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.

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

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

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

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

What does nutrition have to do with our brains?

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

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

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

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

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

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

So what should we eat to fuel our brains?

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

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

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

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

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

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

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

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

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

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

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

What should we not eat to protect our brains?

Jill:  What do we want to stay away from?

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

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

Who has it figured out?

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

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

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

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

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

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

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

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

What should we do to stay sharp as we age?

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

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

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

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

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

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

What are the most important steps I need to take?

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

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

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

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

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

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

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

Her older sisters told her that her symptoms were just part of perimenopause. 

But she knew her excessive nighttime sweating, severe fatigue, and especially her unexplained weight loss were signs of something more serious. She felt these were not just warning signs of menopause. She persisted and eventually received a diagnosis: a rare form of cancer. 

After several rounds of chemo and a stem cell transplant, she’s back to thriving””because she knew her body and her symptoms.

Midlife can be as confusing and full of changes as adolescence. Your body is going to do things that don’t feel normal to you but are a natural part of perimenopause and menopause. 

Unless they aren’t.

Chances are, what you’re experiencing is due to hormonal changes in perimenopause/menopause or to aging. But you know your body best, and if something feels more urgent, don’t hesitate to take it to a qualified medical professional. Pay attention to what and how you’re feeling; you may want to take extra precautions with some menopause symptoms if you have a personal or family history of certain conditions or symptoms that come with other discomforts.

If you are experiencing unbearable symptoms, a Gennev board-certified OB/GYN 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.

Talk to your doctor if you notice any of these red flag warning signs for menopause

1. Fractures before menopause.  If you’ve broken a few bones, or even just one, after age 50 and before menopause, you’re at greater risk for  osteoporotic fractures after menopause, even after all other reasons for osteoporotic fractures (like maternal fracture history, bone mineral density, diet, and drug use) are ruled out. Talk to your doctor about preventative measures.
2. Post-menopausal bleeding or discharge. Irregular, inconsistent bleeding or unusual or foul-smelling discharge should raise a red flag for people with uteruses at any point in their lives, but any bleeding or discharge after your periods stop in menopause is a major red flag; it could be a sign of uterine cancer. Your doctor may order some testing for you, including an ultrasound and biopsy.
3. Weight gain, brain fog, fatigue, temperature regulation, and irregular periods if you have an autoimmune disease or family history of thyroid problems. Many of the symptoms of hypothyroidism can mimic the symptoms of perimenopause. The most common cause of hypothyroidism is Hashimoto’s disease, an autoimmune disorder that attacks the thyroid, which is why people with Type 1 diabetes or celiac disease especially should rule out Hashimoto’s. And, of course, if hypothyroidism runs in your family, you might want to talk to your doctor.
4. You’ve had a major depressive episode prior to perimenopause. Fluctuating estrogen is enough to make anyone in menopause moody. But if you’ve had a major depressive episode in the past, you are 59% more likely to have another as you enter perimenopause. And if you haven’t, but are experiencing fatigue, headache, and a sense of prevailing sadness now that you’re in midlife, you may be depressed and not even realize it. Mental illness is no joke; talk to your doctor about your options before your mental health takes a downturn. There’s no shame in it, and no shame in seeking help.
5. Excessive sweating. Hot flashes are a normal part of menopause, but excessive sweating, especially nighttime sweating, can be a sign of something more serious, along the lines of heart attack or lymphoma. If you’re soaking through the bed sheets every night, especially if you also have unexpected and unintended weight loss, and/or a lump in your armpit, neck, or groin, talk to your doctor.
6. Incontinence. 30-40% of women experience midlife incontinence, but feeling pressure on your bladder or sudden urges to urinate when you haven’t had them before could be a sign of ovarian cancer. Ovarian cancer in its early stages has few to no symptoms, and in the later stages can easily be mistaken for menopause symptoms. If you have just incontinence, chances are you’re experiencing the normal issue that comes with estrogen withdrawal. However, if you’re also experiencing bloating, quickly feeling full when eating, unintended weight loss, pelvic pain, changes in elimination (like constipation), and incontinence, make an appointment with your doctor. 
7. Cognitive challenges that go beyond brain fog. Menopause and brain fog is a normal combination or symptom. Mood fluctuations are a normal part of menopause. It’s not uncommon to forget where you put your keys every now and again or have a word right on the tip of your tongue. However, if you have trouble maintaining a conversation, regularly forget the month, year, or where you are, or can’t remember how to pay the bills, or if your friends and family begin to notice changes in your personality, see a doctor. It could be a sign of something more serious such as early-onset Alzheimer’s or dementia. 
8. Headaches. If you’re someone who regularly suffers from headaches, the good news is that the prevalence of headaches tends to decrease in your 40s. The bad news is that headaches after menopause could be a sign of something more serious. If you didn’t have headaches before menopause or your headache is accompanied by fevers, chills, muscle aches, nausea, or weight loss, gets progressively worse, or hurts more when you stand up, call your doctor. But don’t let this stress you out: migraines and tension headaches are still the most common form of headache in midlife and beyond.
9. Back pain. Pain is never a good thing, though we often see back pain as a normal part of getting older. Sitting too much, poor posture during exercise, and even your mattress can all contribute to spinal aches. But when the pain is localized or acute, you might want to get it checked out, especially if you have osteoporosis or a family history of cancer. If your pain gets worse at night, while you lie in bed, or when you take a deep breath, or occurs without activity, talk to your doctor””especially if you have a cough, unexplained weight loss, fatigue, or begin to cough up blood. 25% of lung cancer patients report mid to upper back pain before being diagnosed. Lower back pain, when combined with constipation, bloating, pelvic pain, loss of appetite or urinary issues, can be a warning sign of ovarian cancer. Best to talk to your doctor and get yourself checked out.
10. Your doctor dismisses your concerns. If you can’t have an open conversation with your OB/GYN about your menopause symptoms or feel like he or she dismisses your concerns, find a new doctor. Seriously. Here’s more on what to look for when selecting an OB/GYN in menopause.

