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

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

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

What is gout?

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

How does uric acid get produced? 

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

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

What does gout feel like?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Foods to avoid, limit, or moderate regarding gout

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

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

On alcohol and gout

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

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

Further reporting from the Framingham Heart Study shared that:

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

Foods to include

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

Recommended eats & drinks:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Will anxiety get worse?

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

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

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

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

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

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

What can others do to help?

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

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

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

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

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

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

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

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

We can help you find relief for anxiety in menopause

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

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

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

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

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

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

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

The elements that make up this perfect storm are

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

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

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

The Stages of Adult Development

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

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

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

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

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

The Happiness U-Curve

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

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

The Social and Economic Realities

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

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

Perimenopause

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

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

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

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

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

The Sandwich Experience

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

Cultural Beliefs about Midlife

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

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

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

There is calm after the storm

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

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

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

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

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

Remember that high school gym teacher who told you to “walk it off” when you were hurt? Yeah, well, turns out Coach J may have had the right idea, at least when it comes to mood.

Exercise may be the last thing you want to do when you’re dealing with menopause issues, but it may also be your first line of defense against many of the emotional impacts of this major transition.

Walk it off, run it off, swim it off, lift it off as there is enormous healing power in movement, and we’re going to talk about how to tap (dance) into it.

Menopause exercise and emotional wellness

Research proves it: regular, moderate exercise improves mood. But you have to stick with it.

As a matter of fact, if you need help keeping up with your fitness goals, a menopause-certified health coach can be helpful. Book 30 minutes for your personal consultation with a health coach.

What can exercise do?

Exercise promotes endorphins, the feel-good hormones. These natural mood-boosters are great at combating mild-to-moderate depression of the kind many women report during perimenopause and menopause.

Also, exercise and endorphins suppress cortisol, the stress hormone that can keep us in an elevated state of fight-or-flight during the menopause transition. High, long-term stress and anxiety have all sorts of down-stream effects on our bodies and psyches and can worsen many menopause symptoms. Aerobic exercise, even just 20 minutes of it, can help pull cortisol back to manageable levels.

Regular exercise can also help you sleep better and aid in weight management, both of which can make us feel healthier and happier. Nearly any woman in menopause and midlife will tell you that decent sleep is both rare and gloriously mood-elevating when it happens, so anything we can do to increase our chances is worth a little effort. Just avoid exercising too close to bedtime, as that can bring on night sweats for some women.

More reasons to move: our PTs filled us in on how exercise helps women dealing with osteoporosis. 

Moving more regularly gives us energy. Yes, exercise can wear you out and help you sleep, but paradoxically, it also shores up our energy reserves. Start slowly, if exercise isn’t part of your daily routine now, but over time, your body will adjust to the higher energy demand by producing more and working more efficiently. And having the energy to do what we love (and let’s face it, the stuff we just need to do) is key to emotional wellness.

Exercise can be a social activity. Lots of women in menopause withdraw due to depression, embarrassment over bodily changes like weight gain or incontinence, or low energy. But being with other people is really good for our brains and our spirits. Because social isolation often leads to higher mortality rates, exercise can help save your life in more ways than one!

Does it really work, or is it a lot of hype?

A small study of 23 healthy post-menopausal women showed a clinically significant improvement in anxiety, depression, health worries, and quality of life with exercise. The women, who were not active prior to the study, took on a six-week walking program, completing roughly 15 hours of exercise over the course of the study.

A follow-up of the women showed that benefits continued as long as the women kept walking. At the end of the first six-week period, the women were split into two groups: one kept walking, one stopped. The group that kept it up kept reaping the benefits, while those in the sedentary group made fewer gains or none.

A much larger study of nearly 34,000 Norwegian adults found that not only does exercise help on a day-to-day basis, it can also help inoculate you from depression in the future.

Menopause and exercise. So, how do I start?

Talk with your doc. As ever, if you’re going to add something new to your daily regimen, a quick check-in with the doc is a great place to start, especially if you haven’t been exercising or you have a medical condition.

