One of the problems Gennev is out to solve is the lack of information many women run up against when they try to research some strange new thing their body is doing. (Cold flashes in menopause? Who knew those even existed?!)

One concern we hear about from women is bleeding months or even years after a woman is in full menopause. Bleeding after menopause, like many things in midlife bodies, is probably not caused by anything dangerous. However, any bleeding after menopause isn’t normal and can signal something more serious.

We talked to Dr. Jessie Marrs of the Swedish Cancer Institute. Board-certified in obstetrics and gynecology with a special interest in women in menopause, Dr. Jessie was able to give us some very comprehensive answers to some very important questions.

What is post-menopausal bleeding?

Dr. Jessie: First, let’s start with a definition so we all know we are on the same page. When someone goes through menopause, it essentially means their menses have stopped.

Women are considered “menopausal” when they have had no period for an entire year. This definition is important because it also helps us define post-menopausal bleeding which can have some important implications.

Why does post-menopausal bleeding happen?

Dr. Jessie: Post-menopausal bleeding (PMB) can happen for a variety of reasons. Sometimes it is from tearing of the vaginal tissues after intercourse. It can happen because of polyps or fibroids in the cervix or uterus.

Some women will develop such a thin lining of the uterus after menopause that they can bleed a little bit. Medications, such as hormone replacement therapy, anticoagulants or tamoxifen can also cause bleeding after menopause.

Occasionally it is related to pre-cancer or cancer of the lining of the uterus.  This is obviously the thing we worry most about. The good news is, cancer of the uterine lining (endometrial cancer) generally presents early with vaginal bleeding and is often curable. This is why it is important to see your doctor if you have any bleeding after menopause.

If you are bleeding after menopause, 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.

What is the most common cause of bleeding after menopause?

Dr. Jessie: About 40 percent of bleeding after menopause is caused by non-cancerous polyps in the lining of the uterus. The second most common cause is vaginal atrophy or thinning of the uterine lining. 

How can I distinguish more serious issues from spotting after menopause for other reasons (post-coital tearing, etc.)? Are there other warning signs?

Dr. Jessie: It can be very challenging to distinguish pre-cancer or cancer of the uterus from other causes without an exam. Things like weight loss, pain or persistent bleeding are more likely with advanced cancers.

Bleeding without any other symptoms can be a sign of early cancer. Because of this, I don’t recommend trying to decide for yourself where your bleeding is coming from. It is always worth seeing your doctor for this issue.

Can fibroids cause bleeding after menopause?

Dr. Jessie: Yes, although this is unusual. Most fibroids shrink after menopause and become less symptomatic than they were prior to menopause.

Fibroids that are pushing in to the cavity of the uterus can certainly cause post-menopausal bleeding, but I usually see this in patients who are in their early 50s; they think they are not menopausal because they continue to bleed, but the bleeding is actually coming from the fibroid and not a hormonal cycle.

I don’t usually see bleeding from fibroids starting up when a woman is already well in to menopause. If you know you have fibroids and are having bleeding after menopause, I would definitely recommend a visit to your doctor rather than writing the symptoms off as coming from the fibroids. Very rarely, women can develop a fibroid-related uterine cancer called a sarcoma.

Is any post-menopausal discharge normal?

Dr. Jessie: Most women develop some level of vaginal dryness after menopause. This is related to the decreasing hormonal effect of estrogen can create vaginal issues and changes and effect tissues. Some discharge can still be normal, particularly if it is white, clear or creamy in texture. Copious amounts of watery discharge, bloody, or even brown- or pink-tinged discharge would be considered abnormal.

Does it matter how far after menopause you are? Say, six months post-meno as opposed to six years?

Dr. Jessie: It doesn’t. Post-menopausal bleeding can be an indicator for abnormal cells in the uterine lining at any point after menopause. While there are probably more benign conditions that can cause some vaginal bleeding the closer you are to menopause (including a late burst of hormone from the ovaries), if you have gone a full year without a period, you need to get in to see your doctor.

I have spotting after menopause on my underwear; what do I do?

Dr. Jessie: Please call your doctor and make an appointment. As long as the bleeding is minimal, this is not an emergency, but I like to get patients in for this problem within the next week. While seeing your gynecologist is generally not as fun as, say, buying some new shoes (yes, that is my weakness), the work up for post-menopausal bleeding is pretty straight forward and can bring some peace of mind.

Does it matter if it’s heavy or light? Is just a little spotting OK?

Dr. Jessie: Great question, I frequently have patients delay seeing me for bleeding after menopause because it was a small amount. Even the smallest amount of vaginal bleeding after menopause is considered abnormal and deserves a work up.

What will the doctor do if I tell her I have post-menopausal bleeding?

Dr. Jessie: When you come in to the office for bleeding after menopause, your doctor will take a thorough history to get a better idea where the bleeding might be coming from. She will do a physical exam and inspect the vulva, vagina and cervix to look for a potential source of the bleeding. She’ll also do a pelvic exam to see if the uterus feels enlarged or the ovaries feel abnormal.

Because PMB is a warning sign for pre-cancer or cancer of the lining of the uterus, even if she finds a likely cause during the exam, your doctor will do some sort of an evaluation of the lining of the uterus. This may be an ultrasound to determine the thickness of the lining or it may be a biopsy of the lining of the uterus.

Can I wait and see if it happens again before going to my doc?

Dr. Jessie: Please don’t wait! It is very likely that your bleeding is nothing to worry about and just a nuisance, but occasionally it can be a sign of something more serious. It is always worth a check-up!

If you’re experiencing post-menopausal bleeding, please follow Dr. Jessie’s advice and schedule an appointment right away. If you don’t have an ob/gyn, you book a virtual appointment at Gennev Telehealth. If you’ve dealt with PMB, what caused it and how did you deal with it? Please share with the community: leave us a comment below, or talk to us on our Facebook page or in Midlife & Menopause Solutions, our closed Facebook group.

Douching, according to the US Department of Health and Human Services, is “washing or cleaning out the vagina with water or other mixtures of fluids.”

Douching, according to most of the women’s health professionals we’ve talked to (and HHS), is generally not a good idea.

Why do women douche?

Douching has been around for centuries, originally employed as a contraceptive method after sex (it doesn’t work) or as protection against infection (no good for that either). The idea of douching as a cleansing method is relatively recent. Retailers in the US had been claiming their product “cleaned” since as early as the 1920s, but still the focus was on contraception.

However, when the birth control pill became widely available and socially acceptable, douche producers had to find another way to sell their product. Marketing teams then changed their sales pitch to women to focus on “freshness” and hygiene.

As many as one in five women in the US uses douches, and the practice is most common among teenage girls and Latina and African American women. The reasons given for douching are to cleanse and refresh, particularly after a period or after sex; to control vaginal odor; and to prevent or manage bacterial vaginosis.

Does douching work? Should you do it?

While douching may temporarily cover up vaginal odor, the answer to the question “Does douching work?” is pretty overwhelmingly “no.”

Bacterial vaginosis – BV is a vaginal infection that occurs when the good Lactobacilli bacteria are overwhelmed by anaerobic bacteria and Gardnerella vaginalis. All these organisms are normally found in the vagina, but sometimes the proportions get out of balance, resulting in infection.

One of the symptoms of BV is a fishy odor, so women may use douches to attempt to counteract the odor. Unfortunately, douching can make matters worse by helping to spread the bacteria up into the uterus, fallopian tubes, and ovaries.

Using douches to prevent BV doesn’t work either; douching upsets the normal bacterial balance and the healthy pH of the vagina, so it actually makes BV more likely rather than less.

Odor – Some vaginal odor is totally normal and healthy, and that odor may change as you move through your cycle, exercise, or engage in sexual activity. So first, let’s dismiss the myth that the vagina should be odorless or smell of strawberries and sunshine. It shouldn’t, and trying to force it to can lead to actual health problems.

A change in odor can result from several things: if you think you have an infection such as BV or trichomoniasis (an STD) or a yeast infection, you need to talk with a doctor. Douching won’t solve or prevent any of these and may well make them much worse.

