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Hands up, who is experiencing some (additional, worsening) achiness or pains in their joints since beginning to shelter in place? 

Schedules have turned on a dime, and so have a few roles and responsibilities over the last few weeks with the outbreak of coronavirus, COVID-19. Amid changes around the kids’ schedules, work logistics, or even being lately laid-off, there can be a tendency for people to shut down on some level, not only emotionally, but physically. 

 

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

Do any of these menopause symptoms for aching joints apply to what you’re going through?

You may be sitting for longer-than-usual periods of time, and feeling stiff or painful when you get up to run errands, prep or make the next meal, or take a bio-break. 

You may be working longer hours in a chair or even at a standing desk. And while we affirm that there are definitely a few benefits to the Netflix&Chill movement, we’re also firm proponents of experiencing (and enjoying) some varied tasks each day. 

 

Gennev is telemedicine for women. Online healthcare & support at home is here.

 

Incorporating a little more movement to prevent stiffening or aching joints or weight gain  can likely help brain and body balance as well. Shake up your day a little bit; variety in the schedule is a good thing!

 

What else could be causing pain or aches in my joints now?

It could very well be perimenopause or the onset of menopause. Review the Big List of common menopause symptoms or take our initial online assessment. 

So, what’s the connection between aching joints/joint pain and menopause? A handful of studies have been conducted, and more are needed. In a clinical research led by psychologist Carolyn Gibson, Ph.D. with the San Francisco VA Medical Center, she shared that women with menopause symptoms are nearly twice as likely to have chronic pain diagnoses, such as fibromyalgia, migraine headaches, and lower back pain.

When it comes to science and studies, observations are noted, but testing and specific findings have not been done. The observations that were documented:

“(Menopausal) Arthralgia is experienced by more than half of the women around the time of menopause. The causes of joint pain in postmenopausal women can be difficult to determine as the period of menopause coincides with rising incidence of chronic rheumatic conditions such as osteoarthritis. Nevertheless, prevalence of arthralgia does appear to increase in women with menopausal transition and is thought to result from reduction in oestrogen levels.” “” M. Magliano

Plus,

“Chronic musculoskeletal pain represents an enormous health burden, affecting over 50% of adult populations. Common sites of pain are the spine, knee, hand, hip and shoulder.1,2 There is a female preponderance irrespective of the cause of the pain.1,3,4 At the time of menopause, musculoskeletal pain is reported by more than half of women.5 Presentation with joint pain in women is greatest between 45 and 55 years of age.6 Although this appears to implicate the menopause and estrogen deficiency, direct causal evidence of a role for menopause is lacking, partly because musculoskeletal pain is so common throughout life.” “” Fiona E. Watt

The above study also notes that it is difficult to assess whether musculoskeletal pain is caused by arthritis or arthralgia due to the way previous epidemiological studies have reported on joint pain.

 

First things first

Talk with your doctor. This is a great topic to talk about and try out our doctor for women telemedicine at the same time. 

Safe movement is key here, so discussing best exercise options with one of our Gennev primary care specialists (or your doctor) online can support your physical, mental, and emotional health while minimizing exposure risk to COVID-19.

While you’re on the call, ask about nutrition, supplementation (specifically, magnesium glycinate for joint pain and as a sleep aid), best forms of exercise, and stress management. 

Movement is a helper, now more than ever, for physical, mental, and emotional health. We’ve got a short, browsable list of recommendations:

 

Movement resources 

 

More regular movement can support your whole body in myriad ways. If the topic of productivity feels like one of your pressures right now, a little time invested in exercise can assist in minimizing worries and maximizing your ability to sleep, stemming menopause symptoms, lubricating your joints and muscles to alleviate pain, and releasing needed endorphins. 

Balance out your schedule, engage in fantastic self-care, and feel better with a little more safe, regular movement.

 

What types of exercise are you considering right now? We’d love to hear about what’s working for you in the Gennev Community Forums. Join us.

 

It was a Tuesday, she remembers, and she was walking down the carpeted steps of her home to the kitchen on the ground floor. She miscalculated as there was one more step where she expected none, and her feet slipped out from under her. Just that quickly, it went from a normal Tuesday to the last normal day she’d see in a long time, as that misstep cost her two broken ankles.

Osteopenia and osteoporosis

Osteoporosis is a condition in which bones lose density, becoming weak, brittle, and less able to withstand impacts. Worldwide, one in three women and one in five men are at risk of an osteoporotic fracture, and the older we are, the higher our risk can be.

Most of our bones’ mass is created in our youth, and we reach peak bone density in our early 20s. After that, bone formation slows. In some, bone loss can outpace replacement, making bones porous and vulnerable.

When bone density is less severely compromised, it’s called osteopenia; when bone mass is even more reduced and risk of fracture is higher, it’s osteoporosis.

While neither condition can be cured, there are lifestyle and exercise modifications you can take to prevent osteopenia from becoming osteoporosis (or slow down the process) or to manage osteoporosis to reduce your risk of breaking a bone.

To understand how we can deal with bone density issues, we talked with our awesome physical therapists, Meagan and Brianna.

I’m a woman over 50; what do I need to know about bone density?

The first thing to understand, according to our PTs, is that there are no outwards signs of osteoporosis or osteopenia. Often the first time someone realizes their risk is when they’ve broken a bone. And while women are at higher risk, a significant number of men suffer bone loss, so everyone can and should take steps to have healthier bones, even if they feel fine.

Second important note from our PTs: a diagnosis of osteoporosis or osteopenia doesn’t mean that your active life is over and it’s time to break out the bubble wrap.

Just the opposite, actually, Bri says. People with bone loss need to be exercising to stay mobile, build strength, restore or maintain good balance, and retain a decent quality of life. Continuing to move is a key factor in staying more independent longer and later in life.

Lifestyle and exercise modifications for bone density

Straighten up! Posture and alignment are really important, say our PTs. Those of us who work at computers especially spend a lot of time in a “kyphotic,” leaning-forward posture, with our backs rounded. The vertebrae are constantly being compressed on one side, which can really put a lot of strain on those bones. As Meagan says, think of your spine as a stack of jelly donuts. If one side of those donuts is constantly being squished, you’re increasing your risk of spinal compression fractures, one of the most common fractures among people with osteoporosis. Exercises can help you maintain a more upright posture, strengthening back, shoulder, and butt (glutes) muscles to pull you out of the hunched posture that makes you more vulnerable for fractures.

Celebrate gravity. Gravity takes a lot of heat for its effects on us as we age, but here’s one time gravity can be a real help. As Meagan says, “bone gets laid down in lines of stress. Our bones are strong in the way we use them, so let gravity assist.” How? Think of your bones, like the long bone of the thigh, the femur. Lengthwise, from knob to knob, the bone is strong, and using it vertically against gravity, like climbing stairs or walking, builds bone. But if you stress it horizontally, it’s like taking an end in each hand and trying to break it across the middle. Introduce force along the length of the bone, the way nature intended; don’t bend, twerk, twist, or rotate along a different axis and risk a break, particularly if you’re already dealing with weakened bones.

Embrace resistance. Using your own body weight (plus our new friend gravity) in impact exercise is a great way to build bone. Squats, lunges as done correctly, these are safe exercises that don’t require twisting and can help with balance. Balance is critical when bones are weakened, since a fall can do a lot more damage than when bones are stronger.

Get lifting. According to Bri, both aerobic and resistance training exercise can provide weight-bearing stimulus to bone, but research indicates that resistance training may have a more profound, site-specific effect than aerobic exercise. Translation: get lifting (but don’t give up running).