Ease into it. Ramping up too hard and too fast is a recipe for sore muscles and a quick quit. Start from where you are; do more today than you did yesterday. Adding just 20-30 minutes a day can be enough to see benefits, but if five minutes is what you’ve got in you today, that’s five minutes your body and mind will appreciate.

Find what you love. I know, this makes me laugh every time too, but it is possible that there’s an activity out there you will enjoy. Walking is a great exercise and will do perfectly well, but if you’re looking for something different, there are lots of options. Try something outside your comfort zone: go rock climbing, borrow a buddy’s road or mountain bike, go for a hike, hit the pool, take up fencing or swing dancing. If there’s something you’ve always wanted to try, now’s the time to try it. Groupon has a “fitness classes” section (pole dancing!), so grab a deal, talk some friends into coming along, and do something new. (Nature is a natural mood-elevator, so bonus points for those who can get outside among some trees for their 30 minutes.) Join a group like One Million Women Walking for support, motivation, and tips to get you moving and keep you moving.

Make it a habit. Plan your exercise into your day the same way you plan meal prep, board meetings, or kid-activity chauffeuring. To be effective, exercise needs to be frequent and consistent. Wake up earlier in the morning (if you can spare the sleep), use part of your lunch break to walk, if work allows. But make it a non-negotiable priority, five days a week.

Track to see improvement. Positive feedback is a great motivator, so track a metric that will help you see results. Track mood, sleep, measurements, consistency, give yourself a notch for each new thing you try as whatever will help you see the benefits and keep you moving forward. Just remember to measure yourself against “¦ well, yourself. You’re not competing with your superfit friend or that gal training for her 3^rd Ironman (unless competition is what revs your engine, in which case, kick butt).

Remember the end goal: to support your emotional well-being through a trying time. How you do that is up to you.

If exercise has helped you overcome emotional difficulty, we’d love to hear what you’re doing, how you got started, how you stuck with it, and how it’s helping. Yes, that’s a lot, but come on, share with us! Leave a comment below, or let us know on Facebook or in Midlife & Menopause Solutions, our closed Facebook group.

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

Now for a light topic: menopause at work.

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

Managing Menopause At Work

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

How many of you work outside the home?

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

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

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

Managing Menopause Symptoms At Work

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

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

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

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

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

That’s not enough.

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

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

So many people suffer back pain as they get older, we’ve come to think of it as a “normal” result of aging. Perimenopause aches and pains are nothing new, so it follows that they could be even worse in full fledged meno. Right?

Well, pain may be common, but it’s not “normal.” It’s the body’s signal that something is wrong, and as spoiler alert as quite often, things that are wrong can be fixed.

As with many things going wonky at this time in our lives, the estrogen depletion of menopause may be playing a role in your back pain. A study done in China in 2017 looked at the spines of 1,566 women and 1,382 men of the same age.

Results? In the 15 years after menopause, women’s lumbar discs degenerated much more quickly. So if you’re feeling back pain, it’s important to act right away to protect your spine and your active future.

If you are suffering from constant lower back pain, a menopause-certified health coach can be helpful. Book 30 minutes for your personal consultation with a health coach.

When it comes to bodies and dealing with arthritis or other pains, we turn, as we often do, to our fabulous physical therapists, Meagan and Brianna.

Menopause and lower back pain: causes and countermeasures

According to Meagan and Bri, there are lots of possible causes, including muscular pain or strain, herniated disc, problems with the SI joint (stay tuned for more on that in an upcoming blog), kidney stones, and issues with your bone density.

For women in midlife and menopause, additional common issues might be postural changes resulting from pregnancy, changes in exercise form and technique, poor stability, poor activation of your core, and poor breathing. Menopause and joint pain are often spoken in the same sentence, but many of the above factors can be mitigated through intention.

Also, a surprisingly big culprit? “Doing YouTube exercises that are inappropriate for their ability are a huge problem,” Brianna says. “Please don’t do that.”