Your period or menopause can cause changes in vaginal odor. Your period is actually your body’s natural cleansing process as the uterine lining is shed, so douching after is wholly unnecessary. Menopause can change the vagina’s pH and cause a change in odor. Topical estrogen may help with this, but as always when adding hormones, you should discuss the pros and cons with your doctor.

Exercise and diet – Exercise and diet can both affect vaginal odor. You’re familiar with asparagus pee? Well, welcome to broccoli vagina. Strongly scented foods can actually translate to a change in vaginal odor, so tracking what you eat and eliminating affecting foods can help. Equally, exercise can increase odor in the groin, just as it does in the armpits. Be sure to change out of sweaty exercise clothes right away, and if you feel you must “cleanse,” stick to the external parts of your lady bits and use a pH-balanced product like Gennev’s Ultra-Gentle Body Wash or Cleansing Cloth Vagina Wipes.

Cleanse and refresh – The idea that the vaginal area requires special “cleansing” comes more from our societal squeamishness about a woman’s body as and the desire of douche producers to make money asthan it comes from any real need. Douching, many wipes, and feminine shampoos and sprays can destroy healthy bacteria and even change your body’s natural pH, allowing the bad bacteria to overwhelm the good.

How douching causes problems

Instead of solving problems, douching can actively cause them, often resulting in the same problems women were hoping to avoid, namely infection, odor, and discharge. It can also impact fertility.

According to Dr. Lora Shahine, MD, FACOG at Pacific NW Fertility, “The vagina has a natural balance of bacteria, proteins, and more that get altered with douching. This can lead to overgrowth of certain organisms and lead to a higher risk of infection.

“Douching can also decrease chances of conception by decreasing the amount of cervical mucus that helps sperm gets through the cervix on their way to fertilized eggs.” So if you’re trying to get pregnant, douching can interfere.

According to research by Jenny L Martino and Dr. Sten Vermund, douching has been associated with a higher risk of infection and higher risk of pelvic inflammatory disease, BV, cervical cancer, fertility and pregnancy concerns, HIV transmission, STDs, ectopic pregnancy (where the fertilized egg attaches in the fallopian tube rather than continuing to the uterus), recurrent and vulvovaginal candidiasis. It can also contribute to a higher rate of urinary tract infections (UTIs).

Removing the natural vaginal flora by douching leaves the body vulnerable; forcing infections and bacteria further up into the body can complicate and worsen existing issues. In some cases, douching can actually be quite dangerous: in women who douche more than once a week, there appears to be an increased risk of cervical cancer.

When is douching a good or useful practice?

There are times when douching serves a useful purpose. Trans women who have had vaginoplasty may find that douching helps manage post-operative healing, for example. For the most part, however, douching is an unnecessary practice that says more about society’s stigmas around the female body than it does about your personal hygiene.

When to see a doctor about vaginal changes

If you’re experiencing a change in your vaginal odor that is strong and persistent, especially if it comes with a thicker discharge, you need to make an appointment with your ob/gyn. These can be indicators of an infection such as gonorrhea, BV, yeast vaginitis, or even a forgotten tampon or contraceptive sponge. Your doctor will be able to diagnose the issue and set you on the right course of treatment.

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.

In Part 1 of our conversation with neuroscientist Dr. Lisa Mosconi, we learned about the connection between estrogen, menopause, and Alzheimer’s.

In short, in perimenopause and menopause, as estrogen declines, women lose some of the neuroprotective advantages of the hormone, making them more vulnerable to Alzheimer’s disease.

Make sure to listen to Part 1 to get grounded in the science. In Part 2, Dr. Mosconi lets us in on how we can help protect our brains from the cognitive decline of Alzheimer’s. Food, exercise, intellectual stimulation all have a part to play, so you’re going to want to hear what Dr. Mosconi has to say. (Bonus: a lot of these tips can help men age better, too.)

If you want to start nourishing your brain against age-related decline (“eating for retirement,” as Dr. Mosconi puts it), get your hands on a copy of her fascinating and very readable book, Brain Food: the Surprising Science of Eating for Cognitive Power.

What does nutrition have to do with our brains?

Jill:  So, we talked a lot about HRT and estrogen and the power of hormones. But for those women who can’t as you obviously have done a lot of work in this area as well, and you’ve recently released a book, titled Brain Food: The Surprising Science of Eating for Cognitive Power, and this starts to address the alternative, I think, if you will. I really want to hear more about the book.

Dr. Lisa:  I’m a neuroscientist and also a nutritionist, and I find that there is a lot of confusion around healthy diets, especially diets for the brain. So I decided to write the book as a scientist’s answer to all those questions. Like, is it true that some foods can really affect our brain performance and impact our mental capacities? Is it true that diet influences risk of Alzheimer’s as we get older? Is it true that high-fat diets are great for you and for your mental performance? Is it true, is it true, is it true”¦ I get a lot of these questions, and I thought: well, I can write another several papers in scientific journals and nobody will read them; or I can write a book for the public that is based on solid, peer-reviewed research and hopefully provide some clarity. That’s really the purpose of the book.

And the reason I did it is, number one, it’s part of my research. I’ve been working in the field, I’ve been looking, I’ve been researching brain nutrition for at least 10 years, I think, at this point. We use brain imaging techniques to really look at the effects of diet on the brain in real-time, because most research was done before brain imaging techniques even became available. And so, what people would do was to measure diet now, and then wait 10 years to see if somebody would get Alzheimer’s or mild cognitive impairment or show any signs of cognitive decline and then try and correlate that with diet. But that’s kind of bypassing the brain. So our question was: well, what’s happening in the brain that’s really related to your diet?

So that was my research and I think it “¦ it is still my research, I’m still doing it. It’s really important, because as a society we are comfortable with the idea that we eat for our bodies, but we’re not as aware that we feed our brains as well.

And I think it’s really important that we spend a little less time focusing on the immediate present, like, “ok, I need to slim down for the wedding,” “I need to go out on a date,” “I need to prepare for summer” as that’s usually why you change your diet, but I think we should also really start thinking about our future and focus on the fact that some foods and nutrients can help us age gracefully and keep our mental capacities intact. Whereas other foods will have the opposite effect and really increase the risk of dementia and cognitive deterioration down the line.

So, in a way, the same way that we would like to save for the retirement, we should also start eating for retirement. And that’s what I wanted to share.

So what should we eat to fuel our brains?

Jill:  Oh, I love that as eating for retirement! So, I obviously want you to sell more books and I don’t want you to give it away, but of course, I”¦ I’m going to ask two questions. I’m going to say: what should we eat to prevent or to fuel our brains? And what do we want to stay away from? And I’m sure there’s so much more in the book that’s covering all of this. You’re not going to totally give away the punchline, but please share.

Dr. Lisa:  Sure, no, gladly! So, what should we eat? I think because we’re doing this podcast about women, I would like to focus on what women should eat as well. There are, of course, foods that are helpful to both men and women. And I think, in general, it sounds intuitive. The problem is that just so many people don’t do that.

We should all really, really focus on fresh vegetables and fruit, fish, healthy, unrefined oils, healthy sources of glucose, which is really important for the brain, because the brain runs on glucose. And also drink water. I find something that so many people underestimate is the impact that water has on brain function.

So, the brain is made of water. 80% of the brain’s content is actually water. And every single chemical reaction that happens in the brain needs water to occur, including energy production. So, if you don’t have water or you don’t have enough, your brain will just not be able to make energy.

And this is really important to understand, because even a minimal loss of water, like 2% reduction, which is not even clinical dehydration, it’s just a very mild dehydration as it can actually cause neurological symptoms, like brain fog, confusion, fatigue, hormonal dizziness and even worse. Brain imaging studies have shown that people who are just mildly dehydrated show brain shrinkage as compared to those who are well-hydrated. You don’t want your brain to shrink.

Jill:  Right, no, absolutely not! And water is easily attainable.