While lifting weights is slowly gaining in popularity among young women, Bri says we should all be lifting weights at least a couple of times a week. Previously, many women avoided weights, not wanting to “bulk up,” but strength training can improve BMD (bone mineral density), and therefore improve bone strength. So add it to your exercise regimen, Bri says, but carefully. Free weights of anywhere from one pound to 10 or 15 pounds are probably sufficient for most of us, and weighted lunges or squats or light dead lift can give us the extra resistance. Consider getting professional help to learn how to lift, and how much, she says.

Work from where you are. If you don’t move much, now is the time to get going. But increase gently, especially if you’re already osteopenic or think you might be. Start with a 5 as 10 minute walk, Meagan says. Walk on a treadmill if balance is an issue. Add in stairclimbing or step-ups. Work the back side to improve posture, then walk some more to cool down. Ideally, you should be doing at least 30 minutes of exercise 5 days a week. If you’re doing things like yoga, Pilates, swimming, or biking, those are great, but they don’t generate enough impact to build bone; add in impact exercise such as walking or stairs to get a more fully rounded workout.

Breathe out and in, not up and down. We talked about breathing in the blog on avoiding prolapse, so here’s yet another reason to breathe right. Diaphragmatic breathing (from the belly) and core control help with posture and lung function to maintain mobility in your neck bones (“thoracic spine”) and ribcage. Since the thoracic spine is the biggest victim of spine compression fractures, this is a good place to work on.

Be your body’s best friend. Eat your calcium-rich leafy greens. Ditch cigarettes. Reduce or eliminate caffeine and carbonation. And advocate for yourself as insist on a bone density test. Since osteoporosis and osteopenia have no symptoms, this may be your only way to know if you’re at risk (short of breaking a bone, and let’s not count on that, shall we?). Get tested every other year, starting with this one, so you have a baseline to compare to in future. Eat right, and that includes eating enough calories. Women with a too-low BMI are also at an increased risk of osteoporosis.

Listen to your doctor. We’ve only addressed lifestyle modifications here, but there are medical interventions that can help you manage this condition. If you have osteoporosis or osteopenia, or think you might, seek professional advice before adding exercise or changing your diet to be sure you’re moving forward safely.

Finally, one really great thing you can do is to start educating the younger women in your life. Bone building mostly happens early, so you can do someone a huge favor by helping them maximize those years.

If you have osteoporosis or osteopenia, how are you handling it? We’d love to hear your story, so share in the comments below, on Gennev’s Facebook page, or in our closed Facebook group, Midlife & Menopause Solutions.

 

Talk to a group of women dealing with menopause symptoms, and it won’t take long before someone brings up the question of hormone replacement therapy (HRT) and “bioidentical progesterone cream” or “natural” hormones vs “traditional” or “synthetic” hormones.

Which is best, most effective, safest? Chances are you’ll get nearly as many answers as questions and still not know for sure.

It’s your health, your comfort, and your quality of life that are at stake here, so at Gennev, we want you to have the facts. Our Director of Health, ob/gyn and epidemiologist Dr. Rebecca Dunsmoor-Su, breaks it down for us.

What are bioidentical hormones?

So that we’re all talking the same language, let’s be clear about our terms.

The term “bioidentical“ refers to synthetic hormones that are identical to the ones your body naturally produces. “Natural“ hormones come from plant or animal sources, and while not synthesized in a lab, they still have to be processed in a lab in order to become bioidentical (and usable for the body). “Compounded bioidenticals“ are treatments that have been created in a compounding pharmacy using bioidentical hormones. It’s these compounded bioidenticals that can be problematic.

A lot of people will assert that “bioidenticals” (meaning “compounded bioidenticals”) are safer than those traditionally prescribed in Western medicine. Sadly, not only are compounded bioidenticals no safer than traditional medications, they’re often actively hazardous to a woman’s health.

According to Dr. Rebecca, the truth is, treatments bearing the bioidentical or natural label are made of the same stuff traditional treatments are made of. “There’s only one place to buy estrogen and progesterone,” Dr. Rebecca says, “and that’s from the pharmaceutical industry.”

So the estrogen and progesterone in compounded bioidentical treatments and in traditional treatments start from the same place as as big crystals of hormone which are then turned into treatments.

The difference is in how those base elements are made into the treatment you pay for.

Compounded hormones

First, says Dr. Rebecca, it’s important to understand that hormones are healthy and good and safe when prescribed and used correctly. “I do not want to put down compounding pharmacies in general, they are excellent for many purposes. In fact, I use them myself for topical numbing cream for my clinic. I am warning specifically about compounded hormones.”

So what’s bad about compounded hormones? The problems occur in the preparations.

“Compounders are literally taking the exact same medications I would prescribe as estradiol and micronized progesterone as grinding it up, mixing it in a cream even though the medication may not be designed for systemic absorption, and telling you to rub it on your body,” Dr. Rebecca says.

If it’s the same medication, why is that a problem?

“There are a couple of problems here,” Dr. Rebecca tells us. “You don’t know how much of the hormone you’re getting, that’s a huge problem. These treatments are not FDA-regulated, and there’s no way to tell how high of a dose you’re getting even from day to day. There’s no way to take a pill, grind it up, mix it with cream, and guarantee consistency of dosage. It’s not possible. Plus, that medication wasn’t designed to be used topically, so it may not even absorb into the skin.”

“Women are being told to rub it on their stomach, their arms, their clitoris, insert it in their vaginas, all sorts of places,” she tells us. “Topical estrogen absorbs through skin really well; we know that, which is why we make absorbable versions. And it can absorb in high doses. So I see women who have gotten a very dose of estrogen one day, and maybe a very low one the next day. Because it’s not consistent, her dosage and her experience with the medication can vary wildly from day to day.”

The situation is even worse when it comes to progesterone. For women with a uterus, if they are given estrogen, they must also have progesterone to avoid developing endometrial cancer. Taking estrogen alone, if you have a uterus, is practically a guarantee of endometrial cancer eventually.

Help from compounded progesterone cream

“Women are given progesterone cream by practitioners to prevent cancer as but the cream doesn’t work. Often the progesterone that’s used in these compounded preparations is micronized progestin, because it’s considered “˜bioidentical.’ But micronized progestin is too large, the molecules are too big to be absorbed consistently through the skin. So these women are taking estrogen, rubbing this cream on themselves to prevent cancer, and getting cancer anyway, because the cream doesn’t work. It wasn’t designed to be absorbed.”

There are two forms of progesterone that can be used topically and are typically found in “combined” patches (patches that contain both estrogen and progesterone): norethindrone and levonorgestrel. Even these don’t absorb all that well through surface skin, Dr. Rebecca says, and so the dosage of progesterone has to be quite high.

“Progesterone is absorbed best through the GI tract as so, an oral pill; through the vagina if prepared for that purpose; with a combo patch, though that’s not my favorite, or via an IUD like the Mirena in the uterus. I use these because I know what kind of dosing a woman’s going to get, I know it’s going to be consistent, and I know it’ll be protective against endometrial cancer.”

If you’re given a vaginal cream for your progesterone, be sure it’s not micronized progesterone. “Vaginal progesterone is for pre-term labor prevention and miscarriage prevention as these are the only uses it’s been studied and approved for. We do not have data to support the dosing and use in prevention of endometrial cancer with HRT. The small studies we have are inconclusive, so I would not use it for that reason.”

What about hormone pellets?

Dr. Rebecca is quite adamant in her objection to pellets. Why? Because they can have pretty awful side effects, and once the pellets have been implanted, side effects or no, they can’t come out.

Hormone pellets are tiny pellets no larger than a grain of rice that are surgically implanted under a patient’s skin or in muscle tissue. The pellets are intended to give a slow, continuous release of hormone. DHEA testosterone pellets are particularly popular for women hoping to revive their sexless marriage after menopause.