Know what’s normal and what isn’t.

Read up on what to expect in perimenopause and menopause.  

And always trust your gut. Talk to your doctor or one of ours if you have any concerns about your health, your body, and your journey through menopause.

Guest blogger Anne Miano talks about her efforts to be proactive with her health care and how the system makes it tough.

About six months ago, I got a letter from my health care provider asking me to participate in a study. They’d chosen me, the letter said, because my breasts had a significant amount of dense tissue, and therefore, I had a higher than average risk of developing breast cancer.

I stared at the paper and felt a chill. I didn’t know I had dense breast tissue, and I’d never heard this was associated with breast cancer.

I’m no stranger to breast tissue or cancer.

My mother developed breast cancer when I was in graduate school. It was a tumor the size of a grain of sand. Slow-growing and relatively non-aggressive. The doctors recommended a lumpectomy and radiation, which she did. And now, almost twenty years later, she remains cancer-free.

When your mother receives a diagnosis of breast cancer, her life changes. But yours does as well. Not as much. Not nearly. But now someone you care about will live with the specter of cancer. Because you’re never really cured. After my mother’s surgery to remove the lump, she had several more surgeries to take out suspicious tissue. All benign. But when you’ve had cancer, the doctors become hyper-vigilant. The first five years after her lumpectomy, she had so much tissue removed for biopsies that one breast become significantly smaller than the other. She had breast reduction surgery to rebalance her body.

My mother considers herself lucky. Her tumor was small, the cancer seemingly contained, and she didn’t have chemo. But she still went through a lot. And every year, she holds her breath as she goes to the oncologist for her annual checkup, her ongoing reminder that the cancer could return at any time.

The day my mother was diagnosed, my risk for developing breast cancer shot up, and her doctor told me to make an appointment for a mammogram. I did, and when I went for my session, I explained to the doctor at the university health center what had happened and said, “I guess I’m destined to get it, too.” She told me I was wrong, that my risk was no more than 10%, and so the odds were in my favor.

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Invited to a study

When I got the letter in the mail about the study, I responded immediately, saying, “Yes, I want to participate.”

The study had nothing to do with medication. It was focused, instead, on education:  If women with a higher risk of breast cancer were given information about their risk and ways to reduce it, would they take steps to do so?

The health care provider had created a special website, designed to educate women like me. Some women in the study would be given access to the site; the control group would be directed to WebMD. I was delighted to learn that I would have an account on the new site.

I read every page, completed every questionnaire, and discovered my risk for breast cancer, according to the site, was 3.7% over the next five years and 7.9% over the next ten. The average woman’s risk is 1.4%, so I was more than twice as likely to develop breast cancer.

I also learned about breast MRIs for detecting cancer and medications that reduced risk. Because MRIs are only recommended for women with a much higher lifetime risk, over 20%, they didn’t make sense for me. But I was curious about the drugs, Tamoxifen and Raloxifene, which have been shown to reduce breast cancer risk by half.

I read about these drugs on the website and discovered:  1) Raloxifene is used most often to treat osteoporosis and can only be taken after menopause; and 2) the drugs work by “starving” cancer cells of estrogen, the food they need to grow, by blocking their estrogen receptors. With either of the drugs, I’d have to take a pill every day, and they both come with some nasty side effects, including a higher risk of stroke. Moreover, they’re expensive. Raloxifene, which I investigated because it seemed to be a bit more benign, would cost me about $100 per month.

I printed out my reports from the site, showing my breast cancer risk and “Questions to Ask,” and went to see my doctor. I wanted to discuss my options with her.

The limits of health insurance

Here, I’ll interrupt my story and tell you about my health care coverage. I’m a freelance writer, and I buy my own coverage. When I did work for a company, I belonged to a health care cooperative, and I decided to continue my membership. I didn’t have the option of keeping the plan I’d had when I worked for a corporation, which was a pretty darn good plan. Although my membership fees are the same, about $400 per month, I have a $7000 deductible, and nothing is covered until I reach that amount in out-of-pocket costs. I’ll get back to this later.