If you really want to watch something on YouTube, check out our painful sex webinar. 

So, first thing to do is figure out what’s causing the pain.

Best way to do that? See a doctor or a physical therapist and talk about what you might be doing (or not doing) that’s causing the hurt. Here’s a handy list to help you zero in on causes and fixes to help you have that conversation.

Is it your exercise program?

“There are lots of pieces of information you need to tell your doctor or PT,” says Bri. “How long does the pain last? Is it days or hours? Is it just muscle soreness from exercise, and is it triggered by a particular exercise? If it’s specific to an exercise, it may be as simple as changing position or modifying a little: tweak, rotate, breathe, and you may solve the problem.”

Meagan adds, “If you have other joint or muscular pain that’s dull, that happens during exercise, your doc or PT needs to know that. If it warms up and goes away or comes on at the end and is gone soon, that’s probably diffuse muscular pain, that’s just the discomfort of getting in shape. But if it’s localized or increases or is sharp as you need to respect that. The body is designed to use pain as a signal that there’s a problem. But our brains can sometimes override those pain signals, if we really want to get fit or lose weight.

“More often than not, pain should not be pushed through.”

 Is it your mattress?

It might be time to update or replace your mattress, Bri says. They’re a pain to replace and they can be expensive, but the wrong mattress or a too-old mattress can set you up for a great deal more pain and expense down the road.

Is it your job?

Most of us just aren’t aware enough of our body position when we’re working, says Meagan. We hunch, we lean, we curl forward, all of which can put more strain on your back. A better option is just don’t sit all day, nor stand all day. “Every 5 as 10 minutes, just stand up,” she tells us. “That’s it. Just stand up, then sit down again. Stretch a little, walk around the office if you can. This allows your body to use its natural lubrication on those joints. It’s just unreasonable to sit for 8 hours and assume it won’t have an impact.”

Their thoughts on adjustable desks? If you or your office can afford it, go for it, Bri and Meagan agree. Varying posture during the day is a great way to reduce the load on any one part of your body.

Is it your commute?

Car seats are designed to be able to fold forward, so the place where we need the most support as the lower back as tends to be a hole instead. If your car seat situates you so your hips are lower than your knees, get a lumbar roll or just roll up a towel to stick behind you to get your butt and hips level with or slightly above your knees.

A lumbar roll that’s easily removed can do double duty with your office chair.

Is it something more serious?

Back pain can have more serious causes that require medical intervention: visceral pain could be from a kidney infection. Pain that’s up high, between the shoulder blades (what Bri calls the “bra strap area“), could indicate a compression fracture. So if you feel pain there as especially if you have osteoporosis, osteopenia, or a family history of either as you need to get to the doc for some x-rays. Here are some steps to prevent osteoperosis.

Sudden back pain can also, rarely, be an indication of certain kinds of cancer, so if the pain is sudden or worsens at night, or you have a personal or family history of cancer, take it seriously and make an appointment.

Exercise and back pain

When we hit midlife and suddenly have some extra pounds (particularly in menopause, when many of us start to put on belly fat), there’s a tendency to go all-out to get back to our younger bodies.

There’s nothing wrong with wanting to get stronger and fitter, and exercise can be very helpful in relieving back pain or avoiding it altogether. But you have to do it right, with good form, while breathing correctly, and after making sure you have the basics in place before you move on to more challenging workouts.

So what are we doing wrong?

Back pain from exercising incorrectly is often the result of poor stabilization, says Meagan. When pelvic floor muscles and the bottom of your core are weak, you don’t have the structural integrity to hold your pelvis, SI joints, and lumbar spine (lower back pain) in good alignment. Then, when you bend or twist, things can shift out of alignment and cause sudden pain. This can be exacerbated in menopause and perimenopause, when aches and pains due to these factors can be triggered more easily and be worse in terms of pain.

This often happens in an exercise classes where moves are difficult and unfamiliar, and you may not have the form, strength, or stability to do the move you’re being asked to do, Bri adds.

