Midlife can feel like a time when we have to drastically reduce or give up so many things we love: sugar, wine, coffee, carbs, sweaters that don’t button down the front, good sleep.

For some women, quitting smoking just feels like one sacrifice too many.

To you we say: add something else back, but please…get rid of cigarettes.

Quitting smoking and menopause with Stasi Kasianchuk

May 31 was World No Tobacco Day, according to the World Health Organization. Part of the Tobacco Free Initiative (TFI), it’s a day of awareness and learning.

Gennev participated, with a webinar with our Director of Health Coaching, Stasi Kasianchuk, hosting Gennev’s Chief Medical Officer, OB/GYN Dr. Rebecca Dunsmoor-Su, and pulmonologist Dr. Anne Lipke.

They spoke not just on the benefits of quitting smoking, but also on the particular reasons women in menopause should quit.

In addition to entering menopause up to a year or two earlier than her body might naturally (and thus losing the protections of estrogen earlier), smoking is hard on the skin, the heart, the brain, the teeth, and just about every part of a woman smoker’s body.

Listen to the podcast for more information on why to quit, how to quit, how to nourish your body after (and avoid weight gain). Then make an appointment to speak with a physician or a health coach to begin your journey to a happier, healthier life!

TRANSCRIPT COMING SOON

Did you quit or are you trying to quit? We’d love to hear whatever magic you used to quit or what didn’t work. Hit us up in the Gennev Community forums!

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

“Some studies show that  one-third of women will experience a major depressive episode  in their lifetime.”

Depression can be debilitating as sucking the joy out life, making activities we once enjoyed uninteresting, rendering work impossible, closing us off from those we love. Even more, clinical depression, when untreated, significantly increases a person’s risk of suicide.

In the manner of ripping-off-the-Band-Aid, let’s get the ugly statistics out of the way first.

According to the Centers for Disease Control and Prevention:

• Suicide rates among women increased by 50 percent from the year 2000 to 2016.
• Suicide rates are accelerating among women, going from a 2 percent increase per year between 2000 and 2007 to a 3 percent increase each year from 2007 to 2016.
• Suicide rates among women were highest in the 45 as 64 age group.

Perimenopause and menopause can cause or exacerbate depression. Depression can lead to suicidal ideation, attempt, and completion.

So, with all that said, well, we really need to talk. Openly. Honestly. Often.

Kate Spade’s suicide at 55 was as mystifying as it was devastating to many of us. She was bright, beautiful, wildly successful, and overflowing with talent and creativity. Who could have imagined she would “choose” to end her life? And while no one but Ms. Spade can truly know what was going on in her mind and heart, her suicide has helped lend urgency to an overdue conversation about the link between menopause and depression.

A link that leads, too often, to suicide.

So what’s going on here?

If you are experiencing perimenopause depression, 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.

Defining terms: what is “clinical depression”?

We use “depression” as a blanket term to cover a range of emotions, and that’s not only inaccurate, it can be dangerous. Anyone who’s suffered from clinical depression will tell you it’s very different from sadness or grief and needs to be treated accordingly. Depression rises to the level of “clinical” when it lasts for two weeks or longer and comes with other symptoms such as change in appetite, loss of interest or pleasure in things you usually enjoy, changes in sleep patterns (too much or too little), feelings of worthlessness or guilt, increase in “purposeless” activity like pacing, and thoughts of death or suicide. Depression as a symptom of perimenopause is not uncommon, but should be taken seriously.

What causes perimenopause depression? Is it hormones?

Rather infuriatingly referred to as the “menopause blues,” depression in perimenopause as the years leading up to menopause as is fairly common, though it should never be regarded as “normal.” Estrogen interacts with certain chemicals in the brain, including those which regulate mood (which explains menopausal anger). In some women, this translates to rage, in others, menopause anxiety symptoms. And in many, depression. Hormonal fluctuations during the perimenopause years seem to make women particularly vulnerable.

The risk is even greater when a woman has experienced depression earlier in her life. Birth control and HRT can cause depression in some women, help alleviate it in others. Pretty clearly, there’s a hormonal component. This is critical to understand because so many women are too ashamed and embarrassed to seek help, feeling as though they’re just being “weak.” They try and tough it out on their own, the way they grit their teeth and get through the hot flashes and headaches.

But we wouldn’t ask someone to simply “tough out” diabetes or leukemia or hypertension, and depression is no different. If your depression lasts longer than two weeks and significantly impacts your day-to-day life, you should seek professional help.

Is it a midlife crisis?

In addition to hormones, the realities of aging may play a role. Realizing you haven’t yet achieved your goals may be tougher at 50 than at 30, particularly in a sexist, ageist society that seems bent on telling women their lives are pretty much done when their ability to reproduce is gone.

Is it external pressures?

There are plenty of pressures outside our heads and hormones that can contribute to depression: Aging parents. Empty nest or wishing it were empty because the kids are in their “challenging” teen years. More responsibility at work, or more competition from younger colleagues. Physical challenges of perimenopause and menopause, including hot flashes, poor sleep, weight gain, headaches. Relationship challenges from a deflated libido and painful sex. Worries over a financial future in retirement.

So now that I’ve scared you and have you rethinking every time you got tearful at a Budweiser commercial (come on, those Super Bowl ones with the Clydesdales have all the feels), here’s the good news:

Depression is treatable

Depression is among the most treatable of mental disorders. Between 80 percent and 90 percent of people with depression eventually respond well to treatment.

Emerging from depression is not easy. It might mean taking medications you’re not entirely comfortable with, like SSRIs or other antidepressants. It may take time in psychotherapy. Cognitive behavioral therapy (CBT), where you train your brain to problem-solve its way out of negative thought patterns, can be quite effective against depression. Brain stimulation therapies such as ECT can help in more severe cases.

When depression is painful but not “clinical” in intensity or duration, there are many effective things you can do on your own: exercise is a wonderful, natural mood elevator (especially when it’s over), quality sleep, Omega 3s, sunshine, St. John’s wort, strong social connections with family and friends, good work, avoiding sugar, and as we have the science to back it up, self care. It’s true: simply doing more pleasurable activities helps us be more positive generally. Surprise!

And the even better news for women in midlife: rates of depression decline in post-menopausal women once hormones level out and the body and brain adapt to their new normal.

Depression should never be taken lightly. Mild depression can disrupt our ability to enjoy our lives fully. Major depression is dangerous. Life-threateningly dangerous. And it takes far too many women who are truly in their prime.

If you feel you or someone you care about may be suffering from depression, there is help. You can start finding your way back from depression by talking to a doctor or calling the National Suicide Prevention Hotline at 800-273-8255. If you’ve dealt with depression or had thoughts of suicide, how did you recover? We’d love to hear from you. Please feel free to comment here, or start a thread in our community forums. You can also reach out to us on Gennev’s public Facebook page or in our closed Facebook group.

This article was first published on PRiME WOMEN and is republished here with permission.

Ringing, buzzing, whooshing, or clicking sounds in your ear(s) could mean a couple of things:

1. You’ve made some interesting lifestyle choices, and/or
2. You’ve got tinnitus, our clinic for menopause’s Symptom of the Month.

Let’s talk about tinnitus and menopause.

Tinnitus? What’s tinnitus?

Tinnitus is the sensation of hearing certain sounds that aren’t present. That roaring, hissing, ringing noise could be caused by damage to your inner ear as or it may be caused by the hormonal changes of menopause.

There are two kinds of tinnitus: subjective, the far more common version where only the sufferer hears the noise, and objective, the very rare kind where some internal function of the sufferer’s body, like blood flow or body movement, is actually audible to others. This is also commonly accompanied by headaches.

What causes tinnitus?

Lots of loud. Remember when you trooped off to see Huey Lewis and the News’ Sports tour and your mom told you to wear ear protection or you’d regret it when you were older? No? Just me?

Mom wasn’t wrong. One of the major causes of tinnitus is long-term exposure to heavy noise. While one bout of Huey and Co. may only result in short-term tinnitus, too many high-decibel concerts, with too much loud MP3 boogie in-between, can result in permanent damage. Because hearing damage can be cumulative, if you have kids, start bugging them early to “turn it down.”

Ear pods.  Professor Dean Garstecki of Northwestern University says ear buds that fit directly into the ear can cause more damage than headphones that sit atop the ear “” from 6 to 9 dB more. So if you wear the in-your-ear kind, turn the volume down or save them for quiet places where you don’t need to crank the sound up to compensate for city or road noise. 

