Can you touch your tongue to the tip of your nose? Bend your thumb to your wrist?

If you are (or used to be) “double-jointed,” get compliments on your soft skin, and experience joint pains, there’s a chance you could have a rare disease and not know it. 

Fans of RuPaul’s Drag Race know that Season 11 winner Yvie Oddly wowed viewers with her fierce looks and jaw-dropping contortions. For many people, this was their first exposure to Ehlers-Danlos Syndrome (EDS).

The disease is rare, so we don’t know a lot about how it works. But there are some interesting ties to perimenopause and beyond.

What is Ehlers-Danlos Syndrome?

EDS is a group of rare disorders affecting the skin, blood vessels, bones, tendons, ligaments, and other connective tissues; faulty collagen, the protein that adds elasticity to this tissue, is to blame. One or two people out of every 10,000 have EDS, though some doctors think this number is actually higher.

There are 13 types of EDS but the two most common (if you can call a rare disease “common”) are the classical type and hypermobility type (hEDS).

Soft, velvety, and extremely stretchy skin that bruises and scars easily is the hallmark of classical EDS.

hEDS symptoms include joint hypermobility, dysautonomia, and musculoskeletal pain, though there’s some overlap: velvety-soft skin, easy bruising, and the ability to extend joints beyond the normal range of motion are present in most types. 

Tiredness, digestive disorders, easy bruising and bleeding due to weaker capillary walls, and anxiety risks can be present in both forms as well. 

Basically, wherever there is connective tissue, you’re more likely to have issues.

Hypermobility leads to hyperextension, dislocation, subluxations (partial dislocation), and overall pain. For many sufferers, this pain can be debilitating, requiring braces, crutches, or even a wheelchair, all while looking “normal.”

EDS, and especially hEDS, often go undiagnosed; most doctors receive very little training on the disorder, even those who specialize in joint and skin conditions. 

Need a trained doctor’s opinion about hEDS? 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.

There’s no genetic test for hEDS, so diagnosis is dependent on clinical criteria, including the Beighton Scoring System (try it yourself!) to assess joint flexibility and self-reported pain. 

The lack of knowledge and diagnostic tests can lead to years of frustration for sufferers, as doctors ignore their issues, tell them it’s all in their heads, or recognize that there’s something wrong but just don’t know enough about EDS to be effective.

The hypermobility-estrogen connection

Women experience hEDS at a much higher rate than men, and the current theory is that estrogen plays a role. 

Estrogen overall has an effect on connective tissue. Women, in general, have looser ligaments than men and people with higher testosterone, which leaves us more prone to joint injury.

Estradiol receptors, proteins in cells activated by estrogen, are present in skin, cartilage, and other connective tissues. Estrogens help regulate the metabolism of these cells.

Research done on a normal population shows that tendon injury is more common in pre-menopausal women, with the highest risk being when estrogen in the menstrual cycle is at its lowest after ovulation.

This hormonal link to loose joints shouldn’t come as a surprise: ligaments relax in pregnancy to allow the birth canal to expand to fit a baby.

Puberty is often the onset of hEDS symptoms, and those who previously had symptoms notice that they worsen after their periods start.

Women with hEDS often have gynecologic difficulties like heavy periods, heavy cramps, and pain with sex, and report more hEDS symptoms with their menstrual cycle. Combined hormonal contraceptives (CHC) and Progestin-only contraceptives (POP) can help symptoms and reduce fatigue in some patients with hEDS.

What does this mean for menopause?

Well”¦ there isn’t a lot of solid scientific information out there about how menopause specifically impacts people with hEDS. Anecdotally in Facebook groups and online forums, many women with EDS report early menopause, but research does not support this. 

However, because of the hormonal involvement, menopause certainly has an impact on hEDS. For starters, connective tissue in the general population changes post-menopause and skin collagen decreases 1-2% each year after menopause.

Joints stiffen with age for all of us, which can be a good thing for people with hEDS, as less supple joints are less prone to overextension. In a study of 386 women with hEDS, 22% of the post-menopausal women reported that their symptoms decrease after menopause. 

However, more than one-third of participants experienced a worsening of symptoms before their periods while in perimenopause. The most rapid shifts in hormone levels happen during this transition, which is why it’s not surprising that the time just before menopause can be when hEDS is first diagnosed. 

As we previously mentioned, women with hEDS have more gynecologic concerns than the rest of the population. They’re more likely to experience incontinence, vaginal dryness, and how to do sex without pain, concerns that increase for all people with uteruses in menopause.