If you want to exercise or continue to exercise while still protecting your back, there are ways to do it safely.

One: focus on the basics first

Avoid hurting your back by first mastering the basics. A really great way to do this is to see a physical therapist (PT) who can help you identify weaknesses and design a plan to get stronger, wisely.

Most people benefit from a three-dimensional program, Meagan tells us: stabilization to address the central core; flexibility, to address restrictions in your range of motion that you might be compensating for; and cardio, to build up your aerobic capacity. A good PT or coach can help you design a plan that covers all three.

According to Meagan, ramping up slowly is key, especially for those who already experience back pain. “I’d start with breathing, breathing Kegels, getting the pelvic floor and breath working together. You need to get into functional positions right away. Squats, lunges, getting rotation in there, developing movement strategies with appropriate stability and activation of core musculature to allow you to increase difficulty.”

If you don’t have access to a PT, and you’re taking a fitness class, Brianna advises you opt for classes with as few students as possible. If you can, take an individual lesson or attend a class with no more than 3 students per instructor, she says, so you get more personal attention. Learn to do the moves safely before moving on to harder exercises or bigger classes.

Don’t have a PT of your own? We have two, but we’ll share. Here’s what a PT might tell you NOT to do. 

Two: have realistic goals

When you’re getting ready to launch your new “I’m going to get fit, and this time, I mean it” program (just me?), have actionable, reasonable goals in mind.

What are you hoping to achieve, asks Bri. Do you want to be able to walk longer, are you trying to build strength, are you focusing on cardio or core? There’s no one-size-fits-all exercise program, she warns, because, “We’re all good at hiding our dysfunctions, and we need to tease them out. A gradual, progressive program will address those areas of weakness and allow you to build endurance and stability as you work towards your goals.”

But but but, you say, I feel fine! Nothing hurts!

That may be true, Meagan says, but chances are it just means you aren’t experiencing symptoms yet. “Few of us are perfect,” she says, “and most of us are just getting away with bad habits that will likely catch up to us later. Posture, breathing, proper warm ups and cool downs as because we ignore these, it’s just a matter of time before something is going to hurt or break or get inflamed. The answer is to interrupt the problem now before it becomes apparent.”

“Apparent,” by the way, is PT-speak for “painful.”

Three: not keeping up ≠ wimping out

When you take a class, you focus entirely on the instructor, following her steps, mimicking her form, and never everchecking out the person next to you who, 45 minutes in, hasn’t yet broken a sweat. Right?

“One of the issues we see with taking classes,” Bri says, “is you might be standing next to someone who’s been doing this for years. They look great, they make it look easy, and you try to keep up. But they may have core strength you don’t have yet, and you could end up hurting yourself.”

Be OK with  modifying some of the moves  or simply sitting out portions of the program if you’re not ready. Sure, the gal next to you is 10 years older, but that may just mean she’s been developing her skills and strengthening her core for 10 years longer.

Regular exercise can be enormously beneficial for your  body, brain, and  mood, but no one benefits from a slipped disc or strained muscle. If you plan to add or increase exercise, consider getting some expert help to do it safely.

If you’ve experienced back pain, what did you do about it? (You did something, right?) We’d love to hear how you managed the pain, so please share what you’ve learned with the class. Tell us your experience in the comments below, or on Gennev’s Facebook page or Midlife & Menopause Solutions, our closed Facebook group.

We know what you’re thinking. Isn’t it enough that perimenopause and menopause bring on a whole host of less than appealing symptoms and bodily changes? Do we really have to add a link between menopause and sexless marriage issues? Well, yes. But it’s not hopeless! Disparate expectations, increased physical pain during sex, differing levels of desire, reduced ability–all of these symptoms are frustratingly common in middle age, and allthey can make intimacysex difficult. According to therapist and author (Sex Without Stress) Jessa Zimmerman*, about 20 percent of people are in “sexless” marriages, meaning they have sex fewer than 10 times per year. Of the remaining couples, about 25% have sex less than once a week. 