Ear stuff. A significant build-up of ear wax, congestion, dirt, hair, etc. can irritate the inner ear and cause that unpleasant ringing sound. Get it out quickly, if you can, as long-term irritation can make tinnitus permanent.

Age. Hearing loss is often accompanied by tinnitus, which is why it’s so common in adults over 60.

Head and neck trauma. Injuries that affect blood flow to the area or impact nerves or muscles can result in tinnitus.

[Got itchy skin? Check out this symptom of the month article on four ways to handle itchy skin in menopause.]

Other, less common causes, include TMJ, a disorder of the joint where the jaw attaches to the skull, sinus pressure, injury from barometric trauma (think SCUBA diving), brain injuries such as concussion, and certain medications.

Tinnitus can be a symptom of a more serious medical issue such as hypo- or hyperthyroidism, anemia, Lyme disease, high blood pressure, etc., so if you’re suffering, please consult with a medical professional.*

If you are worried about ringing in your ear, 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.

Is menopause a cause of tinnitus?

The direct cause-and-effect has yet to be established. Because both menopause and tinnitus often happen around the same age, it’s difficult to tell if one causes or worsens the other, or if they’re both just a factor of getting older.

Having said that, many women report increases and decreases in tinnitus that seem to be linked to the rise and fall of their hormone levels. Because women complain of this during pregnancy or around their menstrual periods as well as during perimenopause or menopause, it may not simply be a product of aging.

There is also some evidence to suggest  that taking HRT (hormone replacement therapy) or hormonal birth control can worsen tinnitus.

[what causes and how to handle (or not, if you value your life) sore menopause breasts]

What can I do about the ringing in my ears?

First, see a doctor to rule out more serious causes. Next “¦

1. Figure out your triggers. Certain foods, caffeine, alcohol, nicotine, salt (nooooooooo!!!) all may trigger or worsen tinnitus. Keep a journal to determine what might be causing yours.
2. If you take a lot of pain reliever, you could be making your tinnitus worse. Aspirin, Aleve, ibuprofen, all can cause or make tinnitus worse, says Harvard Health. If you have joint pain, maybe consider trying magnesium for relief instead!
3. Some antibiotics and antidepressants can also trigger or make tinnitus more noticeable. If your tinnitus seems to coincide with starting a new medication, check with your doctor to see if there could be a connection. It might be worth exploring alternative medications of the ringing in your ears affects work, sleep, or quality of life.
4. White noise. Silence makes tinnitus much more noticeable. The soothing sounds of ocean waves, a rainstorm, a fan can all help distract sufferers from the ringing in their ears. There are lots of free or low-cost apps available (personally, I’m a huge fan of SimplyRain).
5. Regular exercise n menopause is good, but not in the 2-3 hours before bed.
6. There are medications that help suppress the noise, if it starts to interfere with life and work.
7. Relaxation makes tinnitus less noticeable and less impactful. Yoga, tai chi, and meditation are all good ways to reduce the stress of tinnitus.
8. Oddly enough, check with your dentist. Is it possible you grind your teeth, perhaps when you sleep? Jaw clenching and teeth grinding can make tinnitus worse, but there may be things you can do to reduce these often subconscious habits. Bonus: your teeth will likely be less sensitive and last longer if you don’t grind them at night.

Tinnitus is fairly common to women in their 40s, 50s, and 60s, but that doesn’t mean it’s simply a result of aging or menopause. Because there can be more serious causes, before you sign up for that tai chi class, please consult a doctor. Then sign up for the tai chi class, because it’s good for you.

If you’ve dealt with tinnitus, we’d love to hear what you did / are doing to combat the ringing. Please share with us in the comments below, on the Gennev Facebook page, or in Midlife & Menopause Solutions, our closed Facebook group!

*Thanks to American Tinnitus Association for information relating to the causes of tinnitus. This information is for education only and should not be used as a replacement for professional medical care. If your ears are ringing, go see your doc, hear me?

If the average American woman hits menopause at 51, she’s likely to have a whole lot of living left.

What will The Change change in your life? Is it time to pursue your passion into a whole new second act?

In her article for PRiME WOMEN, leadership expert and founder of The Perfect Fit Nancy Keene lays out the steps.

To Design Your Second Act, Flash Forward”¦Then Fill in the Blanks

Your life may span more years than you think. Best to be proactive, not reactive in designing as and funding as the life you want to lead. Start now to lay the groundwork for your second act.

Expect the Unexpected.

Be expansive in imagining the possibilities you want to pursue, but do incorporate an underpinning of reality planning. What if an elder parent whom you are supporting lives for another 10 years? What if you become responsible for the lifelong care of a younger sibling as or grandchild? What if you make an investing mistake? A back-up plan is like money in the bank!

Maintain your Certifications.

Do NOT let your professional licenses expire. They are lifelong assets you’ve worked too hard to earn.

Pinpoint your Superpower.

Take the Gallup Strengths Finder assessment. Have your significant other do the same! It will shine a mirror on your core assets and what is important to you. Why not build your second act on your strengths, rather than try to change a lifetime of who you are?

Shop Around.

Maybe you have a vision already in place. If not, scope out what others are doing. What looks interesting? What is attainable and within reach? What is a scenario you would be willing to sacrifice for? How are others integrating challenge + enjoyment + revenue continuity? Start researching and networking, either on-line or in-person!

All Aboard.

Are you hoping to serve on a public company board? Here is the #1 criteria: previous board experience. Desirable candidates include: public accounting audit partners; public company CEOs, COOs or CFOs; public company line executives with ops/line responsibilities. Does your current company support major non-profit organizations? Could you win a slot representing them on the board? This is a way to gain exposure with other board members who may also be serving on for-profit boards.

Zig, then Zag.

A female banker took a separation package in the aftermath of a mega-merger. Instead of retiring, she stayed in the game. She took a business development role for a virtual CFO consultancy as still connected to key banking decision makers. When a new bank entered the market, she was offered a dream role as based on her longstanding experience and current, active client contacts.

Don’t Do. Teach.

As you enter a new stage of life, you may not want the rigor of a 24/7 top executive position. But, you can teach others what you’ve learned. A successful magazine editor pursued a PhD while she was still on the masthead. As the print publication market upheaved, she was able to pursue a follow-on career in academia as also gaining an additional pension revenue stream. She is now partially retired and still teaches an abbreviated schedule of classes.

New Line of Service.

Earlier in my career, I noticed a number of older tech colleagues and clients moving into the field of retained executive search. They were applying the same principles of client service to a different discipline. The traits of maturity + wisdom + experience were highly-valued in high-level recruiting. Something an earlier career entrant couldn’t instantly osmose. Look for new channels that can deliver career longevity and on-going revenue for your second act.

Tap into Mature Industries.

Another game-changer for me was a consulting assignment in the construction and building materials industry. Many of my clients in the go-go tech and start-up sectors thought I was crazy as like a fox. It was a mature industry with an executive population that skewed older as and male. I could be a fresh young face as for a long time. 20 years later, I still operate successfully in heavy-industry realms.

Find a New Demographic.

The pioneering TV newswoman, Linda Ellerbee, saw her network career cut short as management sought younger, less expensive, more glamorous on-camera talent. Ironically, her future was with an even younger demographic than those who replaced her at NBC. She wrapped up a 25 year, award-winning run anchoring Nick News as for kids as on the Nickelodeon channel. Talk about a contrarian move!

Gain a New Competency.

As the world of technology evolves at a lightning fast pace, entirely new business disciplines are being spawned. There are high-demand, high-growth opportunities in areas such as coding, social media, SEO and more. And top-ranked business schools are offering highly strategic Digital Marketing executive education programs as a powerful imprimatur that can punctuate your portfolio of offerings and even break the tie if you are in a panel of candidates being evaluated for a senior position, consulting engagement or board slot.

Partner Up.

Tracey Jackson had a 20 year run as a successful screenwriter. Then, she turned 50 and hit the brick wall of gender bias in Hollywood. Not to be deterred, she joined forces with Grammy and Oscar-winning songwriter, Paul Williams, to create Gratitude and Trust, a brilliant new book + blog + conference platform as appearing together on Oprah, the New York Times bestseller list, and more! Why go it alone when you can collaborate and trigger some serious synergy?

Passive Revenue Pathways.

Direct marketing companies can provide a way to leverage your contacts and business skills. Beauty, fashion, decor and other product categories abound. Research the categories and talk to existing consultants and team leaders. Many successful executive women are adding this to their second act platform to enhance discretionary spending budgets.