Dr. Lisa:  And what is even more important is to talk about the quality of the water. Because I had so many people come up to me and say, “hey, I’m drinking water right now.” And I say, “hey, that is purified water.” That’s not water as it does not have any minerals, it does not have any electrolytes. That is not water, it’s just fluids. It will not help you at all. And some of my friends will be like, “oh, but I’m drinking club soda or seltzer,” that’s not water. It’s not water. It does not contain the nutrients that keep you and your brain hydrated.

Tap water should be accessible to a lot of people. I understand, in many parts of the country, it’s just not good. So, it needs to be filtered. If you filter your water, you have to take supplements as mineral supplements and electrolytes. It’s really, really important!

Specifically, for women there’s evidence that women, more than men, really need plants in their diet. Especially if you are menopausal or you’re in your 40s. There are some foods that really support production of estrogen in the body. And that could help.

There are some foods that actually contain phytoestrogens. And phytoestrogens are estrogens from plants. The really interesting thing, if you’re a scientist, about hormones, is that they go cross-species. So, hormones that are made by plants pretty much mimic whatever effects human estrogens have in the body. So, that’s very helpful”¦ you can eat plant-based foods and have more estrogens inside your body or other compounds that mimic the effect of estrogens.

The foods that are helpful specifically to women to support estrogen production would be sesame seeds, flax seeds, chickpeas, all sorts of legumes; many fruits like apricots, strawberries. Veggies like yams, carrots, kale, celery; of course, the soy products. The soybeans are very rich in estrogens in a compound called Genistein, I think, that has a similar function as estrogen inside the body. So, women probably would do well to really up their veggies and fruit in their diets starting from age 40. And even much more so than men.

What should we not eat to protect our brains?

Jill:  What do we want to stay away from?

Dr. Lisa:  We want to stay away from processed foods, fast food, deep-fried foods. And we also want to minimize the amount of animal products in the diet. All these foods, overall, are pro-inflammatory, and they cause inflammation everywhere in the body and the brain. There’s evidence that some ingredients in these foods are especially bad news for the brain, like trans-saturated fats; saturated fat when it’s too much. Copper, as well, for some reason, is really a problem inside the brain.

There’s evidence that people who consume more than 2 grams of trans-saturated fat a day have twice the risk of dementia than people who eat less than 2 grams a day. And 2 grams is not much.

Who has it figured out?

Jill:  That just explains the epidemic nature that you’re projecting in Alzheimer’s, because that is how the American public eats or a large portion of people eat on a regular basis. Have you studied then “¦ obviously if this is so related to diet and diet is very cultural, have you studied the growth and rise of Alzheimer’s amongst the Japanese culture? Because the diet you laid out there, many of those aspects they embrace “¦ lifelong.

Dr. Lisa:   They do and they don’t. Even in Italy “¦ Italy is considered a Mediterranean country, I mean, we are a Mediterranean country. We are known for our diet and our food. But now, whenever I go back to Italy, it’s quite evident that more and more people are actually adopting a Western diet, because it’s more convenient. You know, nobody has time to go to the farm and pick up fresh fruits and veggies and spend 3 hours cooking. And so for convenience they start eating processed foods.

And I don’t remember whether this is in Japan or China, but for Christmas they actually go to KFC. It’s the Christmas special. So culture “¦ unfortunately, diets everywhere are changing for the worse.

So, it’s really interesting I think to look at centenarians as people who are hundred years old or older than that, and they still have their mental capacity intact. In fact, they’re much healthier than all of us put together, basically. There are some longevity hotspots everywhere in the world, they’re called the “Blue Zones.” One is in Italy, in Sardinia; there’s one in Greece; one in Japan, Okinawa as it’s an island of Japan. There’s one in Costa Rica; there’s one in California, actually, Loma Linda. There’s one in China; and in a little town in India. Pretty much everybody there is a centenarian.

And, if you look at their lifestyle, overall, they’re very similar, regardless of whether they are in Italy ,in Japan, in South America as they share common principles. And for diets specifically, all of them follow plant-based diets. They’ll have veggies two or three times a day. They start with a big breakfast and a smaller lunch and just a little bit of something for dinner. They’re high-carbohydrate diets, they’re veggies and fruit, local, fresh, seasonal; and then they’ll have healthy grains and sweet potatoes, potatoes, fish as many of them eat fish. They of course drink water. Occasionally, they’ll have a little bit of alcohol, but it’s made in the house. And animal foods like meat or dairy or eggs, they’re more like treats. And also, sweets are very hard to come by. They’re making it with honey or maple syrup or whatever is local and sweet, but that could be like a Sunday special. I think their diet should be an inspiration to all of us, because they’re clearly doing something right.

Jill:  Do you make any estimations around to what degree could diet minimize the onset of Alzheimer’s?

Dr. Lisa:   I think it’s hard to tell. We need clinical trials to really look into that. But I think, based on the epidemiology, it should have a fairly large impact.

We now have clinical trials that actually show an effect of lifestyle modifications on risk of cognitive decline. There’s a very large study called the FINGER study, it’s done in Finland. And they show that if you take a group of people and really do a complete revamp of their lifestyle and change their diet, the way I’ve been talking about, and you have them exercise consistently, nothing crazy, just consistently, even just walking. You keep them intellectually stimulated and also address cardiovascular risk factors, then those people really improve cognitively over time. There’s a 150% improvement in executive function.

What should we do to stay sharp as we age?

Jill:  So that’s physical. How about mental? You see a lot of new apps and tests and things coming out that if you keep your brain stimulated, you can ward off”¦ I see you rolling your eyes. Tell us more about that, what do you think?

Dr. Lisa:   I think there’s evidence that “¦ it’s controversial, it’s controversial. I think that companies have to market their products in a way that makes them very appealing to people and so saying that “this is going to help you avoid Alzheimer’s” is a strong factor in driving sales. I think we need a lot more research to see if playing a little game makes you a little better at the game, or really improves your memory in every aspect of your life. I think that’s a little bit of concern among scientists, that you’re not necessarily improving memory as you’re improving people’s ability to play that particular game, right? And there are clinical trials that show how intellectual stimulation of that kind actually helps. And there are trials that show the exact opposite. So, I think we need more work. It’s wonderful that people are interested in doing that.

But outside of apps and games, there is actually evidence from very large-scale studies that intellectual stimulation definitely helps. You need to exercise your brain, it’s like a muscle. You either use it or lose it. Connections between neurons are only strong if you keep them linked together. We have this saying in the neuroscience that “neurons that wire together, fire together.” Keeping your brain intellectually stimulated is actually really good for you.

These studies are, again, in France and Italy, but they show that if you’re like”¦ I think the average age there is between 50 and 75, so people who keep intellectually stimulated by playing board games show very low rates of decline to dementia, as compared to people who never play board games. Even playing cards or Scrabble, and that kind of board games as they really keep you engaged and intellectually stimulated and also have a social component. They keep you part of the community. It looks like being part of a community and the sense of belonging is also preventative against dementia. Just feeling supported and loved as I know it sounds a little strange or corny, but it’s true.

Jill:  And I think, it’s important to note the difference between board games or intellectually “¦ keeping your brain active and its correlation to dementia versus its correlation to Alzheimer’s.

Dr. Lisa:  Dementia is basically a larger and broader term that includes many different kinds of pathologies. Alzheimer’s is the most common form of dementia, but there are other forms of dementia as well, like vascular dementia is very prevalent; Parkinson’s disease with dementia, frontotemporal dementia, Lewy body dementia as there are many different forms, but most people with dementia actually have Alzheimer’s or a combination of Alzheimer’s and something else.

What are the most important steps I need to take?

Jill:  I could keep this conversation going forever; I don’t want it to come to an end, but like every good thing, we’re going to wrap this up. And I hope to continue down a few different lines in the future with you, Lisa. But as a closing note, what would your advice be? I’m a 44-year-old woman. What is your advice to me in terms”¦? Obviously, I heard diet, but what do you recommend, in terms of me taking control of my health and “eating for retirement” and thinking about protecting my brain as I head into menopause myself?