Pause and take a deep breath. You don’t have to settle for a sexless marriage. And once you understand what’s causing the issues getting in the way of your sex life, you’ll know how to move forward with confidence and control.

Struggling with a sexless marriage? A menopause-certified health coach can be helpful. We can provide a personalized plan to revitalize your marriage’s sex. Book 30 minutes for your personal consultation with a health coach.

Why Do Menopause And Sexless Marriages Happen? Let’s Look at What’s Going On, Down There

Couples who don’t have sex are missing out on that physical connection in their relationship. There’s a correlation between divorce and menopause due to lack of sex.

As you probably already know (but it bears repeating) estrogen and testosterone levels drop during perimenopause and menopause. This can cause thinning and drying of the vagina of the vaginal tissue–the vagina may even become shorter, narrower, and less flexible during menopause. Put this all together and you’ve got painful sex. Not to mention you’ll still have these same struggles with sex after menopause. First, talk to your doctor.** There are all sorts of options available to try, including lubricant, topical estrogen, a clinical therapy device (used to increase blood flow to the vagina), and even drugs–though there are some serious side effects that come with these medications, so, not to sound like a broken record, but talk to your doctor.

Another sexual side effect caused by lowered estrogen and testosterone is a lagging labido. The one-two estrogen/testosterone punch can lessen your sensitivity to touch. Throw in some of the other distracting symptoms such as menopausal depression,sleep disturbances, anxiety, and stress, and it’s pretty easy to understand why sex might not be at the top of your to-do list. What can be done? Well, it might be time to try something a bit outside your box. Look for inspiration in erotic films and books. Put a new foreplay plan in place by adding sensual massage or extended oral sex. Play with new sexual positions, especially ones that allow for you to control the depth of penetration. First and foremost, have fun! And please, remember to communicate with your partner. If something isn’t working for you, they need to know.

Sex and Intimacy: Different, But the Same

There’s sex, and then there’s intimacy. They’re inexorably linked, and both are vital to a healthy marriage. Sex is exciting, pleasurable, a mood booster, stress reliever, and can even strengthen your immune system. Intimacy, on the other hand, is the closeness that builds between two people over time in a loving relationship. Does sex increase intimacy? You bet. Do the two work as a team to make you and your partner feel fulfilled in your relationship? Yep. Which is why it’s important when talking about menopause’s impacts on your sex life that we address what it can do to your level of intimacy, too.

So we asked Jessa about how couples can navigate the rocky terrain of sexual and intimacy issues in a relationship. What can couples do to keep the closeness and intimacy if sex is complicated? This is a big part of her couples therapy, Jessa says, and it begins by widening our definition of “sex.” It doesn’t have to be limited to penetration to “count.”

“My definition of sex is that it’s the physical expression of our innate drives for love, intimacy, and pleasure. That means any pleasurable physical intimacy between partners counts as sex. I encourage people to find ways to touch and be touched that each find pleasing. If one person wants sexual stimulation and the other wants their hair brushed or their feet rubbed, they can participate in pleasure with each other. It is so important to open up your idea of what sex is and what it’s for; it takes the pressure off the couple and allows them to find intimacy and pleasure in new, flexible ways.”

Incolulating a Healthy Relationship

So, let’s say you’re happy, you’re satisfied, you’re compatible sexually, and in your approach to midlife. How do you keep this going as menopause starts to throw hurdles in your way?

If your relationship is happy and has been for a number of years, chances are you’re already doing what you need to do. But even good relationships take work, so Jessa gives us three tips to be sure your happy partnership stays that way. 

1. Keep investing in the relationship; don’t get complacent

“Marriage is like a garden; it needs tending,” Jessa explains. “Continue to spend quality time together. Make sex and intimacy a priority. Don’t let yourself get so comfortable you don’t water and weed the garden, letting it fall into disrepair.”

