“Are you using your butt?”

Menopause coincides with (or contributes to) an uptick in lower back pain and joint pains are common in menopause, and many women find their knees are causing quite a bit of trouble at this time.

At Gennev, we’ve heard from a lot of women that knee pain makes it tough to be motivated to exercise. Since exercise is really important for helping of , heart disease, and dementia; since it helps us control weight as well as endorphins and alleviate menopause depression; since it helps us sleep “¦ well, not being able to move just isn’t an option.

So we turned to our two awesome DPTs, Dr. Brianna Droessler-Aschliman of Four Pines Physical Therapy and Dr. Meagan Peeters-Gebler of Orthopedic & Spine Therapy, for some help.

If you are dealing with knee pain, a menopause-certified health coach can be helpful. Book 30 minutes for your personal consultation with a health coach.

Knee Pain In Women Caused By Their Butts?

If you’re experiencing knee pain and you go to a physical therapist, “Are you using your butt” is one of the first questions you’re likely to hear, says Brianna. “If the pain is not from an obvious injury like a sprain or twist or tear, I start with the glutes.”

Why questions about the butt when it’s the knee that hurts? Well, knee pain is often caused not by a problem with the knee itself, but by tight, weak hips and weak glutes.

“The glutes are both stabilizer and powerhouse,” says Bri. “There are three muscles working together back there: your gluteus maximus, which is the big muscle of your butt cheek that provides a lot of power, and the gluteus medius and minimus, which are stabilizers that run along the sides of your hips. When people come to me with knee pain, I test these first, and often I find that weak glutes are the culprit.”

If you want to test your glutes, lie on your back and raise one leg. Ask a friend to push down against your leg and see if they can force it down. If there’s little resistance from you, chances are you’ve got some weak glutes. (Hint: it’s really best if your “friend” is a qualified PT or coach).

So what’s really going on here?

We spend a lot of the day on our butts, which can cause the hips and the smaller glute muscles (med and min) to tighten. Combine that with weak glutes generally, and you end up relying on the powerful quad muscles in the front of the thigh and the big hamstring in the back to do the power work the glutes should be doing.

The quads and hammies mostly do pretty well, which is why so many of us default to them. The problem is your body mechanics aren’t set up for the quads and hammies to take this much of the load. Your quads insert into your knee in a way that applies extra pressure when that big muscle contracts, compressing the patella into the knee. Glutes do the same job without that compressive kneecap force, Meagan says, so they don’t constantly inflame the knee and cause pain.

Fire up yer glutes!

Strengthening, stretching, and activating your glutes and hips may go a long way toward alleviating your knee pain. Clam shells, side hip raises, side walking, tightening and squeezing your butt while sitting at your desk or standing at the sink to do dishes as these can help you start to strengthen those muscles. Walk up and down stairs, but put your whole foot on the step and push up with your heel rather than your toe.

You can also do a “toes-up bridge” where you lie on your back, knees bent, toes pointed upward. Bring your hips up to form a straight line from shoulders to knees, while squeezing your glutes. Hold at the top for a count of 10, then come back down. Ten reps at a time a few times a week, and you can start to feel the glutes getting stronger.

Oddly, getting those big, powerful muscles to activate is harder than it seems, so for awhile you may have to consciously engage your butt. “Self-talk,” Bri advises. “You have to be intentional about it at first, think about those muscles firing as you walk or run or do a squat. You’ll tire faster than you expect, but that’s OK; you’ll get stronger and eventually you won’t need to concentrate as much.”

Check your posture in midlife as you walk, Meagan says. If you have your butt tucked under, your glutes can’t work as well. Think about leaning slightly forward so your “headlights” enter the room before your pubic bone does, as this forces the glutes to engage to move you forward.

And at the end of the day or after your workout, stretch and roll those big muscles with a foam roller to relieve the tension and relax tightness. Stretch out your quads by bringing your knee gently up to your butt, knee pointed down. Even if you didn’t get to exercise that day, just sitting is hard on your body, so give yourself a little love.

Solving from below: ankle, feet, and knees

Your glutes may not be (entirely) to blame for knee pain in women. As Meagan says, when the middle joint is hurting, it’s probably menopausal arthritis and the problems often start in the joints above as well as below. Tight hips is one issue, but tight ankles and weak feet can also cause problems and pain in the knees.

Protect your knees by keeping your calves stretched out so your ankles stay flexible and have a good range of motion. Be sure the shoes you’re wearing have a decent cushion and good support. If you’re a runner or walker, have shoes fitted at a running store and replace often. Bri suggests over-the-counter orthotics or even prescription orthotics if a doc recommends them. 

How to deal with the pain now

So, you’re pretty sure the pain you’re feeling isn’t due to an injury or accident (you got a doc or PT to figure that out, right? And no, Dr. Internet isn’t good enough). How do you control the pain as you’re working to strengthen your glutes, hips, feet, and ankles?

Consider wearing a compression sleeve made for knee pain. Not only does it take some of the pressure off the knee, it also helps your brain be more aware of what your knee is doing as you move. (Note: do NOT use compression if you have circulation or blood clot issues or a skin sensitivity to the material.)

If you’ve ever seen a pack of distance runners, you may notice one or two have colored tape on their legs. That’s elastic therapeutic tape or kinesiology tape, and it could be well worth exploring. The tape works by lifting the skin off the fascial layer and connective tissue beneath so the body can flush out built-up toxins via the lymphatic system. It also allows in more oxygen and better blood flow for faster healing. With the tape “making room,” the layers of tissue and muscle glide over each other with less friction, and the brain sensory input reteaches your brain the proper movement pattern. The only concern is if you’re sensitive to the glue.

And the advice you knew was coming: “Relative rest,” says Meagan. “That doesn’t mean total inactivity, it just means you choose actions that don’t inflame the knee. If going down stairs hurts, take them one step at a time,” for example. Give the inflammation in the knee time to subside, and stop triggering more pain. “Ride a bike,” says Bri. “Maybe you can’t run a mile right now, but maybe you can bike for five. Just make sure what you’re doing isn’t making it worse.”

But as ever, be aware of limitations, and if something hurts, stop. “Knee pain isn’t something that gets better by pushing through it,” says Meagan. Catching and diagnosing the pain early gives you a great opportunity to fix less-than-ideal body mechanics. Pushing through it is a great way to make a small problem into a much bigger one.

How are your knees holding up? If you’re managing knee pain, we’d love to know how you’re doing it. Give us a shout via 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. 

Let’s face it: the female reproductive system has a lot of parts. And because our society is a bit squeamish when it comes to discussing sexual organs “” particularly women’s “” the names may be familiar, but we don’t always know which bits are which or what they do.

In keeping with our mission of putting women in control of their health, we’d like to present: your body.

Obviously, the more you know about your body, the better you’re able to monitor your health and stay on top of changes. However, because virtually everything about our reproduction is hidden up inside, it can be tricky to know what’s going on in there.