When I called my provider to find out how much Raloxifene would cost if I bought it through their pharmacies and if it would be covered by my plan, they refused to tell me. I had to have my doctor put in a request to get the cost. But when she did that, she was told that I couldn’t take Raloxifene until I’d tried Tamoxifen and found it ineffective.

“Ineffective?” I asked my doctor in email. “Wouldn’t that mean I got cancer?”

“No,” my doctor wrote back. “It means that you can’t tolerate side effects.”

It seemed like a crazy way to go about choosing medication.

We know Tamoxifen is nastier, but I’d have to try it first and get really sick or maybe have a stroke before my doctor could prescribe an alternative.

“What if I pay for it myself”? I asked. She responded, “You shouldn’t have to.”

Fortunately, I have a great doctor. (If you’ve read my earlier posts, you know I kicked my previous doctor to the curb and carefully chose a new one.) She recommended that I see an oncologist. That way, I could get better information, find out whether I should take medication, and if I should, maybe an oncologist would have more freedom in prescribing drugs.

Last week, when I showed up at the oncologist’s office, she was a little surprised to find out I didn’t have cancer. I told her about the study, showed her the reports I’d printed, and explained that I wanted her guidance on the best way to take action to reduce my risk. At that point, she seemed to warm up and enjoy having the opportunity to talk with a patient about prevention, something, I imagine, she doesn’t get to do very often.

The oncologist asked me questions about my family history and my lifestyle (did I drink, smoke, exercise, etc.?), and then she left me for about 10 minutes to input my information into a risk assessment model that she said was better than the one on the website. When she returned, she told me that my risk was lower than what I had thought, about 2.6%.

The reason, she explained, was”¦well, you can probably guess:  I’ve never smoked, I eat well and exercise regularly, my stress level is low, and I’ve never been overweight. In fact, without knowing it, I’ve been managing my risk for most of my life. Not only for breast cancer, but for a long list of other things, including heart disease, which actually plays a bigger role in my family history.

But since I wanted to do more, I asked about genetic testing, and the oncologist said she didn’t recommend that for me. Medication? Not that either. My breast cancer risk just wasn’t high enough to justify taking on the added risk of stroke.

I’d gotten the information I needed to make a wise decision

I left the oncologist feeling better. Not because I didn’t have to take drugs with horrible side effects or because my risk was lower than I’d thought. But because I’d gotten the information I needed to make a wise decision. Which is how all of us should be able to approach our health care. We should all have access to clear information tailored to us as individuals that lays out facts, choices, and recommended next steps as like I got on the website. Then we should be able to talk about that information with our primary care physician and ask questions. And if our doctor doesn’t have the answers we need to make informed decisions, she should refer us to another doctor, probably a specialist, who does.

In my case, this fact-finding journey enabled me to choose with confidence not to take expensive medication that wouldn’t make me healthier and to continue managing my risk as I’ve been doing. This is preventative medicine as having conversations with our doctors before we get sick. And all of us should have access to it. Not only does it help us each live healthier, it keeps our entire health care system running more efficiently.

But strangely, our health care system isn’t set up for prevention. In fact, this kind of preventative medicine is downright expensive. Prohibitively expensive. My visits to see my doctor and the oncologist each cost me $250. That’s five hundred bucks right out of my pocket. I can afford that. (And not because I didn’t choose to buy an iPhone.) But most people can’t.

Which means the majority of women who joined me in the study, even if they wanted to, won’t be able to take action. No matter what information they discover on the website or how high their risk for developing breast cancer, they won’t be able to afford MRIs or medication.

But that wasn’t part of the study.

If you have a story to share with the Gennev community, please let us know at info@gennev.com. You’re always welcome to share with us in the comments section below or on Gennev’s Facebook page or in Midlife & Menopause Solutions, our closed Facebook group.

Read Anne’s saga of enduring hot flashes and her discovery of low-tech solutions for the dreaded hot flashes.

Our telemedicine doctors and coaches have been getting a lot of questions about the COVID vaccine, so Gennev CEO Jill Angelo asked me to share my thoughts on the safety and efficacy of the vaccines which are rolling out.

Normally, vaccines take years to develop; this one took a matter of months, and I know many of you have questions, given how fast these have become available. Let me give you some reassurance on that front.

Are the COVID vaccines safe?

Yes. For the vast majority of us, the vaccines are perfectly safe, and certainly a great deal safer than risking catching the COVID 19 coronavirus. Here are the facts, to help ease your concerns:

• The mRNA technology used has been in development and testing for many years. This is just the first commercially viable vaccine made from it.
• If you think about it, we make a new flu shot each year, in less time, with less testing, and these are very safe.
• Rumors of widespread severe allergic reactions (there have been only a few) and infertility (this is COMPLETELY false) are part of what seems to be a large disinformation campaign. If you see information on the Internet about the vaccine, check the source “” is it coming from a respected medical professional or magazine? Or is it coming from a click baity popular magazine? It’s highly unlikely that a qualified medical journal will have a sensational headline with lots of exclamation points, for example.