Keep the Lights On.

In evaluating the future, you may choose to step off the fast track. Enjoy! But remain visible and maintain a re-entry ramp. Stay connected via social media and professional organizations. Be strategic in your non-profit and community service commitments. Maintain your brand, tweak it as or experiment with an entirely new platform!

Have you embarked on your second act? Are you considering a change? How have you laid the groundwork to prepare? We’d love to know the steps you took. Leave us a comment below, or talk to us on our Facebook page or in Midlife & Menopause Solutions, our closed Facebook group.

It can be a conversation-stopper: “I’m CEO of a company that plans to make vaginal dryness a thing of the past. And what do you do?”

Of course that’s not all Gennev is about, but it makes for a hell of an elevator pitch.

Just over a year ago, I was a marketing executive at Microsoft. It was a fantastic job, working with super smart people, helping users discover products that genuinely made their lives easier and more productive, and leading an incredible corporate life. I’d always been in tech, first at an ERP-software company, then venturing to Microsoft via acquisition over 15 years ago. I traveled the world. I launched consumer and enterprise products. I worked with some of the most incredible leaders and pioneers in the tech industry.

But I knew there was something else I was meant to do.

I like tech a lot, but I’ve always been a passionate advocate for women, and not just because I am one! Women are smart, strong, ambitious, and resilient, but often we’re held back from being our best selves. I’m a student of this predicament, so why not figure out a better way?

In my heart of hearts, I want to help women claim their power and place””but that can be hard to do when you don’t even feel comfortable in your own skin. That’s what motivated me to start Gennev.

How did I get from high tech to vaginal health?

Not surprisingly, I get this question a lot. “Why leave an incredible job at Microsoft to launch a start-up dealing with [whispers] vaginal dryness???“

I’d been with Microsoft for more than 15 years when a mutual friend introduced me to Jacqui Brandwynne. Jacqui was the driving force behind building the Neutrogena brand, and she had a line of products for women’s hormonal health. Jacqui wanted someone to take on the business, and I saw an opportunity to make a real difference in women’s lives. I made the decision and, with the support of friends and family, I made the leap.

I knew I wanted to get Jacqui’s products into the hands of more women, because 1 in 3 women suffer from poor vaginal health””namely, vaginal dryness.

I decided a brand refresh was in order, products and packages that reflect women’s new openness about the changes their bodies go through. With the help of a few brand-savvy friends, we decided that Gennev would represent the woman we wanted to serve: feminine, classy, confident, and non-apologetic. She can put a tube of Gennev Intimate Moisture next to her bed or in her shower, no embarrassment or explanation needed.

But healthy products in new packaging wasn’t enough. I asked a bunch of questions of my friends, I surveyed thousands of women, and I came to understand that there’s too much taboo and not enough education, support, and conversation around women’s hormonal health. Until that changes, too many women will still struggle unnecessarily, feeling silenced and alone.

We needed a media platform for women (and men!) to share stories, find information, and have an open conversation about the journey every woman goes through in her lifetime. It wasn’t going to be another academic, hard-to-understand health website, but a platform that carries a real, honest and open voice. As such, the g-spot was born to bring this taboo topic out of the shadows.

My own journey

At 42, my hormonal journey has been relatively easy so far. I’m in the perimenopausal phase of life, but I haven’t experienced the kinds of symptoms women talk about”¦yet. I don’t have biological children, so I’m learning like crazy from women who are moms about what their bodies go through during and after pregnancy and while breastfeeding.

Why get involved if hormonal change hasn’t affected me (yet)?

I wanted to get involved because our approach to women’s hormonal changes is, well, disastrous. Not always, but let’s face it: Women endure a lot, and as a society, we rarely even acknowledge the struggles, much less provide support for the women dealing with them. We need to change that.

Periods, breastfeeding, menopause”¦these are natural things, yet women are taught to be embarrassed and secretive about them. Having healthy, happy vaginas is what we need to be talking about! Going through hormonal changes would be so much easier if we met them with empathy, laughter, open minds, and listening ears. And for those women who experience hormonal change for other reasons””cancer treatments, hysterectomies, prescription medicines, etc.””a community of support and information can be critical.

I’m building a company that’s approachable, trustworthy, and trusted. I try to bring all these traits to every conversation I have with women, and it works. We share, we laugh, we shake our fists, and then we put our heads down and get to work.

“You’re taking on too much.”

“Building a new brand with new products to come AND creating a media platform? You’re taking on too much!” as well-intentioned advisors.

I disagree. The more I listen to women, the more I hear how ready we are to face these issues chins-up and head-on. Women are eager to share their stories, get best tips on handling symptoms, turn their workplaces into safe spaces for all women, educate others, and have healthy, happy bodies!

Is it a lot of work? You bet. But I’ve never done more important work. And I’m not doing it alone. I’m building a team and network of experts, advocates, scientists, educators, storytellers, and frankly, saints, who are willing to share their experiences and expertise for the better of all.

Who do I want to reach?

I’m putting out my call right now: I’m calling all women who are fired up about feeling incredible in their bodies, women who want open dialogue, healthy, fabulous relationships, and great sex. No matter where you are in your hormonal journey, there’s a place for you in the Gennev Community. Also, calling all men who have women they love in their lives. We’ve saved seats for you too.

Why Gennev and no one else?

Yes, our products are tried, tested, and trusted, and you can use them with confidence, but Gennev is about more than lubricants and moisturizers. It’s about comfort. It’s about confidence. It’s about enjoying your sexuality. It’s about all the wonderful things that can happen when you take back control of your body and you’re not ashamed to make that happen.

The very best part of my job is hearing your stories. Please send me a personal email at jill@gennev.com.

We’re building something special here. I hope you’ll join us.

Talk with us! Be a part of the movement and the conversation: Leave a comment on our blog and engage with us on Twitter, Facebook, and Pinterest.

Stephanie was asked to put together a presentation at the last minute for an upcoming board meeting. Though it’s a fantastic opportunity, one she has been waiting for, this new responsibility has also added to her stress level and taken a big chunk of time out of her already busy schedule. Sure, she’d had more hot flashes in the past few days, but whatever… she handled it, sweated through it, and moved on in her focus and work.

So the day comes, and Stephanie is ready. Prepared, confident, and ready. 100%. She woke up early, drank a big glass of water before her first cup of coffee and was feeling amazing about the day ahead until”¦

She looked in the mirror and saw a big, red, swollen bump on her chin. A double-take and then a close-up only confirmed her dread and suspicion: a cyst. Painful and hot to the touch, this one was deep”¦ and mad.”Grrreat,” thought Stephanie, “Important day, huge zit right on my face”¦ that I can’t get to and pop. Aghhhh.”

Stephanie is 52.

Acne and menopause? The results are”¦ vague

A couple of years ago, a review of six studies called Emerging Issues in Adult Female Acne was released in The Journal of Clinical and Aesthetic Dermatology. And of course, as science and the medical industry “catch up” to menopause, the results are inconclusive and “more research is needed.”

Despite the fact that middle-aged women have long complained about a resurgence of adolescent acne, the incidence of peri/menopause-plus-acne wasn’t studied specifically. Up until recently (the article was released in 2017) all women over 25 years old who reported an incidence of adult acne were studied together. Further subdivision (women 25-44, and then women 45 and up) for some additional study wasn’t really suggested until a couple of years ago. 

What was clear?

Adult acne is more prevalent in women than in men across all age groups. One study also noted that depression was more common in women experiencing adult acne than in men (specifically, 10.6% in women versus 5.3% in men).

It was also noted that women seek treatment for this skin disease across age groups as well. 

Beyond the physical

Does adult acne bring the same embarrassment and self-consciousness it might have done in puberty? The best and fastest thing to do is to check in with yourself about this question. Does this acne affect me on a psychological level? Is my quality of life being affected? If so, how?

A few prompts for reflection: Am I…

• Self-conscious to the point I am limiting my social interaction and time with friends, family, and in groups? 
• Withdrawing from activities and relationships? 
• Staying at home more when I have breakouts?
• Depressed? And am I more depressed when I’ve got a breakout?

On androgens and estrogens

Androgens and estrogens are two of the major types of hormones that regulate the sebaceous glands in the skin system. (Any of this ringing any middle-school science class bells?) 

In the stages of menopause, we’re fairly familiar with the fact that estrogen levels are decreasing over time, so that is one major hormone that is in a state of change. Check.