With the help of our Chief Medical Officer, OB/GYN Dr. Rebecca Dunsmoor-Su, we’ll take you through the parts, where they are, what they do, how they fit into your body and wellness as a whole, and how the choices and decisions you make affect them.

Looking to understand your body better? Take Gennev’s OB/GYN-designed Menopause Assessment

Your cervix

The cervix is a short tube that connects the lower uterus to the upper vagina. There are a couple of parts to it: the ectocervix, the bit that’s exterior enough to be seen in a pelvic exam, and the endocervix, the canal that leads from the opening of the cervix (the “external os”) through to the uterus. The border between ecto and endo overlaps and is known as the “transformation zone” or “transition zone.”

The cervix is narrow and produces mucus to protect the uterus from harm like bacteria; it expands to allow blood and babies out.

The “glandular” cells that line the tube are known as the endocervical cells. They are a different type of cell than the tougher, “squamous” cells that make up the outside of the cervix. There is a line where the external cells give way to the internal ones, and this transitional zone is the most vulnerable to HPV.

In younger women, the transitional zone is larger and more exposed. As a woman ages, that zone shrinks and climbs up into the cervix, making it less vulnerable. HPV tends to live in the transitional zone and/or the endocervical cells, which is why that’s the area your OB/GYN tests in a pap smear.

HPV, cervical cancer, and pap tests

With the cervix, the biggest concern is cervical cancer.

All cervical cancer is caused by the human papilloma virus (HPV), though not all strains of HPV cause cancer. There are hundreds of types of HPV, some which cause warts on different parts of the body, and some which cause warts on the genitals. There are also versions that are higher risk for becoming cancerous.

In the past, many if not most women contracted HPV at some point in their lives, and for many, their immune system was able to clear it. However, sometimes that HPV can lead to HPV disease in which cells become pre-cancerous, ultimately causing cancer if not treated.

A problem with HPV is that many women can have it and show zero symptoms. It can be “sitting in your cervix and doing absolutely nothing you would ever notice,” says Dr. Dunsmoor-Su, “but we can pick it up on a pap smear when we test for HPV.”

Take control of your menopause with your Personalized Menopause Plan. Talk with a Gennev Menopause Coach.

Decisions you need to make regarding your cervix

Depending on your age, you may want to consider the HPV vaccine. Now approved for women up to age 47, the HPV vaccine may help protect you against some kinds of high-risk HPV. (It may be worth getting the jab for women older than age 47, says our Doc, but as it hasn’t been studied in older women, it hasn’t been approved and thus may not be covered by insurance.)

Pap tests. According to Dr. Dunsmoor-Su, the recommendation is that women of perimenopause and menopause age be tested for HPV during their pap test. To clarify: a pap test looks for abnormal cells that could indicate cervical cancer or that could become cervical cancer. The HPV test tests for the presence of HPV as these are not the same thing. If both tests come up negative, a woman is good for five years.

Why only every five years? Well, because of the age-related changes to the external cervix, and because older women generally have fewer partners, the chances of a woman contracting HPV and of it developing into something more serious within that five years are low. There is a particularly aggressive cancer that can invade the glandular cells, called cervical adenocarcinoma, but it’s fairly uncommon. Of course, if a woman of any age has persistent HPV or other changes in the cells, her doc might recommend she be tested more often.

Younger women are tested more often, says Dr. Dunsmoor-Su, because there are two distinct “waves” of cervical cancer: it is most common in younger women in their 20s and 30s, then again in older women in their 50s and 60s.

Younger women may develop cervical cancer more because they tend to have more sexual partners, but also because that transitional zone we spoke about earlier is larger and more exposed. Older women may have had asymptomatic HPV for years, only to have it develop into cancer later.

Pelvic exam vs pap test

We’d like to take a slight detour here to talk about the difference between a pelvic exam and a pap test. These are often done at the same visit, but they aren’t the same thing. The pap, which tests for abnormal cervical cells (and can include an HPV test), is done when the doc inserts a paddle and scrapes a few cervical cells for testing.

A pelvic exam is when the doc inserts their fingers, places a hand on the abdomen, and feels the uterus and ovaries. This should be done every year, says Dr. Dunsmoor-Su, as this is the best test we currently have for ovarian cancer. The doc is feeling for abnormalities, like an ovarian tumor or nodules, and for flexibility in the pelvis (the uterus should be able to move when the doc moves it). Regardless of age or HPV status, women in menopause should continue to get an annual pelvic exam, ideally with the same doc.

What if your doc discovers something concerning?

A pap test tells the doc what the individual cells scraped from the cervix look like, that’s its purpose. “We’re looking at the form of the cell.” If there’s something of concern, your doc will likely call you back in for a test called a colposcopy. This is a scope of the upper vagina. The test consists of the doc placing the speculum, painting the upper vagina with white vinegar (abnormal cells pick up the vinegar and turn white very quickly), and looking at the area with a high-powered microscope. It’s much like having a really long pap test. “If I see anything of concern at that point,” says Dr. Dunsmoor-Su, “that’s when I’ll take a biopsy.” (Pro tip: If you have to have a biopsy, ask your doc to give you a countdown, then cough when it happens. You may well not feel anything, says our doc, though you should let your doc know what you’re planning.)

The biopsy looks at the cells in situ (in its original context), to determine what proportion of cells are abnormal, how deep the abnormality goes, and how much change there’s been to the tissue structure. The results are graded as 1 as 3. If a woman’s cells rate a “1,” it’s a “come back next year; let’s keep an eye on it” situation. Two and three are more concerning, as it can mean the abnormality has gone deeper into the cervix.

LEEP and cone biopsies. In the LEEP procedure (Loop Electrosurgical Excision Procedure) “” hang on, this is going to sound worse than it is “” the cervix is numbed, and the doc takes a wire loop, turns on some electricity, and basically removes the transition zone of the cervix. This can function as a larger biopsy, taking the whole “concerning” part of the cervix out. A pathologist can then look to see if there’s been further invasion, or if this was pre-cancerous vs cancer. A cone biopsy is done with a scalpel and takes a deeper sample. Both of these biopsies can also be effective treatments. As long as the lesion or concerning cells don’t extend beyond the area removed, these biopsies can actually be curative, taking all the cells and HPV along with them.

If these procedures don’t address the issues completely, or if the abnormalities recur, a woman may be offered a hysterectomy. “We don’t need to take the ovaries,” says Dr. Dunsmoor-Su. “Those have a separate blood supply, so we leave them because they may still be hormonally active. Even in menopause, they can still be producing testosterone, and many women just feel better if they’re left in. If there’s no medical reason to remove them, we generally don’t.”

So, your takeaways:

1. Always wear a condom, even after menopause. Condoms aren’t 100 percent effective against HPV because other body parts also carry HPV and aren’t covered by the condom, but they’re still pretty darn good and definitely better than nothing.
2. Get the HPV vaccine, unless your doctor advises against it.
3. Get annual pelvic exams and pap tests on the schedule your doc recommends.