Dr. Lisa:  I think everyone one of us would really benefit for a very complete evaluation. I think this is a good time to get a baseline that really looks at every aspect of your health and not just your diet as although, of course, diet is very important as but also your sleep quality or your exercise activity levels, that’s also very important in women to prevent osteoporosis and heart disease as we get older.

Stress as are you stressed out, are you not? Because stress really increases inflammation everywhere in the body; actually, seriously increases risk of cardiovascular events. How much coffee do you drink? Do you take medications? What’s your family history? Also, since we are talking about women and fertility, I think it would be really important to find a doctor, preferably a neurologist who also understands hormones, or an endocrinologist or OB/GYN who also understands brains. Otherwise, find more than one doctor so that you really get all the support that you can get.

Or, come to the clinic, since this is exactly what we are doing. So, we just started a study on women’s health and Alzheimer’s risk, and that’s exactly what we offer. And it’s a research study, so it’s free.

You know, get a baseline. Just really look at everything you can possibly look, so that you have it. And then you can check if there are any changes as you get older and you go through these different stages in your life. I, personally, I want to get a brain scan.

Jill:  I think you’ve made all of us want to get a brain scan, at this point. Well, Lisa, this has been, I think, riveting, in terms of the knowledge that you are bringing to the world, and I’m such a fan of your work. Thank you for what you’re doing. Thank you for joining us today.

Dr. Lisa:  Thank you so much for having me as real pleasure.

Life is nothing if not the opportunity to continuously learn about, well, anything you’re interested in, especially yourself. In our ongoing quest to help answer questions around the hormonal journey, we thought it would be fun to test your menopause knowledge. A fun test? Absolutely, because this one provides helpful clarification around some of the common questions you might have. And, afterall, knowledge is power.

Get ready. Get set. Let’s take the Gennev team’s 10 Question Menopause Quiz!

If you are dealing with unbearable symptoms, a Gennev menopause-certified gynecologist can give you a trusted opinion, determine if medication is right for you, and they can provide prescription support. Book an appointment with a doctor here.

The 10 Question Quiz For Menopause

1. Should you continue to use birth control even if the frequency of your periods decreases?
2. Does the arrival of perimenopause mean no more PMS?
3. What’s the average age for menopause to begin?
4. Could smoking bring menopause on sooner? 
5. Is it true that soy products may help alleviate some menopause symptoms?
6. Are there any mammals that experience menopause?
7. Is there a test that will confirm the onset of perimenopause?
8. “Manopause.” Does it exist?
9. Are there natural medicinal alternatives that may help with perimenopause and menopausal symptoms?
10. Will menopause spell the end of my sex life?

Answers

1. True! Until you’ve gone a full year with no periods (which is the definition of “menopause”), you may still be fertile, so continue using birth control because you may still get pregnant until your one-year meno-versary (and yes, we just made that term up). Also, you should probably check in with your doctor if your periods are changing in any way.*
2. Wouldn’t that be awesome? But it’s false. The onset of perimenopause may actually make PMS symptoms worse for a while. Irregular ovulation, fluctuating hormones–even perhaps our lessening ability to deal with PMS because of perimenopausal symptoms–all contribute to this fact. Talk to your doctor* about treatments that can help relieve some of the symptoms of PMS.
3. The average age of menopause is 51 for women in the US. If you chose 42, that’s probably because it’s the answer to life, the universe, and everything. It’s just not the answer to this question. It is important to note, though, that this is just an average. We’re all individuals, and our hormonal journeys will be unique to us.
4. Smoking can cause menopause to start as much as two years sooner. While two extra period-free years may sound like a bonus, it’s important to remember that estrogen protects us from many health concerns. Two extra years of no periods can also mean two years of increased bone loss and increased risk of heart disease, Alzheimer’s, diabetes, and some kinds of cancer.
5. Soy lovers rejoice: It’s true! Certain plants such as soy contain phytoestrogens which can mimic some of the behavior of women’s natural estrogen. Eating tofu, edamame, miso, and tempeh may help reduce hot flashes and other menopausal symptoms. However, there are potential drawbacks to over-consumption of soy. Soy can lead to a possible higher risk of breast cancer, so, as always, talk to your doctor.*
6. Orcas also experience menopause, and we think the ocean sounds like the perfect place to be during a hot flash, frankly. Scientists theorize one reason orcas and human women cease reproduction relatively early in their lives is because the community benefits more from their wisdom than their reproduction. We think society can benefit from women’s wisdom any time in their lives. Probably pods, too.
7. While most women assume menopause is the reason for their symptoms and don’t get a formal diagnosis, it is possible to determine onset of menopause by taking a test. A blood test can determine if FSH””the follicle stimulating hormone””is at menopausal levels. Women with a history of thyroid issues may want to be tested to be sure the issues they’re experiencing are menopause or perimenopause and not due to thyroid malfunction.
8. “Manopause” (OK, it’s actually “andropause” but come on, “manopause” is much funnier) is actually a decrease in the male sexual hormone testosterone. Defined as “a syndrome associated with a decrease in sexual satisfaction or a decline in a feeling of general well-being with low levels of testosterone in older men,” this hormonal decline happens much more gradually than the drop off in estrogen in women, and therefore symptoms are usually less dramatic. So yes, it’s true that men experience hormonal changes, too–though we’re not willing to go so far as to say their experience is on par with what a woman goes through in menopause.
9. Very true! Many women report great success in managing a variety of menopausal symptoms through the use of natural medicine. You may lower menopause symptoms through acupuncture, herbal supplements, and meditation. And it’s entirely possible that one of the above or many of the options not mentioned will help you. As always, though, check with your doctor before exploring any options outside of what you’re currently using to manage your perimenopausal or menopausal symptoms.*
10. False, though you’re going to have to work a bit harder to keep sex fun, easy, and something you’re just as interested in as you were before menopause. Don’t settle for a sexless marriage in menopause. Changes in hormones can make for painful sex, so you’ll be investigating various lubes, sex toys (we recommend you try the Lionness Vibrator), and such to see what helps. Also, your desire for sex may wane, so more homework may be required to identify erotic options that stimulate both your mind and your body. Honestly, though, can tht even be called homework? We think not.

How did you do?

8 as 10 correct: You are a Hot Flash! (in a good way)

Menopause holds few mysteries for you. Go forth and spread your wisdom to the uneducated masses. You probably give menopausal colleagues tiny fans for their desks and bring your special, hot-flash-relieving soy-slaw to every office picnic. You are adored. Bask in your awesomeness.

4 – 7 correct: Congratulations, Menomaven!

Your knowledge of menopause, while not perfect, exceeds most folks’, and for that you should be proud. We’re guessing what you don’t know, you’re always willing to learn and share, and you are probably the office go-to for resources. You don’t shy away from hormone conversations and can say the word “vaginal” in public. Celebrate your greatness.

1 – 3 correct: So, just FYI, “menarche” is not the queen of England.

(It’s actually the onset of periods.) So, you’ve got a few gaps. Who doesn’t? Having the facts on menopause and women’s hormonal journeys generally can increase understanding, empathy, and all manner of good things. You’re here on this blog, taking this quiz, so we can only believe you know that and are bumping up your meno-smarts as we speak. And for that, we thank you.

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

Looking to learn more from your peers? We’d love to hear about your experience, so please share in our  community forums, on our Facebook page, or in Midlife & Menopause Solutions, our closed Facebook group

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

Interested in finding a doctor who specializes in menopause? Didn’t even know they existed? Read our article on not only how to find the best menopause specialist near you.

“I want to go home!” 

“Dad, we are home.”

“I want to go home. I want to go home.”

Being the caregiver for a parent or relative with Alzheimer’s disease (AD) is an emotional rollercoaster with more downs than ups. 

There’s the sadness that comes with watching the smart and funny person you grew up idolizing struggle to make a sandwich. There’s the frustration of never getting a break and knowing it’s only going to get worse. There’s the guilt of wanting to just put them into a home and take a vacation. 