The major androgens are testosterone, androstenedione, and dehydroepiandrosterone (DHEA). These are produced in the adrenal glands and the ovaries in women. 

According to this study, most of the decrease in the androgen testosterone happens in women between the ages of 20-40 years old. No further decrease happens in menopause, but slight increases may occur. Could this be considered a “fluctuation”? It’s not unreasonable to think so.

Hormone fluctuations, plus stress, may increase the frequency of breakouts in menopause. Speaking of stress…

Stress and acne flare-ups

Would it really surprise you to find that chronic stress is one of the primary aggravating factors in adult acne? Given the levels and intensity of responsibilities that women work with on a daily basis in modern life, it isn’t much of a “revelation,” in our minds.

Continual stress increases hormone levels. Increased hormone levels can lead to increased oil production in the skin, starting in the sebaceous glands.

Painful cysts deep in the skin”¦ Ow!

So what’s the deal with cysts vs. pimples? Cysts are usually buried deep in the dermal tissues, where a pimple is a clogged pore that is closer to the surface of the skin. Many times cysts are reported to be located in the lower third of the face (jawline and chin).

More than a clogged pore, a cyst is often attributed to infected, clogged pores, which then develop bacteria and go deeper into the skin. A cyst can be itchy and painful, and, a gross bonus here, it’s filled with pus. If a cyst bursts, the infection can spread and lead to more breakouts. Ugh.

If you think you may have cystic acne, consider putting a call out to your doctor (or call our Telemed docs) to talk.

How can you level-up your anti-inflammatory lifestyle?

What you can do is review 4 major pillars in your life and health: nutrition, hydration, exercise, and stress levels. If you can improve any or all of these foundational aspects, you’ll also be better flushing your system and promoting balance and regularity in all of your body and mind’s systems. That’s a big win. 

A few small steps to improvement:

• When can you drink a little more water? Instead of an 8 oz glass, maybe you switch to a 10 or 12 oz tumbler and drink the same number of glasses, but, sneaky-sneaky, you get more ounces in? Or, maybe you try to drink 4-5 ounces before you’re fully awake in the morning, while the kettle is heating?
• One more vegetable. Even one more bite of a vegetable will count. Two bites of leftover cauliflower mash? A few cherry tomatoes or snow pea pods will also work here. How about splurging a little on a pre-made side dish from the deli you would never make for yourself? It’ll make a difference to get that little extra veg into your body to fuel it.
• Fruit before or with a processed snack or candy? Perhaps it’s not about substituting, but about adding in. Do you have an afternoon ritual that must include salty chips? Great! Keep it! And how about a little fresh fruit to go with it? A couple of berries, a tangerine or satsuma orange pack a zippy-fresh, nutritional punch.
• When can you do two more minutes of new movement in your day? Stretch or try a wall squat while the kettle is heating or the coffee is brewing. Alone in an elevator? How about stretching both of your arms overhead or a gentle twist at the waist, right and left? Sure, you can still be holding your phone. Absolutely. And… where else can you eek in some new movement?

A final word about skincare and cleansing

According to the Mayo Clinic:

• Wash your skin twice each day with a gentle cleanser
• Shower after you exercise to remove oil and sweat that can trap bacteria and dirt
• Avoid touching or picking at acne-prone areas

What’s missing here? Moisturizer!

A decrease in estrogen is a big part of how the skin dries, thins, and changes. Your skin’s moisture-level is an important factor here. So find a good one that your skin and body can just drink in and pat it on to your freshly washed, still-damp skin with pride and pleasure. And sunscreen… don’t forget your sunscreen.

The largest organ of your body is your skin system, and it’s working doing a tremendous amount of work for you day in and day out. Take a moment to find some appreciation for it, see if you can be grateful, and see how you might continue to take good care of your skin.

What else are you noticing in your skin? What’s surprising, maddening, confusing, or even hilarious about your menopause path? Join us in the Gennev Community Forum to share with other women on the same path.

While on a birthday trip to Bermuda, Rolonda Wright wasn’t feeling well. VERY not well. Constipation turned to abdominal pain bad enough to send her to the ER for 15 hours.

On her return “” after a vacation that wasn’t at all what she’d hoped for “” she went to her great OB/GYN for tests and discovered she had a uterine fibroid “the size of a four-and-a-half-month pregnancy” or, as Gennev CMO Dr. Rebecca Dunsmoor-Su translated: about a personal-sized watermelon.

Sitting up high, it was actually visible as a bump when Wright was lying down.

“That’s not at all uncommon,” says Dr. Dunsmoor-Su. “So many women come to me with large fibroids thinking they’ve been eating too much bread. It’s not bread! It’s a big ball of muscle.”

“I thought I had to do more sit ups to get that ab down! A doctor a few years ago suggested a hysterectomy for my fibroids, but I didn’t really have any problems: no pain, no problems with sex,” Wright says.  She had heavy periods, but the heavy flow only lasted for a day. “One day I couldn’t leave the house or it would have been a disaster, but the next day it was fine.”

The problem, she says, wasn’t so much the fibroid. It was how little information she had. She came to Gennev to share her journey with us and our readers so that other women would be better informed. You can follow her journey on Facebook, Instagram, TikTok at Rogirll01, or her website.

When you know more, you can act faster, she says. She might have had the fibroid removed when it was much smaller and required less invasive surgery. She might have had a hysterectomy years ago and had a much better time in Bermuda.

Dr. Rebecca Dunsmoor-Su Answers Hysterectomy Questions

Hysterectomy is a big deal, and no one should make the decision to have one without all the information they need and want. So before Wright went in for hers, she came to ask to the questions that should have been answered long ago.

What follows is a very important conversation between Rolonda Wright and OB/GYN and menopause specialist Dr. Rebecca Dunsmoor-Su. Rolonda Wright’s questions are in italics.

How do I prepare for this, both mentally and physically? This housed my child, so it is a little bittersweet. I’m good with it, I’m ready for it, but it’s also a subtle loss.

“It’s a transition,” says Dr. Dunsmoor-Su. “This marks a new stage in your life, and while that’s a good thing, it’s also a loss. You can be happy and sad at the same time.

“I’m glad you’re doing this and sharing this because women put up with a lot: we endure the pain, the bleeding, the discomfort for such a long time. Partly this may be because it increases slowly and gradually over time. If we went from a normal period to a super heavy period in one month, we’d see a doctor. But because it happens incrementally, we feel like it’s a normal part of aging. So I’m glad you’re bringing this to women’s attention.”

That’s part of the reason I came to you. I’m not even sure what questions I should be asking right now. What do I need to know?

“First, there are multiple kinds of hysterectomy. As physicians, we tend to define it by route of hysterectomy: both by how are we going to do the procedure, and also by what we’re taking and what we’re leaving behind, like ovaries or cervix.

“Fibroids are balls of uterine muscle that grow in the wall of the uterus. They can grow very large. And they are progressive, as they’re estrogen-stimulated. So as long as there’s estrogen in the system, they will continue to grow. We tend to see particularly quick growth through perimenopause when women get these really high spikes of estrogen. So a lot of women end up sort of in that perimenopausal stage, coming in to see us because suddenly this thing has grown quickly.”

Why do Black women have more fibroids than white women?

“Unfortunately, this is one of those things we don’t understand. Black and Asian women tend to have more fibroids; there are thoughts about vitamin D lack and other things, but the research just isn’t sufficient to draw conclusions.

“Not only do Black women have more fibroids, they’re more frequently undiagnosed or misdiagnosed and improperly treated because of systemic racism and sexism in medicine. And because Black women are used to being treated poorly by medical professionals, they may not seek treatment as early. Which is so unfortunate, because the sooner fibroids are caught, the more easily they can be treated.”

I’m a few days prior to surgery. What do I need to be thinking about now?

“In the days prior, you should know how your surgeon is going to do the surgery. It matters because different surgeries have different recovery periods. So if you don’t know, be sure to ask. Also, how are you going to recover? How active can you be, and how quickly? Who’s going to help you out at home, especially in the first couple of days?

“This is even more important now, in the time of COVID, because you need to take extra precautions. Anyone you come in contact with needs to be wearing a mask and washing their hands frequently, and so do you. If they can be tested for COVID and minimize contact with others, that’s best.”

So why have a complete hysterectomy?

“We do hysterectomies because the surgery is much simpler, and generally the women we see are done having children. It’s possible to preserve the uterus for women who are still planning to bear children,  but it is a much more complicated, much more difficult, and much higher blood-loss surgery than just removing the whole uterus. Also, you never have just one fibroid. We usually can see one, but there’s always other fibroids in the wall.