Women in perimenopause and menopause are not immune to HPV disease and cervical cancer, even if they’re not currently sexually active. While women’s bodies generally pass HPV out and “clear” it, they may not always be able to, and HPV that’s hung out for years doing nothing harmful can suddenly turn harmful.

Knowing your body, knowing how to keep it healthy and what to do when problems arise are powerful ways of taking control of your health. Stay tuned for more information on the female body, in all its complicated, sometimes challenging, glory.

What about your body would you like to understand better? If this is helpful to you, or you’d like to suggest what part we discuss next, we’d love to hear from you. Drop your suggestions and any other thoughts into our community forum.

At Gennev, we’re announcing an expansion of our popular HealthFix subscription service. In this time of the COVID-19 virus, our online services are even more in demand, so we’re making it even easier for women in menopause to access the answers and services they need.

We talked with Gennev co-founder and CEO Jill Angelo about what this new HealthFix program includes and why it’s needed.

What is HealthFix?

Gennev HealthFix is a monthly membership that offers on-demand access to OB/GYNs and Health Coaches for personalized menopause care with nutrition, exercise, sleep, stress management and prescription support.

Why is HealthFix such a great resource for women in menopause?

Gennev has learned that menopause management goes beyond providing prescription support, because not every woman can or wishes to take hormone therapy. To fill the gap, Gennev built the HealthFix membership to offer women both behavioral and medical solutions to menopause symptoms through a team of health coaches, registered dietitians, physiologists, and OB/GYNs.

Gennev’s continued innovation advances the possibilities of telemedicine to give women the physical and mental health support they need online through the entire life cycle of menopause. In addition, because Gennev’s platform is online, at this critical time with COVID-19, Gennev is focused on helping women stay out of waiting rooms to keep space open for critical patients and to follow social distancing protocols.

You’ve recently created a second subscription option as how does it differ from the first?

We originally launched HealthFix to provide only behavioral support for improving nutrition, exercise, sleep, and stress management as they relate to menopause symptoms. Patients worked with Health Coaches who are also Registered Dietitians to create a personalized menopause plan for their care.

More than once we heard from women that they wanted medical care as well. They wanted their Health Coach to be talking directly with their doctor rather than them having to be the go-between. In response, we created a second HealthFix membership which we call HealthFix Premium to include unlimited access to Gennev OB/GYNs, Health Coaches, as well as complimentary Gennev products.

This Premium option includes medical care, including access to MDs who can make diagnoses, prescribe medications, and then connect with the patient’s Health Coach to help keep that patient accountable to nutrition, exercise, sleep, and stress management behaviors for managing their menopause symptoms.

And in a time where social distancing is becoming so important, we see HealthFix as remote care option for women in menopause to get the help they need from the comfort and safety of their homes. This leaves clinics and ERs available for critically ill patients.

How can I decide which HealthFix plan is right for me? Is there an ideal candidate for each?

It really depends on what a patient needs. If a patient wants to try managing their menopause symptoms purely based on nutrition, exercise, sleep and stress lifestyle behaviors, then working with a Gennev Health Coach and accessing Gennev dietary supplements, lubricants, and hygiene products might be the best option for them. These services and products are all available for $25 per month in the HealthFix Basic membership.

If a woman prefers to also have a doctor as part of her menopause care team, then HealthFix Premium at $75 per month is the plan for her. Note that this pricing is less than a telemedicine appointment on Gennev.com, so it’s a great value, not to mention it offers unlimited video and chat access to Health Coaches, quarterly complimentary Gennev products (value of $50), and 10% discount on all Gennev product purchases plus free shipping.

If a woman starts with HealthFix Basic, and she and her coach determine that she should see a doctor, she can upgrade to HealthFix Premium at any time.

We’re working to price healthcare for the everyday woman, rather than having personalized, remote care available only for wealthy people.

How closely do your docs and coaches work together?

HealthFix Premium was created from feedback from women asking for a “team approach” to their menopause care. They wanted doctors and coaches to work hand in hand and remove them as the middle-person always responsible for relaying messages.

With that as our grounding feature of the Premium membership, our doctors and coaches work very closely together, while still respecting the doctor/patient privacy that is expected with quality health care.

Can I use HealthFix if I’m pre- or post-menopausal? What do you have to offer me?

What’s awesome about HealthFix is that it’s personalized to every member. When a woman signs up, her initial conversation is with a Health Coach who creates her personalized menopause plan. This plan aligns to the goals the patient wants to accomplish as whether that be better managing her mood swings, or minimizing fatigue, or helping her sustain nutrition habits that will minimize hot flashes, for example.

Whether a woman is in perimenopause or post-menopause, we all need a healthy way of living. HealthFix is designed to help women achieve that. And, during times like coronavirus, we also need to boost our immune systems, and HealthFix Coaches and Doctors are experts at helping women achieve a strong immune response.

Since you brought it up”¦. I’m worried about the coronavirus. How can HealthFix help me?

Coronavirus most often impacts people with respiratory problems or compromised immune systems. HealthFix and the healthy lifestyle behaviors your Health Coach will work with you to create improve your immune system, not to mention your menopause symptoms.

Plus, having access to quality health care specialized for women through HealthFix can help keep women out of clinics and ERs where more critically ill people may be. Social distancing is becoming the new normal, and HealthFix is making that possible for women everywhere who still need access to health professionals, but from the safety and convenience of their home.

According to Gennev’s Menopause Assessment, I’m a type 3 as does my coach know what that means and how to help me?

Your Gennev Menopause Assessment is secure and accessible only to you, until you release it to your Gennev Health Coach and/or doctor. So, yes, when you provide access to your Menopause Assessment to your health care team, they can help you manage the symptoms you’re experiencing and also help you understand how you will transition through menopause as from Type 2 to Type 3 and beyond .

What is the Personalized Menopause Plan? What does “personalized” mean?

A Personalized Menopause Plan is a care plan that you and your Health Coach design together. It’s created to fit a woman and her needs vs. the typical trial-and-error searching (and money wasting) that women often face when looking for menopause symptom relief.

The Health Coach has a template that she will work with you on to define your health goals (e.g. sleep better, minimize night sweats, improve energy, minimize mood swings). Once your goals are defined, she helps you identify and then modify habits in your nutrition, exercise, sleep patterns, and stress response with different behaviors. Our coaches’ number one goal is to create a sustainable plan for you. They are accountability partners who will check in on women to help them be successful in reaching their goals and feeling better. They can also help women understand what their doctor may be advising, and then be the go-to on a daily, weekly, or monthly basis for check-ins, questions, or simply a listening ear.

So, a Personalized Menopause Plan is personalized to a woman to include what she needs to feel better as both physically and emotionally. It may also include recommended supplements or over-the-counter products or even prescriptions if a woman is subscribed to HealthFix Premium.

Consider HealthFix and our Personalized Menopause Plan as remote concierge medicine that’s affordable to women at various levels. It’s been published that, on average, women spend $2116 per year on menopause care. Our goal at Gennev is affordable health care, and HealthFix and Personalized Menopause Plans are our answer to reaching millions of women, not just the few who can pay a lot of money.

