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“Hot flashes, night sweats, anxiety, headaches, menopausal acne, joint pain, and brand-new belly fat during menopause? BRING IT ON!” said no woman. EVER.

And yet, if we are fortunate to live long enough, we women are guaranteed to go through menopause at some point along the way, and many of us will endure at least some of these of these symptoms at perimenopause and menopause.

Erratic and dropping estrogen is the primary culprit behind many menopause symptoms. Before reproduction shuts down for good at around age 51, rises and dips in hormone levels are responsible for the emotional and physical roller coaster ride many women experience, starting as early as their mid-30s.

The effectiveness of birth control pills

One way to manage many perimenopausal symptoms may be a treatment you thought you were done with: the Pill.* Because hormonal birth control provides estrogen at an even, predictable rate, the Pill can smooth the dips and peaks of fluctuations and balance out the hormones you’re losing.

For many women, hormonal birth control is an escape (maybe temporary and incomplete, but still an escape) from some of the more disruptive symptoms of perimenopause and menopause. If you’re having a hard time of it, and are a good candidate for hormonal birth control (no abnormal clot risk, not a smoker, etc.), a few years on the Pill might be a good way to go.

Why should you use birth control pills for perimenopause?

NOTE: As Dr. Sherry told us about birth control delaying menopause, if you’re still having periods, erratic or otherwise, you can still get pregnant. So if you engage in intercourse with men, some sort of birth control is called for. After teens, perimenopausal women have the second highest rate of unintended pregnancies. Remember, however, that the Pill does NOT reduce your risk of sexually transmitted diseases like herpes, so please continue to use condoms. 

The pluses

Low-dose birth control pills can help ease the perimenopause transition for many women by regulating hormones. This can reduce hot flashes, ease mood swings, lessen the menstrual flow, regulate erratic periods, and lessen the impact of endometriosis. According to Harvard Health, birth control pills may also reduce vaginal dryness and prevent bone loss, all while protecting you from endometrial and ovarian cancers and those unintended pregnancies. And, WebMD adds, low-dose birth control pills may also help stave off colorectal cancer.

Want to try birth control for menopause symptoms? A Gennev menopause-certified gynecologist can give you a trusted opinion, determine if medication is right for you, and provide prescription support. Book an appointment with a doctor here.

Risks of low-dose birth control

Because the amount of hormones is so low, and because current formulations of the Pill are safer than previous versions, there are fewer side effects and risks to fear. Studies show low-dose birth control doesn’t cause weight gain, and vascular issues like deep-vein thrombosis and stroke aren’t generally an issue for women over 35 who don’t smoke.

The minuses: The risk of increased breast cancer is still a subject of some debate, particularly when it involves women who are older (possibly because they started with the riskier, higher-dose oral contraceptives that were available when they were younger) or who have a family history of breast cancer.

Migraines may worsen with hormonal birth control, and the possibility of blood clots does still exist for some. Pills containing estrogen are not advised for those at risk of cardiovascular disease or hypertension or for those who smoke. Finally, research is being done to determine if birth control pills contribute to vaginal atrophy and painful sex. For more info, check out our podcast with Rachel Gelman, DPT, PT, of the Pelvic Health and Rehabilitation Center on the effects of birth control.

And because the rates of STDs among the over-50 crowd are increasing (thanks, perhaps, to the advent of that little blue pill), we’ll remind you again: the Pill does not protect against sexually transmitted diseases such as herpes, gonorrhea, genital warts, or HIV. Continue to use a barrier method such as condoms to reduce your risk of an STD.

When can I go off birth control?

Because the Pill can mask menopause symptoms, a woman on mixed-hormone oral contraception may not know she’s completed the transition to menopause. There are many hormone menopause tests available. Getting an FSH (follicle-stimulating hormone) test during a break from taking the Pill may help a woman and her OB/GYN determine where she is in her menopause journey. 

When a woman goes off the Pill to get a sense of her cycles (or lack thereof), some research indicates that may be a good time for her to transition from oral contraceptives to HRT (hormone replacement therapy), if she decides to go that route.

There are natural ways to manage menopause symptoms that are highly effective for some women. There are also lifestyle choices or foods to eat for a healthier gut that can make life during this challenging time easier. If you prefer not to take the hormonal route, or can’t because of an increased risk of breast or other cancers, you’re not out of luck. We highly recommend you talk with a Gennev Registered Dietitian Nutritionist. They have special training in ways to mitigate menopause symptoms through nutrition, exercise, stress management, sleep hygiene strategies and more. 

Book a personal consultation with a menopause specialist.

Do your research and reach out for help

And for some women, there are birth control pills for perimenopause symptoms. There are risks to oral contraceptives, higher for some women than others, so please as do your research, talk to your doctor or one of ours, to make sure the information you’re getting is recent and reliable.

But as always, there is no need (and no medal that we know of) for suffering in silence. Reach out and talk with a menopause doctor OB/GYN or Dietitian at our menopause clinic  to find the solution that works best for your lifestyle, medical history, and current situation.