Do the COVID vaccines work?

In terms of efficacy (how well it does the job), we have data on the two mRNA vaccines already, the one from Pfizer and the other from Moderna:

• The Pfizer vaccine was tested in a blinded, randomized controlled trial with 43,000 participants. They saw 162 COVID cases in the placebo group and eight cases in the vaccine group. The notes show that there was 95% effectiveness by day 28 after the first shot. They also did a sub-analysis showing 94% efficacy in adults greater than age 65.
• NOTE: just because the vaccine is highly effective after one dose, DO NOT skip the second shot. The series is intended to lengthen the time the vaccine is protective, and one jab may not be sufficient. For the Pfizer vaccine, the second shot should come within 17-21 days after the first.
• The Moderna vaccine was tested in 30,000 individuals, and they reported 185 COVID cases in the placebo group and 11 in the vaccine group. They report 94.1% efficacy, and again two shots are required.
• Both vaccines will reduce the severity of disease, even if you still contract it. Neither has data yet on “passive transmission,” which is to say, if you are vaccinated can you silently pass the virus if you are exposed. The thought is no, but studies continue on this (all 73,000 of these participants get weekly swabs; they deserve a medal!) So when you do get vaccinated, continue wearing your mask, and of course, wash your hands regularly!

Do the COVID vaccines cause side effects?

Regarding side effects, some that have been reported include arm pain, fatigue, and headache. Apparently the second dose hits some people a little harder, with more reporting flu-like symptoms of muscle aches and feeling a bit feverish. This generally lasts 24-48 hours.

Note that these side effects are mild, much more tolerable and short-term than the disease itself, and are actually evidence that the vaccine is working! Your body has recognized a foreign invader and raised its defenses to fight it. That way, if and when it ever sees the “real thing,” it’ll be ready.

I’ve had COVID. Do I still need the shot?

If you’ve had COVID or got passive antibodies in the last 90 days, it is not recommended that you get the vaccine. Studies are showing that having contracted the disease provides protection against reinfection for three months. However, after 90 days have passed, yes, get in line. Having had COVID does not guarantee immunity; there are cases of people who’ve survived COVID contracting it a second time.

Is the COVID vaccine expensive?

The vaccine itself is free, here in the United States, even for those who have no insurance. However, vaccination providers are allowed to charge a fee for administering the shots, so it might be worthwhile to “comparison shop” administrators. You can find more information on costs and reimbursement on the US government’s Health and Human Services website.

What about drug interactions and allergies?

There are no known interactions with other medications, though it’s always good to check with your doctor to be sure no new information has come to light. If you are immune-compromised, your body may not have as robust a response from the vaccine, but you’ll still get some protection and you should definitely take the opportunity to get the shots.

One thing to understand is this vaccine is not “attenuated,” meaning there is NO live, weakened virus in it. This virus cannot give you COVID, only the antibodies to fight it. There is NO live virus in either the Pfizer or the Moderna vaccines.

For those with allergies, if you have severe anaphylactic responses to multiple things (medications or other), tell the doctor when you get the shot. You should be observed for at least 15 minutes after the administration of the vaccine.

Once I get the COVID vaccine, can I visit my grandparents?

Having the vaccine isn’t a get-out-of-quarantine-free card. We still don’t know if those who have been vaccinated can be passive carriers of the disease, we just don’t have enough data yet. So continue to exercise safe practices, and wave at grandma through the window or over Zoom. It’s not ideal, but it does keep you both safer.

Would you get the COVID vaccine, Dr. Rebecca?

YES! In fact, I stood in a very long line of medical health professionals to get my first shot on Friday. This vaccine, plus continuing to wash hands and wear masks, is how we defeat this terrible and deadly virus and get back to normal life.

And it IS deadly; we are losing over 3000 Americans EVERY DAY currently. I HIGHLY recommend getting the vaccine and have no qualms about that recommendation.

Sincerely,

Dr Rebecca

At Gennev, we’ve been on something of a quest to find the perfect sleepwear and menopause clothing for women who deal with night sweats and daytime hot flashes (or summer heat, for that matter). We’ve tried several, with mixed results. Then we found Cucumber Clothing. We loved the feel, the moisture wicking, and the cool, flattering cuts and styles. Cooling clothing for menopause, if you’ve been there, might strike you as a fantastic idea. We are inclined to agree.

We loved how it helped us get a better night’s sleep and enjoy cooler days.

Cucumber Clothing’s line, like all the products we bring to our Gennev community, helps you feel and be your best self. And the founders, Eileen and Nancy, are women over 40 who understand the realities of this whole perimenopause to menopause transition. They made the clothes they were searching for, so now the rest of us can (finally!) quit searching.

We asked them to share their story with us; we think a lot of what they told us may sound familiar “¦.

______________________________________

Serious sleeplessness

So here’s the thing, some of us are good at sleeping and some of us are not.

Neither group is well defined as in my lifetime I’ve flitted between the two camps. A sound sleeper as a child, an impossible-to-rouse teenager, a late-night owl in my twenties, and a fretting, nocturnal pattern of wakefulness through the next decade with young children.