And there’s the fear that your children will one day need to provide the same service for you. 

For many women, a parent’s AD diagnosis coincides with the onset of menopause, adding another layer of stress and concern to an already emotional situation. 

And menopause itself can be a risk for the disease (more on that below in the Alzheimer’s-estrogen connection).

What is Alzheimer’s disease?

If you have a loved one among the 5.8 million Americans living with Alzheimer’s disease, you know that the disease is devastating for both patient and family. By 2050, the number of people with AD is expected to more than double. 

AD is a progressive, degenerative brain disease that affects memory, thinking, and the ability to perform basic tasks. Over time, plaques, protein build-up, and inflammation in the AD patient’s brain destroy the way the signals (called neurotransmitters) move across neurons. Neurons are the cells responsible for memories, thoughts, and emotions. 

There are two forms of AD: early-onset, where symptoms first appear in patients’ 30s to 60s, and the far more common late-onset variety, with symptoms first manifesting in people in their 60s and older.

AD has three stages. In the early (mild) stage, patients display some memory challenges. They may forget something that they just read, misplace an important document, or struggle to remember someone’s name, but more or less can function independently.

In the moderate AD stage, the longest of the three, patients begin to forget more and more significant events in their lives; how to do everyday tasks, where they went to high school, where they are, or what day it is. And, for the most part, can still carry on conversations. Their personality and behavior change: they grow moody, suspicious, and easily confused, and may act in unexpected ways. They often wander and become lost.

In the final stage of AD, patients need around-the-clock care as they lose all understanding of their surroundings, ability to communicate, and, eventually, control over physical functions like walking, sitting, or swallowing, ultimately leading to death.

While the terms “Alzheimer’s” and “dementia” are often used synonymously (and AD is the most common form of dementia), dementia covers any irreversible decline in memory or cognitive function. Dementia is diagnosed after a patient demonstrates two or more areas of cognitive impairment, including disorientation, disorganization, language decline, and memory loss. 

(While we’re on the topic, “senile” is often used pejoratively to describe cognitive decline but is not a medical diagnosis.)

Historically there has been no way to diagnose AD as a patient’s specific form of dementia, beyond a post-mortem autopsy, but amyloid PET scans now offer promise in this area.

The Alzheimer’s and estrogen connection

Age is the primary risk factor for Alzheimer’s, but women develop the disease at twice the rate of men, and it’s not because we live longer (even though we do). Black women have an even higher incidence: twice the rate of white women.

Neuroscientist Dr. Lisa Mosconi (on our advisory board) wanted to know why. 

Dr. Mosconi is the director of the Weill Cornell Women’s Brain Initiative (WBI) and has devoted her career to studying AD after watching women in her family suffer from the disease.

By scanning women’s brains, she’s found a possible connection between the onset of Alzheimer’s and the onset of menopause. Our own CEO Jill Angelo participated in the study. 

Estrogen protects the body against aging and seems to protect the brain against the plaques that lead to Alzheimer’s. 

Dr. Mosconi’s brain scans show Alzheimer’s-related changes in women’s brains may happen between ages 40 and 65: earlier than in men, before symptoms become apparent, and right around the start of menopause. 

As Dr. Mosconi told us in a 2018 interview, “In straight talk: menopause causes metabolic changes in the brain that seem to increase the risk of Alzheimer’s disease.”

So, if you feel like your brain is changing as you go through menopause, it’s not all in your head: it really is.

But don’t panic: plaques in your brain don’t mean you will definitely get AD, but it does mean that there is something there that may cause it. 

How do I reduce my risk?

Early-onset AD is genetic, but only 1% of AD cases are directly linked to genes. Late-onset AD is caused by some combination of genes, environment, lifestyle, and medical factors. In fact, one out of every three cases of AD could be prevented by addressing non-genetic factors.

While not an exhaustive list, the following are some of the biggest ways to reduce your risk. 

• Use it or lose it. Research shows that social contact and mental stimulation keep your brain fit. Grab coffee regularly with your girlfriends, do sudoku puzzles, take a continuing education class, brush up on your Spanish, or read books””whatever you can do to exercise your brain.
• Exercise your body, too. Studies show that regular physical activity is linked to a smaller likelihood of mental decline, as it promotes healthy circulation and production of chemicals that keep the brain healthy.
• They don’t call it “brain food” for nothing: a healthy diet can lower your risk of AD, especially once you hit your 40s. Dr. Mosconi recommends eating plenty of fresh vegetables and fruit, fish, unrefined oils, healthy sources of glucose, and foods that mimic or support estrogen in your body, like sesame seeds, flax seeds, beans, apricots, strawberries, yams, carrots, kale, celery, and soy products. Avoid trans-fats, processed foods, and anything deep-fried, and limit your consumption of animal products; these all cause inflammation in the body and brain. Consuming too much copper and too little zinc may also contribute to heightened AD risk.
• Hydrate! Your brain is 80% water and actually shrinks when you’re dehydrated. Drink plenty of water; tap water is best since it contains the minerals and electrolytes your brain needs to keep your brain running its best. We know many either do not want to (or cannot) drink water directly from the tap, or just prefer filtered water or seltzer. When drinking filtered or seltzer, consider supplementation for those missing elements.
• Mitigate medical factors. Heart and metabolic conditions, such as high blood pressure, stroke, heart disease, obesity, and diabetes, are linked to cognitive decline. 
• Quit smoking. Or whatever form of tobacco you use. Cigarette smoking can lead to early menopause, which means less time with estrogen’s protective benefits. 
• Know your risk. While there is no cure or way to stall the progression of AD, medication and therapy may alleviate some of the symptoms, especially if the diagnosis comes early.
• Minimize stress. Stress is linked to an increased risk of AD. 

What about Hormone Replacement Therapy (HRT)? 

Estrogen replacement therapy may help protect against AD, but also may be linked to reproductive cancers. Dr. Mosconi concludes that more research needs to be done into the source of the hormones, the correct dosage, and breast and ovarian cancer risk factors for each individual entering menopause. Read: our stance on HRT.

If stress is an Alzheimer’s risk, what is caregiving doing to my menopausal brain?

Taking care of a loved one with a life-altering disease is stressful, no way around it. Add hot flashes, fluctuating hormones, and a changing body to the mix and”¦ yowza. 

Make caregiving easier on yourself. It’s never going to be easy, but there is hope. Learn how to prepare your body for the physical requirements of caring for another person with limited control of their own movements. Figure out how the person you are caring for can help you. They may not be able to go to the supermarket, but can they order groceries online? 

Read: Helping caregivers take care of themselves.

Create a welcoming environment for your loved one when they move into your home. The more comfortable they feel, the better you will feel. Read: Preparing your home for a parent with dementia.

Practice self-care. You need to take care of yourself as well as your loved one. Talk to your doctor or a counselor, find a community of women in similar situations. Don’t be afraid to ask for help. In the words of Twin Peaks’ Agent Dale Cooper, “Every day, once a day, give yourself a present:” do one small thing for yourself the first thing in the morning. Read: Self-care for caregivers in menopause.

Burnout is real, but you’re not in this alone. We’d love to hear more about how you and your family are managing, so please feel free to join and share with the Gennev community.

I think we can safely say that 2020 has been an above-average year for just about everyone “” in terms of stress, anyway.

For women dealing with perimenopause and menopause symptoms on top of everything else, the stress can seem unmanageable. And because 2020 has been harder on women, it’s no surprise many women are looking for relief from stress.

One relatively new avenue for many is CBD, the non-hallucinogenic compound found in hemp. While research is still underway, many women have found CBD helps relieve stress and joint pain and promote sleep.

Interview with Aimée Shunney, ND about CBD

In this conversation, Gennev Director of Health Coaching Stasi Kasianchuk talks with naturopathic doctor Aimée Shunney about the potential of CBD and how to choose a CBD supplement that’s high-quality, safe, and contains what it claims on the label.