“Additionally, fibroids will continue to grow. So we could do the surgery, take the fibroids out, and in two years you could be right back where you are now. If there’s a need to keep the uterus, then we would do the myomectomy, which is the removal fibroid surgery. But if you’re done having children, the hysterectomy is quicker, safer, and has an easier recovery.”

Should I keep my ovaries and fallopian tubes?

“In most women who are having surgery for fibroids, we don’t remove the ovaries, because there’s no reason to put someone into sudden menopause when really the only problem is the fibroids. We usually take the tubes now because there’s some question about whether they contribute to ovarian cancer rates. However, we usually leave at least one or both ovaries because then you drift into a gradual menopause. Your ovaries also have some roles after menopause in terms of making precursor hormones and testosterone. Those are good, so we want to preserve that function if we can.”

Why do some women elect to have their ovaries removed?

“It’s always a balance of risk/benefit ratio. When I counsel patients, I ask, “˜Do you have a high risk in your family of ovarian cancer or familial breast cancer?’ Familiar ovarian cancer history could mean you’re at higher risk for ovarian cancer, so we might want to consider removing the ovaries.

“Also, if you personally had breast cancer, removing the ovaries can mean reducing the stimulation of the breast tissue with estrogen which can help prevent recurrence.

“But in most women who are just having surgery for something like a fibroid or heavy bleeding, and whose ovaries are not at particularly high risk, there’s a greater benefit to leaving them. Ovarian cancer  doesn’t happen very often, especially in women with few risk factors. Whereas cardiovascular disease and bone fractures and all those things that come with menopause do happen quite often. And so drifting into a more gentle menopause at a later age is just more beneficial for women.”

What are the different methods of hysterectomy, and how do surgeons and women decide which route to take?

“It really depends on the reason for the hysterectomy and what your provider has been trained to use. It’s amazing what we can do without opening your abdomen anymore. Now that we have all these techniques and tricks. Some can be done vaginally, which means we go in through the vagina, grab it, snip it loose and pull it out. In those cases, women don’t even have an incision. And that works when the uterus is small, with no large fibroids. But when you have a larger uterus with large fibroids, we use the laparoscopic camera or the robot, depending on training. We make a couple of centimeter-long holes in your abdomen, and we can get that larger uterus out that way. We disconnect the organ with all the fibroids still in it, put it all into a bag to keep it contained, use a device to turn it into one long strip, then pull it all out. The bag is a precaution because rarely the fibroid can contain cancerous cells that we don’t want spreading throughout the body.

“The beauty of this is that the pain of surgery is generally from the incisions. When incisions can be kept really small, or when you don’t have to make them at all, the pain is much less and the recovery is faster. There will likely be a dull aching in the low pelvis, but women won’t have to struggle to recover nearly as much as previous generations.”

How is the uterus anchored inside the body?

“Generally speaking, it is anchored where the uterus and the cervix meet. If you think of the uterus as a fist, the cervix would be the wrist that hangs out into the vagina. It’s anchored at the connections or the point where the uterus and cervix are joined by two ligaments that go back to your sacrum or tailbone. There are tubes that come off the top of the uterus and sit around the ovaries, but they’re not really connected to the ovaries. There is a little vascular connection between the ovary and the uterus, and that’s pretty simple to disconnect. And then it’s mostly blood vessels.

“At the bottom of the uterus, we take the cervix and close the top of the vagina. Taking the cervix removes cervical cancer concerns, and there’s really no reason to leave it behind. It doesn’t had to do with sexual pleasure, nor does it provide support for the vagina, as was once thought.”

Will I feel any different without a uterus?

“Because your fibroid is quite large, you may feel the lack of the fibroid, but that’s a good thing! You’ll probably feel a bit thinner and less heavy, you’ll have less constipation, possibly less urinary urgency without that big thing putting pressure on your bladder or making constrictions. In terms of sexual pleasure, there shouldn’t be any difference. The center of women’s sexual pleasure is the clitoris, and we don’t remove that ““ it’s very important! If your ovaries are not removed, you won’t have a difference in hormones.”

What should I look out for? Are there concerns after the surgery?

“Of course, every surgery carries risks, so let’s talk about them. There are three main things that I counsel about in terms of risks of any surgery and specifically a hysterectomy risk.”

“Number one is bleeding. Because of the fibroid, you have a big uterus; it’s got big blood vessels to feed it. So we have to tie those off properly. We’re performing the surgery under visualization, so we can see that nothing’s bleeding, but it’s not impossible for a blood vessel to be in spasm and not bleeding and then open up later. So if you suddenly feel dizzy or lightheaded or have severe abdominal pain, those are signs of internal bleeding.

“Number two is infection. We give antibiotics before surgery, and it’s not a big infection risk, but obviously high fevers, chills, and severe abdominal pain can be a sign of infection.

“The last one’s a little more vague. It’s damage to structures around the uterus. There’s bowel all around the uterus, and the bladder in front. Ureters are tubes that carry urine from the kidneys to the bladder, and they go down the side of the uterus and up and over it to get to the bladder. Experienced surgeons will identify them and make sure they’re out of the way and check them at the end, but rarely an unrecognized injury can happen.

“The most common unrecognized injury is actually to the ureter, that tube between the kidney and the bladder. As we’re coming down the side of the uterus to seal off the blood vessels, we’re usually using cautery because it seals the edge of the blood vessel and then we can divide it.

“If the cautery is just a little bit too close to the ureter, even if it wasn’t cut, it could have some localized thermal damage and that can show up a week or two later. That usually ends up presenting as severe abdominal pain, sometimes flank pain. That’s something to look out for as well.

“Again, all of these complications are very rare, but they can happen even to the best surgeon. If there were complications during surgery, your surgeon will let you know about it and tell you what to be on the alert for, but by and large, this is a low-risk surgery.”

What will happen as a result of the surgery? Am I going to gain weight or lose my hair?

“I tell women who are near to the menopause that for about six weeks after a hysterectomy, you may have an upswing in hot flashes. A lot of that’s just inflammation and healing; after all, the ovaries took a little hit! But it usually settles out, and you should drift into a natural menopause like you were before the hysterectomy.

“The best way to minimize problems in recovery is to go in healthy and really well nourished. Make sure you’ve got all the nutrients you need for your body to undertake this big healing process. I am not personally a huge supplement taker. I tend to eat a very balanced diet and that’s generally enough, but before my own surgery, I took Gennev’s Vitality product, which is a daily supplement. I used it for the months surrounding my surgery. I knew that I would be barreling through all these nutrients as my body’s trying to heal, so I wanted to do everything I could to help my body do that. Vitality is a very focused supplement for women age 40 and above, and it has the things we need more of like vitamin B and vitamin D and so on.

“Before surgery, I talk to my patients about their health goals, their history, and their risks because all of those should inform their surgery.

“Even though you may not go into menopause because of your surgery, you’re eventually going to go into menopause. How do you want to handle that? What are your fears about this process of menopausal transition? And, you know, what’s most important to you to preserve?

“You know, some women say my biggest fear is weight gain, in which case I say, well, there are a couple of really important things you need to keep in mind: One, you lose muscle mass as you go into menopause. So adding more weight training to your regimen rather than more cardio can help you maintain weight. Two, you need fewer calories as you get older.

“Is fear based around sexual function? In that case, I tell them there are important things they need to do during menopause. One is make sure your relationship and your stressors are under control because probably the most key things in any woman’s libido are stress and relationship stress. Number two, make sure vaginal tissues and happy and healthy and take pleasure from intercourse. We can do that by treating vaginal tissues with local estrogen or other moisturizers and using a really good lubricant. Do it right away, because once you start to experience pain down there, you may start to fear sex and it will drive your libido down.

“For some women, fear centers more around longevity in terms of cardiovascular health and bone health. Maybe they have a strong family history of osteoporosis or heart attacks. Then we talk about hormone replacement. Certainly if someone’s having significant symptoms around menopause, like significant hot flashes, significant sleep disturbances, HRT can really help them transition comfortably and safely.

“For many or most women, we experience menopause in our fifties, when we’re not done at work. We are at the height of our careers. We can’t really afford to be having seven hot flashes a day and not sleeping at night. So we take hormone replacement through our fifties and into our sixties and come off it when we retire. I have patients who use hormone replacement for two years. I have patients who use hormone replacement for 10 years. I have patients who use hormone replacement until they die because they love it and it makes them feel good. And all of those are appropriate responses to menopause.”