“The problem with pellets is, again, they’re not FDA-regulated, and we’ve seen that they can give an exceedingly high dose of hormone depending on where and how deeply they were implanted. Many women suffer significant side effects as a result, especially with testosterone. Women think they’ll get their libido back, have more energy, feel younger, and they may “¦ but they may also grow a beard, develop acne, have clitoromegaly, where the clitoris grows and becomes very like a small phallus, and develop a deeper voice. Those last two don’t go away when the testosterone does. The small phallus and the deep voice are forever.”

Frustration with pharma

Given all the risks and dangers, why do women still choose compounded bioidenticals?

According to Dr. Rebecca, often women who come to her to get help with menopause symptoms and side effects of poor treatment tell her they simply weren’t told.

“Whether the person giving her the treatment doesn’t know about the risks or is more interested in the profit, I don’t know,” Dr. Rebecca says, “But they just don’t warn women of the risks they’re taking.”

Another reason may be that women have come to be distrustful of standard Western medicine and doctors.

“I understand, I do. Western medicine has not always done right by women; ob/gyns don’t always listen, they don’t always understand the hormonal journey, they’re not always sympathetic. We haven’t done the research into menopause, we don’t have a lot of solutions. It makes sense that women are frustrated. And the flawed WHI study that convinced everyone that HRT is dangerous just compounded the damage.

“Unfortunately, often the only people offering relief are even less trustworthy, and their treatments are less regulated, less understood, less studied than the ones we have. And women are bearing that risk.”

How to be healthier

Women need to be their own best advocates while science and Western medicine catch up.

“Get a doctor you can truly trust,” Dr. Rebecca says. “We’ve gotten poorer at judging someone’s credentials and knowledge base and approach, so ask the important questions until you’re confident this person knows what they’re talking about.”

One good measure is to see if they’re certified by the North American Menopause Society (NAMS) for menopause care. All of Gennev’s telemedicine ob/gyns are required to have this certification.

And do your own research. Read Estrogen Matters by Drs. Bluming and Tavris to have a more informed understanding of HRT and the WHI study. Browse NAMS’ resource library. And of course, check out the resources right here on Gennev.

“If you have questions, a menopause specialist ob/gyn is probably your very best bet for answers. You’ll find them in Gennev’s telemedicine.”

Are you considering HRT and not feeling confident about the options? We’d love to continue the discussion. Please join us in our public forums, leave us a note on the Gennev Facebook page, or join our community in Midlife & Menopause Solutions, our closed Facebook group. 

 

That thing you’re doing that’s “good” for you? It’s not. Stoppit.

There’s so much information out there, from so many sources, it’s difficult to know what’s true and what’s false when it comes to taking care of our health.

So”¦we talked with our awesome physical therapists, Brianna and Meagan, to find out what things women are doing in an attempt to be healthier, and why they really shouldn’t. Turns out, some very “normal” things really aren’t good for you.

#1. You don’t have to pee it if you didn’t drink it.

The problem: incontinence or urgency. One of Brianna’s clients was suffering from urgency as needing to urinate very badly and occasionally not making it to the bathroom in time. She assumed she was simply drinking too much water.

The wrong solution: intentional dehydration. To fix the problem, she pretty much stopped drinking water and other fluids while at work. The problem with doing this, says Bri, is it means the small amount of urine she is producing is much more concentrated, increasing her risk of urinary tract infections, for example.

The right solution: water. It turned out that her problem wasn’t caused by drinking too much water; she was actually drinking too little, and her bladder was constantly irritated. Bri worked with her to slowly and properly increase her fluids, ending the irritation and getting her back to walking to the bathroom instead of sprinting.

#2. Baths are for the outside.

The problem: pain during intercourse. Meagan’s client was experiencing pain during sex as well as overall vaginal irritation.

The wrong solution: douching. Meagan explained to her client that the vagina has its own balanced system to keep it clean, and that the douching was only causing more irritation. “She was doing it more out of hypervigilance. She believed she could smell something,” Meagan tells us. “I examined her, and there was nothing abnormal or to be concerned about. Douching is not something we encourage. You’re messing with the delicate balance of the vaginal tissues, and you’re risking infection both on the outside and deeper within the vagina.”

The right solution: promote and protect healthy tissue. Sometimes the issue with painful intercourse is the tissues around the vulva are thin and delicate due to too little blood flow to the area. Pelvic floor exercises, Kegels, vibration and massage helped make the vaginal tissue healthy and more durable. Once that was resolved, the client no longer felt she had unusual discharge or sloughing of tissue, the issues which had led to her deciding to douche in the first place.

Irritation can also be resolved often by simply switching to cotton underwear, using a fragrance-free detergent, using the right intimate soap, and ditching the thongs, Bri adds. PS: this applies to steam cleaning of the vagina, according to Meagan as not necessary and potentially damaging to sensitive tissue.

#3. Clenching the core as nope.

The problem: wanting six-pack abs. While there’s nothing wrong with six-pack abs, a lot of us damage our bodies in the quest to get them.

The wrong solution: over-exercising our core and pelvic muscles. We hold our stomachs in, do too many crunches, over-exert our core muscles and basically put our pelvic muscles in a state of constant spasm. This can actually cause pain, incontinence, and urgency issues. “Hold weights over your head for 30 minutes, then tell me your arms don’t hurt,” Meagan says. “It’s the same with your pelvic floor as muscles need to clench and relax in order to become stronger.”

The right solution: exercise your core properly. Learn how to exercise your abdominals properly. Consult with your doctor or a pelvic floor specialist if you’re not sure.

#4. Is it over yet?

The problem: painful intercourse. Pain during intercourse can happen for a number of reasons: vaginal dryness due to hormonal change, birth control, or medical procedures; pelvic floor issues such as spasms, etc.

The wrong solution: endure. “Too many women think painful sex is normal and they should just “˜grin and bear it’,” Bri says. “They go somewhere else mentally and just endure it, but it really ends up hurting them, hurting the relationship.”

The right solution: education, openness, and lubricants! Painful intercourse doesn’t have to be your new normal after menopause or for any other reason. “Gals feel like they should be able to have intercourse without any supplemental lubrication,” Meagan says, “and they’re ticked off that their bodies don’t make what they need. They don’t want to deal with using lube, reapplying lube”¦ The problem is they’re causing all these micro tears in that tissue, and pain, increasing risk of infection. Just use a lube!”

#4.2: Amendment to #4 as “Use the RIGHT lube!”

The problem: painful intercourse, coupled (ha ha) with a desire to use “natural” lubricants.

The wrong solution: olive oil. Olive oil has exfoliating properties, meaning it causes the skin to slough off dead cells. This is not a part of the body one should exfoliate, Meagan says; nature has already taken care of that. Bonus info: jojoba isn’t the best choice either, as it’s wax based, and the small amount of wax can build up internally.

The right solution: do your research. If you prefer to go the natural route, there are choices that may well work for you. Just be sure you read research from credible sources, test any substance on another body part first, start small to test for a reaction, and report any unexpected or unwanted reactions to your doctor right away.

[Choose a lube that fits your needs and your lifestyle. Check out this lubricant info sheet from A Woman’s Touch]

#5: Hovering is for helicopters and hummingbirds

The problem: yucky public toilets. Few of us are completely comfortable trusting our bare bottoms to a public toilet seat or outhouse, no matter how picturesque. We’ve all heard horror stories of people picking up strange diseases or at least sitting in something suspiciously moist.