*The information in this blog is for educational purposes only. To understand your potential risks and benefits, talk to a doctor.

 

“Every woman that reaches middle age will experience some level of menopause symptoms. Left untreated, these symptoms can lead to a significant reduction in quality of life,” says Gennev Chief Medical Officer, OB/GYN Dr. Rebecca Dunsmoor-Su.

And because none of the 1.3 million American women who enter menopause each year will have exactly the same experience as another “” and because two women can have vastly different experiences “” there’s never been a real attempt to chart the journey through the transition.

Until now.

Recently we crossed a major milestone here at Gennev: 50,000 women have taken our Menopause Assessment! Created in 2017 by Dr. Dunsmoor-Su, the comprehensive Gennev Menopause Assessment asks women for information about their age, menstrual cycles, symptoms, and history.

Based on women’s responses and Dr. Dunsmoor-Su’s 20+ years of expertise as an OB/GYN with special expertise in menopause, we identified five distinct menopause types. From there, Dr. Dunsmoor-Su, along with our CEO Jill Angelo, created the first-of-its-kind Menopause Journey Map.

Why the map for menopause stages matters

Why is the map a big deal? According to Dr. Dunsmoor-Su, “We’re excited to deliver the Menopause Journey Map to help set expectations for women and offer predictive solutions for symptom relief, something that’s never been done before.”

If you’re a Type 1 (periods becoming irregular, occasional hot flashes), it might be very helpful to know what probably lies ahead in Type 2 (skipping periods, heavy periods, some hot flashes, poor sleep). You can start making lifestyle changes now to combat symptoms, and perhaps the first time you experience normal, harmless, hormonal heart palpitations, you’ll know how to distinguish them from something more serious.

Perimenopause is an opportunity to start practicing some serious self-care in terms of diet, exercise, sleep hygiene, and more. But many women miss a lot of this window, not knowing the symptoms they’re experiencing are hormonal. And if your primary physician isn’t well-educated on menopause (as many aren’t), they may not know either.

Too many women spend years being misdiagnosed, or worse, ignored, before getting the answers they need. But because our health in perimenopause can affect our longer-term, post-menopausal health (think brain, bones, and heart), it’s important that we know when we’re in it.

And no, your getting hormone levels tested probably won’t tell you.

Hear more about the map from the creator of the Menopause Assessment, Dr. Rebecca Dunsmoor-Su:

What are the Menopause Types?

Our Menopause Map breaks menopause into 5 types. (A detailed overview of Menopause Types is available here):

Knowing your symptoms and cycles is the best way of pinpointing your place in the journey, but to truly understand your body, it helps to discuss your experience with a menopause expert.

Know where you are in the journey

Cliché or not, knowledge truly is power as the power to take control: To manage perimenopause and menopause symptoms now, and to make good choices to preserve your health, independence, and quality of life for the many decades that come after menopause.

“For too long, women’s health 40+ has been treated as shameful, but with GenX women aging into midlife, demands for menopause information, community, and solutions are on the rise,” says Jill Angelo, co-founder and CEO of Gennev. “The healthcare industry has been stubborn to evolve, but now we have the data, software, diagnostics, products, and services that allow us to tackle menopause symptoms head on. We have the ability to create the What to Expect When You’re Expecting for menopause.”

If you’re ready to find out your Menopause Type and start charting your path on the Menopause Journey Map, the first step is to take the Gennev Menopause Assessment. This free and confidential questionnaire takes less than 10 minutes.

Once your Assessment is complete, you’ll be directed to create a free account on Gennev. From your personal, confidential dashboard, you can learn all about your menopause type, get product recommendations specific to your symptoms, find educational materials tailored for you, and connect with a Health Coach or OB/GYN. Then, with your Gennev menopause team, you can build the plan that’s right for you.

The definition of menopause is actually really simple: it’s just one day. Menopause is the one-year anniversary of your last period. This is perhaps the only thing about menopause that’s “simple.” But menopause doesn’t have to be unpleasant or something to dread. With knowledge and a Menopause Plan, you can survive and thrive through the transition and for many many years beyond.

 

Menopause Journey Map

 

If you struggled to button your jeans this morning, you are NOT alone. Most women gain about a pound a year on average during the menopause transition.  While that doesn’t sound like a lot, the big issue is where those pounds are suddenly going””right to your belly! Belly fat is such a common occurrence that there’s even a name for it, the menopot. Unfortunately, it isn’t just a problem when you’re trying to zip up your jeans, extra weight in this area can lead to a host of health problems.

Belly fat & menopause: What’s happening?

During childbearing years, the hips, thighs, and butt were likely the go-to spots when you gained weight. But once perimenopause arrives, your middle is more likely to be expanding. Estrogen directs fat to the lower body early in life to support childbearing. When estrogen declines, fat instead migrates to the abdominal area, similar to the pattern in which men gain weight.