Rolonda Wright is sharing her journey with us so other women will have an easier “” and certainly more informed “” journey of their own. While we’re comfortable talking about all kinds of personal things (ask any runner about their digestive system, for example), hysterectomies have long been considered embarrassing and shameful. And that does not help women be healthier.

Our thanks to Rolonda for sharing her experience, asking questions so many women share but are too afraid to ask or have no one to ask. If any of her experience sounds familiar to you, we encourage you to talk to your doctor or ours to learn more. Don’t wait, don’t suffer, don’t be embarrassed. Be healthier and happier instead!

Are you dealing with fibroids or do you suspect you might be? Come ask questions and learn more from the Gennev Community forums!

The red cup is back at Starbucks, and you know what that means: the holidays are just around the corner.

Finding gifts for everyone on your list can be enough to put even the most seasoned shopaholic in a bad mood.

And if you traditionally use Thanksgiving as your cue to start shopping, we have bad news: there are only 26 shopping days between Thanksgiving and Christmas in 2019.

And Hanukkah starts on December 22 this year.

Don’t: stress

Hooray! “˜Tis the season for an extra layer of emotion slathered over everything. It may be your first December without a loved one or the annual reminder of rough times with your ex. Family expectations are high, and your mother-in-law still hasn’t forgiven you for marrying her favorite child.Staying relaxed is easier said than done, but stress is both no fun and a big trigger for hot flashes.

If listening to music calms you, bring your headphones while you shop. Take a break for self-care: get a massage, soak in the tub, or go for a long walk before you start to feel burnout.

Doctor’s orders.

We’re hoping this list helps, as well.

Do: prioritize Cyber Monday over Black Friday

Who really wants to wake up at 4 a.m. to beat the Black Friday (November 29) crowds? Cyber Monday (December 2) has become a solid alternative. You’ll get great deals, save gas, and you can do it in your PJs with a cup of (decaf) coffee.

And you don’t need to wait: many retailers already have their Black Friday discounts listed online. For example, Cnet has curated a few ideas from favorite retailers like Walmart and Amazon, and TechRadar has predictions about upcoming Cyber Monday bargains.

Fear not, procrastinators: even if you snooze on the post-Thanksgiving deals, you can take advantage of Free Shipping Day on December 14.

Do: plan out your brick-and-mortar shopping routes

Online shopping makes it easier than ever to cross off everyone on your holiday list without leaving the house.

But when your partner or kids have prying eyes, you want a one-of-a-kind gift that can only be bought in a brick-and-mortar location, or you’re desperate for a new outfit to wear to the office holiday party, you need to put on your big girl pants and get out there.

Whether you’re hitting the mall or the mom-and-pop shops on Main Street on Small Business Saturday (November 30), write out what you want from each store and in which order to visit them to save time, gas, and stress.

Don’t: forget your comfortable shoes and your FitBit!

Hitting the mall can be a great way to get in your steps. Exercise during menopause is important for bone health, weight management, and to lower your risk of breast cancer. Make shopping work to your advantage!

Take the stairs or walk up the escalator. To really get a workout when shopping during the day, park as far from the entrance as you can, or on the opposite end of the side that you’re planning on visiting.

But”¦

Do: be safe

Safety first, always! Law enforcement professionals remind you to park in well-lit areas, keep your hands free and keys and cellphone easily accessible, roll your windows all the way up when parking, store gifts and bags in your trunk, and always lock your car.

Cybersecurity experts remind you to use trusted websites, make sure the site is SSL encrypted (you’ll know because the URL will start with “˜https’ and you’ll see a locked padlock in the address bar), and other best practices when shopping online.

Don’t: shop hungry, and Do: bring water and healthy snacks

Who can resist the alluring smell of Cinnabon? When that cinnamon-sugary aroma wafts across the food court, it can be hard to resist, especially when you’re stressed. Unfortunately, sugar, caffeine, and other mall delights can lead to hot flashes and midlife weight gain.

Stash a few snacks filled with fiber, protein, vitamins, and healthy fats in your bag: nuts, apple slices, dried fruit, hardboiled eggs, a cup of yogurt or cottage cheese, string cheese, or single-serve hummus and carrots are all portable and healthy.

You’ll feel better and make better shopping decisions.

Don’t forget your water bottle!

Thirst has a funny way of sometimes coming across as hunger, and water is good for your brain, body, and holiday spirit. It’s extra important that you stay hydrated in perimenopause, menopause, and beyond.

Do: play sleuth on social media

You can always count on Santa to let you know what the wee ones want. Teenagers and adults, not so much.

Time to do some sleuthing. Your friends and family members’ “Likes” on Facebook or “Hearts” on Instagram can give you insight into what they would like to find under the tree.

We promise this doesn’t make you a stalker. Well, maybe a little bit, but finding a thoughtful, inspired gift that the recipient will cherish makes it cute, not creepy.

Don’t: gift a DNA testing kit (unless you’re positive the recipient wants one)

Many of us in midlife find ourselves wanting to get in touch with our roots or explore our family tree. DNA tests have become a popular gift in recent years, and the most popular services offer deals around the holidays.

These tests can provide amazing genealogic and health insights but may be problematic as unsolicited gifts.

• Privacy: Many users have concerns about giving their DNA to private companies.
• Family: nonpaternity events are more common than you would think; your gift might be the key to a closet full of skeletons.
• Carrier Status: The tube of spit doesn’t lie, and you can’t unlearn your risk for genetic disease. Not everyone wants or is ready for this truth.

Do: buy gifts that support health

Perhaps your sister is trying to shed a few post-menopausal pounds, or your best friend is getting hit hard by hot flashes. Maybe makeup and nail polish are easy stocking stuffers for your daughter or niece.

We’ve written about how makeup, nail polish, and other cosmetics can be a bummer for breasts. Pick products that are free of parabens, phthalates, phenols, and other potential toxins.

Use this as an opportunity to help your friends swap out bad for better, such as alternatives to plastic (which may be full of cancer-causing chemicals). [A few ideas for reusable gifts]

And browse our gift ideas for women in midlife and menopause or our menopause wish list; from float sessions to cooking classes to smart vibrators (oh my), we’ve got you (and your sister, and your girlfriends) covered.

Don’t: buy gifts at all

What do you get for the person who has everything? Sometimes the answer is nothing””nothing besides memories and experiences.

Sure, you can’t give everyone on your list a vacation or spa day, but there are plenty of experiential options for all budgets, for kids, and for the entire family.

You could also give cold, hard cash, but what’s better than getting $5? Giving $5 to charity. Research shows that the pleasure of receiving money fades, while philanthropic contributions leave a warm and lasting glow. Charity Navigator can help you find reputable non-profits and causes that will resonate with your friends and loved ones’ areas of interest.

And you can’t go wrong with a homemade gift from the heart–even if you aren’t crafty enough to upcycle an apron, you can have a lot of fun putting together a DIY bubble bath set.

Do: get a head start on next year’s shopping

You can score seasonal cheer at a deeply discounted rate after Christmas… while you buy yourself what you really wanted from Santa. If you have the space, stock up on holiday decor and evergreen gifts to save your future self some of the stress you’ve just vanquished.

Don’t: be afraid to say “œno”

While there is some truth behind the idea of retail therapy, don’t shop if you know you aren’t in the right headspace for it. The holidays can be hard, and your mental and physical health needs to come first.

While you’re at it, feel empowered to skip the office holiday party. Unless you found that perfect outfit on your shopping adventures.

If you’ve mastered the art of stress-free holiday shopping, help a buddy out and share it with us in our community forums!

Do things just slip through your fingers? Do you continually bump into things, drop things, misplant a foot when descending the stairs or stepping off a curb?  

Remember that gawky awkward phase you went through as you entered puberty, when suddenly your legs were longer, your arms reached farther, and all these new bits of you felt out of your control?   

Well, like the acne, mood swings, and erratic periods, clumsy is back, and menopause may be (in part, at least) to blame. Fortunately, like adolescence, it’s generally temporary on this end too.

The possible link between clumsiness and perimenopause and menopause

Estrogen as particularly estradiol as appears to have a beneficial effect on fine motor skills. It’s why, at certain points in a woman’s cycle, she may feel a bit clumsier or more graceful than at other times.

It’s also why many women in perimenopause and menopause notice a marked difference in their ability to hold onto things and move comfortably through the world.

