would need a minimum of 63 grams of protein a day. Be aware that your needs may increase with higher levels of activity. Protein-rich foods include eggs, chicken, lean beef, dairy, nuts and seeds, lentils and legumes, soy.
If you are checking all the boxes to optimize your health, but still feel your energy and wellbeing is lagging, consider speaking with a menopause specialist. They can help you understand how hormone fluctuations may be a contributor, and support you with a personalized treatment plan. The information on the Gennev site is never meant to replace the care of a qualified medical professional.
Hormonal shifts throughout menopause can prompt a lot of changes in your body, and simply assuming something is just menopause can leave you vulnerable to other possible causes. Always consult with your physician or schedule an appointment with one of Gennev’s telemedicine doctors before beginning any new treatment or therapy.
Are you allocating any of your flexible spending account (FSA) funds toward menopause symptom relief? This post is a reminder to set up appointments in order to use all of your benefits before the year turns over. It’ll be the New Year before we know it.
FSA is an arrangement through your employer that lets you pay for many out-of-pocket medical expenses with tax-free dollars. Allowed expenses include insurance copayments and deductibles, qualified prescription drugs, insulin, and medical devices. You may have access to a flexible spending account (FSA) through your group health plan such as an HMO or PPO. In most cases, these pre-tax benefits are lost if not used before the start of a new calendar year.
Gina was reviewing her pay stub from work when two things happened: 1. Another hot flash revved and rolled through her body (it had to be the 6th or 7th that day already) and 2. She saw 3 letters jump out at her on her stub…”¯FSA. She blotted her upper chest and neck with a tissue and thought, “Why not use some of my flexible spending account dollars to get some relief from these [expletive] hot flashes?””¯ What a great idea! Put those saved, pre-tax dollars to work especially if you’re experiencing an onslaught of perimenopause symptoms.
Book appointments now (or get referrals) to get in to see new practitioners before the New Year turns over. Use your FSA dollars on the health-related appointments and treatments you need. And if there are a few dollars still in your account that are un-attributed, consider trying a form of care you’ve been curious about.
For now, let’s take a look at some of the alternative, non-invasive types of health care that may be covered in your health care plan.
No more grinning and bearing the symptoms of menopause, book an appointment with Gennev’s integrated menopause care team. Gennev patients find relief from symptoms ranging from vaginal dryness and pain, loss of libido, hot flashes and night sweats, brain fog and moodiness, sleep disruptions, urinary symptoms and more. With a letter of medical necessity from Gennev providers, coverage for appointments, supplements and lubricants are included on most plans.
Spinal alignment with gentle, corrective, chiropractic care can relax the autonomic nerves, which can aid in”¯improving sleep, decreasing”¯stress, and increasing overall vitality. Some find that headaches are also reduced when chiropractic care is conducted.
Relaxing and gentle, a massage can soothe frayed nerves, improve overall well-being, and aid in stress-reduction, while providing some quiet, restful time on the table.
Massage pairs well with other types of care listed here, as well as with more standard Western medicine.
Even if you’re nervous about needles, you might be pleasantly surprised by acupuncture. This kind of care can treat and reduce multiple symptoms at the same time in one session. From anxiety and depression, to hot flashes and sleep trouble, there is evidence acupuncture provides real relief. So be sure to ask HR or your benefits provider about acupuncture and your FSA.
Learn more about how”¯Chinese medicine”¯can balance a menopausal body.
Are you looking for a more holistic approach to supplement your primary care? Consider consulting with a naturopathic physician (ND). Ask about herbal options and/or HRT (hormone replacement therapy) alternatives.
Learn more about naturopathic medicine.
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Separately, or in combination, these alternate health care programs can alleviate menopausal and perimenopausal symptoms. And you may already have the pre-tax dollars saved in your FSA account.
Connect with your insurance provider to be sure that these kinds of care, and their practitioners, will be covered in your plan. You will be glad you did, as this additional me time may balance your stress levels and bolster your self-care through the coming hectic holiday season.
Hint: if a loved one says, I never know what to get you for a gift, massage and acupuncture appointments can make excellent, unique gifts!
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Now that we’ve reminded you of the unused funds in your FSA account, how might you use the money for better menopause care? Share your thoughts with us in”¯our community forums!
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If you thought yeast infections were for vaginas only, get ready for your mind to be blown wide open.
Chances are good that you’ve heard of vaginal yeast infections, and perhaps you’ve experienced them firsthand? You wouldn’t be alone as the Centers for Disease Control shared that 75 percent of adult women will experience Vaginal Candidiasis at some point in their lives.