If you’re a HealthFix subscriber, we’d love for you to share your experience. What has it been like working with a Health Coach? What have you been able to put into practice, and how has it helped your quality of life? Tell us in the Gennev Community forums!

You wake up with a sore throat, and immediately your mind starts to rumble and twist: a post-nasal drip from allergies? Or COVID 19?

You’ve heard you really shouldn’t physically visit your doctor or clinic until symptoms demand it. But when is it time? And what should you do now?

A Gennev Doctor Is Always There For Women

First, don’t panic. Yes, this is a scary time, but late-spring colds and allergies are not new and they’re certainly not uncommon.

Our clinic for menopause, we’re opening up our telemedicine services to help women get medical attention for gynecological or primary care issues without taking the risk of going to their doctor’s office or clinic.

We talked to two of our telemed docs, Dr. Lisa Savage and Dr. Kristen Innes, about the services they offer, both during “normal” times, and now, during the COVID 19 crisis.

1. In “normal” times, what services do you provide via Gennev’s telemedicine services?

According to Dr. Innes, the Gennev doctors, who are all OB/GYNs, generally provide counseling on menopause and perimenopausal issues such as hot flashes, sleep pattern changes, mood and weight concerns, and so on.

2. What if I have a problem, like I’m concerned I might have an infection? How do you handle that?

Says Dr. Savage, “If you are concerned about an infection, I can discuss your symptoms and offer advice about whether an exam is needed; usually it is. While we sometimes advise or prescribe without an exam for an infection, the best management for infection includes exam and sometimes culture/tests to establish a diagnosis.” Dr. Innes agrees, adding: “It depends on symptoms; some vaginal infections are easier to treat based on common symptoms. Recurrent infections, lesions and other persistent issues need to be addressed in person with a gynecologist.”

If the problem is severe and urgent, of course, see a medical professional in person immediately. But if you’re just not sure the right next step, a consultation with a Gennev doctor is a good place to start. 

3. What prescriptions can you help me with online?

Obviously, new conditions may well require an in-person visit, but, recurring prescriptions and conditions that don’t require a visit are perfect for telemedicine. Says Dr. Savage, “With telemedicine, I can prescribe menopause hormone replacement therapy and [other, non-hormonal] meds for menopause management, contraceptives, antibiotics/antifungals (rarely) and some other medications. Usually I limit prescriptions for non-gynecologic conditions to short-term refills of stable meds for chronic conditions in the event that a gyn patient is between primary care doctors or otherwise has a reason the prescriber is not available. I always want to be mindful of not fragmenting a patient’s care or stepping away my area of expertise.”

4. How does telemedicine work, if I need a prescription?

It’s actually pretty simple, says Dr. Innes. “When you have your visit, make sure to have your pharmacy information available. If a prescription is needed, we can call the medication in for you to the pharmacy.” We’ll also bill your insurance, as applicable.

5. Tell me how you help women with menopause symptoms?

In “normal” times, Gennev focuses mostly on menopause and the symptoms that can come with it. What does that look like? It’s all about listening to the woman, understanding her current situation and medical history, and tailoring treatment to her body and her needs. That can include medications, lifestyle modifications, naturopathic or alternative therapies, or the perfect blend of all the above.

Says Dr. Savage, “Helping women with menopause symptoms includes assessing whether symptoms  are due to menopause/perimenopause, evaluating symptom severity, educating patients on what to expect and offering solutions, which may include medications in addition to holistic/lifestyle ways to manage any troublesome symptoms or changes.”

Dr. Innes agrees, adding, “There are some supplements that may be helpful in a percentage of women who take them. There are also non-hormonal and hormonal medications that may be helpful for some symptoms. There are many ways to individualize care depending on patients’ wishes as well as medical and family history.”

6. How do you work in cooperation with health coaches?

Hand-in-hand, both of our doctors attest. Women get the most from Gennev when they access all our services, because doctors and coaches can help inform one another’s treatment of a patient, says Dr. Innes, via Gennev’s HealthFix program.

Dr. Savage: “Health coaches can be especially good and have the time available to review lifestyle/holistic management ideas, not only for menopause but for overall health in general. I always read the health coach’s notes if a patient I see has consulted one. I also remind patients about those recommendations and validate them during telemedicine appointments. Health coaches and physicians can learn from each other as well as both contribute to a patient’s overall experience.”

7. Do you have the same privacy standards as an in-person doctor?

“Absolutely,” says Dr. Innes. Because Gennev is so concerned about privacy and security, we often exceed the required security measures.

“I conduct telemedicine appointments in my home study with the door closed, and document the appointment via technology that has all the safeguards one would expect for online medical services,” says Dr. Savage. Patients can be confident their privacy is being scrupulously protected.

8. What happens during a “typical” telemedicine appointment with Gennev?

By now, you might be curious what it’s like to have a telemedicine appointment. We asked our doctors to detail how typical (if anything about menopause can be called “typical”) appointments go.

“During a typical telemedicine appointment, the patient and I “˜connect’ via video chat, or sometimes on the telephone,” says Dr. Savage. “Before each appointment, I have reviewed the intake history a couple of times and read any prior notes, so I’m prepared and can make the most of our time. Preparing ahead of time also gets my diagnostic and therapeutic wheels turning, so I usually already have an idea how to help the patient before we meet. It’s very helpful if patients can be specific when filling out the intake form about what they are concerned about or hoping to achieve.

“When we start the video chat, I conduct the appointment the same way I would in my office. I clarify the history, solicit any additional information needed, listen to the patient describe what she is concerned about, then enter into a conversation about what can be offered to help. Just as in the office, I solicit any questions before concluding. Any prescriptions are then called in to the patient’s pharmacy.

“Our telemedicine visits are documented with notes about what we did and what follow-up is recommended. The patient receives an email with a summary.

“One thing I would add is that for my personal practice style, it is very helpful to have a 30-minute visit for a new patient. Even that goes by fast! I really enjoy a deeper dive and having more time to explain things and answer questions. Fifteen minutes is great for a follow-up. This is not to say that I can’t conduct a new patient visit with the 15-minute option, but having more time with a new patient is very helpful. One complaint that we doctors deserve is that we are “˜rushed’ in the office; being able to have dedicated time and undivided attention is very satisfying.”

9. Gennev has “expanded” its services in the time of COVID 19. What does that mean?

It really pretty simple. The coronavirus is hugely taxing on our medical system, and particularly for women who are medically vulnerable or could spread the illness to vulnerable parents or others, going to the doctor is not a great idea unless the need is urgent.

Says Dr. Innes, “We are seeing more patients for concerns outside of menopause as it may be more difficult for patients to obtain in-person care.” 

Many of Gennev’s doctors are offering primary care assistance; for others, expanded services includes a wider range of gynecological care. Dr. Savage: “‘Expanded’ for me means being able to address gynecology concerns other than menopause, include contraceptive advice/management, menstrual problems, breast issues, etc. This includes helping patients determine when/whether an in-person exam is necessary for complete evaluation.”