The location of the fat isn’t the only difference. Weight gained in the hip, thigh, and butt areas is usually subcutaneous, right below the skin. But when you start packing on pounds in your midsection, the fat builds up deeper and around your organs. This fat, called visceral fat, appears to be more active than surface fat, releasing substances, affecting hormones, and increasing your risk of high cholesterol, heart disease, diabetes, and even cancer. According to a study in the Journal of the American Heart Association, women with more central body fat had a 10 to 20 percent greater risk of having a heart attack during the seven-year study than women with more overall body fat. A widening waistline can even be risky if you’re otherwise a healthy weight.

Vanity aside, it’s smart””possibly even lifesaving””to take steps to manage your midsection.

What to do about belly fat

Don’t worry, you won’t have to do dozens of crunches. It’s impossible to spot reduce. Instead, a comprehensive approach to all-over weight loss is your best strategy for shrinking your belly and protecting yourself against future health problems. Here are some additional steps that may target belly fat.

Eat more fiber, especially the soluble kind. This type dissolves in water to form a gel-like substance that helps to lower cholesterol and glucose levels. It also appears to help keep belly fat at bay. For every 10-gram increase in soluble fiber, there was a four percent decrease in the accumulation of abdominal fat, according to a study in the journal, Obesity. Good sources include oatmeal, oat cereals, barley, beans, nuts, lentils, peas, apples, blueberries, oranges, Brussel sprouts, and sweet potatoes. Fiber also helps by filling you up for fewer calories and improving digestion.

Kick up the intensity. All exercise is good for your health and body weight, but pushing yourself a bit could help slim down your middle. When researchers tracked over 1,000 adults for five years, they discovered that those who did some type of vigorous exercise””think jogging, jumping rope, fast cycling, speedy walking””at least a few times a week accumulated less belly fat than those who rarely or never got their heart rate cranking. An easy way to up your intensity is by adding short intervals to your usual workout.  So, if you normally walk for exercise, speed up or jog for 30 to 60 seconds, then recover for a minute or two, and repeat throughout your workout. Increasing the speed of any activity or adding some impact””if your joints don’t mind””will ratchet up the intensity.

Skip the cocktails, or at least limit them. Drinking alcohol has been linked to a larger waistline, though it’s not exactly clear why those Cosmo calories seem to be drawn to your middle. Most drinks are high in calories, contain a lot of sugar, and often contribute to poor food choice when you’re indulging.

Pick up some dumbbells. If you’re not strength training, you’re losing vital muscle mass that fuels your metabolism. The decline can start in your 30s and means that you’re burning fewer calories. No wonder it’s harder to lose weight and easier to gain it as you get older. But lifting weight, using resistance bands, or doing body weight exercises like pushups can curb the loss and even rebuild some of the lost muscle. And according to research, it can help shrink belly fat. And just two or three workouts a week will do the trick. You can even pump out some reps while your binge watching your favorite show.

Find a way to chill. We know, we sound like a broken record. But, when you’re stressed, your body pumps out higher levels of the stress hormone cortisol. One of the effects””there are many negative ones“”of increased cortisol appears to be a bigger belly. The good news is there’s no right way to relax so pick what works for you. Walk. Meditate. Listen to relaxing music. Take some deep breaths. Do yoga. Sit on the couch and stroke your dog or cat.

Most importantly, stick with these healthy habits. Because visceral fat is so deep you may not notice the changes right away, but research has found that even if you don’t drop any pounds, you’re reducing your risk of future health problems.

When to get help for belly fat

A large waistline puts you at risk for metabolic syndrome, a cluster of symptoms that can lead to heart disease, type 2 diabetes, stroke, and other health problems. If you have any of these related symptoms or are taking medication for any of them, you should see a doctor.

Increased belly fat is also a primary risk factor for insulin resistance””a precursor to diabetes, and a warning flag for heart disease, stroke, fatty liver, and vascular disease.

Other warning signs that should prompt a call to your doctor:

We can help you manage belly fat

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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.

From Gennev CEO, Jill Angelo…

A couple of weeks ago, I wrote to you about Gennev’s position on hormone replacement therapy (HRT).

I heard from many of you about your personal stories of using hormone therapy effectively to combat menopause symptoms. From others, I heard concerns.

And that’s OK.

Our health is not a quick decision. What we do know is that there is no one-size-fits-all for women’s health in midlife.

In the last week, a new observational study hit the wire from Finland about HRT and Alzheimer’s. The researchers looked at outcomes involving nearly 85,000 postmenopausal Finnish women and found that those who had taken hormones long-term (like 10+ years) had a very small increased risk for Alzheimer’s.

Note the word “postmenopausal.” This study was done with women 65 years and older.

 

 

Immediately, I reached out to sources I trust most, and here’s what they had to say.

Dr. Rebecca Dunsmoor-Su, M.D. and Gennev’s Director of Health and resident ob/gyn, breaks down the study in terms we can understand. Mind you, she’s also an epidemiologist who is schooled on the virtue of broad observational studies such as the one in Finland versus the randomized approach most medical studies prefer.

In summary Dr Rebecca says, “”¦ this study does not increase my worry about prescribing HRT for my patients.”