Take a listen, then check out Gennev’s high-quality CBD supplements, tincture, and Sleep System. 

Have you tried CBD for sleep, or are you considering it? What was the result, or what concerns do you have? We’d love to hear your thoughts, so please share in the Gennev Community forums!

While it may not be menopause-related, viruses are certainly a women’s health issue! And with all the concern around the coronavirus outbreak, we wanted to be sure we addressed it with you. 

Unless you’ve been in a very deep cave or lengthy Netflix binge, you’ve likely heard about the coronavirus. There’s been a lot of very scary coverage of the illness, but is it really worth so much intense focus and concern?

We talked with our Chief Medical Officer Dr. Rebecca Dunsmoor-Su, who, in addition to being an OB/GYN, is also an epidemiologist (epidemiology is the study of diseases in given populations). Here’s what she told us.

What is the coronavirus?

Says Dr. Dunsmoor-Su: The coronavirus is basically just a cold virus. There are lots of coronaviruses, actually; “corona” just describes the shape and format of the virus. We’ve known about multiple coronaviruses for a long time; the most recent version is known as 2019-nCoV.

The concern, according to Dr. Dunsmoor-Su, comes with the viruses that jump from animal to human. When we haven’t seen one before, she says, it raises some concerns because we haven’t had a chance to study it and we don’t know much about it.

“We saw the same panic with the SARS and MERS viruses, when they made the jump from animals to humans. These are all just coronaviruses. And the panic around SARS and MERS turned out to be largely unwarranted. There wasn’t the global pandemic some of the more sensational news outlets were speculating about, and it’s very likely this coronavirus will be the same.”

We asked her where the virus came from. In terms of this one, she tells us, “It probably jumped from animal to human in China, where there’s more active, public trading of live animals than we generally see in the west. We’re not sure yet what animal the virus came from. It’s been speculated that the origin may be bats or pangolins, but we don’t know that for sure.”

Don’t live with fear about physical symptoms: talk to one of Gennev’s telemedicine doctors and get back your peace of mind. 

Should we be concerned about coronavirus?

According to Dr. Dunsmoor-Su: No. This coronavirus is highly infectious because it spreads easily. However, it is what is called a “droplet precautions” illness because it can only spread via droplets of spit or mucus from infected people coughing and sneezing. Droplets from the cough land on a surface which you then touch, picking up the virus, and infect yourself by touching your face or eating before you wash your hands. It’s not aerosolized, so you likely can’t be infected from someone breathing on you.

So”¦.as long as you wash your hands frequently and don’t touch your eyes, nose, or mouth, you can likely avoid getting sick.

Not only is it largely preventable with ordinary precautions, there’s not much opportunity to be exposed, outside a specific region in China. The coronavirus hasn’t been seen much in the US as 3 cases initially, and as of February 11, that number has grown to 13.

But a lot of people are sick

True. But most of them have very mild cases. As of February 11, in China, the numbers are 42,700+ cases and just over 1000 deaths. According to Dr. Dunsmoor-Su, those deaths are largely among people who are elderly, medically fragile, immunocompromised patients. For most people, this is a cold that comes with runny nose, maybe a fever, a cough, etc. The reason some die is because the virus turns into a viral pneumonia in medically fragile people, and viral pneumonia is very hard to treat.

What should I do to protect myself?

First, don’t panic. And don’t let sensational headlines urge you into taking unreasonable measures.

For example, don’t take Tamiflu as that won’t help you avoid contracting the illness.

In truth, says Dr. Dunsmoor-Su, the likelihood of coronavirus becoming a widespread pandemic in the US is very small; it’s being monitored, we know when people come in from that region of China, so we can track them. Also the regions where it is an epidemic are being isolated to keep the virus from spreading.

However, for those who are at risk, if you believe you have been exposed, go see your doctor. There is a test that can detect coronavirus, so ask to be tested for it.

If you have it, the procedure now is to provide supportive care as monitoring symptoms, Tylenol for fevers, keeping an eye on you for breathing issues. If you do have respiratory distress, then go to the doctor and get admitted to the hospital for treatment.

What about a mask, we asked: Is wearing a mask a good idea? You can wear a mask, says Dr. Dunsmoor-Su, but frankly washing your hands is more important. If you touch a doorknob that has the virus on it, then touch your eyes, the mask won’t do you any good. Basically, the mask is a good reminder not to touch your mouth or nose without first washing your hands.

How long can the virus survive on a doorknob? We don’t really know, Dr. Dunsmoor-Su tells us. Most viruses don’t survive long outside a body as maybe just an hour or two. But we don’t know yet for this particular virus. So best practices are to wash or sanitize your hands often and don’t touch your face.

Who is most vulnerable?

Are some folks more prone? Not really. Anyone can catch it, but some just get sicker, says Dr. Dunsmoor-Su. Pregnant women are considered medically fragile because their immune system is suppressed. Children are always medically fragile because their immune systems aren’t as robust as they haven’t been exposed to as many contagions, so they haven’t built up an immune “bank.” Anyone on chemotherapy or biologic immunosuppressant drugs for, say, colitis or arthritis/joint pains, can be at greater risk, as can the elderly.

Reduce your risk of all kinds of problems by eating a healthy diet. Our Menopause Health Coaches can help!

Should I go live on an island?

That depends on the reason. Vacation, sure! To escape the coronavirus? Probably a bit extreme.

Yes, the coronavirus sounds very scary, and there’s a lot of hype around it, but honestly, it’s flu season, which is a much deadlier disease: flu has killed 12,000 people so far this year, Dr. Dunsmoor-Su says, so get your flu shot. If you’re medically fragile or have a weak immune system, you’re much more likely to get it, and you’re much more likely to get sick from it. Flu is airborne, so it can be easier to spread and catch because you can breathe it in.

According to Dr. Dunsmoor-Su, the flu shot doesn’t protect against all strains, but it does protect against the most worrisome strains that are circulating. It might not stop you getting sick, but it will minimize the illness, so you’re likely to have a much easier time of it. So, especially if you’re medically fragile, get your flu shot! And of course, take all the usual precautions of washing your hands, not touching your face, etc. as which, bonus, will help protect you against the coronavirus as well.

Your takeaway re: the coronavirus “” Don’t panic

Panic is not warranted at this point. If you’re going to China, take lots of hand sanitizer, and don’t touch your mouth, nose, or eyes (wear a mask, if that helps you remember).

Yes, the number of the infected continues to rise, but the percentage of those who actually die from the disease is going down. Why the change? Because more people are going to the doctor or hospital with symptoms, and more people are getting tested. It’s likely more people were sick with the coronavirus but assumed they had a normal cold and recovered just fine. Only the worst cases were being seen when the outbreak began.

If you’re sick with a “cold,” here’s how to protect others

If you have a legitimate reason to believe you’ve been exposed to the coronavirus, go to a doctor to get tested. (The Centers for Disease Control request you call your doctor first, to let them know of your exposure and that you’re coming in.)

• If you have upper respiratory problems, go to a doctor.
• If your symptoms are clearly not life-threatening, stay home.
• Cough into your elbow, sleeve, handkerchief, something, so you don’t cough onto things and leave droplets.
• Wash your hands regularly and sanitize when you can’t wash, especially before eating.
• Don’t touch your face (particularly the mucus membranes in your mouth, nose, and eyes).
• If you’re not feeling better within 3 as 5 days, talk with a doc.

Staying informed about the coronavirus is a good idea. But fear and panic really aren’t warranted, even for those who might be considered “medically fragile.” Take good precautions, eat well, get plenty of sleep, drink plenty of water, get your flu shot, and be well!

If you think chatting with others might help you be more at ease about the coronavirus, join the Gennev community forums!

Guest blog from Anne M

What it means to go into menopause early

Going into menopause early means you need to love yourself more and get the medical attention you need, now.

Thirty is the new 20, 40 is the new 30″¦. until it’s not. My 40^th birthday was to be the beginning of fertility treatments and the excitement of planning to be a single mom after years of dating that had proven fruitless. Forty had another surprise in store for me, however, with the abrupt stop of my menses.