10: Why did Gennev think it was necessary to expand services now? Are the doctors qualified to do more?

Absolutely the doctors are qualified. As Dr. Innes says, “Many of us also provide some primary care in our regular practices, so we will provide some basic primary care as well.” 

As to the question “Why expand?” it’s the same reason that underlies every decision at Gennev: to protect women’s health and safety. “Many patients may not have access to in person visits with their physicians due to the COVID 19 pandemic, or they may be uncomfortable leaving their home,” says Dr. Innes. “Telemedicine provides access to a physician in the comfort of a patient’s  home. Expanding our services makes it easier for more patients to receive care regarding their concerns or problems.”

11. Can you help me determine if I have COVID 19?

This question is likely on nearly everyone’s mind. Tests can be hard to come by, and when you have hot flashes, it can be tricky to distinguish them from a fever.

According to Dr. Savage, “Any physician can help determine if your symptoms are consistent with Covid-19.” However, she adds, “To confirm a diagnosis, testing is needed.” If you’re concerned, a call with your doc or ours might be a good next step, but only a test can diagnose you for sure.

12. How will I know when I should go to the doctor and when I should wait?

This is going to be a bit of a judgement call, say our doctors. But if you’re concerned and not feeling confident about your ability to gauge how severe your symptoms are, a telemedicine consult could perhaps put your mind at ease. However, if you are having any difficulty breathing, don’t wait. Seek professional medical help immediately.

Dr. Savage: “At this point in time, I would avoid the doctor’s office unless it’s something that absolutely needs an exam and is acute/urgent. Your annual exam can wait; a raging vaginal infection, extremely heavy bleeding, etc. cannot. Telemedicine can be especially helpful in cases of uncertainty. If you’re not sure about going in vs. waiting, consider a phone call with your local doctor’s office or a telemedicine consult.”

Finally, both say, stay home if you can. Limit your exposure to other people. Eat well, prioritize sleep, manage stress as best you can, and wash your hands.

Arrange a consult with a Gennev physician or health coach if you need help managing menopause symptoms ““ those don’t stop just because there’s a pandemic, and getting symptoms under control can alleviate stress, which can impact your immune system.

if you’re concerned about your health, or need non-urgent medical help, Gennev is here to help.

Just need some community support? Check our our Gennev forums. It’s a great place to ask and answer questions and connect with others who understand exactly what you’re going through!

Things your doctor wants you to know about your middle-aged body

So the fact that your body at 40 or 50 is a bit different from your body at 25 probably comes as a surprise to exactly nobody.

As bodies change with age, the way we behave in them needs to change as well. So what do your docs as and in particular, your ob/gyn as want you to know and do now that you’re 40 or more?

Board -certified ob/gyn, NAMS-certified menopause practitioner, owner of RENUvaGYN, and Gennev Director of Health Dr. Rebecca Dunsmoor-Su filled me in on all the details for the Care and Feeding of Your Over-40 Body.

The Big 3 Screens: Breast, Cervix, Colon

Once you reach middle age, your risk of certain kinds of cancer increases. So it’s important to get regular screenings, says Dr. Rebecca.

However, what constitutes “regular” differs according to your risk factors. If you’re healthy and have no family history of any of these cancers, you can screen less frequently.

Breast: mammograms every year or two through your 40s.

Colon: screenings now start at age 45, which is younger than previously recommended. You should have a colonoscopy every 10 years up through age 75. There are other, stool-based tests that you can opt for, though they need to be done more regularly: the FIT and gFOBT are annual; a stool DNA test (MT-sDNA) is every 3 years.

Cervix: Pap smear done every 1 to 5 years. Talk with your doc about your HPV status and other risk factors to determine the right interval. Even if you’re menopausal, you still need this exam.

STDs

In fact, thanks to the prevalence of erectile dysfunction meds (and other factors), the rate of STD infections is on the rise among Americans 45 or older.

Menopause does not protect against STDs; in fact, the thinning of vaginal tissue caused by a decrease in estrogen can actually make it easier to be infected as the tissue can more easily tear or abrade during intercourse. As long as you’re having sex, says Dr. Rebecca, you should be using condoms.

Pregnancy risk

Even if your periods are wonky, as long as you’re still having them, you can still get pregnant. Menopause is officially defined as a full calendar year since your last period, so until you pass your “meno-versary,” you should be using contraception.

Eating and fitness

“This is a great time to address eating and fitness habits,” Dr. Rebecca says, “because as you head into menopause, weight tends to rise a bit, naturally and fitness becomes harder to achieve.” During our busy 20s and 30s, you could get away with more, but now it’s time to focus on you and your health.

Walk half an hour or 45 minutes a day. The rule that’s “out there” is 10 minutes a day minimum, but Dr. Rebecca recommends at least 30 minutes. “A 30-minute walk can be incredibly relaxing as well as good exercise,” she says. “It’s a chance to clear your head and reduce your stress, so take advantage of all the benefits.”

As far as diet, now is the time to capitalize on the good habits you already have and slowly erode the bad ones. Some things to bear in mind:

• Focus on whole foods and grains and steer clear of processed foods. The less processing your food has endured, the better.
• Regarding supplements, it’s best if you get your nutrition from the foods you eat, so you don’t need to supplement. Be sure your diet is sufficiently varied with lots of nourishing veggies.
• However, vitamin D and calcium are super important to keep bone mass from declining. You can’t build new bone now, but you want to keep the mass you’ve got, so Dr. Rebecca recommends supplementing these two critical nutrients. Take them together to maximize their effects.

Cholesterol, diabetes, thyroid, and blood count

Most of us understand the need to check cholesterol levels, especially if we have a personal or family history of heart disease, but a blood count can also be a useful tool for other health concerns.

Women in midlife and menopause may be at higher risk of developing diabetes, so if you have risk factors, you can include this screen in your blood work as well. If you are 45 or older and have no other risk factors or family history of diabetes, you should be screened every three years, says the American Diabetes Association.

Additionally, you should probably have your thyroid function screened every year or two, says Dr. Rebecca; again, family or personal history of thyroid disease may change the recommended frequency.

With the blood count, the doc is looking to see if you may be anemic. Some medications can reduce your absorption of iron, so it’s good to keep an eye on this. Your doc may also look at the blood work to check that you’re getting enough nutrients.

Heart disease

Unless you have a specific concern, Dr. Rebecca says you probably don’t need what’s called a “stress test” or “stress EKG” where they wire you up and put you on a treadmill to check how your heart is working. Generally this test is reserved for people who already have symptoms or history of heart disease or other risk factors such as diabetes.

What she does want you to know is that heart attacks can look very different in women and men. Women may have jaw pain, shoulder pain, nausea, excessive sweating; the crushing pain under the sternum that we classically associate with heart attack is more common in men and may not be present in women.