It’s a fungal infection and can occur in places on the body where skin rubs together or touches (also known as intertriginous areas, for the vocabulary, biology, and crossword puzzle fans). Yeast infections aren’t just for adult women, either. Men, kids, even infants can get these funky fungal skin infections.
The strain of fungus is called Candida and more than 150 species exist.
No need for alarm at the word “fungus” though; a small amount of yeast is a normal thing on your skin and in your digestive system. It’s the overgrowth or an imbalance of yeast in or on the body that causes infections and the irritating symptoms that go with them.
The easy answer is commonly where areas of skin touch or rub against another area of skin. So, where does skin touch on the body? At the armpits, in the mouth and at the corners of the mouth, inside or around the navel, between digits, on finger or toenails, and certainly around the groin. Skin folds are another spot where an overgrowth of yeast can happen, such as in the abdominal area as well as underneath pendulous breasts.
Here’s another tip: candida skin infections are called by different names in different places on the body. So, you may have heard of oral thrush or diaper rash without knowing that those are types of candida skin infections. Other common types of candida, or yeast, infections are jock itch, athlete’s foot, and nail fungus.
Talk to a medical menopause practitioner. Book your appointment now.
Warm, moist environments encourage more yeast production, so if you’re living in a warm, humid climate, wear restrictive clothing, or get lax about your hygiene, you may be prompting more risk for this annoying skin infection.
You may have a higher risk of developing a yeast infection if you’re pregnant; work outdoors in wet, warm weather; have diabetes, douche or use vaginal sprays; have a weakened immune system due to certain conditions or medications; or are using hormonal contraceptives, such as birth control pills.
We checked in with Chief Medical Officer, Dr. Rebecca Dunsmoor-Su to see if hormone replacement therapy (HRT) contributed to the overgrowth of yeast. She said, “HRT is actually preventative as it tends to keep vaginal pH correct and prevent yeast overgrowth.” Regarding oral contraceptives, “…(they) are a plus minus, depending on the levels of estrogen and progesterone.” Definitely a few good talking points for your next exam or appointment.
Note: Treatments do vary for each area of the skin, and preparations should only be used as intended where symptoms appear. For instance, a spray may be really convenient for athlete’s foot, but using it for a case of thrush (in your mouth) isn’t a great idea.
Best bet is to
1. Get the right diagnosis with your doctor
2. Take the right medication, as directed.
The most common symptom is a rash or irritated, red skin: it can develop under an abdominal fold of skin, between toes, inside or around a navel, beneath breasts, or on the underside of a penis. Once diagnosed, anti-fungal creams and ointments will generally clear up this symptom, if it is, indeed, a yeast infection. Symptoms won’t improve if the real issue is bacterial instead of fungal”¦ see below for more on that.
Other common symptoms:
Thrush is actually a type of yeast infection that develops in the mouth. It appears as red or white patches of skin, and a medicated mouthwash is often suggested or prescribed to clear it up. Keep an eye on the inside of your mouth as you age, as risks of developing thrush increase with age. Risk increases even more if you wear dentures. Keep brushing and flossing twice daily, plus swishing with mouthwash (as needed) daily for best prevention.
If you’re taking antibiotics for a bacterial infection, you may develop a yeast infection. For women, the balance of the body’s natural production of vaginal yeast can get thrown way off when antibiotics are used to fight off bacteria. Talk with your doctor about replenishing your digestive system’s good gut flora if they prescribe a course of antibiotics.
For vaginal yeast infections, symptoms may include:
If you’re unsure about whether or not you’ve got a yeast infection, make an appointment with your doctor and get it checked out. Usually, a skin sample (such as a swab or a bit of a gentle tissue scraping) and completed test can illuminate what’s going on with your skin.
Feeling alone in your menopause journey? Work with a Menopause Health Coach. Learn more.
Your best health is worth your time and effort. Experience excellent health, not to mention some good, healthy pride and satisfaction in caring for someone really important”¦ YOU!
Yeast infections are a topic worthy of open conversation and one safe place to talk about it is in the Gennev Community Forums. Join the conversation today.
February 4 is World Cancer Day
The C-word is scary. We picture hospitals, hair loss, debilitating treatments, and the worst-case scenario.
Cancer is the second-leading cause of mortality in the United States. The odds are good that someone in your family or someone you know has fought cancer. While there is a hereditary component to some cancers “ as our practitioner Dr. Lisa Savage says, “choose your parents wisely ;)” “ your genes don’t always have the final say.
You can’t change your family tree, but you can make lifestyle decisions that can improve your chances of staying healthy. Here are the best tips from our in-house medical experts:
This is a biggie. Tobacco kills 8 million people worldwide every year, according to the World Health Organization, and is the leading cause of preventable death in the US.