Dr. Lisa Mosconi, PhD, Director of the Women’s Brain Initiative and Associate Director of the Alzheimer’s Prevention Clinic at Weill Cornell Medical College (WCMC)/New York-Presbyterian Hospital, weighed in with a simple comment, “I think this article only confirms what we already knew as initiating HRT after menopause doesn’t work and can actually increase risk of dementia in women who are older than 60, in part because of an increased risk of ischemia (part of your body not getting enough blood and oxygen).”

According to CNN, “The study’s authors say the results cannot show a cause-and-effect relationship between the use of hormones and an increased risk of Alzheimer’s. That’s partly because the study was not able to capture age and other risk factors for comparison, such as genetic risk for Alzheimer’s, diabetes and cardiovascular disease.” And the BBC warns women to “”¦not be alarmed.”

We asked Dr. Lisa Savage, MD and ob/gyn and new guest blogger for Gennev, to give us the 101 on HRT application forms. For me personally, this review grounded me like no other.

We’ve explored HRT for a number of menopause symptoms, for longer-term issues like heart disease, and for as you guessed it as Alzheimer’s and dementia.

We’ve even taken head-on your questions about HRT versus bio-identical hormone replacement therapy (BHRT) in a recorded webinar with Dr. Rebecca Dunsmoor-Su. And we’ve given you a straightforward perspective on testing hormone levels.

Gennev is seeking the truth on HRT, and it’s our intention to bring you credible, tested, and trusted opinions on this topic. With less than 7% of women in menopause getting the help they need to manage symptoms, we believe HRT is a viable option for more women than it serves.

I’ve labored on now twice in the past month about hormone therapy, so I will give it a rest (for awhile).

If you have questions and concerns about whether or not HRT is the right treatment for you, there is no better place than Gennev’s community forum or our private 1:1 practitioner appointments to get your questions answered by experts you can trust.

As always, if you have comments or recommendations for future topics you’d like me to weigh in on, please email me directly at jill@gennev.com.

Have a great weekend!

Jill

 

When hormone levels change, it seems like your whole body changes, doesn’t it?

This is especially true for women with diabetes who are entering the beginning stages of menopause, perimenopause. True still and again for pre-diabetic women entering the same life transition. Hormones have a whole lot to do with both menopause and diabetes, and it’s baffling at times to navigate new symptoms and identify what they are in your body, in addition to living your busy, awesome life.

A concern for the undiagnosed

In 2015, of the 30.3 million adults who had diabetes, 23.1 million were diagnosed, and the remaining 7.2 million were undiagnosed. 

What will serve you through this is your awareness and attention to what is going on in your body.

If a new diagnosis of diabetes coincides with the onset of menopause, you may be navigating some similar symptoms. For instance, you may experience a symptom of foggy thinking both menopausally and diabetically. The element to zoom in on might be to determine if and/or when there is a difference in it being a diabetic symptom vs a menopause symptom. So much is new, and not much is fun. 

Still, staying informed and aware of symptoms and changes in your body is where your power lies in making good choices and taking good care of yourself. We do recommend talking with your doctor and getting your blood sugar levels checked, especially if your risk is higher for diabetes.

A few of the main symptoms in common

 

What else will help?

Whether you’ve been diagnosed with pre-diabetes, diabetes, or menopause (or not), there are a few things you can do to help your overall health until you talk with your doctor or check in with our telemed team (but please, do talk with a doc. Soon). What can you do? Self-care, support, processing, and testing.

Your health journey is a precious and vibrant part of your life (and quality of life). The attention and care you take to feel better will serve you in both the long and short run. 

We’d love to hear your experience – both the good and the challenging – around diabetes, pre-diabetes, menopause”¦ life!

Join us in the Community for shared knowledge, wisdom, and support.

 

“Estrogen dominance” may sound like the crowd at a showing of Wonder Woman, but it’s actually a fairly common hormonal experience among women in perimenopause and menopause, according to Nicole Negron, Women’s Health Consultant.

Estrogen is a wonderful thing: it helps regulate women’s cycles, it increases the feel-good chemicals in our brains, it helps build strong bones, keeps skin elastic, and helps hearts stay healthy. With all those good benefits, you’d think, the more estrogen the merrier; bring it on!

You know what they say about “too much of a good thing,” right?

Nicole Negron

Estrogen dominance happens when estrogen levels are too high relative to progesterone levels in the body. And according to Nicole Negron, certified Integrative Women’s Health, Nutrition, and Lifestyle Consultant, it can cause a host of discomforts, including a decreased sex drive, insomnia, difficulty articulating thoughts “¦ sound familiar?

Spoiler alert: according to Nicole, estrogen dominance “is a direct result of the foods we eat, the products we use, stress, poor sleep, and other environmental circumstances.” Because these factors are within our control, she says, this challenging hormonal experience can be managed through better nutrition and stress management. The menopause clinic team at Gennev will break it down for you. Read on!

What causes estrogen dominance?

During a menstrual cycle, in the two weeks before a woman’s period, her estrogen levels go on a steady rise. The body is preparing a soft landing for an egg, and to increase the chances of fertilization, all that extra estrogen works to line the uterus but also to amp up a woman’s sexual thoughts and bump up her energy and confidence.