Also, many of us still regard heart issues as primarily affecting men. Not true: about 10 years after menopause a woman’s risk is equal that of a man’s. Heart disease is the #1 killer of all genders, so it’s important to pay attention to your heart.

Ob/gyn stuff

Incontinence: If you’re having any leaking, Kegels, Kegels, Kegels, says Dr. Rebecca. Make them an everyday part of your exercise regimen, because continence issues don’t solve themselves. In fact, don’t wait until you have a problem; any woman can and should be doing pelvic exercises to strengthen the pelvic floor. Bonus: better orgasms. However, you might want to get some guidance on how to do the exercises properly, since a too-engaged pelvic floor can also be problematic. Check out a pelvic physical therapist for great, expert advice.

Vaginal tissues: Please talk with your doc. Don’t self-diagnose, don’t self-medicate, don’t clean it with products, and really truly consult with an ob/gyn if you have concerns or questions about any product that’s advertised (or rumored) for use intra-vaginally. Just because someone’s a celebrity doesn’t mean they’re fully informed on vaginal atrophy or pelvic health.

Infections: If you’re getting frequent infections, check with your doctor. Frequent UTIs can indicate menopause; frequent yeast infections can be an early warning sign of type-2 diabetes.

Sex: Use lubes. Always, every time, says Dr. Rebecca. Make it part of the fun. Lubes can protect the tissue from the friction and reduce the risk of infection.

How to talk with your doc

Finally, Dr. Rebecca urges all women to be very direct with their doctors.

Many women feel unheard or dismissed by docs, she acknowledges, so it’s important to be as clear and upfront as you can. Let the doctor know what you’re experiencing, but if you have a specific concern, let him or her know that too. The doc may be able to explain why they don’t share that concern, or she may follow you on that path to see if it’s a factor.

Be direct, and if you don’t feel heard, you’re perfectly within your rights to find a doctor who you trust. However, Dr. Rebecca adds, just because the doctor isn’t saying what you want to hear doesn’t mean she isn’t listening.

Aging and menopause are your body’s way of saying “Take care of YOU.” You’ve likely spent a good chunk of your life caring for kids, taking care of your career, your home, friends, family, etc, and that’s great. But to age well may mean diverting some of your attention back to you, to habits and behaviors that not only keep you healthy but also give you joy.

This article has been reprinted with permission from PRiME WOMEN. 

Gut health might seem like the latest fad, but this “fad” is for real, and it has major implications on your wellness as especially for women in midlife and menopause.

Beneficial bacteria in our gut microbiome do a whole lot of very useful things, including helping to make many nutrients in our food available for our bodies to use. They keep our intestines intact to prevent “leaky gut,” they help regulate our immune system, they impact brain health, emotions, even reproduction.

It pays to keep your microbiome well-fed and happy.

Gut health for women over 40

There’s a special pocket of gut flora called the “estrobolome” which helps metabolize estrogens in our body. When these are disrupted or die off, we are at higher risk of heart disease, osteoporosis, and obesity. In turn, estrogen in the body helps these flora “¦ flourish! Obviously, these bacteria are at greater risk when we hit perimenopause and estrogen levels begin to drop.

How to protect our gut health

Fortunately, there are ways to optimize the care and feeding of your gut biome to prevent dysbiosis, or the die-off of beneficial bacteria. Check out “Gut Check: How to Increase Beneficial Bacteria” on Prime Women for the full scoop on maintaining a healthy gut and reaping the benefits.

What do you do to protect and nourish all those helpful bacteria in your belly? Share with us in the comments below!

Check out our other articles in cooperation with Prime Women, including How to get good sleep and the effects of low-dose birth control in menopause.

Many of us still believe heart disease is more a problem for men than women: that just isn’t true.

Heart disease is the leading killer of women in the United States.

According to Go Red For Women, “Cardiovascular diseases and stroke cause 1 in 3 women’s deaths each year, killing approximately one woman every 80 seconds.”

Heart disease risk after menopause

Ten years or so past menopause, a woman’s risk of heart disease equals a man’s. As estrogen declines, it takes a great many protections with it, including keeping blood vessels within artery walls flexible so blood can flow freely. And, post-menopause, cholesterol levels can change: good (HDL) cholesterol may decline, while the bad stuff (LDL) starts to rise.

Not enough HDL or too much LDL can allow plaque to build up in arteries, restricting blood flow.

To better your chances of avoiding or surviving heart disease, it’s a really REALLY good idea to know your numbers and your risk.

Cholesterol: screen at home?

Several screen-at-home tests for cholesterol have hit the market in recent years; what do you need to know about DIY cholesterol testing?

Check out this article in PRiME Women for more information on at-home cholesterol screenings and other facts to protect your heart health.

While you’re at it, be sure you know the symptoms of heart attack in women (which can look very different from men’s), and when what you’re experiencing is more likely to be menopause-related, non-life-threatening heart palpitations.

The information in this article is never intended to replace advice from a medical professional. If you feel you may be experiencing heart problems, get help right away. 

Do you have experience with heart disease? How are you managing it? We’d love to hear how you’re protecting your heart, whether you’re high-risk or low. Please share in the comments below, on Gennev’s Facebook page, or in Midlife & Menopause Solutions, our closed Facebook group.

Resiliency is our ability to adapt to as and thrive through as times of change.

New job, new spouse, adding babies, subtracting college-bound kids, moving, losing a parent: change, whether happy or sad, adds its own challenges to our lives.

If we’re resilient, we stay focused on the positive, are confident in our ability to get to the outcome we want, and embrace the opportunities change brings.

What do sex and flossing have in common? Increasing our life expectancy. Yep.

Menopause and resiliency

Think about it: who is more immersed in change than a woman in perimenopause / menopause? Our bodies are changing, our emotions change (sometimes from minute to minute); if we’re in midlife when the transition comes, more than likely our lives are undergoing some changes as well.

Any woman going into or out of the menopausal transition is already pretty darn resilient. She has to be. But resiliency is kind of like joy: a little is great. A lot is better. Good news! Even if you were born with only a little resiliency, you can still have a lot.

Evidence suggests that resilient people live longer and experience more satisfaction with their lives. Evidence also suggests that resiliency can be learned, developed, and strengthened. If you’ll live better and longer with a little practice, isn’t that worth the effort?

If you’re ready to become even more resilient, to meet changes with a smile and a strategy, check out this article on PRiME Women about seven ways to build your resiliency.

What’s your experience with change? Do you dread it, celebrate it, grit your teeth and get through it? Let us know how resilient you are and how you deal with changes in your body and world. Share with us in the comments, on our Facebook page, or in Midlife & Menopause Solutions, our closed Facebook group!

We hear it a lot, and it’s a legitimate concern: science and medicine aren’t doing enough to help women, particularly women in midlife and menopause.

Well, times are changing.

Innovation around menopause care is happening, often at organizations led by women.

We’re truly excited to tell you that Gennev is partnering with one such innovative organization as MiraKind. Their research into the intersection of genetics, development of cancer, and menopause has revealed an exciting path for exploration and hope for women at high risk of certain kinds of cancer.