Roll on a few years and my circadian rhythms have re-set again. Sleep has become a capricious bed mate, undependable, playing to its own rules, and not to be relied on.

Beyond puffy eyes, foggy head and a general sense of weariness, why is this lack of sleep so important, and why do so many women who may once have felt they owned the holy grail of sleep, now feel they have lost, or at the very least, misplaced it? There are a few things to think about here and not all of them are under our control.

Menopause clothing, hormones, and sleep

We know that as our bodies enter peri-menopause and menopause, our level of hormones begin to fall. One of these, progesterone, helps us sleep, so as the level of progesterone tails off, our ability to have an unbroken, deep sleep does too.

A general fall in hormones can also herald the onset of hot flashes and flushes and the aptly named “˜sweats.’

Just these two factors can mean a swing from a good night’s sleep to an “˜I tossed and turned and sweated and didn’t get a wink’ sort of night, followed by a nightmare sort of day.

We need sleep to refresh ourselves, to reorganize our thoughts and memories, to repair our bodies and to rest our cardiovascular system. So necessary, and yet so frustratingly elusive for some of us.

That’s how Cucumber Clothing was born. Travelling home from a holiday with a bunch of like-minded forty plus year old women, our week-long bonding topics covered everything but the kitchen sink, and most definitely included the menopause.

Why, we wondered, were there so few solutions out there? Busy women all, some of us were suffering from the self-same debilitating double whammy of fractured sleep and sweats, which impacted hugely on the jam-packed days.

Moisture wicking clothing for menopause

We decided then and there to create a beautiful and intelligent range of thermo-regulating nightwear and clothing. One that allowed you to look great and feel great wearing it and that quickly moved any moisture (sweat!) away from the body at speed. One that meant that if you woke up in the night feeling sweaty or even drenched, within a few minutes you would feel dry again. We couldn’t stop you from getting hot, but we could help you get back to sleep comfortably and quickly.

Cucumber Clothing was launched in September 2017 and, since then, our original range of six simple and elegant jersey pieces in two colors has expanded to include a summer collection in a silk-like fabric (that works just as hard) in three new colours.

We’ve broadened the range to include leisurewear pieces that work for the gym (our drawstring trousers are great for Pilates or yoga), to the poolside (throw our ruffle dress over your swimsuit), to work (our v-neck t-shirt looks perfect under a summer jacket with tailored trousers on a hot day). They work for any time you are going to get hot. So now there are cooling clothes for “menopause belly” as well as the gym. 

They are all mix and match, and best of all, after a long day staying cool with Cucumber, you can fall into bed wearing them knowing they will be dry, odor-free (that’s our anti-bacterial nano-technology!) and help keep you cool through then night.

Cucumber’s multi-tasking pieces are ideal for travel as our fabrics don’t crush, are happiest cold-water machine or sink washed and like to hang dry as they dry super fast because of their moisture wicking properties. Remember, don’t iron our jersey pieces, and our “˜silk’ pieces rarely need a light press.

Have you tried Cucumber Clothing? What did you think? Let us know your thoughts in the comments below, on the Gennev Facebook page or by joining Midlife & Menopause Solutions, our closed Facebook group.

 how technology can help improve your pelvic health

“Technology,” “fun,” and “pelvic floor muscles” aren’t usually used in one sentence, but for Tania Boler, women’s-health-expert-turned-tech-CEO, it’s a daily conversation.

Tania is the CEO of Chiaro, a women’s tech company that is pioneering smarter technology for women. Their most immediate goal is to help women strengthen their pelvic floor muscles using technology and a very smart device called Elvie.

We at Gennev were intrigued, because vaginal health and pelvic floor health go hand-in-hand.

We Skyped with Tania this week and learned what every woman needs to know about her own pelvic floor health: If we don’t take care of it, we can be susceptible to incontinence—better known as bladder leakage or peeing our pants. If we do take care of it, we can look forward to better core and pelvic strength, better sex, and bladder control.

Why am I leaking? Why is sex painful?
Consult with a menopause-specialist physician
from the comfort of your home with Gennev’s telehealth services.

Pelvic-floor strengthening is something that dance studios, barre classes, Pilates and yoga teachers and cross-fit gyms teach around the globe. It’s not just Kegels—it’s a weight-lifting regimen for your pelvis, and Tania and team are finding a better way to do it.

Tania Boler is an expert and PhD in sexual and reproductive health who spent years working in HIV-prevention and sex education in Africa. And yet, even she wasn’t familiar with the importance of the pelvic floor until she was pregnant with her first child. Tania’s first lesson in pelvic floor health came from her Pilates instructor.

This led to discussions with other women, and ultimately to the realization that so much of women’s health care is reactive—as Tania says, “We only know about some of the most intimate parts of our bodies when something goes wrong.”

As Tania told us, “The more I read about it, I was shocked by how common so many of these women’s health issues were, and it really resonated because a lot of them are easily preventable and there’s treatment available. We just didn’t have the educational tools.”