There was nothing in my family history that would have predicted this. My mom and aunts had gone into menopause in their late 40s, early 50s, “like normal.” Having started at age 11 and never once missed a month since, I naively, secretly, and happily thought I might have been pregnant from a relationship that had ended the month before when my period stopped.

The next month I had a very light period, however, so I scratched that idea but thought I should see my ob-gyn when the month after that was extremely light (spotty almost) as well.

Hard to forget that day. The ob-gyn came in, did an exam, ran a menopause test, and left. And then came back in. I can still see her face as she told me, somewhat glibly, that I was in menopause. I asked””dumbfounded and shocked”””so, wait, you mean I can’t have babies?” No. “Well, what about having eggs harvested?” “Nope. Too late.” And she left.

Nope, too late

I numbly got dressed, walked out and didn’t go to an ob-gyn doctor again for five years. Denial and rebellion ensued.

My period pretty much stopped immediately, and the menopause hot flashes and urinary tract infections (UTIs) began. The mental head games weren’t fun either, as I dated and battled with how I would tell my boyfriends (another post, another day).

Odd things happened as well””my handwriting that had often been praised as beautiful started to become incoherent. I went to a psychiatrist about my mental fog and he gave me Prozac. Never made the connection. Of course it would have helped had I told him. He never suspected, given my “youth.”

Fast forward to 45. I decided it was time to accept my fate and went to an ob-gyn. While I had been “playing” with some herbal remedies, I still was apprehensive. The doctor I saw was lovely. He recommended hormone therapy as a trial for three months to see if it improved my symptoms and scheduled a bone density test for me that afternoon. I left feeling better, optimistic, and had my test.

At 10 the next morning the nurse called and said the doctor wanted to see me back immediately. I was petrified, thinking maybe I had cancer, an STD, anything. The doctor told me that my bone density was extremely low and that my hormone replacement was no longer a trial but permanent and very necessary for me to maintain supple bones as I grew older. I had the bone mass density of a 63-year-old, at 45.

My five-year, self-imposed menopause denial and consequent medical hiatus was a mistake, and it cost me my health in many regards.

Lessons learned from early onset menopause

You cannot control when your body goes into perimenopause or full-on menopause. What you can do is get educated, re-examine the best time for you to have your own biological children if this is important to you, and understand your body and what you can do to best take care of yourself before, during and after.

1. Realize that not everyone goes through a perimenopause stage. I didn’t. My period was normal the month before it stopped, and no other symptoms were present (that I was aware of) up until the day it stopped.
2. Continue to have regular checkups. Your doctors, health practitioners, holistic shamans are your friends and ready to help.
3. Ask questions. While I had been having regular checkups throughout my 30s, I treated them like I did when I was 18. Get educated about perimenopause.
4. Consider your timeframe for children and plan accordingly””perhaps earlier than you may otherwise have. Even my married friends with kids had trouble conceiving in their 40s. The Hollywood lies we had believed in the 90s weren’t really accurate.
5. Realize that there are some good things””I was the envy of many friends on numerous trips with no cramps or soiled sheets, and many boyfriends were actually pleasantly surprised to not have to deal with a four-day hiatus in our sex lives. Many boyfriends didn’t want children, and therefore my menopause was a non-issue for them.
6. Your body has brought you far and deserves to be taken care of””by you. By the time you reach menopause. you have both been through a lot. Perhaps you had kids, or not, or maybe not as many as you desired. Either way, your body is the vehicle that hosts your beautiful soul, and it needs to be taken care of as you age. Not getting the medical attention you need is not the answer.

Feeling alone in your menopause journey? Work with a Menopause Health Coach. Learn more.

Inflammation, food allergies, and food reactivity are on the rise, making optimal health harder to achieve. We wanted to know why there are so many issues with foods these days, and what people can do to feel better.

Jill sat down with holistic health coach Amanda Giralmo of WellthieLife to talk about food, chronic inflammation, and how we can make better food choices to support our health. Here’s what she learned:

1:11
Discovering our life’s true path often starts with fixing a problem within ourselves. For Amanda Giralmo, founder of Wellthie Life, bringing herself back to health and wholeness after a difficult divorce helped her uncover her passion for leading others to their best selves. She tells us how she found the strength to take that journey.

3:24
Did she feel she needed permission to take that journey, considering it meant taking time off and focusing on herself? We asked her how she came to that very necessary decision.

4:39
The experience brought her to where she is now, helping others as a certified holistic health coach focused on lowering inflammation. So, we asked her, what is inflammation, what causes it, and why is it so bad for us when it becomes “chronic”? Amanda explains the importance of the gut microbiome and how long-term inflammation damages the good bacteria we depend on for optimal health. (Ever heard the expression “leaky gut”?) What are the long-term consequences of inflammation?

9:22
Chronic inflammation caused by eating the wrong foods can be constant, if you consider how often we eat. Fifty million people as at least as suffer an autoimmune disease in the US. Knowing the right foods to eat for our bodies can help us avoid that fate, Amanda says.

10:26
So what are the symptoms? So many people have chronic inflammation due to eating foods they’re sensitive to, so clearly we’re not all as in-tune with our bodies as we should be. How can we know we need to change?

11:49
How does this condition start? Amanda tells us that formation of a healthy gut goes all the way back to how we’re born and our very first food. She also tells us what we do as adults that can cause inflammation besides eating the wrong foods.

14:25
As Amanda knows from her own personal story, stress is a major cause of inflammation. She talks about how stress affects us and what happens when we’re not able to “rest and digest.”

15:25
OK, so we’re chronically inflamed. If that inflammation isn’t reduced or eliminated, what can happen? The consequences can be pretty dire, Amanda warns us. Hear why you want to reduce that inflammation, like, yesterday.

16:17
What’s the difference between a food allergy and a reactivity or sensitivity? Both are signs of chronic inflammation, Amanda tells us, but allergies may be easier to detect. Because sensitivities can be slow and sneaky, we tend to just live with the discomfort for years. Amanda gives us the simple diagnostic.

17:34
Does aging have anything to do with inflammation? Yes, says Amanda, particularly in women, the lack of reproductive hormones makes chronic inflammation more apparent in women in midlife. She tells us the thinking around the intersection between inflammation and menopause.

18:34
Amanda has developed a three-phase program to help her clients eliminate harmful foods from their diet. Through the program, clients heal their bodies by identifying what causes the reactivity and learning to avoid or manage those triggers as with Amanda providing resources, guidance, and support throughout.

20:57
The program takes time to work through: Amanda gives us an idea of how long it typically takes to begin healing the chronic inflammation. And you don’t get to cheat, she warns us: eating a trigger food will set your body back to start.

21:55
It’s not an easy process, but the results can be well worth the effort. Amanda shares with us a client’s experience of losing weight, regaining energy, and generally feeling like embracing life again.

24:40
The role of “coach” gets interesting when the goals are so intensely personal. Amanda tells us about keep clients honest and their need to confess and apologize when they cheat or backslide. “I’m just here to play support and accountability,” Amanda says, “It’s all about what they need to do for themselves.”

25:09
If you need Amanda, how do you find her? The quickest way is by going to her website: wellthielife.com. (It’s a great place to find a whole lot of information, incidentally.) The initial, 50-minute consultation with Amanda is complimentary. It’s important to find a coach who’s a good “fit,” Amanda tells us, so choose your coach carefully.

Many thanks to Amanda for sharing her expertise with us. Also, be sure to check out her Guided Meditation for Beginners, a six-minute start to a better day. You can find her meditation in the sidebar of gennev.com.

Want to learn more about how to eat for optimal health? Check out our podcasts with nutritionist and Food Peace advocate Julie Duffy Dillon: Making Peace with Food and Accepting Your Midlife Body. And don’t miss Michelle Cartmel’s blog on How to Shop the Bulk Aisle to access all the nutrition and remedies for women in midlife and menopause.