We talked with Dr. Joanne Weidhaas, MD, PhD and founder of non-profit MiraKind, about the KRAS variant she discovered, what her research means for women, and how she’s achieving her desire to bring doctors, patients, and scientists together for the benefit of all.

Can you explain what MiraKind is and what you do?

Dr. Joanne: MiraKind was founded in 2013, as a spin out from MiraDx, a company built on the discovery of a very new kind of cancer-associated genetic mutation. The purpose of MiraKind has been to share information about these mutations to the people they can help the most. Right now that is for women, as their first mutation, the KRAS-variant, predicts an increased risk of cancer.

Another priority of MiraKind is to help find prevention strategies for patients with the mutations they have discovered. For patients with the KRAS-variant, this strategy is to avoid estrogen withdrawal.

On your website, it says you engage in “patient-centric research.” What is that?

Dr. Joanne: At MiraKind, working hand-in-hand with the patient through direct patient contact and input is really a cornerstone of our philosophy. We want to learn from the patient as much as we want to educate them about our mutations and what they mean. We can’t find answers without them. And our goal is to find answers for them. Thus, it is really a two-way street!

So tell us about KRAS as what is it?

Dr. Joanne: Well, KRAS is a protein, and it is really important in cancer development, and treatment resistance. The KRAS-variant is the mutation that we discovered, which is basically the control knob for the KRAS protein. In people with the KRAS-variant, they do not control KRAS like other people. The communication between the regulators in the cell (micro RNA’s) and KRAS is flawed. So when non-KRAS-variant people lose estrogen, their cells stop growing; in those with the KRAS variant, cells start to grow, for example.

In some aspects of life, this probably makes them stronger, but, in certain situations, like hormone withdrawal, there is a miscommunication because of this different control knob, and they can develop cancer. The KRAS-variant is the very first example of a mutation of its kind in cancer. It is fundamentally different than other mutations associated with cancer, as we think we really can control it!

Should everyone get tested for it?

Dr. Joanne: Gosh, yes. we certainly think so! Absolutely all women when they become peri-menopausal at a minimum. It is so easy to be tested, and it is such important information to have when you are going through decisions about your health, from hormone replacement therapy, to screening! Because you can inherit the KRAS-variant from your dad, and cancer happens later, you do not need a strong family history of cancer to have the KRAS-variant.

Why is it particularly useful for women to get tested?

Dr. Joanne: As mentioned earlier, women are at a higher risk of developing cancer than men with the KRAS-variant. We have found that declining estrogen levels seem to be a main trigger for their cancer; thus, maintaining hormone levels is a really easy option to help prevent it.

How can I get tested?

Dr. Joanne: You can get tested by visiting our website at MiraKind.org,  selecting the KRAS-variant test, and placing your order. We will send you a simple at-home cheek swab to obtain your KRAS-variant results, which we can share through a doctor of your choice, and ideally through the network at Gennev! The cost of testing is $295. You can also join a study through MiraKind.org and get a discount.

If I test positive for the variant, what’s my next step?

Dr. Joanne: The most important thing is to team up with a doctor who understands the KRAS-variant and is there to support you. The general recommendation is to continue estrogen and have that carefully managed. Also to get routine screenings, especially of the breasts and the ovaries.

What is the role for HRT in this conversation?

Dr. Joanne: Since we have found that declining estrogen levels trigger cancer in KRAS-variant positive women, we know that estrogen is protective for them. We support HRT, particularly in women with the KRAS-variant, as it helps protect them against their cancer risk.

Does HRT help prevent ovarian or lung cancer as well?

Dr. Joanne: We believe it will protect against all cancers in KRAS-variant women.

Why am I just now hearing about this very important research?

Dr. Joanne: There are a couple of reasons. First, this important research is really very new, and is such a paradigm shift. We now know that there are mutations that are control knobs, that they can be triggered (and thus managed), by external factors like estrogen, and that they can be as common as the KRAS-variant is. It’s very new, so we’ve chosen to develop this slowly and responsibly. Also, we wanted to find solutions, and not just scare people. We have chosen to do this through a non-profit model because we want to partner with patients to find prevention strategies. For us, prevention is the ultimate goal.

Where can I learn more?

Dr. Joanne: Visit us at our website at MiraKind.org or follow us on Facebook or Twitter @Mira_Kind. You can also just email me at joanne@mirakind.org!

Are you working on other genetic research?

Dr. Joanne: We have spent the last 10 years proving that the KRAS-variant is the incredibly powerful mutation that it is and finding other mutations like it. We now know exactly how to treat people with the KRAS-variant if they do develop cancer. We also can predict which patients will have toxicity to certain cancer treatments, like immune therapy, and radiation therapy. While the work on directing cancer treatment is done through our sister CLIA lab, MiraDx, the common theme to all of our work is to improve how we care for people and patients.

What is your role now, as head of MiraKind? What’s next for you and your organization?

Dr. Joanne: I also work as a radiation oncologist and vice-chair at UCLA, where I see breast cancer patients and run an R01 funded laboratory. I oversee the work that is done at MiraDx. I have always felt that MiraKind is where the heart of it all is. The ultimate goal for me is to empower people to get the necessary information to protect themselves from ever developing cancer. So the next steps are for us to find like-minded partners to help us do this!

At Gennev, we’re very excited to be able to help Dr. Joanne and MiraKind spread the word and get more women tested. If you think you may be a good candidate for the test or to help MiraKind in their research, we urge you to go to the MiraKind website to learn more and get started.

Have you been tested? Would you consider it? We’d love to know your thoughts on testing for genetic risk factors such as the KRAS variant. Please share with us in the comments below, join our community forums, tell us on Facebook, or join our closed Facebook group, Midlife & Menopause Solutions.

Fast Company cares about women’s hormonal health!

The word is getting out that women’s hormonal health shouldn’t be a taboo, but instead we should feel fabulous in our bodies.

I sat down recently with Fast Company to talk about Gennev’s mission for women to feel empowered and confident in their bodies”¦starting with their vaginal health. Listen in and then tell us what you hope Gennev takes on in our quest for open dialogue, helpful information, and healthy bodies.

see the original article on Fast Company

Americas future surrounding women’s empowerment and the new presidency

This morning I watched Kate McKinnon’s performance (as Hillary Clinton) of Leonard Cohen’s “Hallelujah”.

And I finally cried.

It’s taken me a while to process last week’s election. As a woman, let alone a CEO of a women-focused business, I knew that I needed to make a statement. Take a stand. Be part of the solution. Not be a victim.

And yet, I couldn’t sift through the disbelief, the anger, the sadness, and the understanding and empathy for the millions of people who believe the outcome is right for them.

So I took some time and just buried myself in life with the reassurance that I indeed will process the outcome and share how I see it with you””women who aspire to be the best versions of themselves.