The wrong solution: hover. To keep our tushies safe, we hover above the seat when it’s time to urinate. Not a good idea, say our PTs. “If you’re not in a relaxed, sitting posture or full-on squat position, the muscles through your hips and pelvis aren’t relaxing. This means you’re having to generate extra abdominal pressure to push and force the pee out,” says Meagan. “This recruits the wrong muscles and totally messes with how normal peeing should happen.”

WHO KNEW???

The right solution: sit, Ubu, sit. Layers of TP on the rim. Know that if you don’t have an open sore at a contact point, the chances of contracting anything are pretty minimal. You’ll be fine. Or you can squirt some hand sanitizer on a piece of TP and give the seat a quick cleanse (but wait for the surface to dry to avoid skin irritation). Just don’t hover.

#6: Sunning it where the sun don’t shine.

The problem: lack of Vitamin D in the nether region. Apparently women feel their vaginas aren’t getting enough Vitamin D.

The wrong solution: exposing one’s genitals to sunlight or tanning beds. The real problem? THIS ISN’T A PROBLEM. This part of the body is hidden and shaded for a reason as nature intended it that way. A burn in that area can be extremely painful and damaging to very delicate tissue over the long term.

The right solution: get enough Vitamin D in the usual ways. Exposing the skin to sunlight is good, when done carefully to avoid damage. But maybe bare only the skin that nature and culture have deemed reasonable. ?

 

If adopting one lifestyle change could ease many of your menopause symptoms, would you do it?

What if it were an an easy, painless lifestyle choice for most women to make (though sadly, not all)? Chances are you have it in your house 24/7 and readily accessible most other places.

It’s water.

Drinking more (good) water is the one simple lifestyle change that can possibly improve brain function, make skin, hair, and nails healthier, reduce urinary urgency and bladder irritation, relieve menopause nausea and hot flashes, reduce the intensity and frequency of headaches, and ease menopause cramps.

As we age, our bodies don’t retain moisture as well. In youth, we are 60-70% water; after menopause, women may be only 55% water, which is a substantial drop.

Why so dry?

Estrogen makes it easier for our tissue to retain moisture. As levels of the hormone drop, so does our body moisture.

Dehydration affects your everything.

Let’s start with your brain. According to neuroscientist Dr. Lisa Mosconi, “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.”

So not enough water means less energy. But not only that. Dr. Mosconi continues: “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 estrogen brain fog, confusion, fatigue, 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.”

If brain shrinkage doesn’t send you running to the water fountain, some other issues include drier, more brittle hair and nails, skin that’s flaky, dry, and itchy.Constipation and bloating are common as well as hormonal headaches. Unlubricated joints ache more. Your body thermostat may get (even further) out of whack: Some studies show an increase in hot flashes among women who are chronically under-watered. And drinking more water may help guard against bladder infections, and, somewhat counter-intuitively, incontinence.

How to rehydrate

First of all, not all liquid is created equal. While we’ve been told lots of liquids are actively bad for you, they may not be as bad as all that. Carbonation, it appears, doesn’t affect bone density. >Caffeine isn’t that dehydrating after all (but an FYI on that as the studies most seem to point to involve all men, and we know caffeine affects women differently).

On the other hand, sodas, caffeinated and carbonated drinks, and sugary drinks don’t provide the same benefits you get from plain water. Diet drinks, it seems, may have risks of their own, including an increased risk of stroke as though more research needs to be conducted to verify a link.

What to drink

Staying hydrated in menopause is important. Water contains nutrients, electrolytes, and minerals our brains and bodies need, says Dr. Mosconi, so filtered or otherwise processed water may not contain the same essential nutrients.

Spring water, on the other hand, may be best liquid for your brain and your body, as it contains the most natural assortment of nutrients. Just be sure you’re getting actual “spring” water, which is an FDA-regulated term.  

You should also get hydration from your food, namely fresh fruits and vegetables.

Many liquids can help you hydrate (not alcohol, though, sorry as that is a dehydrator), but they may come with other negatives such as affecting your teeth (fruit juices, sugary soda) or impacting your weight or wallet (fancy coffee drinks).

How much should you drink to help dehydration and menopause symptoms

According to our doctors of physical therapy, Bri and Meagan, divide your body weight in two, and that’s how much liquid you should be consuming in a day. For a 150-pound person, that’s 75 ounces a day. Drinking more water will definitely effect how many times you pee a day.

Oh, and if you suffer from night sweats and hot flashes, you need even more water to make up for the additional loss. Staying hydrated will also help you lower your other symptoms like fatigue and dizziness in menopause.

But that’s not all the math: two-thirds of that 75 ounces should be water. The remaining third can be “other,” such as coffee, tea, or juice. The PTs recommend getting a reusable water bottle with the ounces marked on the side to help you keep track of your daily hydration.

A study from 2013 found that nearly half of Americans weren’t drinking enough water. And the older we get, the study concluded, the worse we are about water. Our sense of thirst fades as we get older, so it may be time to track your intake if you’re concerned you’re not getting enough.

How much water do you drink in a day? Have you changed the amount lately, and if so, how has it impacted your menopause symptoms? Share your thoughts with the community in our community forums, on our Facebook page, or in Midlife & Menopause Solutions, our closed Facebook group.

 

your sexual wellness is in your hands

Or it could be.

Midlife brings a lot of changes, not all of them welcome. Maybe your desire for sex has dropped off, intercourse has become painful, or you’re ready to up your game when it comes to sexual pleasure and the goodness it brings to your body and spirit.

Team Gennev is partnering with Lioness to conduct a study in the latest innovation in sexual health and prepare women for the best sexual fulfillment of their lives. We’re looking for forward-thinking women to participate in a seriously open and frank conversation about age, sex, sexuality, and their impacts on our overall physical and emotional health.*

By completing the survey, you’re agreeing to be considered for our study. Those chosen will be asked to provide requested updates to the Gennev and Lioness teams. We’re going to ask some pretty intimate questions, but we will protect your identity, using only a first name and last initial or a pseudonym.

What’s the study like?

So, what do you think? Ready to help yourself and other women get their sexy back? Complete the survey, and let’s get started!

About our partners: Lioness is a women-led company whose mission is to destigmatize women’s sexual health through knowledge and conversation. Their first product is the Lioness vibrator, a smart vibrator that helps you explore your own, unique sexual response (yes, including your orgasm) and how your sex drive changes over time so you can have the best sex of your life.

*This study is open to residents of the United States only. All online applications must be received by August 4, 2017 at 11:59 PM PT.

The fact that blood clots is a good thing. It’s what allows us to think of minor, ordinary cuts, scrapes, and bruises as trivial rather than life-threatening.

However, blood clots become much more serious when they’re travelling around your insides, potentially blocking blood flow to your brain (stroke) or (heart attack in women), or when deep venous thromboembolism (DVT) moves up from your legs to your lungs (pulmonary embolism).

According to the US Surgeon General, pulmonary embolism from DVTs cause at least 100,000 deaths each year. And because we become more likely to suffer a blood clot as we age, it’s important we understand what they are, why does estrogen cause blood clots, and what we need to do to minimize our risk.

Menopause and Perimenopause Blood Clots

The link between hormones, menopause and blood clots in women is complicated and not entirely understood. Understandably, many women are concerned about their risk of blood clots if they decide to take birth control for menopause or use HRT to manage hot flashes as well as other perimenopause and menopause symptoms.

To get some answers, we turned to Dr. Emily Larmore Cooper, MD, of Sound Medicine and Wellness.*

How do blood clots in women form?

Dr. Emily: Blood clots form because the blood slows down or stops moving. Anything that prevents your blood from moving can make you more prone to developing a blood clot. Common examples include: genetic factors; personal history of a blood clot; immobility either from surgery, chronic illness or even travel; age, smoking, obesity and hormones all increase your risk of developing a blood clot.

