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.

Twelve period-less months, symptoms aplenty, and now”¦ now”¦ a future opens up both with and without new possibilities.

Menopause is here. 

Every woman’s life, including her menopause experience, is deeply personal and dynamic. Once the dozen cycle-free months have passed, and a woman enters menopause, her genetic reproduction journey has come to an end. 

For some women, entering menopause may feel like freedom, transformation, even amid the unexpected torrent of hormonal changes, emotions, and physical changes.

For other women, menopause may evoke feelings of sadness. Feelings of loss and grief can be part of the menopausal change and can feel overwhelming, even surreal, and painful. Intensity and frequency of feelings may vary, person-to-person, even day-to-day. 

It’s definitely possible throughout the course of continuing hormonal change that a woman can feel all of these feelings and more as she enters more deeply into this rich part of life. 

In light of Infertility Awareness Week, especially during this unprecedented time of COVID-19, let’s take a look at this important topic together.

A complex life transition

We checked in with Lora Shahine, MD, FACOG (Fellow of the American College of Obstetricians and Gynecologists) with Pacific NW Fertility for her thoughts and insights about menopause and infertility. 

“Menopause is a complex life transition for women with or without a history of infertility. It’s a combination of hormonal shifts, body changes, and emotional changes as often combined with a stage in life full of career, family, and external demands.”

“Menopause means the end of the ability to conceive a genetic child and for many women as this can feel like grief as whether a woman has completed her family building journey or not,” shared Dr. Shahine.  

“This loss can be especially painful for women with a history of infertility. Even if their fertility journey is in the distant past or they have completed their family, Menopause can be a trigger to the emotional toll infertility took in the past. Infertility has been compared to trauma and recovery compared to post-traumatic stress disorder (PTSD).”

Feelings of loss without infertility challenges

Some women may feel a sense of loss at menopause even if they didn’t have a strong desire to have or raise children. Others may feel a sense of bittersweet sadness or sorrow at menopause though they’ve had all the children they had their hearts set on. It may feel surprising, baffling, or even confusing. It is the nature of change, and sometimes change evokes unexpected feelings and emotions.

One woman, Barbara, described her experience for us, 

“When I turned 49 my menstrual cycle came to a halt. Month after month she did not appear. As the year of not having my period was coming closer and I was preparing to step over the threshold into menopause, I started to feel a deep sense of loss and grief. What I realized was I did not take the time during that year to say goodbye, thank her for being in my life, and to bless her.” 

“The day before the year was complete, my period came again. I was gifted another year to be with her and to be present to the process of saying goodbye. It was a rich year, which I am so grateful for. And when the final hour to let her go came, I felt complete and ready to move into what was waiting for me.”

Dr. Shahine encouraged, “Menopause does not have to trigger a negative response as it can help women reflect on their life so far as family, reproduction, and more. Recognizing that this transition can be emotional (positive or negative) is important. Menopause is a transition no matter who it happens to and making space for the emotions, being aware of the emotions that can arise are important.”

Important to note: Risk for depression in menopause

Whether or not depression has been part of her life experience prior to perimenopause or menopause, the risk of depression definitely increases with this transformation. According to Harvard Health Publishing (for Harvard Medical School):

“A woman’s risk of depression doubles or even quadruples during the menopausal transition.” 

Note: This doesn’t mean it’s a guarantee that a woman will develop depression during menopause, only that the risk increases. 

Still, if infertility has been a painful part of a woman’s life experience, an increased risk for depression during menopause may be helpful to know going in.

More support, including primary care Telemedicine: Learn more now.

What if all this is happening now? In the middle of the COVID19 pandemic?

Feeling the feelings of grief and/or depression, navigating changing menopause symptoms, and staying diligent about safety precautions during the coronavirus pandemic is a lot to process. That almost feels like an understatement. A few gentle suggestions to look at:

• Easier with support: Getting practical, emotional, medical support from a menopause expert is easier to access than ever with telemedicine. Our online clinic for women at Gennev offers myriad options, from 1×1 support to podcasts, webinars, and forums. Knowing you’re not alone can offer tremendous relief.
• Easy does it: A forceful, driving pace may not serve your body, mind, or spirit. Consider reflecting on priorities, journaling, talking with your partner and trusted, supportive friends. From work to family to self-care, consider your pace in doing “all the things.”
• Self-care: We’ve written many times how self-care can stave off or diminish menopause symptoms. During this COVID crisis, self-care is proving more important than ever. Nutrition, exercise, drinking water“¦ these are a few of the self-care topics to consider. There are more options for sure, but these are daily self-care tasks to review and continually improve when you feel willing and able. 

For partners, family, and friends of women who are struggling

Our relationships and support systems are critical at this time, both with those in a shared household and outside it.

Shahine notes, “Friends can support women going through menopause by being aware of the emotional piece to this transition, being kind, and encouraging self-care.”

Good insights for all of us, yes? 

If you’re experiencing menopause, feelings of grief or loss, or simply want to connect with other women who are curious about the same things right now, join the community at the Gennev Community Forums.

Turns out, spinach and kale and the like aren’t the only greens that are good for you. Today we’re talking about the health value of the other type of “leafy greens” as actual leaves.

Like, the kind that grow on trees.

Turns out, spending time in nature is healthy. Really healthy. Healthy enough that some doctors are actually prescribing it for patients with attention deficit disorder and anxiety along with many physical health concerns.

“Exposure to non-threatening natural stimuli,” says Aaron Reuben in an article for Outside magazine, “”¦lowers blood pressure, reduces stress-hormone levels, promotes physical healing, bolsters immune-system function, raises self-esteem, improves mood, curtails the need for painkillers, and reduces inflammation.” So as long as there are no bears, a little time in nature can do real good.