Drops in estrogen can also make concentration a bit more difficult, and that moment of inattention can be the difference between enjoying a glass of wine and cleaning it off the carpet.

Additionally, blurred vision from dry eye or even cataracts can add to the number of accidents we seem to be having lately.

Finally, some women say slight dizziness or light-headedness during this time also causes a lack of coordination.

What to do about it

Constantly having to clean up messes is annoying, takes time, and can start to drain our already flagging self-confidence, so here are a few tips to get through this second “awkward phase”:

1. Slow down. Cleaning out the dishwasher is a crappy chore, and we all hurry through it, but you can avoid adding extra layers of crappiness by slowing down so things don’t slip through your fingers and break.
2. Do less at once. Not having to make more than one trip from the car is kind of a fun challenge, but where you used to be comfortable balancing 18 boxes and bags in one trembling pile, now you may not. Consider it an opportunity to get a little more exercise, and bring in the groceries in multiple trips.
3. Be mindful. This one is really important for women who may have osteopenia or osteoporosis. Pay attention to the terrain, step carefully off the curb, so you plant your foot soundly. Your depth perception may be a bit challenged right now, so give yourself that extra second to save yourself any risk of a fall.
4. Get your eyes tested. Be sure you’re seeing well. Get drops for dry eyes, check the prescription on your glasses. If you’re knocking things over, you may just not be seeing them clearly and misjudging the distance.
5. Exercise. In menopause particularly, balance and strength are critical to maintain. Balance, strength, and coordination exercises can help you regain more control of your body (think Tai Chi or qigong, or yoga). And bonus, the right exercise regimen can help strengthen muscles and retain more bone density, so it’s basically a win-win-win. Talk with a physical therapist, if possible, about exercises that help with motor control. These activities from wikiHow might help with fine motor skills, hand strength, and hand-eye coordination. My personal favorite tip: learn to juggle. It’s great for hand-eye coordination.
6. Be patient with new things. Everyone is clumsy with unfamiliar tools or activities, and you may need a bit more time to master new skills. But learning new things can be really good for your brain, so give yourself extra time and leeway for making mistakes. Don’t give up or decide not to try something new just because you’re really going to look like the newb you are.

When to seek help

An increased tendency to drop things and bump into furniture during this time is common, but if your “clumsiness” seems very sudden, very extreme, or comes with slurred speech, numbness, headaches, or difficulty swallowing, seek medical help right away.

Of course, if you have any concern that what you’re experiencing is more serious that a dip in estrogen, please talk to your doctor.

And now for the good news

While there’s not much research on this, what there is, plus anecdotes from women I’ve spoken with seem to indicate this is transitional and temporary, and most women regain motor control after their bodies adapt to less estrogen.

Of course, you can help yourself recover more completely by doing strength exercises. The lost muscle mass many women experience doesn’t regenerate without effort, and much of motor control depends on strength.

We can help you feel in control of your menopause

• Meet with a Gennev Doctor – our menopause specialists can help you understand the expected and unexpected symptoms you may be experiencing and devise a personal treatment plan to help you feel better
• Partner with a Health Coach for actionable lifestyle solutions and the support you need to tackle menopause on your own terms
• Vitality as our most popular daily supplement is a nutrient-packed multi-vitamin supports mood, energy, stress response, immune health, joint pain, and inflammation
• Magnesium as Our super-power supplement can help relieve joint pain, muscle cramps, Restless Leg Syndrome, headaches, depression, fatigue, anxiety and supports better sleep.

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.

Fast Company cares about women’s hormonal health!

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

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

see the original article on Fast Company

Why are “grey divorces” so common?

Conversations around divorce in  midlife  ordinarily focus on the couple and their shared concerns: Financial worries.  Empty nest  syndrome. Parent care.  Painful sex.

But what if the dissolution of long-term marriages were about something else entirely? Something that hides behind arguments about retirement planning and how to spend weekends? What if the problems of midlife aren’t the concerns couples share, but are instead the expectations they don’t?

Menopause Divorce Regret: Show me your midlife and I’ll show you mine.

For men, the second half of life can feel like a reduction. Physical strength is waning. Authority at work may be less as younger colleagues with different skills start asserting themselves. Sexual appetite and ability can be more complicated. Less hair, less energy, less respect, fewer choices.

For women, midlife often looks more”¦ liberating. The children are grown or nearly grown. She may hold a position of high responsibility, or she may be passing the torch and freeing up her time for other things. She may have a decent salary and therefore some disposable income. She’s likely still healthy and active and may even (finally!) be liberated from the inconvenience of a monthly cycle and pregnancy concerns.

Her body is changing and maturing in ways our sexist, ageist society disapproves of, but she cares less about the opinions of others as which, for many women, is the biggest liberation of all.

What do you do when one of you feels like you’re going to seed and the other is on the verge of bursting into blossom? Does a difference in perspective on what the future holds mean a marriage is doomed?

Travel Plans

Add together dissatisfaction and a sense of urgency, and you have a recipe for throwing out babies with bathwater and deciding it’s time to remodel the upstairs bathroom or maybe just sell the darn house and move to Tahiti.

Big impulsive decisions can be made in a midlife crisis in menopause as after all, there’s only so much time left to do all those things you planned, and if anything (one) is holding you back, you need to jettison it (him/her) and get on with living!

But hasty decisions can have lasting consequences and bring lasting regret. Thinking through the possible repercussions before acting could be the difference between facing the music and dancing to it.

It might be helpful to think of all your possible futures as travel destinations. How do you plan for the trip that is the rest of your life?

1. Decide on a destination. What do you want from this journey? Excitement and adventure? Relaxation, comfort, and predictability? Bear in mind that this isn’t two weeks in Prague, this is the rest of your life as you have time for many adventures. It may be risk and wild times now, familiar comforts next. You don’t have to make decisions that cut off future choices.

2. Pick a travel partner. To do this right, ask yourself: What do you need from your partner? Someone to come along with you, step for step, as eager to take on the next adventure as you are? Or someone to come home to, tell your menopause stories to, who provides a safe and familiar harbor? You may discover the travel partner you need is the one you already have. And if not, you may be better equipped to choose the next one, or to decide it’s time to go it alone.

3. Be aware of baggage fees. We all carry a lot of extra emotional and spiritual “weight” around, and our dissatisfaction with ourselves and what we feel we haven’t accomplished can turn into resentment of our partner. Is that person truly holding you back? If so, a re-evaluation may well be in order. But if the baggage is your own, be careful you aren’t jettisoning your best support system and your best friend.

4. Know the weather at your destination. Okay, this analogy is pretty much milked, I admit, but here’s what I mean: if you’ve been together a long time, your lives are all tangled up together. Untangling all that may mean losing some mutual friends, in-laws, estranging children. You may lose access to meaningful places, events, and activities. It will likely be a bit cold and lonely at first, and while that may not be the most important aspect of your decision, it’s important to be realistic”¦ and ready.

So what do you do now?

The urge to throw it all off and flee, wind in your hair, bridges alight behind you, may be nearly overwhelming, but you owe it to yourself and to the person who’s shared their life with you to get this right.

If your partner as male or female as is imagining the future differently than you are, they may not even be aware of the gap in your expectations. One of you is envisioning matching recliners and sports teams on the telly, while the other is signing up for scuba lessons and learning Japanese, and the two points of view seem utterly incompatible. But are they, really? Might it be possible, with a bit of negotiation and compromise, to have it all?

Give yourself and your partner the respect of having the conversation. Be kind. Be open. Be honest. It may not save a marriage that has truly reached its expiration date, but it may help preserve a relationship that’s meant a lot for a long time.

Are you finding your long-term relationship is wearing a little thin in midlife? What are you doing about it? If you’re willing to share, we’d love to hear your thoughts. Comment here, join the “gray divorce” conversation on our forums, or find us on Facebook or in Midlife & Menopause Solutions, our Facebook group. 

This article first appeared on PRiME Women and is reprinted here with permission. 

It used to be called the “mask of pregnancy” because it happens so often to women in that condition. But melasma as those darker patches on your skin as isn’t limited to pregnant women. It can first happen, or happen again to many women in menopause.

These changes in pigmentation usually occur on the face, and while they aren’t dangerous, they can impact our self-confidence. To understand the condition, skincare tips, and what concerns it raises, we talked to dermatologist Dr. Keira Barr, author of The Skin Whisperer.

What are the causes of melasma?