Why Does Estrogen Cause Blood Clots?

Dr. Emily: The risk of developing a blood clot increases with age, particularly after the age of 40. Taking hormones also causes a small but increased risk of developing a blood clot. Together, the two combine to increase your risk. However, smoking alone increases your risk of a blood clot by 8.8 times.

Yes, you still need regular Pap tests, even after menopause. Learn why. 

There is a dose-dependent risk and lower doses of estrogen carry less risk. The risk of developing a blood clot is increased in the first 6-12 months of starting hormones. Hormones and blood clots do not increase with the length of time that someone it. Your risk is eliminated when you stop the hormones. There does not appear to be an increased risk with progesterone-only formulations.

Are blood clots more likely in perimenopause or menopause?

Dr. Emily: Women are at the highest risk of a blood clot during pregnancy and in the post-partum period. This is an even higher risk than women taking contraceptives.

“There is a small but significant increased risk of blood clot in
women taking hormone therapy,
but for healthy postmenopausal women,
the absolute risk is very low.”

In the Women’s Health Initiative study, a 2-fold increase in blood clot was found in women taking HRT. The risk was highest within the first year of taking the hormone replacement. Age is an independent risk factor for blood clots. The risk may vary with the type/dose and route of estrogen, but at this time, there is insufficient evidence to recommend one type of hormone replacement over another. There is a small but significant increased risk of blood clots in women taking hormone therapy, but for healthy postmenopausal women the absolute risk is very low.

If I have a personal or family history of blood clots, does that mean no hormones, like HRT?

Dr. Emily: A family history of blood clots could indicate that you have an inherited risk of blood clots. You should speak with your doctor about whether you should undergo genetic testing. If you have a genetic predisposition toward clotting, then you should have a discussion with your physician about the best options for you. Since pregnancy is an even higher risk condition for a blood clot than hormones, you should definitely discuss the risks and benefits.

If you need a professional opinion about blood clots for you, a Gennev menopause-certified gynecologist can give you a trusted evaluation, determine if medication is right for you, and they can provide prescription support. Book an appointment with a doctor here.

What can I do to minimize my risk, both in terms of medications to use or avoid and in lifestyle choices?

Dr. Emily: The biggest lifestyle measures are to be active, stop smoking and lose weight if you are overweight. Get up and move around when traveling long distances. Don’t cross your legs when you are seated. If you can’t get up, you can pump your calves by lifting up on your toes to keep the blood flowing in your calves. Discuss any medication questions with your doctor.

If you want a personalized lifestyle plan to tackle your blood clots, a menopause-certified health coach can be helpful. Book 30 minutes for your personal consultation with a health coach.

What are the signs that I might have a blood clot?

Dr. Emily: Pain, swelling, redness and warmth in a leg are all symptoms of a blood clot. It tends to be unilateral and it’s uncommon to have symptoms in both legs.

Fuzzy vision may be dry eye in menopause, or it may be menopause cataracts. Learn the difference and what to do next.

If I suspect a blood clot, should I head to the ER? When is my situation serious?

Dr. Emily: If you suspect you have a blood clot, you should seek immediate medical attention. Call your doctor and let them know you are concerned about a blood clot. You should be seen right away, but you don’t necessarily need to go to the Emergency room. If you can’t get into your doctor, you should go to the ER. If you are experiencing shortness of breath, chest pain or a racing heart, you should go to the ER as this can indicate that you have a pulmonary embolism.

If I have had a blood clot, will I have another? Should I never fly again?

Dr. Emily: You are definitely at higher risk to have a blood clot if you have previously had a blood clot. In fact, the biggest risk factor for having a blood clot is the history of a prior blood clot. However, this doesn’t have to cramp your travel plans. Speak with your doctor about ways to minimize your risk.

If I have a blood clot, what can my doctor and/or I do about it?

Dr. Emily: Blood clots are treated with blood thinners. Newer medications have made this much simpler in recent years. In the past, you would be hospitalized for initial treatment and then continued on blood thinners that required frequent monitoring with blood tests. Some patients can take oral medications while others require injectable medications. New medications are available that can be given orally and do not require frequent blood tests.

Your doctor will advise the best treatment for you. Typically, treatment lasts between 3-6 months.

So, what is your takeaway from all this? Well, blood clots are not something to be taken lightly. If you have a history, personally or in your family, make sure your doc knows and it’s a part of your conversation. But if you are a healthy, non-smoking, postmenopausal woman who’s never had a blood clot, the benefits of HRT may well outweigh the risks. Be sure to explore all your options ““ types of HRT, doses, and delivery systems ““ with your doc.

MORE ABOUT THE DOC: Dr. Cooper is a board-certified internal medicine physician who has practiced in Seattle since 2004. She is passionate about developing lifelong relationships with her patients. She recently launched her own clinic, Sound Medicine and Wellness.

Have you ever had a blood clot or is this a concern for you? Our team of menopause specialists would love to hear how you’re thinking about it, so please feel free to share with the community by leaving us a comment below, or talking to us on our Facebook page or in Midlife & Menopause Solutions, our closed Facebook group.

 

Americas future surrounding women’s empowerment and the new presidency

This morning I watched Kate McKinnon’s performance (as Hillary Clinton) of Leonard Cohen’s “Hallelujah”.

And I finally cried.

It’s taken me a while to process last week’s election. As a woman, let alone a CEO of a women-focused business, I knew that I needed to make a statement. Take a stand. Be part of the solution. Not be a victim.

And yet, I couldn’t sift through the disbelief, the anger, the sadness, and the understanding and empathy for the millions of people who believe the outcome is right for them.

So I took some time and just buried myself in life with the reassurance that I indeed will process the outcome and share how I see it with you””women who aspire to be the best versions of themselves.

We started Gennev with the profound belief that women should feel fabulous in their bodies. No matter their age. That comes with taking care of the symptoms life’s aging and processing throws our way. The vast majority of Gennev-ers that we reach everyday with our articles and our healthy products are in the most vibrant years of their lives. They’re at an age where they’ve got confidence, they know what they want in life, they’re financially OK, their kids are relatively self-sufficient, their careers are in a good place, and their relationships are well-grounded or becoming more clear.

For many of us, the outcome of this election threatens the path for women’s empowerment and feeling fabulous. And for others, their lives are not threatened. They either believe that the new president will not impact their day-to-day, because they frankly don’t stand for many of the womanly things that a women-led, democratic administration would have stood for. OR, they’ve risen above it to say, “I’m the boss of me” and are taking action to sustain the path of success, confidence-building and support for other women they believe in.

I’m in the latter camp.

I grew up in North Dakota on a cattle ranch and farm. It was awesome, because there was beauty, peace, fun things to do every day, hard work (which I didn’t mind), and family. The days where we gathered, dirty and tired in the house at 10 p.m. after a long hard day of work for a drink and a late-night snack were blissful. It was a very conservative culture””both morally and politically. I understand it well, because I grew up in it. I don’t share the same conservative views today, but I certainly have empathy and love for the culture of people who do. Conservatives don’t represent all the bad parts of the incoming president””in fact, many have love and compassion for all types of people. But, in this election, many of those people didn’t have a better choice, and when needing to select a candidate that most closely represented what they stood for, Trump was their person. For others filled with hate and anger, I simply don’t understand them and only hope there is a uniting force that brings our country together in a way that I cannot see at this point.

I voted for Hillary. I was with her and still am. Am I ready to band together and work through our differences? I don’t genuinely feel that way””like a kid who’s been instructed to say they’re sorry when indeed they’re not. And yet, I know it’s the right thing to do, and I’ll get there. At my own pace.