If the egg isn’t fertilized, the rich uterine lining is shed (that’s a period), estrogen levels drop, the estrogen floating around in there is swept out, and the body starts prepping for next month.

Estrogen dominance, Nicole says, is when that extra estrogen doesn’t get eliminated properly. And that starts with a bad balance in the gut.

If your gut biome (the living bacteria in your intestines that help you digest your food along with a whole lot of other stuff) isn’t healthy, it doesn’t clear estrogen from the body the way it should. And because modern women get extra estrogen from food and from the environment, not only are we not sweeping out what we’ve already got, we’re adding to the problem.

(learn more about your gut biome and how food, stress, inflammation, and health are all connected)

Even more, stress exacerbates estrogen dominance, so the higher and more sustained the stress levels, the more severe the estrogen dominance symptoms will likely be. How many women do you know living stress-free lives?

Estrogen Dominance Symptoms

The symptoms look a lot like standard perimenopause/menopause symptoms: limp libido, irregular periods, mood swings, breast tenderness, cold hands and feet, hair loss, bloating. These can start as early as the mid-30s and continue for 10-15 years.

Signs of estrogen dominance

However, Nicole warns, women shouldn’t ignore their symptoms or try to simply suffer through them. Estrogen dominance has been linked to autoimmune disorders such as Hashimoto’s syndrome, arthritis, Grave’s disease, lupus, and others, some of which can be life-threatening if left untreated.

How to reverse estrogen dominance naturally?*

You convinced me. So, how do I reverse estrogen dominance naturally? Here’s what we recommend.

First task: get diagnosed

Your gynecologist should be able to test your estrogen levels to determine if they’re high or otherwise problematic. However, Nicole says, many women return a “normal” result even if their levels are high, so if you feel something is wrong, get a second opinion and start the lifestyle changes that (a) are healthy anyway, and (b) can help reduce estrogen levels naturally. Estrogen imbalance is common, but isn’t always obvious.

Second task: test yourself (or even better, get a specialist like Nicole to test you).

It’s possible that high estrogen can be traced back to food sensitivities that cause leaky gut syndrome, weakening the biome responsible for sweeping estrogen from the body. Nicole suggests a food protocol of removing the usual suspects for sensitivities: wheat, gluten, sugar (that’s a biggie), corn, possibly eggs. Eating free of these for 2 as 3 months, then gradually reintroducing them one at a time can help you identify culprits.

Third task: Estrogen Dominance Diet

Add in gut-friendly foods that decrease estrogen. Fermented foods are great for healing the gut and intestinal lining and sweeping extra estrogen, Nicole says. Kefir, kimchee, sauerkraut, and kombucha with no added sugar are great pre- and probiotics that can support a healthy, diverse biome.

(looking for local kombucha or other gut-friendly foods? (try your local farmers’ market)

Fourth task: leverage the nutritional value of food

Lots and lots of leafy greens, grilled or baked veggies, lean proteins, and no refined carbs or added sugars. If you’re still having a period, you can even plan your food to account for the body changes that come with your cycle. During the two weeks before the period when the body is ramping up estrogen, cut back on bread, dairy, and other foods that dump sugar into the blood stream and overtax the liver.

Fifth task: manage stress

We know, we know “¦ easier said than done, but since not feeling well is a major stressor, it’s worth it to try to reduce stress where you can. Get regular exercise. Sleep (and that means for reals turning off the devices well before bedtime. Bonus: you can start getting through that stack of books on the nightstand). Embrace the glory of “no.”

Sixth task: detox your environment

Xenoestrogens (“foreign” estrogens, i.e. not created by the body) can contribute to estrogen dominance, so getting them out of your home and food is critical. Look for natural shampoos, soaps, cosmetics, etc. Eat organic food, look for “phthalate-free” plastics. The DC-based advocacy initiative Environmental Working Group has a list of products it believes to be safe, which is a good place to start. Wash your hands. Don’t wear outside shoes in the house.

Seventh task: get a Nicole (or someone like her).

Managing hormone levels is really safest and most effective with some expert oversight. Find a functional nutrition specialist like Nicole Negron to help you assess your body, detox your personal spaces, manage stress, and eat right for your biome. Look for someone who specializes in women’s bodies, especially in women over 40.

By the time we reach perimenopause or menopause age, we should be experts at our own bodies, even in times of change, Nicole says. But the modern world often makes women feel they need to consult “professionals” for the facts.

If you need expert guidance to help, a menopause-certified health coach can be helpful. Book 30 minutes for your personal consultation with a health coach.

The truth is, we are the only one in there, and that means we have more information and experience than anyone. It also means we have more control. If your body doesn’t feel right and isn’t performing normally, don’t assume it’s a natural part of aging, or it’s “just menopause.”

“It’s important to tell women, “˜you’re not crazy, you’re hormonal, and that’s OK’.“ Nicole reminds us. “Symptoms are a form of communication, your body’s way of expressing its need for realignment. Once we learn our body’s language, we can begin to build a relationship, trust what we experience, and start making the changes that feel right to us.”