Tania decided this was a gap she could fill. She could educate women early to prevent problems or treat issues they were already suffering.

Except the options weren’t exactly awesome.

Physical therapy was effective, but it was short-term and involved having to go outside the home to work with a therapist. Women preferred something they could use alone, in private. Electrical stimulators didn’t really do the job, and passive devices didn’t provide feedback or inspiration to continue, so women quit using them.

What did work, Tania told us, was when women were in a hospital, outfitted with probes. As the women engaged their pelvic muscles, they could see the results on monitors, giving them incentive to improve their performance.

“It was quite a simple eureka moment. I thought, let’s just take this medical equipment and turn it into something women could use at home.”

Introducing the Elvie kegel for pelvic health

Elvie is a beautifully designed device that discreetly fits inside the vagina, tracks pelvic exercises, and streams results to an app on the user’s mobile phone. As a woman contracts and relaxes the pelvic muscles, a digital “gem” moves up and down on the screen. The stronger the squeeze, the higher the gem rises. Six unique exercises employ speed, strength, pulsing, holding, lifting, and stepping to give the pelvic floor a thorough workout.

“I was lucky that one of my first advisors was Alex Asseily, who started Jawbone. He was able to help us find the right engineers and designers to create an exercise tracker you can safely place inside the body, which requires the highest standards of water-proofing, data privacy—it’s more complicated than a typical exercise tracker.”

The real-time biofeedback helps women make that critical mind/body connection and get a real sense of how well they’re doing. As the muscles get stronger, a user can unlock levels and access new games, and the internal sensors ensure women that the exercises are being done correctly.

Wait—”games”?

Yes, we said “games.” As a user progresses, she can unlock levels within games. The creators of Elvie found a better way for women to strengthen pelvic floor muscles—and they made it fun.

Every detail of the Elvie is engineered for the best user experience: the shape and size are optimized to fit a woman’s body; it’s discreet, even elegant. It’s comfortable to use, even for a woman in motion. Chiaro, the company that created Elvie, engaged more than 150 testers to help with the evolution of the device.

Who can benefit from the Elvie device?

“Women. Women can benefit,” Tania says. Pretty much all women, of all ages, whether they currently have problems or want to avoid them in future.

“Women come to Elvie for different reasons at different points in their lives. Millennials find it fun and use it as part of core fitness or for terrific sex. New mums have a pretty damaged pelvic floor, so we have gentle exercises for them. Women get quite competitive with themselves, and it’s all about continuing improvement. We have thousands of women using Elvie now, and they email us asking for new levels, new games, new challenges.”

And it’s not all about warding off incontinence. We hear all the time about the importance of strengthening your core muscles for overall health—your pelvic muscles are part of that core. Tania says ballerinas and many competitive athletes find the information Elvie provides about their pelvic floor engagement really helps them improve their performance.

The conversation around Kegels

Currently, the conversation around pelvic health, what little there is, focuses on the negatives like incontinence and prolapse, and that can dampen (pun intended) enthusiasm for more discussion. But innovations like the Elvie inspire conversation—suddenly there’s this new, fun, helpful thing that can really make a difference in women’s lives. “Women have pelvic floor problems, but they don’t need to be reminded about it. Making it fun helps them associate more positive feelings around exercising, and that’s really key.

“There’s a sort of new revolution for women. Women are very proudly owning their bodies and proudly embracing womanhood, and with Elvie, we’re able to be a part of that.”

Many thanks to Tania Boler for sharing her story and expertise with us. We look forward to working more with Elvie and Chiaro to help all women live their very best lives.

Did you know there are foods to avoid in menopause? Depending on whether you knew or not, this could be good news or not so good news. Let’s start with the good news and what happens when you limit or remove these foods from your diet.  Many common menopause symptoms decrease in severity and/or frequency. That’s huge when you’re talking about an experience where one often feels powerless. So, good because power. But bad because one link of sausage rather than two. We don’t know about you, but it feels like the possible positives far outweigh the negatives. 

If you need a personalized diet or plan, a menopause-certified health coach can be helpful. Book 30 minutes for your personal consultation with a health coach.

6 Foods That Need to Go In Menopause

The six foods listed below aren’t “bad” when consumed in moderation. Yet, it’s easy to overdo it when it comes to all six. In fact, at least one of them has been labeled more addictive than cocaine. Not exactly a selling point, and yet another reason to think twice about what you put in your mouth.

Now, it’s feasible that we’re about to tell you many of your favorite edible options need to either exit your diet all-together, or, at the very least, make far fewer appearances in your meals. And that’s hard. We get it. So we’re also going to look at how best to go about removing/restricting these foods from your life, and what to replace them with. Remember, the likelihood of less severe and/or lower frequency menopausal symptoms. And the added bonus of taking out the non-nutritional trash and increasing your intake of the healthy fuel your body needs to be strong, stable, and ready to support you through whatever comes your way. Let’s get started!