The tears I finally shed today were a lot for Hillary. I feel so badly for her. In spite of her short-comings (hell, we’ve all got “˜em), she cares deeply for doing what’s right. She’s had to rise up to levels of strength that most of us will never comprehend in our lives. She’s had to fight back amongst highly public humiliations and allegations. And she’s always done so with confidence. She may not have the charisma of people we love to love””like many celebrities (that’s likely part of why they’re so famous)””but we don’t always need to like people in positions of decision, leadership and power. We just have to believe in their ability to lead on our behalf. We have to be able to respect them.

You may have seen the photo of Hillary hiking the leafy paths of Chappaqua, NY last week. I love how human she looked”¦still with a smile on her face. That’s the image we need to be reminded of and replicate when we’re feeling down in the dumps. I hope she gets more time for hiking in the woods in the coming days. I’m going to follow her lead and keep living my life with confidence, grace and a positive outlook”¦but not let go of all the things I stand for when it comes to women’s development, rights, health, and success.

Hallelujah for women like Hillary who dare to take such a bold stand!

 

Menopause and sexuality is one of the many challenges of midlife that can take a toll on romantic relationships. If libido is not as robust as it used to be (or is non-existent), or sex is painful due to hormonal changes, or your relationship is on the brink of divorce for whatever reason(s), intimacy is suddenly a whole lot less attractive.

And midlife comes with plenty of “reasons”: caring for teenage children and/or aging parents, increased responsibilities at work, concerns about financial security in retirement, health worries “” who has the energy to even think about sex, much less engage in it?

Jessa Zimmerman

But if you want a more active sex life, you should have it. Sex and intimacy are actually really good for physical and mental health. So we engaged Jessa Zimmerman, licensed couples’ counselor and nationally certified sex therapist, to give us some quick tips to help re-engage your sex drive.

And it’s not just about sex. There are lots of ways to have intimate and supportive relationships, so if you’re looking for suggestions to help navigate uncertain relationship waters, we got that too.

But wait. At this point, we often lose those readers who are unpartnered and assume content about sex and love aren’t for them. This is for you, too. Masturbation and self-love “count,” “” YOU count “” so stick with us.

Sexuality and Menopause: Partnered  

It’s Valentime, which means lots and lots of articles about revving up your romance. But what if one (or both) of you is in menopause, and frankly, sex just isn’t all that appealing right now?

First, let’s all agree on one thing: this is not a “shaming” situation. No one should be shamed for wanting sex, for not wanting sex, or for being conflicted on the subject.

Generally, a woman’s sexual response is more complicated than a man’s, and penetrative sex may not be enough as and at this time of life, thanks to the vaginal dryness of estrogen loss, it may actually be quite painful.

Jessa’s advice for partners of menopausal women:

  1. Let her “warm up.” Give her time. Quite literally, you need to give her time to get the juices flowing. Extended foreplay is a great idea. Letting her set the pace and determine how far things go is awesome.
  2. Be physically affectionate, even if it doesn’t result in sex. If, for example, every backrub is just a prelude to intercourse, and intercourse is painful, suddenly backrubs aren’t all that pleasant. Be prepared to touch and cuddle without expectations.
  3. Buy lube. She may be embarrassed by the changes in her body, or she may want to have sex but fears the pain, bleeding, even infection from vaginal tearing that can result. Buy some lube for sex, have it handy, check in regularly to see if more is needed. Make it sexy or playful so it’s part of the experience.
  4. Talk. This is a tough topic, even with someone you share a bed with. Talk about sex when you’re not having it, and talk about it when you are as what works or doesn’t, what gets her excited or doesn’t, how you can both find pleasure.
  5. Get educated about a woman’s body and sexual response. Very few women of any age experience orgasm from penetrative sex alone. Learn with the clitoris is and how it works, be open to toys like the lioness vibrator to help her along.

And remember, sex isn’t the only place where your partner needs additional support during this time, says Jessa. Now is the time to be her ally and her cheerleader. If her self-confidence has taken a hit, boost her up. Show interest in her passions. This can be a powerful time of growth in career, second career, creativity or menopausal zest, so be supportive and join in if she makes a space for you.

Support her physical health by joining her or inviting her out for walks or runs or other physical activity. Encourage healthy eating by cooking some good Mediterranean diet recipes. Be sensitive and never downplay or joke about or call out her symptoms unless you know she’s truly OK with it. Listen. Ask her how she’d prefer you deal with her hot flashes or irritability, then try to accommodate.

This doesn’t mean you give up your life, we promise! But some flexibility and extra sensitivity could go a long way to making life easier for you both.

Jessa’s advice for menopausal women

You’re in menopause, and sometimes life is kind of “¦ miserable. Not only that, but you fear you’re making those around you miserable too.

We get it. Chances are you’re not the ogre you think you are, but we’ve got some suggestions for you too.

  1. Talk about sex. Advocate for what you want and need, Jessa says. If you’re getting what you want, you’re likely to want it more often!
  2. Initiate sex sometimes. Drive can become more responsive over time, Jessa says, so don’t just wait until you’re in the mood.
  3. Prioritize intimacy. Make time for undistracted togetherness. Be sure your partner understands this isn’t a guarantee of intercourse (to take the pressure off) and let what happens, happen.
  4. Get professional support or treatment if you’re struggling. Guilt or worry over whether you’re “normal” aren’t helpful or sexy, so see if a professional can help you get back on track.
  5. Embrace erotica. Suggest to your partner that you watch a sexy movie or read a sexy book together. Even if this doesn’t lead to sex, it can help “keep the embers glowing,” Jessa says.

This can and should be a powerful time for you. You’re probably freer from obligation and more independent than you’ve been in a while, maybe ever. Give yourself time to enjoy that, get to know you if that feels right, take control, set goals, live the life you want. If you want, you and your partner can find new hobbies, ventures, projects to do together.

Or, perhaps this is time to branch out on your own to live new experiences, then come back together to share. Being confident and finding pleasure in life can help you find confidence and pleasure in your relationships as well.

Unpartnered

Notice we didn’t say “alone.” You’re not alone, even if you’re currently not in a romantic relationship. The longest and most important relationship you’ll have in your life is with yourself.

And you’re changing. This transitional time can change our spirits and psyches as well as our bodies, so this is a really good time to get to know yourself (again).

Jessa asks: Are you ready to pursue new things, invest in yourself, leverage your new power at work or in your life? Or maybe it’s time to take a bit of a break, rest, re-energize, focus on self-love and self-care before embarking on your Next Big Thing. Whatever’s right for your next step, this is your time to figure it out, then pursue it. Be your own cheerleader!

And while you’re moving forward, don’t neglect your sexuality, Jessa says. The more you engage your body’s sexual response, the easier it becomes, so keep the fires burning. There are lots of great toys and tools for women’s sexual pleasure that don’t require a partner. You may have a new “body map” for pleasure, so get to know your body and responsiveness. It’ll be even more fun to share when you’re able to define exactly what suits you best!

Want more tips from Jessa Zimmerman? Be sure to check out her awesome book: Sex without Stress: A couple’s guide to overcoming disappointment, avoidance, & pressure.

Got thoughts to share on relationships, intimacy, sex, and love? Join in the conversations happening on the Gennev private Facebook group!

 

Guest blogger Dr. Barbara Mark weighs in on the parallels between adolescence and “middlescence,” when we get to ride that hormonal roller coaster all over again. 

I imagine many of you have wonderful memories of adolescence: shouting matches with your mother about how she just doesn’t understand you; long, insightful diary entries about your true love; confusing thoughts and feelings about what’s going on with your body; mood swings flinging you from euphoria to the depths of depression and back again.

Well, welcome to “middlescence” as adolescence with life wisdom and life experience as well as many more questions and a lot more responsibilities!