The chemicals in cigarette smoke cause all forms of cancer, not just lung cancer. Seriously: avoid all tobacco products and exposure to secondhand smoke.
Need tips to quit smoking during menopause? We have you covered.
Did you know there’s a link between quality of sleep and cancer? Waking more than twice a night ups your breast cancer risk by 21%. Poor sleep quality can lead to weight gain and diabetes, which itself is a cancer risk.
The National Sleep Foundation recommends seven to nine hours of sleep for adults in midlife. To maximize shut-eye:
And beware: too much sleep may be associated with some types of cancer as well!
Nearly 70% of Americans are considered overweight (having a body mass index, or BMI, of 25 to 29.9) or obese (a BMI of 30 to 39.9).
You’re gorgeous at any size, but being overweight is linked to a number of different types of cancer. Researchers theorize that obesity causes inflammation, excess estrogen in fat tissue, or the body’s ability to regulate insulin, all of which can lead to increased cancer risk.
Maintaining an ideal body weight is easier said than done but can be an important step in prevention. If you’re stuck, try the mindful approach to weight management at menopause.
The American Institute of Cancer Research recommends a diet high in vegetables, fruit, and grains and low in sugar. A plant-based diet full of anti-inflammatory foods, low glycemic starches, and healthy fats is even better. Try the Clean Plate Club 2.0.
Intermittent fasting (consuming all of your daily calories in a specific 8-10 hour window) is another option to reduce your cancer risk.
Alcohol is woven into the fabric of our society but regular consumption increases your risk of cancer. The more you drink over time, the more likely you are to develop an alcohol-related cancer, like liver, esophageal, head, mouth, breast, or colorectal cancer.
Our Dr. Savage advises drinking seven drinks a week or less (though not in one sitting: binge drinking is also dangerous!) Read: how to stop smart and about other foods to avoid in menopause.
Support for self-care during menopause is here.
We all know that the sun is damaging to our skin but may not realize that our risk of skin cancer increases in menopause.
To keep your skin safe, stay in the shade, wear hats, keep your arms and legs covered, apply sunscreen that is at least SPF 15 or higher and protects against UVA and UVB rays, wear sunglasses that block both UVA and UVB rays, and avoid tanning.
A note on sunscreen: applying two SPF 15 products will not add up to a single SPF 30. And, yes, you can burn through a car window.
If you have new spots or growths, your dermatologist should run tests for you to rule out cancer and remove anything risky. Talk to your doctor about how often you should come for screening.
The American Association for Cancer Research suggests that the combination of exercise and preventing weight gain is important for preventing cancer and increasing overall survival after a diagnosis.
We know it’s hard to drag yourself to the gym after a long day or fit a workout into everything else you have going on, but make fitness a priority for your health.
Read: How to really get fit in midlife.
“In women’s health care, our biggest concern is cervical cancer,” Dr. Connie Mao, director of Harborview Women’s Dysplasia Clinic in Seattle, told us in an interview.
HPV (human papilloma virus) most commonly causes cervical cancer but can also lead to cancers of the vulva, anus, and mouth. More than 12,000 people in the US were diagnosed with cancer of the cervix in 2016.
The vaccine can kill 80-85% of these viruses. While the prime target for the vaccine is boys and ages 9-12, all sexually active adults should consider it, though the more sexual partners you have had in your life, the more likely you are to have been exposed already.
Hepatitis is another virus with a link to cancer. Hepatitis C is the leading cause of liver cancer in the US, while people with chronic hepatitis B have a 25% to 40% risk of developing liver cancer in their lifetime. While there’s currently no vaccine for hepatitis C, more than half of all cases of liver cancer can be prevented with the hepatitis B vaccine.
Talk to your doctor if you haven’t been vaccinated and want to schedule your shots.
You can still get pregnant until your periods stop, but the good news is that The Pill can help in preventing both unintended pregnancies and certain forms of cancer. “Most people don’t know birth control prevents cancer,” says Gennev telemedicine physician Dr. Ghazaleh Moayedi.
While birth control pills with estrogen and progesterone may raise the risk of breast and cervical cancers, people who have ever used oral contraceptives lower their ovarian cancer risk by 30% to 50%, endometrial cancer risk by at least 30%, and colorectal cancer risk by 15-20%. Talk to your doctor, or one of ours, to determine if this is right for you.
Understand where are you in your menopause journey by taking the Gennev Menopause Assessment now.
Screening won’t prevent cancer, but it can catch it early and improve your outcome.