1. Caffeine

Caffeine isn’t so bad when consumed in moderation. In fact, it boasts plenty of health benefits. Most people can consume about one cup of coffee a day without any side effects. Sadly, Americans generally drink much more than their recommended share of caffeine.

Coworkers crowd around the coffee machine in break rooms, Starbucks can be found on every block in major cities, and beverages such as sodas and even kombucha have caffeine, too. 

Because chocolate and coffee flavoring often contain caffeine, your late-night ice cream snack or pudding cup may need to go. Even your pain reliever could be hiding caffeine, which is great for speeding relief, but less so when you’re trying to minimize hot flashes in menopause and/or night sweats. The reason? Experts suggest caffeine consumption exacerbates menopausal vasomotor symptoms–hot flashes and night sweats that occur due to the constriction or dilation of blood vessels.

2. Alcohol

Alcohol plays a major role in our society. We toast the new year with a glass of bubbly, socialize with coworkers and friends at happy hour, and some even drink a sip during the sacrament at church. 

Again, drinking alcohol in moderation is perfectly fine. But even in moderation, it can really amp up menopause symptoms such as headaches, hot flashes, night sweats, and mood swings. It can even contribute to depression if you’re drinking heavily. As for why alcohol can increase menopausal symptoms? The jury is still out, but two theories include alcohol impacting our already fluctuating hormones and dilation of blood vessels (we do recommend you try Libeeration beer for menopause symptoms!)

3. Processed Foods

Potato chips. Donuts. Frozen pizza. What do these delicious items all have in common? They’re part of the processed foods group, which the U.S. Department of Agriculture defines as “any raw agricultural commodity that has been subject to washing, cleaning, milling, cutting, chopping, heating, pasteurizing, blanching, cooking, canning, freezing, drying, dehydrating, mixing, packaging, or other procedures that alter the food from its natural state.” 

That’s a big list, so let’s narrow it down by what to watch out for. Inflammation, bloating, weight gain symptoms, and fatigue can all intensify thanks to the unhealthy levels of sugar and sodium found in most processed foods. 

4. Sugary Foods

Processed sugar (sugar not occurring naturally in foods such as fruit, but rather sugar added to foods and beverages) can make your blood sugar levels higher,  which can lead to more intense/frequent hot flashes, sweating in general, and brain fog. With the sugar industry deciding to not play fair by employing 60 different names for sugar on product labels, you might find it tricky to track how much of the white stuff you’re taking in. 

5. Spicy Foods

This one is pretty easy to figure out. Under normal circumstances, foods that rate high on the heat scale can cause sweating, flushing, and elements found in hot flashes. So, for a menopausal woman who’s already dealing with hot flashes and night sweats, it’s probably best to get rid of the ghost peppers and make use of spices that add flavor without the heat, like cumin, turmeric, curry, and basil.

6. Fatty Meats

Everyone knows that fatty meats are high in saturated fat, which can cause all sorts of health issues, including weight gain. But did you know it can also lower anger attacks? And lower serotonin levels in menopausal women can lead to a lack of mood control (anger, irritation, rage). Not good. Not good at all.

So, skip the marbled steak and thick-cut bacon and go for the leaner meats, like turkey, chicken, even ground beef–as long as it’s 90% lean or better.

Foods to Eat During Menopause

Now for the foods that you need during midlife. The key at this stage is to not only eat foods that might help ease menopausal symptoms, but also ones that provide the nutrients vital to carrying you gracefully through this transition and beyond. For example, there are a ton of great foods to ease hot flashes.

Dairy

As estrogen levels decline, your risk of fractures goes up. So calcium-rich foods, like yogurt, cheese, and milk are essential for bone health. It’s also possible that dairy products improve sleep quality in menopausal women. They’re high in the amino acid glycine, which can encourage deeper sleep.

Healthy Fats

Pescararians, rejoice! Foods high in omega-3 fatty acids, such as salmon, mackerel, and anchovies, have been shown to decrease the frequency of hot flashes and severity of night sweats. Other foods high in omega-3 include seeds–hemp, chia, and flax.

Fruits and Vegetables

Packed with vitamins and minerals, fruits and vegetables are a menopausal woman’s friend. Especially cruciferous veggies (broccoli, brussel sprouts, cauliflower, collard greens, cabbage). Many women experience a decrease in hot flashes when they introduce more fruits and veggies into their daily diet.

Fiber

Fiber is good for everyone. But it’s especially good for women in midlife when it comes to depression. Foods rich in fiber, like beans, nuts, oatmeal, broccoli, berries, avocados, and apples have been shown to lower the occurrence of depression in menopausal women. 

Lean Protein

Declining estrogen is at it again, this time causing decreased muscle mass and bone strength. To combat this, get plenty of lean protein. Look to foods we’ve already mentioned, such as fish, legumes, and nuts. Also, try out eggs, lean meat (no red), and tofu.

Supplements

It’s always a good idea to have an awesome supplement on your side, and never more so than during menopause. Even when you stick to a strict diet, it’s likely that you’re not getting enough of this or that. So let a supplement put your mind at ease. 