Some studies have found that people with EDS tend to have lower bone density than the regular population, pre-menopause, which makes them more prone to osteoporosis later in life. While this may be because people with EDS limit bone-strengthening exercise due to pain and mobility issues instead of a structural cause, the implications for bone health are the same. 

It’s been thought that hormone replacement therapy (HRT), selective estrogen receptor modulators (SERM), and oral contraceptives could improve diseases of connective tissues. Unfortunately, the amount of estrogen in HRT is not enough to protect joints, and higher doses may increase the risk of breast and other reproductive cancers.

If you’re a woman in midlife who thinks that you might have the hypermobile form of EDS, talk to your doctor or one of ours; because the disorder is so rare, you may need to be persistent and detailed about your symptoms to get the help you need. 

More research clearly needs to be done on how to help women with EDS in menopause, but awareness of the condition “” and better reporting, so we have a better idea of actual numbers “” can help bring greater attention to the issue.

Sign up and chime in about your path in menopause on the Gennev Community Forum. Come join the conversation.

Introducing our women’s Vitality pack!

As our bodies change with age, so do our nutritional needs. While we recommend getting nutrition from natural sources (food, water, sunlight), those sources may not always be enough.

Nutrition lays the foundation for everything we do at Gennev. That’s why all our HealthFix coaches are also Registered Dietitian Nutritionists. They can help you sleep better, stress less, hydrate, move, stretch, control menopause symptoms, all the good things.

But our health coaches also know that to be truly as healthy as you can be, you need an optimal diet. And in our busy society, full of pre-packaged, salty, sugary (but undeniably tasty) food, a healthy diet can be tough to maintain.

Introducing the best women’s vitality supplement

So at Gennev, we got to work. We asked Naturopathic Physician Dr. Wendy Ellis to formulate the most optimal pack of nutrients for women in menopause, then produce a pack that was affordable, bio-available (easily absorbed by the body), and didn’t require us to choke down a pill better sized for a horse.

It took time, a few versions, and tons of research, but Dr. Ellis created a supplement pack that is quite comprehensive, well-balanced (the nutrients enhance each other, rather than possibly reducing each other’s effectiveness), is created from the highest-quality nutrients from impeccable sources, is guaranteed to contain precisely what is says on the label, and will give you peace of mind regarding your nutrition.

That is not to say you can eat whatever you want as long as you take the Vitality pack, of course, but it does mean if you are less-than-perfect from time to time (and who isn’t?), we’ve got you covered.

In the interview below, Dr. Ellis explains the choices she made and the guidelines she consulted to create the Gennev Vitality pack.

Women’s Vitality Pack

• 2,000IU Vitamin D3
• 100mg Co Enzyme Q10
• 200mg Magnesium (Citrate)
• 600mcg B-12 (Methylcobalamin)
• 20mg Pyridoxal 5 Phosphate B6
• 600mcg Folate (Magnofolate)
• 600mg N-Acetyl L-Cysteine 98.5%
• 200IU Vitamin E Novatol
• 300mcg Biotin
• 2,000IU Beta Carotene
• 500mg Turmeric
• 200mcg Selenomethionine

Why did you choose these particular nutrients?

There are many known nutrient deficiencies and health conditions associated with menopause. We know that lifestyle factors play a major role in our health; however, before and during menopause, we are prone to changes in health that diet and exercise alone may not able to address completely.

In the menopausal transition, we have a significant increase in bone loss and risk of cardiovascular disease. We may have higher requirements for nutrients needed to maintain good health based on our genetics, medications we take (or have taken in the past), or lifestyle factors such as a poor diet or lack of adequate exercise.

We are also affected by our environment, and accumulated exposure over time may be impacting our health.

The nutrients included in our women’s Vitality pack are based on clinical research that outlines which nutrients are commonly needed in peri- and post-menopause as estrogen levels fall and our bodies go through the natural process of aging. Other nutrients were chosen for the benefits on overall wellness to support the immune system, improve energy, reduce joint pain, and aid with stress management.

What do the nutrients do, and what are the risks of being deficient?

Vitamin D is probably the most important nutrient for modern times. We spend a lot of time indoors being sedentary. For post-menopausal females specifically, it is necessary for bone density (to avoid osteoporosis), for the immune system, and also for blood sugar support. We also know that vitamin D is important in cancer prevention (including breast cancer), as well as overall energy.