If you’ve done a “detox” or otherwise taken on chronic inflammation, we’d love to know what you did and how it worked for you. Tell us about your experience in the comments below, on the Gennev Facebook page, or in Midlife & Menopause Solutions, our closed Facebook group.

There are no words that capture the weight of 2020. But what I can share after hearing from countless women throughout the year is: You. Are. Amazing!

• 1 million women consumed Gennev podcasts, webinars and articles to learn about symptoms, be supported, and get inspired.
• 100,000 of you completed the Menopause Assessment to learn about your place in the journey.
• 80,000 women joined our community to get informed, work with our menopause team of doctors and dietitians, and use products like Vitality, Magnesium and Sleep CBD to find relief for hot flashes, fatigue, sleeplessness, joint pain, and dryness.

Most of all, you did something. You took charge versus your menopause taking charge of you.

And then there is this from one of our HealthFix members, who shared it with her Gennev health coach this week…

Menopause is hard, but living is in the journey.

When women commit to caring for themselves, and seeking help, they become a force that no one can hold back.

I know because I’m one of them. Like you, many members of our team are in peri/post menopause and we’re building Gennev for you from the vantage point of menopausal women”¦and we love it!

We challenge you to take care of you in the new year as however big or small that may be as you’ve got this, and we’ve got you.

Happy New Year!

Jill

Best of 2020 in Menopause

These are the 5 most read/listened to resources of the year. Enjoy!

10 Important Vitamins for Menopause Relief

Some basics of nutrition really don’t change: veggies are great, you need fat, and eating the rainbow is still a good idea. We updated our list of nutrients that are good for women in perimenopause and menopause, but the basics remain the same.

Thriving Through Menopocalypse With Amanda Thebe (podcast)

Amanda Thebe was a lifelong athlete and fitness enthusiast, but when she hit perimenopause at 43, things went … awry. Fatigue set in, and she found her previously boundless reserves of energy were drying up. And, like so many of us, she didn’t realize right away that the issues she was having were hormonal.

Supplement Savvy With Dr Wendy Ellis

We’re all looking for ways to optimize our health and especially our immunity “” things we tend to take for granted when we’re feeling good and there isn’t a pandemic going on. 

Gut Health, Immunity, COVID-19, And Menopause (podcast)

One of the most unknown and underrated ways to strengthen your immune response is gut health. Science is only beginning to understand the importance of a healthy gut, including what all the gut does (a lot) and how best to protect and feed it.

Joint Pain and Menopause: Please Pass The Blueberries

Aching fingers, tight hips, sore knees “¦ joint pain is one of the most common symptoms of menopause. If you’re feeling a bit stiff and sore, especiall

To keep hormonal health as balanced and symptom-free as possible, functional nutritionist Nicole Negron starts with the HPA (hypothalamic, pituitary, adrenal) Axis.

This axis is what regulates our stress response system, says Nicole; so if you’re lying in bed at night, unable to sleep because of bills, worries about kids or aging parents, etc., your HPA is responding to that stress.

Your brain (hypothalamus) sends stress signals to the pituitary, which in term triggers the adrenal gland to produce and release more cortisol into the bloodstream.

Cortisol, says Nicole, triggers an inflammatory immune response via inflammatory cytokines. These travel back up and talk to the brain, setting the cycle off again. And inflammation equals heat.

So what can trigger the inflammatory response that can lead to hot flashes?

Stress. This is probably the biggest trigger, Nicole says. Stress starts in the brain, firing off the cycle; it’s also the point where there’s the best opportunity for intervention, because our stressors are often things we have control over.

Controlling triggers in your life

We need to keep the body calm and satiated, Nicole says; this is how we start managing the signals that can set off the hot flash cycle.

Work. Are you where you want to be and doing what you want to be doing? Are you fulfilling your life’s passions and purpose? If not, can you change or find a way to redirect your current job to be closer to your goals?

Family. If you have aging parents or younger kids who need care, are you asking for help when you need it? Says Nicole, many women, including her clients, are wonderful at everything except two critical skills: asking for help, and saying no. Learn to do both of these to make life so much simpler and less stressful.

Partner. Are things good with your spouse or partner, if you have one? Are all your many loads as financial, physical, emotional as being divided equally, or are you taking on more than your share? Can you have a conversation or get therapy to make this relationship a source of strength and not more stress?

Before you turn to a medical intervention, be sure you’re maximizing what Nicole calls the “in-house remedies.” You know what stresses you out; it’s time to do the work to reduce those stressors in favor of reducing hot flashes and supporting long-term good health.

Nutrition and hot flashes, the “no’s”

“People hate me for saying this,” Nicole says, laughing, “but you have to get rid of alcohol, all sugars, and caffeine.”

“It’s about survival. Women wake up in the morning, they don’t have much energy even though they’ve been “˜resting’ for the last several hours. They’re short on time, they’re stressed. But if we’re talking about calming the HPA Axis, you can’t start your day with coffee. One, it’s dehydrating, and two, it’s activating your stress response. Wine is the same, so no wine at night! Alcohol, sugar, and definitely caffeine all can increase the frequency, duration, and intensity of hot flashes.”

Nutrition and hot flashes, the “yes”

Really the question should be, what buffers the stress response? Micronutrients are great, especially if you also have a thyroid condition to consider, says Nicole. Leafy greens are great; cooked if you have difficult digesting or absorbing the nutrients, raw if not. A digestive enzyme might also make the goodness more bio-available.

Selenium is great for supporting your system, so eat a couple of Brazil nuts every day. Many women report feeling better with an increase in foods containing vitamins D and E and Zinc, or adding ashwaganda to their diet.

Phytonutrients: if you have lower estrogen, estrogenic foods can be helpful. Soy foods like tofu, edamame; flax seeds, sweet potatoes as these may have a positive effect.

What else can we do to reduce hot flashes?

Gentle yoga before bed is great for those with night sweats, Nicole says. Think about breathing from the diaphragm, which soothes and calms. Qigong, a type of tai chi, done an hour or so before bed can be very calming to the central nervous system, making it easier to sleep deeply.

Turn off screens, reduce activity and do things that relax the body and mind. No answering emails, no watching TV that hypes up adrenaline. In the two hours before bed, you need to ready your mind and body for rest, so activity, food, and drink all need to support that goal.

If you follow a religious or spiritual practice, that can be very calming. Touch is very nourishing and healthy as well, particularly as we age, so getting a foot or shoulder massage from a loving partner as you discuss your day (the good, calm parts of your day, anyway) may actually reduce night sweats. For those who aren’t partnered, schedule regular massages. Your insurance might even cover it. Finally, as long as you’re not drained all day, every day, an orgasm before bed is great, says Nicole. “And you don’t need anyone else for that.”

Hot flashes can be disruptive to such a level that women even consider leaving their jobs or drastically reduce their social lives to avoid embarrassment. At Gennev we believe there should be no embarrassment around the body’s natural functions, but we understand society hasn’t quite caught up with this notion yet. We also believe women don’t need to suffer in silence as there are remedies that help. You may just have to keep experimenting with different options until you find the solution or combination of solutions that work for you.

Just please, always keep in touch with your doctor about any new lifestyle change, supplement, medication, or practice that could potentially interact with medications or conditions.

If lifestyle and/or nutritional choices have helped you with hot flashes, we’d love to hear what worked for you. Share in the comments below, join the conversation in our community forums, fill us in on Facebook or in Midlife & Menopause Solutions, our closed Facebook group. 

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

In fact, a Gennev menopause-certified gynecologist can give you a trusted opinion, determine if medication is right for you, and they can provide prescription support. Book an appointment with a doctor here.

Do I really need a menopause doctor specialist?

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

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

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

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

What is a menopause specialist?

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

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

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

Questions for your ob/gyn or physician:

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

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

How do I find doctors who treat menopause near me?

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

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

Fortunately, there are resources.

Menopause care via telemedicine

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

Technology is filling the gap for many women.

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

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

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

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

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

Find a menopause specialist

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

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

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

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