Why is nature good for me?  

The world we inhabit most of the time depletes us with its bombardment of sights, sounds, and threats as anything from a near-miss in traffic to a hostile email ramping up our cortisol, triggering the “fight, flight, or freeze” response.  

Nature is restorative, telling the parasympathetic nervous system to hit the “rest and digest” button and enjoy the wind in the trees, the sounds of birdsong, the quiet, the smells, the lack of urgency.

Being outside usually prompts us to do healthy activity, like walking, hiking, biking, gardening, swimming, etc., which is great, obviously. But you don’t have to exercise to benefit. Spending 20 minutes in nature as even sitting in a city park will do as can improve well-being.

Does it really work?

Well enough that insurance companies and health-care providers are beginning to get in the game, with Kaiser Permanente helping to fund park access and upgrades, Humana instituting a program rewards people for spending time outside, and a licensee of Blue Cross Blue Shield offering incentives to clinics willing to write “park prescriptions.”

In 2017, Washington DC pediatrician Dr. Robert Zarr founded Park Rx America, a program that allows health care providers to register as a prescriber of outdoor activity. Non-health care folks can use it to find parks near to them. To date, 220 health care professionals have joined, writing 285 prescriptions.

Menopause and Mother Nature

Women in menopause are often fairly unhappy with Mother Nature, and with good reason. But along with the challenges, nature has given us some substantial gifts.

Time in nature can help relieve some of the worst menopause symptoms.

Anxiety and depression affect many women in perimenopause and menopause, and while lacing up your boots and heading out in the weather may not sound great, nature can provide a significant boost to your mood.

Fatigue is another issue many women fight with in midlife and menopause. It’s likely that fatigue is as much a brain function as a body one, and fighting mental fatigue is one of the things nature does best.

Weight management. Exercise may not be the magic cure for the extra pounds that often come with the menopause transition, but being active can help you manage your weight.

Stress. Nature is an amazing stress reliever. Not only do we get away from stressful triggers, a long walk can actually discourage ruminating on stressful things. We can return to the challenges of life with fresh perspective, possibly greater creativity and problem-solving skills. The stress-reduction power of nature may even extend your life.

Poor sleep. Turns out, spending time in nature may actually help you sleep longer, whether it’s from the increased exercise that often comes from being outside, or the soothing nature of nature itself.

Get lost … in nature

Most of us would acknowledge we feel better after spending time outdoors. Green zones (parks) and blue zones (beaches) can refuel dwindling resources, improve mood, calm us like little else. Unfortunately, not everyone has easy access to natural spaces, and efforts are being made by groups like the National Park Service to make it easier.

National Park Week is April 20 as 28, and park fees are waived on Saturday, April 20, so make a plan to spend some time among the leafy greens.

Freshen up after that awesome nature walk with Gennev Cleansing Cloths. Gentle enough for everyday use.

National Park Rx Day is Sunday, April 28, so find out if there’s a participating park in your area or consider hosting your own. These programs offer great opportunities to learn about parks in your area, hear about the plants and animals you may not be aware of, take tours, do exercises, and more.

It may seem like such a simple thing, but ask yourself: how often do you make the effort to get outside and into a green space, even if it’s only 20 minutes? Is there a park near you where you could walk, eat your lunch on sunny days, take the dog? It could be the magic 20 minutes that make the rest of the day so much easier.

Have you received a “park prescription”? Do you make the effort to spend time in nature, or is it not available to you? Give us a minute and tell us how you feel when you take a walk in the woods. We want to hear about it, so join our community forums, or join the conversations on our Facebook page or in Midlife & Menopause Solutions, our closed Facebook group. 

Sudden hot flashes, poor sleep, wonky irregular periods that lead to no periods, OK, we’re prepared for all of that. But sore feet? No one told us sore feet might be a result of menopause.

If you have sore feet, it may not be entirely due to reduced estrogen, but menopause can certainly play a role. Let’s talk about why your feet hurt and what you can do about it.

What causes foot pain in perimenopause and menopause?

Menopause, with its decline in estrogen, can cause more than pain in your lower back in menopause“”and by that we mean your feet as well. 

Collagen loss is part of the problem. Less estrogen affects collagen production: “Collagen is basically the building block of our musculoskeletal system – bones, muscles, ligaments, tendons and skin. Less collagen synthesis means less elasticity of tendons and skin, constriction of blood vessels, decreased healing, increased risk of developing a soft tissue injury and joint pain.”

Osteopenia and osteoporosis may also play a role. A loss of estrogen after menopause may lead to lower bone density in the feet and consequently a higher risk of stress fractures in the foot.

Plantar fasciitis (heel pain that is worst in the morning) is also common among women in midlife as loss of estrogen affects the elasticity of the thick band of tissue that connects the heel bone to the toes.

Other changes not directly due to estrogen loss can also factor into foot pain: changes in posture due to other injuries or pregnancies, weight gain, compensation for muscle loss or poor balance can affect how we walk or stand and result in pain. Estrogen protects our soft tissues; the loss of it makes soft tissue more vulnerable to injury, inflammation, and pain.

Be aware that gout can happen to women in perimenopause and menopause. Gout pain is very different and usually sudden and severe, so if the pain comes on quickly, talk with a doctor. Gout can also get worse if left untreated, so don’t wait to get help. Plantar fasciitis and collagen loss are generally slow and increase in severity over time. 

Fixes for foot pain in menopause

Low estrogen, osteoporosis, pregnancy posture as is there any way to fix those things? There are, and we strongly suggest talking with a doc or physical therapist about all of these, for your general well-being as well as for your feet.