Nicole Negron is a women’s health advocate, educator, and community leader with a passion for brain health, empowering women, and all things nutrition.

Nicole is a Certified Women’s Health and Nutrition Specialist and is on a mission to bring female brain chemistry and hormonal health to the forefront of everyday conversation. She teaches that understanding the correlation between the female brain and the four phases of a women’s cycle is the key to productivity, better health, and better relationships.

Nicole attended the State University of New York (SUNY), where she studied Nutrition, Gynecological and Wellness Studies. Additionally, she studied at the Institute for the Psychology of Eating and the Integrative Pelvic Health Institute.

If you have dealt or are dealing with estrogen dominance (or you think you might be, after reading this), we’d love to hear about it. Tell us your experience in the comments below, or on Gennev’s Facebook page or Midlife & Menopause Solutions, our closed Facebook group.

*The information in this blog is for education only and not meant to replace the advice of a medical professional. Feeling dominated by estrogen? Please as talk to your doctor.

 

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.

 

The experience of menopause differs from woman to woman, but in our conversations with women, one thing seems nearly universal: the more information a woman has, the more in-control she feels over her body and her transition.

Midlife Mojo with Dr. Anna Garrett

The problem? Because menopause is still so taboo, many women struggle to ask questions and get answers.

Dr. Anna Garrett has been a clinical pharmacist for over 20 years, working in a variety of practice settings. Happily for us, she discovered along the way that working with women in midlife is her true passion. Dr. Anna offers her clients a variety of services including hormone balancing, weight loss, and GeneSNP testing. Her health coaching is designed to help women in perimenopause and menopause escape from hormone hell and feel amazing in their bodies so they can rock their mojo through midlife and beyond.

Dr. Anna is a Doctor of Pharmacy and Board Certified Pharmacotherapy Specialist. She is also a Certified Intrinsic Coach , and has studied through the American Academy of Anti-Aging Medicine.

Clearly, Dr. Anna has answers on midlife and menopause. So we asked her some questions.

(We suggest listening to the whole thing, start to finish, then using the time stamps to go back and listen again to those parts that apply most to you.)

1:25
We asked Dr. Anna how she got started on the path of working with women in midlife and menopause. Dr. Anna shared with us how seeing women floundering and not living life to the fullest prompted her to go into practice helping women reclaim their bodies, lives, and selves.

3:40
What do we mean by “hormones,” “hormonal” and “hormone management”? These are kind of important terms to a woman in or approaching menopause, yet most of us are a little unclear on what they really mean. Dr. Anna educates us on hormones, their interactions, and the impacts when they’re out of balance.

6:05
We wanted to understand the difference between traditional HRT (hormone replacement therapy) and B-HRT (bioidentical HRT). So we asked. Dr. Anna tells us what they are, how they differ, when they’re called for, and the “laundry list” of lifestyle changes women should consider first before you go down the HRT road.

8:50
In this part, we asked Dr. Anna to take a little deeper dive into the differences between HRT and B-HRT. She gives us some great details on the risks and benefits and some of the factors to consider if a woman decides to pursue hormone replacement.

11:30
OTC progesterone is available and does have some benefits, but Dr. Anna schools us on the risks of self-medicating without the oversight of a health care professional.

13:12
How do you know if seeing a professional coach/consultant like Dr. Anna could help you? She explains the profile of an “ideal client” as eg someone who is dealing with hormone challenges and is ready to “do the work” necessary to feel better.

14:55
You’re ready to consult someone like Dr. Anna as how do you go about it? What’s that first appointment like, what expectations should you have? Dr. Anna has a range of possible paths to feeling better in your body, depending on where a woman is in her journey, what symptoms she’s experiencing, her financial circumstances and so on.

18:10
Women may not even know that they’re in perimenopause or menopause, and when symptoms are gradual, they may not even realize how poorly they’re feeling compared to how they could feel. Dr. Anna speaks to the issues women face in getting properly diagnosed and treated and offers suggestions how a woman can prepare in the years before midlife to be their own best advocate. Don’t have the joy sucked out of your life when what you’re experiencing can be solved, she advises. Oh, and don’t rely on your Facebook group for an accurate diagnosis and treatment plan.

21:48
Dr. Anna shares stories of women in menopause who got their midlife mojo back.” When hot flashes and body image issues threatened their quality of life, Dr. Anna helped them get balance and perspective back.

24:14
I’m sold, let’s work together as so what does that look like? Dr. Anna talks about why she thinks six months is the right amount of time to do the serious work of getting your body balance as and your mojo as back on track. And because hormone fluctuations know no borders, Dr. Anna talks a little bit about how and why she set up her business to be able to help women globally.

27:00
Dr. Anna takes on the issue of shame surrounding menopause and aging. “It’s not like anyone gets to opt out of this!” she says; don’t suffer needlessly, don’t be ashamed, enjoy the wisdom you’ve earned and celebrate this special time of life.

28:36
One piece of advice for listeners? Find someone to reach out to, Dr. Anna says. Your problems can be solved, so don’t suffer them needlessly.