We started Gennev with the profound belief that women should feel fabulous in their bodies. No matter their age. That comes with taking care of the symptoms life’s aging and processing throws our way. The vast majority of Gennev-ers that we reach everyday with our articles and our healthy products are in the most vibrant years of their lives. They’re at an age where they’ve got confidence, they know what they want in life, they’re financially OK, their kids are relatively self-sufficient, their careers are in a good place, and their relationships are well-grounded or becoming more clear.

For many of us, the outcome of this election threatens the path for women’s empowerment and feeling fabulous. And for others, their lives are not threatened. They either believe that the new president will not impact their day-to-day, because they frankly don’t stand for many of the womanly things that a women-led, democratic administration would have stood for. OR, they’ve risen above it to say, “I’m the boss of me” and are taking action to sustain the path of success, confidence-building and support for other women they believe in.

I’m in the latter camp.

I grew up in North Dakota on a cattle ranch and farm. It was awesome, because there was beauty, peace, fun things to do every day, hard work (which I didn’t mind), and family. The days where we gathered, dirty and tired in the house at 10 p.m. after a long hard day of work for a drink and a late-night snack were blissful. It was a very conservative culture””both morally and politically. I understand it well, because I grew up in it. I don’t share the same conservative views today, but I certainly have empathy and love for the culture of people who do. Conservatives don’t represent all the bad parts of the incoming president””in fact, many have love and compassion for all types of people. But, in this election, many of those people didn’t have a better choice, and when needing to select a candidate that most closely represented what they stood for, Trump was their person. For others filled with hate and anger, I simply don’t understand them and only hope there is a uniting force that brings our country together in a way that I cannot see at this point.

I voted for Hillary. I was with her and still am. Am I ready to band together and work through our differences? I don’t genuinely feel that way””like a kid who’s been instructed to say they’re sorry when indeed they’re not. And yet, I know it’s the right thing to do, and I’ll get there. At my own pace.

The tears I finally shed today were a lot for Hillary. I feel so badly for her. In spite of her short-comings (hell, we’ve all got “˜em), she cares deeply for doing what’s right. She’s had to rise up to levels of strength that most of us will never comprehend in our lives. She’s had to fight back amongst highly public humiliations and allegations. And she’s always done so with confidence. She may not have the charisma of people we love to love””like many celebrities (that’s likely part of why they’re so famous)””but we don’t always need to like people in positions of decision, leadership and power. We just have to believe in their ability to lead on our behalf. We have to be able to respect them.

You may have seen the photo of Hillary hiking the leafy paths of Chappaqua, NY last week. I love how human she looked”¦still with a smile on her face. That’s the image we need to be reminded of and replicate when we’re feeling down in the dumps. I hope she gets more time for hiking in the woods in the coming days. I’m going to follow her lead and keep living my life with confidence, grace and a positive outlook”¦but not let go of all the things I stand for when it comes to women’s development, rights, health, and success.

Hallelujah for women like Hillary who dare to take such a bold stand!

Friends, I am driven to write this article because of the press release about a large study published in The Lancet, which claims to show that hormone therapy definitively increases the risk of breast cancer.

Having read the study, guidance from the North American Menopause Society, as well as thoughts from Dr. Avrum Bluming, an oncologist and author of Estrogen Matters, I wanted to share with you my concerns about taking these results at face value.

The press loves to put out “scare headlines” even if the results are more complex and muddled than that. This is another example of this type of hype. I have four serious problems with this study and its results:

One: It’s based on observational studies

This is a type of meta-analysis of multiple observational (not randomized) studies run over more than 20 years with different complex regimens. They combine both previously published and some unpublished data (which can not be verified).

For those who do not have a working knowledge of epidemiology, a meta-analysis generally involves taking previously published data and combining it to make a bigger study.

In the epidemiology world, a common joke about meta-analyses is that they represent “garbage in, garbage out.” Unfortunately, this isn’t really a joke. When you bring a bunch of flawed studies together and make the numbers bigger, you magnify their faults.

We have several large randomized trials that, with all their faults, give us better, more reliable data, which do not show an increase in breast cancer on this scale.

Two: It doesn’t reflect current practices

The regimens used in many of the studies that go into this big mash up are, in many cases, higher doses and different types of hormones than are commonly used today.

This mix of past and present practice makes it hard to draw conclusions on what doctors are prescribing today, as different hormones can behave differently in the body.

Three: The study is overly complex

The methodology used to analyze the data from these studies is exceedingly complex and hard to follow, which means it is hard to judge the results.

Dr. Bluming noted in his response to the paper, “In the editorial accompanying this paper, Joanne Katsopoulos, of the Women’s College Research Institute in Toronto, wrote: “˜The complexity of the study design makes it difficult to appraise the results and most of us will take the results on face value.’ What? Meaning: This study is such a mish-mash of complicated analyses that even we professionals can’t make heads or tails of it, and must rely on the investigator’s word of what she found?”

I have to agree with this assessment. I have a master’s degree in epidemiology, and I could not make heads or tails of the study methodology.

Four: It focuses on breast cancer to the exclusion of other concerns

This study does not take into account the balance between length of life and quality of life. Breast cancer is just one risk women face as we age, and is not even the leading cause of death.

Estrogen is one of our best and most studied treatments for osteoporosis and may well protect women from heart disease and those at risk of Alzheimer’s disease.

Most importantly, for women with significant symptoms in menopause, estrogen can be life (and sanity) saving. As always, we need to look at the whole woman when making hormone decisions, as she is more than her breasts.

Professor Michael Baum, a leading breast cancer researcher in London, released a long statement about the study. This is a portion of that response, excerpted from Dr. Bluming’s letter on the subject:

“I think the press release put out by The Lancet is irresponsible and will undoubtedly lead to a drop in the use of HRT/ERT, plunging thousands of women into a life of misery and for all we know shorten the lives of millions around the world. Remember there are more important threats to women’s lives than breast cancer, which is now only 7th in the league whilst those higher up the league might increase as a result of the withdrawal of oestrogen replacement therapy. “˜Statistical significance’ does not always translate into “˜clinical significance.'”

As much as the WHI study published in 2017 had flaws in methodology and the conclusions it made, the data from that study are still better and more reliable than the associations made in this more-recent publication.

The WHI, in the end, showed estrogen replacement alone to be protective for breast cancer (even when started late in menopause) and the estrogen and progesterone arm had a slightly higher rate of breast cancer, but not a difference that was statistically significant (which means mathematically it could be a chance or incorrect finding). It is a randomized trial that showed hormones to be overall safe for women if used correctly.

At Gennev we believe every woman has a right to valid data and information when making a personal decision about whether hormones are right for her. We try to provide a balanced interpretation of complex medical studies. We also try to reach out to other experts to see what they have to say.

On balance, this latest publication in The Lancet probably does not add much to the conversation around hormones, except to stoke fear.

Rebecca Dunsmoor-Su, MD MSCE NCMP
Chief Medical Officer, gennev.com

Want to learn more or discuss HRT with other women? Join our community forums and be part of the conversation!