Here are some things you can do:

1. Get more collagen. Your body makes collagen your whole life, but as we age, that production slows, particularly for women in perimenopause and menopause. Fortunately, you can replace some by eating right. Our menopause specialists suggest eating a combination of protein-rich foods and foods that contain vitamin C, zinc, and copper “” your body creates collagen by combining amino acids, so you can help the process along by making sure all the ingredients are present. If bone broth isn’t your thing, there are menopause supplements available.
2. Manage weight. Reducing weight reduces the impact on your feet, but additionally, since many women gain weight quickly in perimenopause and menopause, that gain can cause women to modify their posture and gait, which can also lead to foot problems.
3. Get out of high heels. Or at the very least, be sure your heels are modified with inserts, foot beds or other cushions. Try to limit the standing and walking you do in heels by bringing along flats or athletic shoes for when you’re up and about.
4. Stretch, tape, and ice your feet. Once you have a diagnosis of what’s actually happening in your feet, some gentle stretches, kinesiology tape, and ice can help manage pain. If you have plantar fasciitis, chances are your feet hurt most in the morning. Some gentle stretches of calf and foot muscles, starting slowly to give your muscles time to warm up are a good idea. 
5. Lace your shoes properly. It sounds ridiculously simple, but for some women, simply lacing shoes differently to avoid pain points is really effective. Shoes come pre-laced from the shop, but like pretty much everything else, our feet are quite unique to us. Harvard Health gives examples for better lacing.
6. Supplements may help. Before opting for surgery or cortisone injections, you might try switching up your diet. Calcium, magnesium vitamins, and vitamin C could be helpful, among other nutritional supplements. CBD supplements for women have also been reported to relieve similar symptoms, and could be worth a shot.
7. Medical interventions. These can include wearing a boot to sleep in that keeps your foot in the proper position, steroid shots to reduce pain, shock-wave therapy to stimulate blood flow, a Tenex procedure to remove scar tissue, and generally as a last resort, surgery.
8. Don’t go barefoot. Supportive shoes that cushion the foot and support your arches will help with foot pain, and there are slippers, sandals, and house shoes now being made with arch support, just for this purpose. 
9. Choose soft surfaces. If you’re a runner or a walker, consider opting for softer surfaces. If you’re a road runner, find a trail to get your miles in (just be careful of falling and/or twisting an ankle). It’s a great way to mix up your training, spend some time in nature, and maybe give your feet a bit of a break.

If you’re an active woman in menopause, don’t let foot pain stop you from staying active, especially as doing less won’t necessarily make your feet hurt less, but it can have a lot of other negative affects on your body and psyche.

If your feet hurt more than usual, it’s best to speak with your physician, and get a referral to a podiatrist or physical therapist who can help you identify what’s going on and get your feet back under you.

A healthy diet—lots of veggies and fruit, lean protein, legumes and beans, healthy fats and carbs—is one of the best ways to manage your hormones and minimize menopausal symptoms. But sometimes you need a little more, like safe, well-tested supplements, to keep your body strong and well. Additionally, your nutrient needs may change as you age, requiring more of some things (protein and calcium) and less of others (iron and folic acid).

Here’s a rundown of 10 key nutrients you want to make sure that you’re getting during menopause from your diet, vitamins, and supplements. When you’re eating right and taking appropriate supplements, you’ll feel more like you’re thriving—instead of battling—through this transition stage of life.

NOTE: You should discuss any changes to your diet with your doctor, particularly if you’re taking medications which may interact. Be sure your doctor has the full list of supplements and medications you’re taking. Even the “natural” stuff can be ineffective, or even dangerous, if mixed with the wrong medications.

1. Magnesium

For many women in our Menopause Solutions Facebook group, magnesium (particularly magnesium glycinate) has been a game changer. We do know many adult women don’t get enough of this mineral.

Why you need it: It’s involved in a wide variety of processes in the body: everything from muscle and nerve function to blood sugar and blood pressure regulation, bone formation, and energy metabolism.

How it can help during menopause: Magnesium is important for improving heart health, reducing blood pressure, decreasing risk of diabetes, combatting osteoporosis, and, particularly if you take magnesium citrate, easing constipation—all issues that increase with menopause. Magnesium glycinate specifically may also help with calming anxiety, easing joint pain, improving sleep and hot flashes as well as cold flashes.

Recommended daily intake: 320 mg

Good food sources: Spinach, pumpkin seeds, black beans, tuna, soy milk, brown rice, nuts like almonds and cashews, avocado, edamame, nonfat yogurt, bananas.

Caution: Excessive doses of magnesium could lead to diarrhea, nausea, and cramping. To be on the safe side, keep your intake to no more than 350 mg.

2. Vitamin A

Your body can get vitamin A in two forms. The retinol form comes directly from animal and dairy products. The carotenoid form, beta carotene from veggie and fruit sources, is converted into vitamin A in your body.

Why you need it: Supports your immune system, vision, and skin health.

How it can help during menopause: While vitamin A does not have any benefits proven to specifically target menopause symptoms, its role in supporting vision, immunity and thyroid function may play an even greater role during menopause at a time when hormone changes add an additional stress to the body.

Recommended daily intake: 700 mcg

Good food sources: Beef and lamb liver, butter, cheese and some oily fish. The body can also produce vitamin A from the beta carotene in veggie and fruit sources such as sweet potato, winter squash, kale, carrots and sweet red peppers and mango, cantaloupe, and grapefruit. Vitamin A is fat-soluble, meaning the body absorbs it better if it’s eaten with a little fat, preferably the healthy, plant-based kind (olive  oil, fatty fish, nuts and seeds, avocados).