2. Maintain open communication; don’t be afraid of rocking the boat

This can be a tough one, Jessa acknowledges: “When things are going well, it can be hard to bring negativity into the relationship. People avoid talking about difficult things because they don’t want to spoil the good feelings they’ve been having with their partner. But it’s crucial that a couple maintain open and honest communication, especially about the hard things. If you stop talking and start hiding things that are bothering you, resentment and distance will grow.”

3. Celebrate

A healthy, supportive partnership is worth celebrating! Jessa underscores. “Recognize that you have something special. Enjoy every moment. Don’t take it for granted because life brings changes, one way or another. Be grateful for what you have and express that to each other.”

Sex and intimacy are so hard to separate, we often use the latter as a softer “code” word for the former. But the link is real. Physical touch is critical to a healthy relationship, whether that’s foot rubs or foreplay. Ultimately, how a couple defines intimacy and satisfaction is entirely up to them–as long as both parties agree.

So, openly communicate about what gives you pleasure, what you love about your partner, and how important the relationship is to you–it doesn’t get much sexier than that. And if you commit to doing these things, menopause does not have to lead to a sexless marriage.

*We are providing these links for informational purposes only; they do not constitute an endorsement or an approval by Gennev of any of the products, services, or opinions of the corporation, or organization, or individual. Gennev bears no responsibility for the accuracy, legality or content of the external site or for that of subsequent links.

**It is not Gennev’s intention to provide specific medical advice, but rather to provide users with information to better understand their health and their diagnosed disorders. Specific medical advice will not be provided, and Gennev urges you to consult with a qualified physician for diagnosis and for answers to your personal questions.

Have you taken our menopause assessment? Join over 100,000 women to learn more about your symptoms and where you are in the menopause journey. 

Dreaming of a good night’s rest? It can be tricky during menopause, but not impossible. Read this to learn more about what you can do to improve your sleep quality.

Parts of this article were first published on PRiME WOMEN ““ a great resource for women to learn more about health, fashion, lifestyle, careers, “second acts” and more.

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

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

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

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

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

Sexuality and Menopause: Partnered  

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

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

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

Jessa’s advice for partners of menopausal women:

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

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

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

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

Jessa’s advice for menopausal women

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

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

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

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

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

Unpartnered

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

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

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

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

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

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

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

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

What causes UTIs?

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

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

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

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

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

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

What causes recurrent UTIs?

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

One: UTIs caused by change in vaginal tissue and flora

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

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

How do you treat them?

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

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

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

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

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

Two: UTIs caused by anatomical issues

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

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

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

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

How do you treat them?

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

What can I do about recurrent UTIs?

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

When should I see a doctor?

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

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

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

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

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

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

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

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

TRANSCRIPT COMING SOON

“I used to love going out, socializing, dancing”¦ Now it’s just gone.” “I have to force myself to socialize.” “I feel safe at home; when I go out I’m anxious the whole time.” “None of my girlfriends are going through this, so I have no one to talk to.” “I’m running out of excuses to say “˜no.'” as real quotes from real women in perimenopause and menopause.

Other people can irritate you by breathing funny, but being alone intensifies the anxiety risks and depression. Or maybe your body is doing things you’d rather not share with others. Or you might be unhappy about your appearance or your attitude and don’t think you’d make good company right now.

Isolation is a pretty common phenomenon for women in the perimenopause/menopause transition. Whether the isolation is voluntary or a result of life circumstances, it’s not always a good or healthy thing to restrict your social circles and contacts.

So why do we find ourselves feeling so separate and alone? What are the consequences of too much solitude on our mental health through menopause? What can we do when being social feels (or is) impossibly hard?

Why do so many women feel isolated in menopause?

First, we should draw a distinction between isolation and being alone. Many women find they relish time alone, especially as creativity increases in midlife. Alone time is time to focus on writing or reading or meditating or painting or whatever hobby or interest has (re)surfaced to demand our attention.

Isolation is involuntary, whether it’s a reluctance to leave the house or the feeling of not having anyone to share confidences with.  