Symptoms of middlescence

Women I work with tell me they feel they are losing their minds. They fear they have serious health issues because of joint pain, heart palpitations, six-week periods, and daily headaches. They might fire every person who reports to them, they tell me, or quit their job altogether because they haven’t slept in weeks and are so depressed they can’t concentrate.

What’s really happening?

In fact, these women are going through significant emotional and psychological changes as normal changes that are part of being at this developmental stage of life.

Yes, just like adolescence, adulthood has stages, some of which seem impossible to navigate. It is a time of great hormonal transition as well as personal awakening to new aspects of yourself. Midlife and menopause are normal for women, and both resolve in time.

Is this happening in your life? The good news is that as just like adolescence as you will grow out of it!

 

Is HRT safe? What can I do about these hot flashes?

Consult with a menopause-specialist physician or nurse practitioner from the comfort of your home with Gennev’s telemed service.

Managing middlescence

While you’re waiting to “grow out of it,” there are things you can do to make the journey a bit more tolerable, even interesting.

First of all, have a good conversation with your doctor. If your doctor doesn’t have much information about perimenopause and midlife development, find a menopause specialist who can support you. Information about what is happening and why will make the experience easier.

Secondly, share information with partners, spouses, and children. No, they don’t need all of the details, but it will help them to understand what is happening to you and why you seem to be a different person than you used to be! This is a good time to find a third party to talk to if things at home are chaotic. A bit of coaching or counseling can go a long way to relieve the strains on a relationship.

Thirdly, develop workplace strategies. We live in a culture that is youth-obsessed. It can be very daunting for a woman to experience the tell-tale signs of perimenopause as like hot flashes as in a work environment. Perimenopause can make a woman feel old, and that can erode your self-confidence.

Most workplaces in the US are not very aware of or supportive of how to accommodate menopause in the workplace. (Countries like the UK and Australia are ahead of us in this regard.) And, because of very valid concerns about ageism, most women in the workplace don’t want to be identified as “middle-aged.” Having a game plan to deal with signs can help you feel confident and continue to be productive.

Let me give you some tips that I share with my clients:

Middlescence at work

OK, so maybe you’re not a teenager anymore, and the option to storm off to your room, slam the door, and write angsty poetry is no longer open to you. And perhaps you’re now on the “mom” side of those teen-mom screaming matches. You survived the hormonal roller coaster once; you’ll survive it this time too. Just be sure your strategies and support network are in place so you can thrive through middlescence.

How have you handled perimenopause symptoms in the work place? Do you have any tips for others? If you have a man in your life, how have you explained what’s going on to him? I would love to hear about your experiences! Please tell me about it in the comments below or on Gennev’s Facebook page, or join me and many women with experience to share in Gennev’s closed Facebook group, Midlife & Menopause Solutions.

 

A journey from diagnosis, to health and hope

A diagnosis of breast cancer can be terrifying, disrupting life, plans, even your sense of hope for your future. In honor of those who have been impacted by this disease, we’d like to offer a story of one woman’s journey from diagnosis through treatment and on to health and hope. 

 

Joanne was diagnosed with breast cancer in 2005. That diagnosis, and the journey it took her on, required all her strength, focus, and resources. But one thing she really needed was surprisingly hard to find: reasons for hope.

“When I was diagnosed, I was lucky””I had friends, family, good medical care, and good information. But the one thing I couldn’t find was hope. I scoured the Internet for stories like mine, but it was all so negative. I wanted stories of people who had overcome this and moved on, but you don’t hear those, you hear the worst-case scenarios.

“I’ll never forget the day I walked out of the hospital after I was done with radiation. That was the final day of a journey that started with the diagnosis, the lumpectomy, the chemo, and finished with radiation. I felt like literally the weight of the world had been lifted off my shoulders. I was done. I just wanted to run forward and live for the future, for what’s out there. There is hope, there are lots of reasons to be optimistic, even with this diagnosis.”

So, if you can’t find a story of hope, become one. Here’s how Joanne did it.

When “life as normal” suddenly isn’t

In early 2005, Joanne was living in Chicago and had just finished her MBA. After two challenging years of full-time work and full-time school, she was ready to enjoy a bit of a break. In August, she got a dog (Molly) for her birthday; in September, she went in for a routine mammogram””all just life as normal.

Except the 45-minute appointment turned into four hours when doctors “found something.” Ultrasounds revealed a small tumor in her left breast, and the decision was made to remove the lump as quickly as possible. In October, Joanne underwent a lumpectomy.

“They removed the tumor, and then they wanted to do both chemo and radiation. I wasn’t gung-ho on doing chemo. Radiation is very specific, very focused on a certain area. Chemo goes through your whole body, it kills everything, both the bad and the good cells, to make sure cancer isn’t lingering somewhere else in your body.”

For a relatively small tumor, this was a pretty aggressive form of treatment. But because Joanne was only in her early 40s and pre-menopausal, her doctors wanted to ensure she’d have the 40 or 50 more years she still had coming to her.

The chemo lasted for two months, with treatments every other week. “After the second treatment, that’s when you lose your hair,” Joanne says. “The irony is, the main reason I didn’t want to do chemo is I didn’t want to lose my hair. I went and got a second opinion, I had additional testing, just because I didn’t want to lose my hair. After I had my surgery in October, they wanted to start the chemo right away, but I postponed because I wanted hair for the holidays. It seems so stupid now, but it was really important then.”

Finding hope step 1: Taking control of the process

“One of the things I learned was, I had to do this””all of this””at my pace. People are pushing you, constantly, from all different directions, but I felt very strongly that I needed to do this my way to feel comfortable with the choices I made.”

Making decisions for herself, even if those decisions were limited to when she lost her hair rather than if, was a source of strength.

“I decided to start chemo in January. I was living in Chicago at the time, but I came home to Seattle in December, and my very dear friends gave me a great gift: as only two gay men can do, they took me wig shopping. We went for a spa day and then to find wigs. In the gay transvestite community, it’s all about celebrating the feminine in the best way, and we had the most fun shopping for wigs. I ended up with two: one we dubbed my “˜Nicole Kidman’ look, and the other was my “˜Meg Ryan’ look.”

While truly fabulous, Meg and Nicole weren’t suitable for work, so Joanne bought a more expensive wig and got it styled by a woman who specialized in adapting wigs for chemo patients. In the meantime, she got her hair cut short so when it did start to fall out, it would be less traumatic.

“I did all of this to be ready, as ready as I could be when you don’t know what’s coming. Everything I read said you have to be proactive, don’t let things happen to you, don’t be a victim. And one of the things you can do is, before you start losing your hair, go get your head shaved.”

Once her hair did start coming out, Joanne decided to take the step. A friend volunteered to go with her, and when they arrived at the salon, they were each given a glass of champagne. The stylist turned Joanne away from the mirror, and her friend kept up a constant stream of gossip from the many celebrity magazines dotted around the place. With all these distractions, Joanne really didn’t pay attention to what was happening.

“When the hair stylist was done, she turned me around to face the mirror. And I was like, huh. That’s not all that bad. I wasn’t in panic mode or anything like that. It just didn’t seem that important. I’d spent three months dealing with the anguish of losing my hair, doing all these things to avoid it, and by the time it came, it wasn’t a huge thing. When we walked out of the salon, my friend asked if I wanted to take my newly bald head out for a drink, and I realized””I can’t. I have a blind date!”

For months, a friend had been trying to set Joanne up with a man she knew, but they’d never managed to get schedules to match. Finally they found a date that worked, but in all that had been happening in Joanne’s life, it had slipped her mind. “I just couldn’t change the meeting again,” Joanne said, so she brought out the very expensive wig and wore it.