Caution: Taking too much vitamin A can result in dizziness, nausea, vomiting, headache, or blurry vision, and over time could increase your risk of bone fractures. Really high doses can also increase risk of lung cancer in susceptible individuals. Also, talk to your doctor if you’re taking any blood thinning or retinol medications.

3. Vitamins B6 and B12

These are two of a group of eight B vitamins.

Why you need them: B6 is necessary for optimal metabolism, immune function, and supporting the body’s ability to manage inflammation. B12 is needed for the formation of red blood cells and is key for increasing energy, protecting your heart and brain, supporting good gut health, and helping your nervous system and eyes work properly.

How it can help during menopause: Vitamin B6 may help ward off menopausal depression and increase energy by boosting serotonin. B vitamins may also help with insomnia and possibly even reduce hot flashes. They are also important for cognitive functions.

Recommended daily intake: For B6, 1.3 mg for women age 50 and younger and 1.5 mg for those 51 and older. For B12, 2.4 mcg for all adults.

Good food sources: For B6, salmon, chickpeas, tuna, chicken, fortified tofu, pork, sweet potatoes, bananas, potatoes, avocado, pistachios. For B12, shellfish, tuna, fortified cereals, beef, fortified soy milk, fortified tofu, low-fat milk, cheese, eggs.

Caution: Too much vitamin B6 can cause nerve damage, so make sure you don’t exceed 100 mg a day.

4. Vitamin K

Eat a salad a day, that’s all we’re saying. This vitamin found often in leafy greens has been nicknamed “vitamin Kale.”

Why you need it: Helps with proper blood clotting, blood vessel health, and plays a role in supporting bone health.

How it can help during menopause: It’s important for bone density, which declines as you get older, increasing your risk for fractures. Eating one serving of leafy greens (a good source of vitamin K) a day may cut your risk of a hip fracture in half, according to the Harvard Nurses’ Health Study, one of the largest and longest running investigations into women’s health issues. A more recent study suggests it may also help with heavy period bleeding.

Recommended daily intake: 90 mcg

Good food sources: Leafy greens (kale, chard, lettuce, spinach), cruciferous veggies (broccoli, Brussels sprouts, cabbage), asparagus, okra, green beans, and soybean and canola oils. Vitamin K is fat-soluble, meaning the body absorbs it better if it’s eaten with a little fat, preferably the healthy, plant-based kind (olive and canola oil, fatty fish, nuts and seeds, avocados). Studies also show that vitamin K is even more effective when eaten with vitamin D.

Caution: Vitamin K is fat-soluble so adding some fat like oil to the vitamin K-rich foods you’re eating will increase absorption. If you are taking anticoagulants, they may affect your vitamin K status, so talk with your doctor.

5. Vitamin C

For decades, vitamin C has been touted as a remedy for the common cold. While research shows it won’t stop you from catching a cold, it may shorten its duration and severity if you regularly take supplements.

Why you need it: Heals wounds, maintains bones and cartilage, helps with the absorption of iron. It’s an antioxidant that protects against aging-related conditions and diseases.

How it can help during menopause: Vitamin C is important for maintaining bone density, which protects you against fractures later in life. It may also help ease hot flashes, and its antioxidant effect may help ward off heart disease, which is more common after menopause.

Recommended daily intake: 75 mg

Good food sources: Guava, kiwi, red peppers, citrus fruits, strawberries, tomatoes, broccoli, kale, papaya.

Caution: Too much vitamin C can cause diarrhea, nausea, and stomach cramps. Don’t take more than 2,000 mg a day.

6. Calcium

Calcium loss accelerates as estrogen declines, so this important mineral becomes even more vital as you enter perimenopause.

Why you need it: Keeps bones strong, maintains proper functioning of muscles and the nervous system.

How it can help during menopause: Calcium is essential to slow bone loss. As you age, your bones become porous (a condition known as osteoporosis) and can weaken, making fractures more likely.

Recommended daily intake: 1,000 mg for women age 50 and younger and 1,200 mg for those 51 and older.

Good food sources: Milk, yogurt, cheese, tofu, calcium-fortified orange juice, spinach, black-eyed peas, sardines, salmon, trout.

Caution: Too much calcium in supplement form may cause gastrointestinal symptoms and increased risk of cardiovascular disease. High intakes may also affect the absorption of other vitamins. Calcium from supplemental forms is best absorbed in smaller doses of 500mg or less. Aim to get the majority of your calcium from food and supplement where needed. If you’re 51 or older, limit your intake to no more than 2,000 mg total per day.

7. Vitamin D

It’s nicknamed the “sunshine vitamin” because your body can make vitamin D from sunlight, the UVB rays in particular. But even if you get outdoors a lot, you may not be getting enough. Sunscreen, pollution, clothing, and age reduce your body’s ability to produce vitamin D from the sun.

Why you need it: Helps the body absorb calcium, a building block for strong bones; important for proper functioning of muscles; supports heart health, neurological function, blood sugar regulation and immunity.

How it can help during menopause: It’s necessary for keeping bones strong and to stave off osteoporosis, thinning of the bones which can predispose you to fractures. It may also help to support brain function, decrease cognitive decline and fight off menopause depression.

Recommended daily intake: 600 IUs

Good food sources: Fatty fish like salmon, tuna, and trout; cremini and portobello mushrooms that have been exposed to sunlight; fortified foods like milk, tofu, yogurt, orange juice, and cereals, pork, eggs. Vitamin D is fat-soluble, meaning the body absorbs it better if it’s eaten with a little fat, preferably the healthy, plant-based kind (olive and canola oil, fatty fish, nuts and seeds, avocados).