There are lots of reasons as and lots of theories as but some major themes crop up again and again in these discussions.

1. Irritability. As estrogen declines, it often takes with it some of our urge to nurture others. We may find we’re simply less tolerant of other people’s company, less willing to put up with behaviors that didn’t seem so annoying in the past.
2. Anxiety. Feelings of doom and gloom or fear of panic attacks make small talk over brunch seem impossible.
3. Depression. Depression can spike, especially in perimenopause, says Pauline Maki, professor of psychology and psychiatry and an OB/GYN at the University of IllinoisasChicago College of Medicine. And that can leave many women vulnerable to crippling isolation.
4. Fatigue during menopause. The exhaustion that often comes as a menopause by-product may make an evening with television so much more appealing than one with friends.
5. Embarrassment. Digestive issues, hair loss, weight gain, body odor“¦while we’re likely far more aware of these things in ourselves than others are in us, it can be hard to spend time with others when you’re not sure if you’ll leak when you laugh.
6. Stigma. Because as a society we’re still so reluctant to discuss menopause as a stigma as and because we’re still so youth-obsessed as women are ashamed to admit they’re in the throes of The Change, even to each other.
7. Divorce. “Grey divorces” are increasingly common, and while some women are relieved to be out of the relationship, they may also have lost access to their usual social circles.

Being social is good for us

Even if you’re naturally an introvert, a little time with others is still good for you. We’re healthier and tend to live longer when we interact with other humans.

According to Maria Cohut at Medical News Today, when we have face-to-face contact (of the right kind, of course), we get a burst of oxytocin, the “love” hormone that reduces cortisol levels, reducing stress. Relationships can lower our perception of pain, improve memory, help protect our brains from neurodegenerative disease, promote healthful habits like mindful eating and exercise, and reduce our risk of depression.

Inhabitants of “blue zones” (where people routinely live very long lives) are almost universally social, with strong interpersonal connections.

However, it’s important, says Harvard Health, that you know and respect your limitations when it comes to socializing. If you’re finding socializing the way you used to is adding to your stress without providing much benefit, you may need to find other ways to connect.

Get your groove back

So what do you do when you want to want to get out there but you can’t quite make it happen?

Reduce barriers. What’s holding you back? Is it really fear of incontinence or embarrassment about weight gain? Is it fatigue at the end of the day? If you’re not quite ready to jump into the party scene, start working through the things holding you back. Look into incontinence underwear or make an appointment with a pelvic PT. Whatever it is, working towards solutions can be energizing and confidence building, so it’s a win-win.  

Be the reason. Instead of doing what you’ve done before, take a different tack: what is something you love to do? Rock climbing? Quilting? Cooking? Mountain biking? Golden retrievers? Is there a club you can join with other people who share your passion? It’s an automatic conversation starter and fall back when the small talk stalls.

Volunteer. Being of service to others is great in and of itself, but when it also provides a distraction from your own swirling thoughts, it’s even better. Just choose carefully: are you more likely to enjoy planting trees or working with seniors or helping at the local food bank? There are lots of good and useful things to do, and if you pick one that works for you, you’re more likely to stay with it.

Get a dog. Honestly, we just think everyone should have a dog because they’re wonderful, but having a dog is a great way to make new friends. Taking your dog for a walk, maybe joining a group training or hitting the local dog park are great ways to meet folks. Plus dogs are good for your health too.

Stay in and in control. If “out” is overwhelming, invite a few friends over and bring the party to you. Keep it low-key and within your limits as order in instead of cooking if cooking adds stress. Give your gathering a start AND an end time to keep from feeling trapped or overwhelmed.

Be social at work. If you’re truly an introvert, giving up alone time may seem more like a punishment than a benefit. Use breaks, lunch with colleagues, quick chats in the corridor to fill that need for human contact. For some of us, that may be enough, and that’s OK.