To learn more about as and from! as Dr. Anna, check out her website at drannagarrett.com.

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

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

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

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

What are the dangers to caregivers?

Back pain

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

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

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

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

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

Pelvic floor strain

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

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

Falls

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

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

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

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

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

Emotional burn-out

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

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

Make it easier on you

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

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

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

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

 

The more consistently you walk, the more benefits you’ll reap. That’s why it’s so important to minimize your risk for injury and make walking as comfortable and enjoyable as possible. Since walking is low-impact, it’s already a low-risk activity, but how you walk, and what you do when you’re walking, can raise or lower your risk of getting hurt or developing aches and pains. Here are seven dos and don’ts that will help keep you on your feet and walking strong.

Don’t walk with weights. The thinking is that you’ll burn more calories by swinging dumbbells as you walk. In theory, it seems reasonable. The heavier you are the more calories you burn. But when researchers put this strategy to the test, walking with three-pound weights didn’t increase calorie burn compared to walking at the same speed without weights. The only thing it upped was the effort, according to the study in the Journal of Exercise Rehabilitation. In addition, swinging a weight could set you up for wrist, elbow, shoulder, or even neck problems. Instead, leave the weights at home and pick up your pace. You’ll burn more calories as well as improve your heart function. If you’re carrying weights in hopes of toning your arms, you’ll get more definition by using heavier weights before or after your walk. Bottom line: there are more risks than benefits of walking with weights.

Do warm up. This may seem obvious, but when your time is limited, it’s all too easy to immediately kick it into high gear. The result can be burning muscles, gasping breaths, and possibly even an injury. Instead, start at a slower pace to feel better and prepare your body for activity. Muscles get warm and more pliable so you’re less likely to strain them. More nutrient-rich, oxygenated blood is pumped to working muscles to fuel them for better performance. More lubricants are produced in your joints, so they move more freely and have a greater range of motion. In a review of 32 studies, 80 percent of the studies found that warming up first improved performance.

Don’t bounce. Up and down movement is common when you bound off of the ground while running. But, when you’re walking, you want to think about directing all of your energy forward for a speedier, more efficient stride. Ask a friend to watch you while you walk (or have them videotape you). If you’re bouncing, your head will be going up and down, and all that vertical motion increases impact on your joints. Instead, you want your head to stay level as you walk, which will minimize impact on your joints even as you walk faster. To do that, keep your front leg straight, but not locked, as you land and until your foot is under your body. Also, avoid landing flat-footed, and instead roll from your heel to the ball of your foot and toes.

Do posture checks while walking. Maintaining good posture allows your arms and legs to swing more smoothly, your chest to open up so you can take deeper breaths, and your vertebrae to be properly stacked which can prevent backaches. A great way to realign your posture mid-walk is by doing a shirt pull, an exercise I learned from walking coach Suki Munsell, Ph.D. Cross your wrists in front of you as if you’re getting ready to take off your shirt. Raise your arms as if you’re pulling a shirt up and off (but don’t actually do it). As you reach up, lengthen your spine. Then let your arms float down to your sides as your shoulders drop away from your ears. Repeat every 10 minutes or so, or anytime you feel like you’re slouching or notice any aches or stiffness.

Don’t walk the same way all the time. You may not notice the slight variations in roads and sidewalks that can alter body mechanics. For example, many are sloped to allow for water runoff which means one leg may be slightly higher than the other. Or you may always turn your head to the same side to talk with a friend as you walk. Over time, little alterations like these may make you more prone to injuries or problems because of muscle tension or imbalances. Instead, occasionally change direction, take different routes, and alter positions as you walk. This can help to keep you more physically balanced and prevent mental boredom.

Do stretch after a walk. This is when your body is primed for traditional static stretching, the kind where you hold the stretch. Stretching when your muscles are warmed up and your joints are loose after a walk helps to keep you flexible and increase your range of motion. It’s also a relaxing way to wind down after a vigorous walk.  

Don’t ignore aches and pains. The sooner you address any issue the less likely you’ll end up being sidelined. Some discomfort like muscle fatigue or a little post-workout stiffness or muscle soreness is normal, but in general, exercise should not hurt.  Feel a blister starting? Apply moleskin or a bandage to prevent it. Notice rubbing under your arms or between your thighs? Apply petroleum jelly or a lubricant like BodyGlide to prevent chafing. Achy low back? Check your posture. For more persistent problems, talk to an appropriate doctor: podiatrists for foot problems, orthopedists for joint issues, or physiatrists (also known as physical medicine and rehabilitation doctors) for any issues impairing your activity level. The sooner you remedy problems the quicker you’ll be back to walking regularly, and the stronger you’ll be.

Join Gennev and get moving

Join the Get Moving Walking Program for Women to receive two 30-day walking programs designed by women for women, support from certified fitness instructors and health coaches, special offers and incentives. Always check with your physician before beginning any new exercise program.   