Many cancers are preventable, and the prognosis can be improved by knowing what to look out for.
A wealth of experience is available on the Gennev Community Forums. You are always invited to join, ready, gain insights, and yes, share.
Have you ever gotten a new job and felt”¦ uncertain? Unskilled? Unfamiliar?
Perhaps similar feelings are emerging right now as we come to terms with living and working from home (as much as possible) during this COVID-19 crisis?
Self-care for optimal good health is on deck for all of us as we do our parts to help flatten the curve of exposure and minimize the risk of this coronavirus spreading.
Self-care can look different for each and every person. It’s not all bubble baths and manicures, (though a soak, trim, and paint do sound nice sometimes). The term gets tossed about everywhere, so before we do anything else, let’s clarify.
According to Oxford, self-care is:
“The practice of taking action to preserve or improve one’s own health.”
And it’s also defined as”¦
“The practice of taking an active role in protecting one’s own well-being and happiness, in particular during periods of stress.”
Sounds reasonable, yes?
Especially now? Heck, yes.
This research study followed participants for a 4-month period: 2 months as a “control” period, and the following 2 months participants entered a physical exercise routine. The findings during the 2 months where participants exercised regularly were that “During the regulatory exercise phase, participants also reported significant decreases in perceived stress, emotional distress, smoking, alcohol and caffeine consumption, and an increase in healthy eating, emotional control, maintenance of household chores, attendance to commitments, monitoring of spending, and an improvement in study habits.”
So, exercise can help equip us to manage stress and other self-regulating behaviors better, per this study. Based on the decreased stress and emotional distress noted, an improved outlook seems like it would figure in too. Sign us up!
How are you feeling about your self-care routine now that we’re a few weeks in?
Is it different every day? It might feel like your capacity is different every day.
We’d like to affirm that is this reasonable, especially right now. No one has ever been here or done this before.
We are all learning as we go.
And of course, all this is doubled if you’re experiencing new symptoms of perimenopause or menopause.
It’s time to slow down, even when you don’t want to, or don’t feel skilled at slowing down.
We do have several suggestions for self-care that don’t take a lot of time but really fuel you and can help to ease symptoms like increased hot flashes, anxiety, sleeplessness, and headache.
It’s time for more support, not less. Gennev is your online, women’s health clinic. Learn more.
Getting familiar and feeling confident in new skills takes practice, even around some of what might be considered as the basic self-care activities. Self-care is made up of myriad practices! Break them down and learn them, take your time and give yourself the grace to feel unfamiliar”¦ you won’t feel this way forever.
In fact, with care and attention, you’ll likely feel better.
You ready? Take a look and try these out:
Water, for the win
Dehydration happens when water is not replenished in the body. We need water for every cell in our body so systems, tissues, and organs can do the body’s work of”¦ well, functioning. Continual replenishment of good clean water definitely counts as excellent care.
Move it, move it
Made for motion, our bodies and minds thrive with regular stretching, muscle-building, and exertion to the point of increased heartbeat and even some sweat”¦ cardio, anyone? A little extra or a little different movement can spark momentum and endorphins for better feelings and an improved sense of well being.
Spice up your current movement strategy or exercise plan with a new stretch, or a new component to your regular routine. Jump rope, sketch a chalk hopscotch outline and play, pick up the pace on your run with a few sprints, or tackle a new hill on your walk. Variety can give your body and mind more to work with during your workout or even a gentle stroll.
Afternoon naps for everyone!
What do we mean by, “nap”? Quiet time. Rest. Heck, even sleep, if that comes naturally. What if a daily rest period were a part of your regular routine? Only you can say for how long. And the length of the quiet time, or nap, may be something that changes and flexes day-to-day.
For a few minutes? Yes, this qualifies.
For an hour? Sure, if it makes sense, is needed, and doesn’t disrupt you or your household’s current sleep schedule.
Sleep is not “required” (though it could happen!); quiet and restful time is the intention. Meditation could feel restful if you’re up for practicing. A few stretches at the beginning and at the end might feel really good and help to transition both in and out of this quiet time.
Ease up
A reminder: this is a highly stressful, unprecedented time. Sleep planning, hygiene, and relaxation are part of balance and self-care. You may need a little practice in order to acclimate and begin to feel skilled in this. Who knows, a gentle, flexible resting time during the day may help with your nighttime sleep routine as well.
What have you got to lose in trying more conscious elements of self-care?
Test drive one or all and see how you feel. We’re hoping that “better” is part of your results.
Join the community and ongoing conversations about menopause, midlife, self-care, and balance: Gennev Community Forums. You’re always invited.