Take it high tech. If you live in an area where socializing is challenging, or if the thought of meeting actual people fills you with dread, make it easy on yourself. While online socializing may not provide all the same health benefits as in-person, it’s a smart gateway. Games, clubs, Facebook groups are all good ways to meet folks like you and strengthen social skills before taking it IRL.

Talk with a doc. If your reluctance to socialize rises to the level of social phobia or social anxiety disorder or is seriously impacting your life, talk with a doctor about medications or other treatments that can help you feel more at ease. It’s possible your anxiety is due to medications you’re taking or an underlying medical condition that a doctor can help you identify and treat.

It’s important to take the pressure off the situation. Meet for coffee instead of a meal. Go for a bike ride or a walk instead of a dress-up affair. Just take a first step and call up a friend. Make a plan that’s as loose or as detailed as you want.

Most of all, understand that this isn’t you being “lazy” or “boring” or “old.” Shifts in hormones and mood are real and can be deeply impactful, so do what you need to do to feel right with your life, whether that’s date night with the partner once a week or chess in the park with passersby or coffee and cupcakes with a buddy. Because cupcakes.

If you’re dealing with social isolation, what’s causing it in your case? Have you taken steps to overcome, or are you just riding it out for now? You can comment here, find us on Facebook or in Midlife & Menopause Solutions, our Facebook group. You can also join us, anonymously, if you prefer, on our community forums. 

You might find the title of this week’s blog ironic.

Menopause has been around as long as women (and whales!) have been on this earth. What I’m referring to is the growing number of women and brands speaking out on the topic in a modern, no-nonsense sort of way.

Let’s start with Apple, the mothership of all brands. They announced a Women’s Health Study this week in partnership with the Harvard T.H. Chan School of Public Health. Their mission is to study a broad range of women’s gynecological conditions, including menopause. Go Apple! My message to Apple: if you want to work with the experts in menopause, you can find us at https://gennev.com.

Every day, it seems, new products come on the market to relieve or reverse the effects of menopause. Some of my recent favorites are a Cannabis Tea called Kikoko for a range of menopause symptoms (notably insomnia and hot flashes) and Better Not Younger hair care. Beautiful packaging that doesn’t make me feel like I need to look younger.

Women’s voices are ringing out strong in op-ed form, online film, and onscreen drama.

One of my favorite new thought leaders on the topic of menopause at work is Denise Paleothodoros. Her latest piece titled Dear Men, I Hope You Don’t Think My Ask Is Too Big on Behalf of Midlife Women is targeted at men. It strives to help them understand the changes they will experience in the women they care about. And it goes a step further to help them understand how to respond in a modern, sensitive sort of way like only cool men can do.

Filmmaker Lisa Kaselak is releasing a new web series called HelloPause that brings women together to talk openly about perimenopause. Their mission is to “de-mystify, de-stigmatize and de-toxify perimenopause so that ALL women can be prepared for the challenges and joys of a third act well-lived.” They’re on the hunt for new women with new stories. Learn more about future episodes and pay it forward by supporting their GoFundMe campaign.

And for the grand finale, I’m in love with Fleabag. In a cameo appearance, Kristin Scott Thomas lays out a monologue on menopause that will go down in the record books of female definition when she says, “And yes, your entire pelvic floor crumbles and you get f***ing hot and no one cares, but then you’re free, no longer a slave, no longer a machine with parts. You’re just a person.”

Why am I intentionally giving you all these links that take you away from Gennev and all that we’re doing for women in menopause?

Ladies, we’re part of a broader movement. Menopause isn’t just one woman’s voice or one doctor’s point of view, or one product on the market. It is many many women’s stories, bold brands and never-done-before services coming together to serve the massive community that we are.

These brands and influential people are ignoring the long-standing stigma and instead sharing loudly their points of view, their solutions for healthy living, their vibrancy and their struggles.

That’s the community I want to be part of. That’s what I want Gennev to represent. That’s how I hope we, together, can change the face of menopause and women’s health forever.

So, yes, we’re a thing. And we’re just getting started.