Caution: It can be difficult to get enough vitamin D from food and sun alone. If you’re not getting enough, look for a supplement containing vitamin D3. Avoid exceeding 4,000 IUs a day.

8. Omega 3s

Many women don’t get enough Omega 3s, yet every cell in your body needs them – especially the eyes and brain. Omega 3s are also important for muscle activity, immune function, digestion and fertility.

Why you need it: Important for heart and brain health, involved in the function of the immune and endocrine (hormones) system, and helping the body manage inflammation.

How it can help during menopause: Risk of heart disease increases after menopause. Omega 3s may help keep triglyceride levels in check. They may also help with psychological issues, depression, and hot flashes.

Recommended daily intake: The National Institutes of Health recommends women consume 1100mg of omega-3s and men to consume 1600mg. Consuming fish twice per week, supplementing, or a combination of the two can help to reach these levels.

Good food sources: Fatty fish like salmon, flaxseed, chia seeds, walnuts, firm tofu, beans, canola oil, avocado.

Caution: Omega-3s can thin the blood, so if you’re on blood thinners, talk with your doctor before adding a supplement.

9. Probiotics

Your gut is a garden. Really! You have trillions of microorganisms hanging around inside your body, doing useful stuff like helping you digest, supporting mental health, and allowing you to use your food to support physiological function.

Why you need it: Life is hard on these critters: antibiotics, poor diet, illness, and stress can kill them off by the millions, leaving you susceptible to harmful bacteria and the diseases that come with them. Probiotics are live beneficial microbes that re-colonize the flora in your body.

How it can help during menopause: Probiotics can help with digestive issues many women confront around this time (bloating, gas, constipation), and they also support vaginal health by contributing to the optimal bacteria of the gut.

Recommended daily intake: There is no recommended amount. Look for probiotic supplements with at least 10 billion CFUs and at least five different bacteria strains.

Good food sources: Yogurt, kefir, kombucha, sauerkraut, pickles, miso, tempeh, kimchi, sourdough bread and some cheeses.

Caution: Read the label of supplements to ensure that you store any probiotic properly; some may need to be refrigerated.

We can help you understand the supplements for menopause that are right for you

Partner with a Gennev Menopause Specialist to help you determine what supplements may be right for you to maximize your health and manage your menopause symptoms.

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 conditions. Always consult with your physician or schedule an appointment with one of Gennev’s telemedicine doctors before beginning any new treatment or therapy.

Vision and eye health can change during perimenopause and menopause, along with just about every other system in the body. While it can feel overwhelming, we’ve got some additional…ahem, insights so you’ll know what you may expect that could be attributed to this major transition.

If you are having eyesight problems during your transition, 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.

Menopause and Eyesight Problems

Here’s the caveat (and the gift): not every person will experience every symptom in menopause. So, keep these on your radar, but don’t panic. 

Blurry vision

Major hormone fluctuations can temporarily blur your vision. If you’ve ever been pregnant, you may have experienced this already due to hormonal change. While it’s surprising, and not safe if you’re driving, blurry vision does tend to go away once your hormone levels even out. It’s the same, and different, with menopause because sex hormone levels aren’t really “evening out” for long”¦ they are continually decreasing.

Could be your corneas

Estrogen can give more elasticity to the corneas in your eyes. In menopause and perimenopause, when estrogen levels are reduced, the corneas aren’t getting as much estrogen and the corneas can begin to stiffen which can affect how light travels into your eyes.

A change in light refraction, plus the corneas being less elastic (causing dryness), can cause blurred vision. These can also contribute to contact lens discomfort if you wear those.

Dry eye syndrome (DES)

Dry eyes in menopause, it’s a thing, a pretty aggravating thing. Symptoms may include itchiness, a burning sensation, eye pain, certainly dryness, mucus discharge from the eye, and it may even feel like there’s a foreign body actually on your eyeball.  

More news is that women are at an increased risk for developing DES as we age. But before you grab a bottle of drops and call it good, consider what else may be driving any dry eye symptoms you are having. If your vision is changing or you’re experiencing eye pain or any of these symptoms, make an appointment with your optometrist to get your eyes tested and screened, then look below for tips to find some relief. 

What else?

• The last thing we need is to exacerbate dry eyes. Ow. So, a word about allergies, which can develop in adulthood. Nope, they’re not just for kids. If you suspect you’ve developed allergies during menopause, consider getting a test done to clarify your suspicion, or rule it out. Allergic reactions or symptoms can include dry, itchy eyes.
• Winter also dries the skin and eyes, so take note of where you are in your year. Incorporating  more self-care as seasons change may relieve some symptoms around dry eyes.
• If you wear prescription lenses of any kind, how long has it been since you’ve updated your “˜script or replaced your lenses? It’s an easy thing to forget to do in this busy age, but it could improve your vision sooner than later to get checked out and purchase some updated specs.
• Many medications prescribed and taken by adults over 40 may contribute to dry eye. Check-in with your doctor, or look up your medications’ side effects to see if dry eye appears on the list.

Am I in menopause? Take the 30-second assessment now.

HRT and DES

Women taking hormone replacement therapies (HRT) are actually at more risk for dry eye when taking estrogen-only HRT. Those on progesterone or progestin plus estrogen hormone replacement therapies have less risk, but they are still at more risk than those not taking HRT. 

Cataracts

Blurred vision is also a potential symptom of cataract development in menopause. While cataract development is not attributed to menopause, it’s a good idea to check for them during your annual eye exams as they develop slowly over time. They aren’t painful, and usually develop due to aging or injury, but they can definitely, and ultimately, impair your vision. If you have diabetes or other eye conditions, you may be at higher risk for developing cataracts.