Dr. Keira shared, “Melasma appears on women’s skin much more often than men’s skin. In fact, though over 5 million Americans are affected by melasma, 90% of them are women. “What causes melasma is not yet fully understood, though current theories suggest that hormones, UV exposure, inflammation, and genetics are all major influencers of the disorder.”

“Melasma likely occurs when the pigment producing cells in the skin (melanocytes) produce too much pigment (or melanin),” Dr. Keira explains. “The underlying hormone responsible for triggering the melanocytes is melanocyte stimulating hormone (MSH). This hormone increases the production of melanin, which is responsible for darkening the skin.”  People with darker skin are more prone to melasma because they have more active melanocytes than people with light skin.

“At all stages of women’s lives, hormones can be in flux. When it comes to melasma, research has found that elevated levels of estrogen, and to a lesser degree elevated progesterone levels, are associated with increased skin pigmentation. “This is why melasma is often seen during pregnancy, and in those women using oral contraceptive pills and hormone replacement therapy (HRT) as because hormonal levels are elevated and stimulate melanocytes both directly and indirectly to increase pigment production.”

Hormones + stress: Cortisol is part of the problem, says Dr. Keira, so avoiding stress where possible can help manage the condition. “As you become stressed (whether it be physical, psychological  or emotional), your body produces increasing levels of the hormone cortisol to help cope with the stress.” More cortisol creates an imbalance in estrogen levels, and “these elevated estrogens upregulates MSH levels, which in turn increases the amount of melanin produced. Re-establishing balance in stress and hormonal levels are one of the keys to prevention and management.”  

Hormones + thyroid: Other hormones also have been shown to play a role in melasma, according to Dr. Keira. Studies highlight that individuals with thyroid disorders, specifically autoimmune thyroid conditions, had a higher incidence of melasma as well. 

Exposure to sunlight and heat: “Ultraviolet (UV) light from the sun stimulates your melanocytes. This means that just a small amount of vitamin d or sun exposure can make melasma return after fading,” says Dr. Keira. “This is why melasma often is worse in summer due to higher levels of sun exposure. It also is the main reason why many people with melasma have recurrences…it comes back, again and again.”

Sun exposure can either trigger melasma, or contribute to exacerbation of the skin patches, according to Dr. Keira. “What’s more, the sun’s heat, and heat of any kind, is a common trigger for melasma as it increases vascular dilatation which is a component of this condition. In addition, heat may lead to more inflammation which can also stimulate melanocyte pigment production. What does this mean? Sun screens and other surface protection may not be enough to keep the skin from darkening.”

Genetics:  While women constitute the vast majority of those with melasma, it’s not limited to women alone. In fact, says Dr. Keira, “Recent studies have found that melasma tends to run in families regardless of whether a man or women inherits the condition. In fact, one study showed that 70 percent of Latino men with melasma also had a family member with melasma.” 

Irritation from skin care products:  Be careful of how you treat your skin, says Dr. Keira. “If a product or procedure irritates your skin whether due to heat or friction resulting in trauma, melasma can worsen due to stimulating melanin production. This has been shown in association with intense pulsed light therapy, microdermabrasion and some chemical peels.”

How do you know it’s melasma and not something else?

Dermatologists can diagnose most patients by looking at their skin, Dr. Keira tells us. “What makes melasma a challenge for treatment is how deeply it penetrates the skin. The more deeply it penetrates, the more difficult it may be to treat. To determine how deeply the melasma penetrates the skin, your dermatologist may look at your skin under a device called a Wood’s light. “There are instances when melasma can look like another skin condition. To rule out another skin condition, your dermatologist may need to remove a small bit of skin by performing a skin biopsy. A skin biopsy is a simple procedure that can safely and quickly be performed during an office visit.”

Is melasma dangerous?

Melasma caused by hormone changes is neither painful nor dangerous. However, since melasma can be caused by other conditions, like thyroid disease or allergic reactions, it’s wise to check it out to be sure of the underlying cause.

The pigmentation can fade or go away entirely when the cause is removed as with some time after the baby is born and hormones settle, or if the patient stops taking hormones. However, the patches can last for many years or be permanent.

What are the most effective melasma treatments?

Melasma may, in time, go away on its own, but it can take time and vigilance. These tips, direct from Dr. Keira, can help manage the melasma as well as protect against recurrence.

Limit sun exposure. The best melasma treatment is often prevention. As sun exposure is a leading trigger for melasma, sun protection is at the top of the list for both prevention and management of this condition. When heading outdoors wearing a broad-brimmed hat, sunglasses, and a broad spectrum sunscreen with at least SPF 30 is important. I prefer moisturizers and sunscreens with physical sunscreens like zinc oxide because it is tolerated by most skin types and less prone to cause irritation. It’s important to remember that damaging sun rays penetrate through a car window. 

Protect with good nutrition. Additional sun protection strategies include eating an anti-inflammatory dietrich in antioxidants and phytonutrients which means loading your plate full of colorful fruits, vegetables, healthy fats like olive and avocado oil as well as omega-3 fatty acids like salmon. Supplements to consider before heading outdoors include those that contain polypodium leucotomas, grape seed extract, green tea extract, astanxanthin and omega-3 fatty acids.

Apply topical treatments. Talk with your doctor about the different topical treatments that are available. It’s important to have the right treatment for your skin type and lifestyle, so be sure to discuss all the options with a qualified professional. 

Hydroquinone. Commonly used as first-line treatment for melasma, it works by lightening the skin and is applied on the skin. It comes in varying prescription strengths as well as less-powerful over-the-counter varieties. One caveat: this medicine should be used sparingly and briefly as it can cause a darkening of the skin called ochronosis.

Tretinoin and corticosteroids. Topical tretinoin (aka Retin-A) may be used to enhance skin lightening. Sometimes a combination of three medicines may be used in one “triple” cream: hydroquinone and tretinoin to help with skin lightening, and the corticosteroid to help alleviate any irritation caused by the other two medicines.

Kojic acid. Kojic acid is naturally found in soy and mushrooms and works in melasma by decreasing the amount of pigment within the melanocytes. However, kojic acid has a high rate of contact sensitivity, so be careful to avoid skin irritation that could worsen melasma. 

Azelic acid: Azelaic acid works similarly to hydroquinone and may be paired with tretinoin as well to enhance the effects.

Vitamin C (L-Ascorbic acid): Vitamin C is a natural antioxidant that prevents the absorption of UV radiation and the subsequent formation of free-radicals, so it prevents melanin from forming. It is well tolerated and can be used alone or in combination with other topical therapies.

Niacinamide (Vitamin B3): Studies have shown niacinamide to be effective for melasma. Melanocytes produce melanosomes which give skin its color; niacinamide can block melanin transfer to the outer layers of the skin.

These therapies may work better when combined with a series of chemical peels with either Glycolic, Salicylic, or Trichloroacetic Acid. Peels and topical therapies should be adjusted according to skin type and under the guidance of your dermatologist for best results.

Other treatments include micro needling, laser, microdermabrasion and light-based therapies. Only a dermatologist or highly trained professional under a dermatologist’s supervision should perform these procedures as worsening of melasma or new skin problems may occur when the person who performs the treatment does not tailor it to the patient’s skin type.

What can happen if it’s left untreated?

Treatment isn’t necessary for safety, says Dr. Keira, but there are implications to doing nothing. “As one of the major triggers is UV radiation exposure, continued exposure can lead to darkening of the skin and make melasma patches permanent. While it is a benign condition and treatment is not required, I have found the emotional and psychological impacts of melasma take the biggest toll for many individuals when the condition is left untreated.”

Anything else we need to know?

Melasma is caused or worsened by irritation, so be aware of everything you do to your skin, Dr. Keira adds. “Choose skin care products that are gentle on your skin. Avoid and discontinue products that sting or burn your skin, as those may worsen melasma. And avoid waxing: Waxing causes acute trauma to your skin and may cause skin inflammation which can worsen melasma, so it’s important to avoid waxing areas of the body affected by the condition. Ask a dermatologist about other types of hair removal that may be right for you.”

We can help you find relief from melasma

• Meet with a Gennev Doctor – our menopause specialists can help you understand fluctuations in your hormones as they relate to melasma along with any other symptoms you may experience, and provide a personalized treatment plan.
• Try Vitality to support your overall health throughout menopause. Gennev’s nutrient-packed multi-vitamin supplement supports inflammation and joint pain, mood, energy, stress response and immune health.
• Are you getting your Omega-3s? Gennev’s Heart & Brain Premium Omega-3 for Women offers care for your heart and brain as well as helps to relieve dry eyes and dry skin.

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.