Our Vitality Menopause Supplement aims to improve energy, mood, sleep, and inflammation while making sure you’re getting all the good stuff your body deserves.

How to Make Changes That Will Stick

There are three camps of thought when it comes to balancing our indulgences and cutting back on the foods to avoid in menopause. Read below for details on all three, then set up an appointment with your doctor or specialist for menopause near you to discuss the best way to go about putting your plan into place.

If you don’t already have a doc, get connected with a Gennev menopause-certified gynecologist who will give you a trusted opinion. Book an appointment here.

Start Slow

Some experts believe that making “too-sudden changes” without a plan can lead to failure. If you up and decide that tomorrow you’re going to go cold turkey on three things you might be both chemically and emotionally addicted to, quitting without a plan could lead to quitting.

Instead, pick a date in the future to make big dietary changes. Do some research. Try to find recipes that will satisfy your sweet tooth and utilize fruits or other natural sources of sugar. Create a list of virgin (or extremely low-alcohol) cocktails that give you a refreshing kick. Or, consider switching to decaf coffee a few times a day to trick your body into thinking you’re still getting your cozy cup of Joe–without the caffeine.

Stop Wasting Time

Many experts believe that waiting until a certain date isn’t the best tactic. One of the ideas behind this is that you’ll probably indulge even more between now and then. Knowing that you won’t be able to enjoy your 3 PM cup of coffee might make you want to drink even more of it between now and stopping time.

Similarly, knowing you’ll miss your happy hour glass of wine or cocktail in the future might encourage you to drink too many right now “” which could lead to menopause dehydration or hangovers. So this plan says there’s no time like the present!

The Best of Both Worlds

There’s another group of experts that believe there’s a happy medium when it comes to indulgence. Begin by seeking some support from your doctor* or coach. Make a plan together. Enjoy a glass of wine at dinner (or happy hour) and don’t “go cold turkey” and deprive yourself in the future.

If you tell yourself that you can eat one cookie today, knowing there will be more cookies tomorrow, you’ll be better able to stop after just one. It’s when we deprive ourselves that we go into panic mode and eat all the cookies.

The truth is, change is one of the few constants in our lives. And having foods to avoid in menopause is just another tweak necessary to keep you on track toward health and happiness. Will this journey be challenging? Absolutely. But a very worthwhile one. Your future self will thank you for your health, energy, and focus. 

How are you improving your health this year? Quitting caffeine? Modifying sugar intake, doubling your daily hydration? We’d love to hear about it, and support you, in our Community forums.

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

If you think you are experiencing perimenopause, then take our menopause assessment test to join over 100,000 women and learn more about your symptoms and where you are in the menopause journey!

The new year has arrived. And whether you consider yourself a “healthy” person or not, January represents an opportunity for new behaviors…or reestablishing old best practices.

Let’s kick off the year with the best of intentions…and actually do them! The team and I at Gennev are doing the same: smarter snacking, revitalize life fitness, dry January…and most of all, booking necessary health & wellness appointments.

Here is the 2021 healthy woman’s checklist…

To your health!

Jill

1. Create a budget

Consider what your health and wellness budget is for 2021. Are you budgeting for self-care? Do you have FSA/HSA coverage through your employer?

If you have FSA/HSA coverage, check to see what it covers in terms of health provider services and products. With a letter of medical necessity from Gennev providers, you can get coverage for appointments, supplements and lubricants on most plans. Here’s a resource for what qualifies for FSA coverage.

2. Book medical appointments

Are you in the practice of annual exams? If not, start now. Book with your physician or with a Gennev doctor.

Have you scheduled your mammogram? If you’re over 45, consider a colonoscopy if you have risk factors in your family. Whatever you do, don’t put the essentials off; talk to a women’s health specialist today.

3. Plan for necessary lifestyle change

Whether you’re in perimenopause or post-menopause, lifestyle behavior change is a must for managing weight, hot flashes, anxiety, sleep, fatigue and joint pain. We know it’s hard, so build a plan for achievable and sustainable change…even if that means baby steps.

Gennev registered dietitians/health coaches work with women of varying levels of discipline, so don’t overthink it, just start doing something. Book an appointment to build a plan for 2021. We believe this will be your best-spent $45 dollars of the year. We want you to thrive!

4. Check your supplement intake

Are you taking the right supplements for your age or stage of menopause? As women, it’s good for us to annually check-in on the supplements we’re consuming “” whether we have the right combination and whether we’re taking them at the right time of day.

If you’re not 100% confident of your routine, start by watching Gennev Director of Health Coaching Stasi Kasianchuk, RDN interview Dr Wendy Ellis about Supplement Savvy. Or – skip to speaking directly with Stasi and her team by booking an appointment with a dietitian (specify that you want a supplement audit).

5. Get the Menopause Guide

We built the Guide to Menopause from the collective expertise of our team of 25 OB/GYNs, naturopathic doctors, registered dietitians and health coaches. It’s a 60-page collection of evidence-based medical, lifestyle and herbal recommendations for every symptom of peri and post menopause. And it’s free. You can’t go wrong.