A cataract is a clouding on the lens of your eye, making it hard to see, read, and drive. Additional symptoms of cataract development are: 

• Clouded, blurred, or dim vision
• Increasing difficulty with vision at night
• Sensitivity to light and glare
• Need for brighter light for reading and other activities
• Seeing “halos” around lights
• Frequent changes in eyeglass or contact lens prescription
• Fading or yellowing of colors
• Double vision in a single eye

At first, stronger prescription lenses and better or brighter lighting may be advised to treat cataracts. Any of these symptoms warrant a visit and possible screening with your eye doctor.

Glaucoma

Glaucoma is a group of eye conditions that contribute to damage of the optic nerve, usually from increased pressure in either or both eyes. 

CBD medical marijuana, as well as other prescribed medications, are often used to treat glaucoma, as there is no cure for the disease. Untreated, glaucoma can permanently damage your vision and even lead to blindness. Another vote for early detection with tests and regular screenings, for sure.

Age-related macular degeneration (AMD)

Unattributed to menopause, but still in the realm of impaired vision, age-related macular degeneration is another condition to regularly test and screen for with your eye doc. This is different from glaucoma in that AMD usually affects the center of the field of vision due to damage to the retina, whereas glaucoma affects the side field of vision. AMD also appears in “dry” and “wet” forms, and similar to glaucoma, it can lead to vision impairment and blindness.

When to check in with an optometrist

• Annually, for vision check-ups and screenings, especially if you’re already wearing prescription lenses
• When you notice a change in your vision or experience any of the symptoms mentioned above
• When in doubt about whether or not you’re experiencing a vision change or symptoms

It won’t hurt to talk with your regular doctor (or one of ours) about your vision symptoms for a referral to a specialist. And don’t forget to mention stress levels, screen time, and other menopause or perimenopausal symptoms you’re experiencing. Help and support available in your corner.

Care to share what’s going on with your vision? Come share with us in the Gennev Community Forums. Join the conversation today.

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

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

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

Menopause exercise and emotional wellness

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

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

What can exercise do?

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

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

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

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

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

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

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

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

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

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

Menopause and exercise. So, how do I start?

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

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

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

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

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

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

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

If you’re considering using birth control to (a) avoid pregnancy and/or (b) manage perimenopause and menopause symptoms, which birth control method would you use?

How about the one most OB/GYNs choose for themselves?

Pretty overwhelmingly, women’s health care providers choose the IUD as their preferred family planning method. It’s also a popular choice for docs prescribing solutions for managing heavy bleeding and irregular periods in perimenopause.

We thought it was worth taking a closer look at the tiny little T that can do so much.

What is an IUD?

An IUD or intrauterine device is a small, T-shaped piece of flexible plastic that is threaded up through the vagina and into the uterus (hence “intrauterine”). Once placed, they can remain for years, effectively preventing pregnancy without impacting future fertility. IUDs for perimenopause and menopause symptoms have also become popular, and often effective, treatments.

Copper IUDs (ParaGard) are wrapped in a bit of copper and rely on sperm’s dislike of that metal to repel sperm away from an egg. Generally, copper IUDs contain no hormones and are not particularly useful for managing peri/menopause symptoms. In fact, they tend to make periods slightly heavier.

Hormonal IUDs (Mirena, Kyleena, Liletta) use a synthetic hormone to prevent pregnancy. These may be more useful for the midlife crowd, and taking estrogen along with Mirena is increasing in popularity as a treatment for symptom relief.

Why do ob/gyns prefer the hormonal IUD?

For women generally, the hormonal IUD is a good option for family planning and managing periods.

With a 99 percent effectiveness rate, they’re highly effective at preventing pregnancy (the Pill weighs in at around 93 percent). Considering perimenopausal women have the second-highest rate of unintended pregnancy (after teens), that can be a real benefit.

They don’t require “perfect use” from the woman. Unlike the Pill, you don’t have to remember to take them, and unlike condoms, you really can’t be caught without.

They can make periods lighter, reduce cramps, have few or no side effects, and last for years. For these reasons, hormonal IUDs for perimenopause symptoms are often the most common.

Mirena For Heavy Bleeding Perimenopause: Using IUDs

Our own ob/gyn Director of Health, Dr. Rebecca Dunsmoor-Su, is an advocate of the hormonal IUD Mirena® for women in midlife, so we asked her to explain the benefits and any risks.

Note: Dr. Rebecca particularly likes and recommends the Mirena® because it has been on the market the longest, so we asked her specifically about that brand of IUD. This information may also pertain to similar devices; however, be aware that the information below is based on the Mirena.

Using Mirena IUD For Perimenopause

Dr. Rebecca: Mirena is an intrauterine device that contains levonorgestrel (a progesterone).  It was originally designed for, and is used mostly for, birth control. It provides highly successful birth control for 5-7 years. 

It works by placing progesterone directly into the uterus. Progesterone’s effect is multiple in that place:

1. It thickens cervical mucus and prevents sperm penetration (this is primarily how it prevents pregnancy).
2. It thins out the lining of the uterus and makes menses lighter; sometimes periods disappear altogether (this is the backup birth control effect, it will prevent implantation if the sperm get past it). 
3. It has the most effect right at the uterus, and you absorb very little of the progesterone systemically after the first month or so, so your ovaries generally continue to cycle normally (or not, depending on where you are in the menopausal transition).

How does it compare with other types of birth control?

Dr. Rebecca: It is placed during a doctor visit and stays in place for 5-7 years, so for ease of use, it cannot be beat. It has less impact than pills on your systemic hormones, which tend to continue to do “their own thing” while the Mirena is in. In terms of efficacy, it is one of the best, as it does not rely on the human factor, and you can’t forget to use it! It doesn’t prevent STDs, so if you are with a new partner or have multiple partners. Quick menopause tip: condoms are still recommended.