“When I tried the wig on before, I had hair, but now I didn’t, so the wig sat further down on my head, and I had to keep blowing my bangs out of my face. And I’d never worn it for more than five minutes, and now, two hours later, it felt like a vice and it itched.“

Neither the date nor the wig was a success, and neither got a second chance with Joanne.

She found cashmere caps at Nordstrom, and in keeping with her plan do this her way, she bought four and banished the wigs to the bedroom closet.

“I was fine,” she says. “The caps kept my head warm, and I liked the way they looked. I was fine.”

She was “fine.” But is being “fine” all there is?

 

For part 2 of 3, join us Monday, October 31. And if you have a comment or story to share with the community, please join us on our Facebook page. 

 

Aching joints is a very common complaint for more mature folks. But what’s the connection between menopause and arthritis?

And more importantly, what can women do to manage joint and arthritis pain to maintain healthy, happy, active lives?

Dr. Darcy Foral, MD, is a board-certified, fellowship-trained Orthopaedic Surgeon at the Edmonds Orthopedic Center. We squeezed ourselves into her busy scheduled to get a orthopedist’s view of arthritis and other aches and pains.

What is arthritis?

Dr. Darcy: Arthritis literally means “joint pain.”

The word arthritis is thrown around by doctors and lay people alike to refer to a wide variety of aches and pains, and this creates a lot of confusion.

When my orthopaedic colleagues and I use the word arthritis to describe a condition, we are referring specifically to damage to a joint, significant enough that it is causing pain. We usually see this initially on x-rays or some other form of imaging (MRI or CT scans). 

When we diagnose someone with arthritis, we have seen changes to the joint, usually narrowing and the formation of cysts or bone spurs, that indicate this process is happening.

Is there more than one kind of arthritis?

Dr. Darcy: There are many kinds of arthritis.

The most common is osteoarthritis, which is the “wear and tear” type that happens to the majority of people as they age. While there is a genetic component to osteoarthritis, as some families get it worse than others, the science behind that is not yet clearly understood.

Another common form of arthritis is traumatic arthritis. If you had an injury, last year or in childhood, it can lead to damage to a joint that eventually causes that joint to wear out. The timing of the joint wearing out is usually dependent on the severity of the original injury. Repetitive injuries, like multiple ankle sprains from “weak ankles” can also lead to arthritis, even if the injury itself doesn’t seem that severe.

Finally, rheumatoid arthritis, falls into the category of autoimmune diseases and usually has a much worse prognosis. Autoimmune diseases can affect almost every aspect of the human body, but they have the common denominator of your own body attacking itself because your immune system has mistakenly identified one of your own tissues and foreign and something it must get rid of.

In rheumatoid arthritis, your body is attacking the lining of your joints and can cause wide spread destruction. Luckily, in the last 20 years, we have new medications to suppress this, and our treatments have improved significantly.

There is a strong genetic component to autoimmune arthritis and the diagnoses and treatment is also more complicated, usually being managed by a rheumatologist.

If rheumatoid arthritis, lupus, or a similar disease runs in your family and you are starting to have pain or swelling in multiple joints, muscle pain and weakness, or other unexplained symptoms that are sticking around and don’t seem related to activity, you should see your primary care doctor and let them know what you are experiencing sooner rather than later. They should be able to help direct you where to go next in obtaining a diagnosis. 

Can menopause cause arthritis or make it worse?

Dr. Darcy: The good news is that menopause does not make your chances of getting any kind of arthritis worse in and of itself, but it can certainly feel that way.

Arthritis and osteoporosis

Most of us know that our bones get weaker with age (osteoporosis), with the maximum density happening before menopause. Once menopause hits and our hormones change, we start to lose bone density if we don’t work hard to prevent it, and sometimes even if we do.

Magnesium can be helpful for both bone health and joint pain, so consider adding a magnesium supplement to your day. 

Having poor bone density will not give you arthritis, but it will make you more prone to injury. Let’s say you start to get some compression fractures in your spine due to osteoporosis. As your spine compresses and the shape of it changes, you then develop arthritis in your spine, or narrowing of the joints, causing pinching of the nerves or narrowing of the spinal canal. These changes lead to back pain, nerve pain and weakness, and can be very debilitating as we age. 

Arthritis and weight management

The other common factor that can lead to joint pain and arthritis is weight gain.

Some of us have to be careful our whole lives to avoid excessive weight gain, but for many women, menopause is the first time in their lives that they see their metabolisms change dramatically. I see so many women who come in for very legitimate musculoskeletal issues, and so many of these issues are either caused or made worse by weight gain.

It’s a delicate topic, because of course no one wants to be overweight, and when your body isn’t working well for you, it’s easy to continue to put on more weight.

We know from many scientific studies on osteoarthritis that extra weight will wear out your joints, especially your weight-bearing joints which are your hips, knees, and ankles.

How can I manage my arthritis?

Dr. Darcy: I think that it is important to remember that many things change as we age, and running five miles over lunch may not be the best choice of exercise for you any more, at least not if you have an injury.

There are so many fun, low-impact options that you can choose to keep active without increasing wear and tear on your joints. Swimming, biking, rowing, and yoga are easy for most people to access if they are motivated.

While many women shy away from weight lifting, keeping your muscle mass up is a great way to keep your metabolism from slowing down, and it also is the single best thing you can do to help keep osteoporosis at bay. Staying strong helps your balance as well; good balance means less risk of falls and fractures and the ability to remain independent well into your 80s and 90s. 

Does diet affect joint pain?

Dr. Darcy: In the case of weight gain, yes, it really can, but there is a lot about diet we are learning, specifically the role of foods that cause inflammation, that may affect joint pain.

The make-up of our gut bacteria may also play a role in our disease processes and weight. I do not proclaim to be an expert in this area but I do watch it closely for solid recommendations to help direct patients who are looking for advice, as well as advice for myself! 

When should I talk to a doctor about the pain?

Dr. Darcy: It is very normal to get a little joint pain here and there. We all get sore and “tweak” a joint lifting something or turning the wrong way. We get excited and over-do it at the gym or on an extra long hike, or if you’re like me, trying to keep up with the kids.

Joint pain or musculoskeletal pain that doesn’t go away with a few days of rest, ice, and ibuprofen should probably be checked out by a doctor. The RICE formula is a good one to keep in mind as your first line of treatment for aches and pains (Rest, Ice, Compression, Elevation).

Orthopaedic surgeons like myself are specifically trained to figure out what is wrong with your musculoskeletal system and direct you to your best treatment course (imaging, lab work, physical therapy, massage, acupuncture, bracing, injections or surgery).

Will I need surgery for my arthritis?

Dr. Darcy: Even though we are surgeons, the vast majority of our patients do not need surgery. My goal is always to try to look at the big picture and find the best course of treatment for my patients, taking their whole lives into account, with surgery as a last option if all else fails.

I encourage all of you to find a doctor you feel respects you, takes your life goals into consideration, and helps make a reasonable plan with you to feel better and stay active and keep moving without daily pain.

I know from being a patient myself, it is not always easy to find and develop that kind of relationship with a doctor, especially if you are in a rural area. Reach out to friends, family, and co-workers to help find a doctor you are comfortable working with. If you can’t, online options might be the next best place to look.

While Dr. Google can be right sometimes, I encourage you to visit a physician if at all possible before you waste precious time and money on bad online recommendations or the wrong diagnosis. 

Do you suffer from arthritis or joint pain? What are you doing to manage the condition and the pain? We’d love to hear your story and solutions, so please share with us by commenting here, or starting a thread in our community forums. You can also reach out to us on Gennev’s public Facebook page or in our closed Facebook group.