We can help you be your best self

Partner with a Gennev Dietitian for actionable solutions and the support you need to keep moving in midlife and menopause. Learn how to get started with a walking program, the nutrition and supplements your body needs, how to maximize your sleep routine, manage symptoms with actionable lifestyle changes and more. 

Meet with a Gennev Doctor – our board-certified physicians are menopause specialists. They will listen to understand your symptoms, answer your questions and develop a treatment plan that is personalized for you.

 

 

Pelvic pain during sex, pain from the pelvic region generally, incontinence, prolapse as these do NOT have to be your “new normal.” There are treatments out there to help you manage, even solve, many of the issues related to pelvic floor dysfunction.

One solution might mean taking a long look at your choice of birth control “¦.

Rachel Gelman DPT is a clinical specialist and branch director at the Pelvic Health and Rehabilitation Center in San Francisco. She specializes in the physical therapy management of numerous pelvic pain disorders, including bowel, bladder and sexual dysfunction. We talked with her about some of the sources of pelvic pain, including the surprising news that hormonal birth control may be part of the problem.

If you have pelvic pain, 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.

1:27 What’s your approach to pelvic pain?

Rachel says she deals with pain from the “ribcage to the knees,” specifically focusing on the internal muscles of the pelvic floor. We asked her exactly what that meant. The list is surprisingly long as clearly this part of the body is responsible for a heck of a lot and needs proper care and attention.

3:13 How do hormones impact our pelvic health or cause pelvic pain?

Rachel also focuses a lot on the impact of hormones on that part of the body. Given that midlife and menopause are a time of enormous hormonal changes, we wanted to understand that better. Rachel explained to us how the sensitive tissue of the vagina and surrounding area are affected by estrogen, progesterone, and testosterone.

(Here’s a fun way to increase pelvic health: get yourself an Elvie)

6:06 “No good birth control method” as what do you mean?

So, what does that mean for women who take hormonal birth control? Especially women who’ve been on the Pill for a long time? Rachel says there’s no truly perfect birth control; oral contraceptives are effective, but it increases sex hormone binding globulen. The take away: the Pill can negatively impact some very sensitive tissue, so if you have a choice, consider carefully when choosing it as your contraceptive method.

8:44 Please explain pain in the vestibular tissue?

So, what exactly is vestibular tissue, and why is it so impactful if this area is inflamed or otherwise unhealthy? Rachel gives us a sort of private-area map and explains the consequences of hormone imbalance here and what can be done about it.

10:52 How can you tell where pelvic pain comes from?

So, we asked, how do you know when pain is caused by hormonal imbalance as opposed to some other concern? You have to look at all the puzzle pieces, Rachel says; she takes us through how she puts them together to figure out what’s going on and how to fix it.

14:43 How do patients find you?

How do patients find you? Is it mostly by referral? She gets a lot of referrals, Rachel says, from ob/gyns, urologists, etc., but a lot of patients simply find her on the Internet. So, shortcut Dr. Internet: if you’re having a particular problem and not getting a solution from the doctor you’re seeing, ask for a referral to a specialist.

15:50 Is age a factor in pelvic pain?

Do you see more older women, or do you see these patients more often? Her practice is pretty evenly distributed, Rachel says, because pelvic issues aren’t limited to age, but yeah, no surprise: age does have impacts as hormones change. So if you’re getting older and have never seen a pelvic specialist, it might be time: avoid problems in the future by being proactive!

17:29 What should patients be doing between visits? Is there anything they can do?

What kind of self-care should women be doing between visits to a specialist like Rachel? It depends on where you are, Rachel says; are you already in pain and need help relaxing or releasing? She gives her patients things to do between visits to help them learn to treat themselves, and that’s a Very Good Thing.

18:19 So “¦ about that Squatty Potty “¦.

“We as humans were not meant to sit on the toilet to have a bowel movement.” Ooooookkaaaaaay. Not giving it up. Just sayin’. Fortunately, says Rachel, there are ways to adopt the optimal BM position without resorting to squatting in the woods. Phew! She explains why not excreting correctly can actually be pretty bad for you.

(speaking of toilets, do you know how much urination is normal for you?)

20:10 Before we let you go, what else should we know?

“Kegels are not the answer to everything,” Rachel says. They can be good for you, but they don’t solve every issue. Best not to self-diagnose a kegel deficiency as if you’re having problems with painful sex, incontinence, bowel dysfunction, there’s help, there are resources. Seek them out and get your standard of living back.

If you’ve had issues with pelvic pain or other issues related to pelvic dysfunction, would you share with us how you managed it? Let us know in the comments below, or hit us up on Gennev’s Facebook page or Midlife & Menopause Solutions, Gennev’s Facebook group.

More about Dr. Rachel Gelman: Rachel is a Bay Area native who received her bachelor’s degree in Biology from the University of Washington in Seattle and her Doctorate in Physical Therapy from Samuel Merritt University. As you heard in the podcast, she’s passionate about women’s and men’s health and strives to promote quality education regarding pelvic health both in the clinic and in the community. We appreciate her sharing her wisdom and expertise with us!

You can follow Rachel directly @RachelgDPT on Twitter.