Why do you recommend Mirena for perimenopause? What is the impact of it?

Dr. Rebecca: In perimenopause, cycles can get more irregular, with bleeding occurring less frequently. When this happens, periods can be heavy and crampy in menopause. The Mirena keeps the uterine lining thin, so periods get much lighter and less painful and easier to manage, without having to use systemic hormonal manipulation to achieve this. 

Also, it’s good protection for the uterine lining (prevents the tissue build up that can lead to endometrial cancer), so if a woman needs estrogen to ease or get rid of hot flashes and sleep disruption, she doesn’t need to take oral progesterone if a Mirena is in place, providing the Mirena has been there less than 7 years and is still working.

How long can it be left in, and is it safe long-term?

Dr. Rebecca: It works for 5-7 years, and is safe to leave in that long. It doesn’t hurt you to leave it longer, but it no longer works as birth control or to suppress menstruation, and will no longer protect the lining if you are taking estrogen.

Are there side effects? If using Mirena for menopause, when should it be removed?

Dr. Rebecca: There is discomfort with placement and removal. 

People are often concerned about infections, as they remember reports from decades ago about different IUDs. With the Mirena, there is a small risk of infection when it is inserted and removed (these are rare occurrences), but once in, it actually thickens the protective cervical mucus and reduces the likelihood of infections travelling up to the pelvis.

Many women see irregular bleeding or spotting over the first 3-6 months after the device is implanted, which resolves. 

While there are reports on the Internet of weight gain, in fact, studies show weight gain is not a side effect of the IUD because, remember, it results in very low hormones being circulated systemically.

Who is a good candidate for the Mirena IUD?

Dr. Rebecca: Most women are good candidates; only women with a history of allergic reaction to levonorgestrel, who have a current pelvic infection, or who have a uterine anomaly are not good candidates.

Unlike estrogen, progesterone is generally considered safe for women who have blood clot risk, and as the Mirena is very low dose, it’s even safer. 

Use of Mirena for women with a history or high risk of breast cancer is generally, but not always, discouraged, so have a good conversation with your doctor about the benefits and risks.

If want an expert’s perspective if Mirena is right for you, schedule a telehealth visit with a Gennev board-certified OB/GYN. 

Is it OK if a woman enters full menopause with a Mirena implanted?

Dr. Rebecca: Yes. The Mirena can easily be removed by a medical professional, if the woman is more comfortable without it, but there’s no additional health risk of leaving it in, even after full menopause is achieved. And often it can be the source of progesterone if you need to use estrogen during the early years of menopause.

What’s the procedure for having a Mirena implanted? Does it hurt?

Dr. Rebecca: At the doctor’s office, the IUD is placed through the cervix. You may feel crampy for a few minutes, but taking some Ibuprofen before the procedure can help with that. Implanting the Mirena takes 5-10 minutes and is almost always covered by insurance. 

Are there things I should look out for if I have a Mirena?

Dr. Rebecca: Bleeding can be irregular for up to 6 months, and this is normal. You should talk to your doctor if you have severe pain, high fevers, or significant discharge from the vagina. Rarely, the IUD can fall out (expel), but generally you will notice, as you will see it come out.

Does the Mirena help with vaginal dryness or atrophy?

Dr. Rebecca: No, it does not, as it provides progesterone only. If you are having these symptoms, vaginal estrogen would be recommended.

I notice it has strings ““ can your partner feel it or dislodge it during penetrative sex?

Dr. Rebecca: No, the strings are soft and typically tuck behind the cervix. If a partner does feel something, your gynecologist can trim the strings short. Intercourse will not dislodge it. The only times I’ve seen them dislodged are when folks use menstrual cups and accidentally grab the strings when reaching up to remove the cup.

If you’re in perimenopause and experiencing heavy bleeding, and/or you need an effective birth control method, a hormonal IUD such as the Mirena may be a good, safe option for you. As ever, check with your doctor to discuss any risk factors you may have. 

Have you used an IUD to prevent pregnancy or handle perimenopause symptoms? We’d love to hear about it. Visit our Facebook page, or join Midlife & Menopause Solutions, our closed Facebook group. 

It’s 9:58 AM and you’re heading into a very important meeting, when, for the second time in an hour, you realize you have to pee. Like, really have to pee, as in may-not-make-it-scurrying-with-knees-together-body-slamming-colleagues-out-of-your-path have to pee.

You get there, but barely in time, and with a sigh of relief, you do your business. Sadly, in the middle of your two-hour performance review, you’re going to have to do this again.

If repeated, frequent urgency to urinate is disrupting your life, it’s time to start a Pee Diary.

Brianna Droessler-Aschliman, PT, DPT, CMTPT

Meagan Peeters-Gebler, PT, DPT, CSCS, CMTPT

Our fabulous PTs, Brianna and Meagan, introduced us to the idea of tracking what we eat and drink and how often we go to help us identify triggers and take back control.

If you are having a hard time controlling your urgency to pee, working with a menopause-certified health coach can be helpful. Book 30 minutes for your personal consultation with a health coach.

What’s a Pee Diary?

A pee diary is a record of all the things you do and consume that could affect your bladder. Irritation of the lining of the bladder is the most common cause for that “gotta go!” urgency, so if you can figure out what’s causing the irritation, you can manage the urgency.

What do I record?

According to Meagan and Bri, the point of keeping a diary like this is to identify your individual triggers, since they’re not the same for everyone.

The best way to do this is to record everything you eat and drink, how much you consume, and at what time you consume it. Take note of when you need to pee and how badly, and when you actually go (as any nurse, teacher, or busy woman will tell you, those are not necessarily the same times). If you take medications, supplements, or vitamins, be sure to record those too, Meagan says, since they can have an effect on urination.

If you can, measure and record how much you go. According to our PTs, you can record if the “void” feels small, medium, or large; you can count the seconds it takes to empty out; or, for the truly detail-oriented, you can purchase a urine hat that will tell you the ounces.

Record your sleep: the time you went  to bed, the time you got up in the morning, and how often and at what times you got up during the night to use the bathroom.

Stress can also be an irritant, so add in your stress levels as they rise and fall throughout the day. Don’t forget to say if it’s a workday or the weekend, since, Brianna says, our bathroom habits can change depending on how busy and distracted we are and how accessible a bathroom is.

The more you record, the better picture you’ll have of your actions and how far “off the norm” they might be.

What am I looking for in my pee diary?

You’re looking for a few things: first, if you’re having urgency issues, there are foods/drinks/substances that are common irritants. Reducing or eliminating those could moderate or even solve your urgency issues.

Look at what you drink for possible culprits: Do you start your day with a cleansing glass of lemon water? Or, if you’re like many adults, you probably start your day with coffee. How many La Croix are you throwing back each day? Maybe a glass of wine or two (or beer, or a cocktail) at the end of the day?

All of those drinks can be problematic, according to our PTs. Citrus, caffeine, alcohol and carbonation all can be really irritating to the lining of your bladder, so check your diary to see if you’re overdoing any (or yikes, all) of these.

Check your foods for possible irritants: Do you eat a lot of tomatoes and tomato-based foods? Do you have a curry or other spicy food for a few meals a week? Are you eating a lot of dairy, chocolate, sugar, honey, or corn syrup? Do your foods contain a significant amount of food coloring (if so, aren’t you a little old for Fruit Loops)? All of these are known to cause bladder issues in some people.

Are you drinking enough plain water? If you do drink irritating liquids, alternating (and hence diluting) them with water can reduce the irritation they cause. As the PTs have said before, your first drink every day should be plain water as this avoids having irritants splash down first and at full strength.

In addition to food and drink, what medications, supplements, vitamins, etc. are you taking? Some medications may have a diuretic quality, meaning you’ll need to go more often.

Other things to watch for: Are you springing any leaks? If you have a full bladder and leak a little with a sneeze, that’s cause for concern, but less so than if you leaked after having recently emptied (or tried to empty) your bladder. Are you constipated? That can impact your bladder as well.

Even if you’re not having issues with urgency or leaking, keeping a pee diary for a time might be very enlightening. Do you know how often you pee every day? Do you know how many potential irritants you consume in a day? These are variables within your control, Meagan says, so why not choose the healthiest route you can and avoid problems down the line?

What do I do with what I learn?

Your diary should be able to tell you if you’re within the “normal” range as at its most basic, peeing every 2-4 hours, voiding completely, feeling the pressure of needing to go but no great urgency and no pain. You should make it to the toilet in a calm and comfortable fashion and have no leaks. If this describes you, great: you’re good to go (ha ha).

But”¦ says Meagan, if you’re peeing significantly more or less than 5 to 8 times in 24 hours, if you’re getting up to pee more than once a night, if you’re not voiding completely, or if you have a “pee cluster” (peeing several times in a short period, like three times in an hour first thing in the morning), your diary is telling you you have work to do.

And if you have “work to do,” it might be time to pull in a professional, like a pelvic physical therapist.

What do PTs see in the pee diary?

PTs view the diary not only as a chance to identify a problem but also as an opportunity to educate, Meagan and Bri tell us. “People don’t realize or understand what bladder irritants are,” Bri says, “so the review can really open their eyes.” She has clients track a second time a few months after the initial diary review. “If things have been going well, chances are it’ll show in the diary.”

Meagan tells us the story of a client who had had quite a lot of problems with urgency, but after working with her PT, she saw good results. Formerly a big coffee drinker, she now drank only water, and with Meagan’s help, she was able to pee as calmly as every 2 to 4 hours during the day and sleep through the night. Suddenly, after a month on her own, she was peeing every 30 minutes or so, and getting up to urinate 2 to 3 times a night.

When she and Meagan studied her diary, the culprit was clear: the cleanse the woman had started as part of her New Year’s resolutions was very high in vitamin B complex as a known irritant. Once the cause was clear, says Meagan, they were able to work together on a solution; in this case, spreading the 3-pill dosage out over the day instead of taking them all at once.

The best thing about a pee diary? It can make the problem as and the solution as obvious. We may not realize we’re drinking six La Croix a day or having our wine a little too late in the evening. Simple adjustments like cutting back on carbonation or drinking water first or more often, Bri says, can give people back control and some real quality of life.

When to go to the PT or doc*

If you’re falling significantly out of “normal” range, you might want to consult with your PT or doctor. Remember that just not drinking liquids is not a solution for urgency as in fact, when there’s not enough liquid, the urine that’s sitting in your bladder can become very concentrated, leading to more irritation, even infection.

A pee diary may not be the most glamorous journal ever, but if it can get you all the way through the movie, let you sleep your full 8 uninterrupted, and make it possible for you to run without scouting for porta potties or exercising with incontinence, it may be one of the most useful journals you’ve ever kept.

Do you have a pee diary, and would you be willing to leak a little of it to us (ha ha)? Feel free to share with the community in the comments below, or fill us in on Gennev’s Facebook page or Midlife & Menopause Solutions, Gennevs closed Facebook group.

*As ever, these blogs are for information only and are never intended to replace expert care by a physician. If you believe you have a serious medical condition, please contact your doctor immediately.

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.