N-Acetyl L-Cysteine We live in an increasingly polluted environment, and many health problems are associated with these chemicals in our environment. NAC is an excellent antioxidant to help offset the effects of pollution and chemical exposure. It is also great for liver support, as our livers metabolize these chemicals as well as any medications we may take. This nutrient is also very important for memory and cognition. Dementia / Alzheimer’s is significantly more common in women, and everything we can do to support our brains to reduce our risk is important.

Biotin Important for hair loss/ thinning and strong nails. Most women experience hair thinning as we age, and biotin can help offset this. Some laboratory results, including thyroid testing, can be impacted by taking biotin. It is recommended that you discontinue this medication for at least two days prior to thyroid testing.

Beta Carotene (Vitamin A) Vitamin A is a super-important vitamin for the immune system and for eye health! Our supplement pack contains beta carotene, which has a slow conversion to vitamin A, to avoid vitamin A toxicity.

Curcumin Where to start with the benefits of this powerful antioxidant, anti-inflammatory, anti-cancer and neuroprotective nutrient? Again, the effects of the environment on aging are significant. This nutrient is a powerful anti-oxidant that offsets the effects of our environment. Most people also have some degree of joint pain as the wear and time of time creates osteoarthritis as and curcumin is a safe and effective way to reduce joint pain. It also supports cognitive function, which is a concern for many women in menopause.

CoQ10A common complaint for many women in menopause is fatigue. CoQ10 is an important nutrient in mitochondrial function (mitochondria is the fuel source for our cells) and is depleted by many medications, including statins and blood pressure medications. As heart disease risk increases ten-fold with the onset of menopause, many women are on these medications. CoQ10 is important for the heart, as it improves physical performance and helps with generalized fatigue.

Pyridoxyl 5 Phosphate (B6)  B6 is very important in neurotransmitter production, mood, and stress support. It is also very important for metabolism of other nutrients in the diet. Many women have a long history of taking birth control pills, which are known to deplete B vitamins. This nutrient is important in reducing heart disease as well as dementia risk.

Magnesium This nutrient is a mineral that many people lack. It is a muscle relaxant, it helps us sleep, and it helps with constipation. It is helpful in stress and anxiety management, aids in blood sugar control, blood pressure control, bone density, and calcium utilization in the body. For some menopausal females, this can be helpful for hot flashes. This nutrient is a cofactor in more than 300 enzymatic reactions in the body! This is one of the most important nutrients for all individuals.

Folic Acid (as the most active form 5MTHFR) This nutrient may be helpful in hot flashes for some women; it is also important for treatment of depression and can be depleted by many medications, including birth control pills and anti-depressants. This nutrient is important in heart health and mood and may help reduce some cancers as well as decrease dementia / Alzheimer’s risk.

B 12 This nutrient is important in making red blood cells, supporting energy levels, and reducing heart disease. The absorption of B 12 is impacted by gastric bypass surgery, excess alcohol intake, and taking acid blocking medications long term. Vegetarians are at an increased risk of B vitamin deficiency, as this nutrient is found mainly in animal products, though some foods are fortified with B12. Although it is rare to have a true B12 deficiency, taking B12 can be helpful for mood and energy.

Vitamin E Three national surveys have found that the diets of most Americans provide less than the RDA levels of vitamin E. This nutrient is a powerful anti-oxidant and has been shown to be anti-inflammatory, support the immune system, and reduce the risk of cardiovascular disease. As an anti-oxidant, it may reduce our risk of cancer. It is also a very important nutrient in eye health, reducing the risk of macular degeneration and cataract formation. It may also be important in long-term cognitive helalth.

Selenomethionine This mineral is a powerful antioxidant, important in reproduction, thyroid hormone metabolism, DNA synthesis, and protection from oxidative damage and infection. Selenomethionine is a cofactor in many enzymatic reactions, including thyroid hormone metabolism and glutathione production, which aids in reducing oxidative stress from the environment. Because of its effects on the immune system, this mineral may play a role in the prevention of cancer and support cognitive function. Selenomethionine is the most bioavailable form of selenium.

Why are these nutrients particularly useful or necessary for women in midlife and menopause?

There are the clinical symptoms that women experience (like mood changes and hot flashes) and there are the things we cannot feel, like heart disease and bone loss. The ingredients in the women’s Vitality pack were chosen not only to help women feel better, they were also chosen to reduce the risk of health conditions commonly seen in association with menopause.

Why these doses?

Many companies will offer a very “full spectrum” women’s formula with a plethora of ingredients. However, these supplements have very little of each ingredient, thus it falls below the therapeutic dose. We cannot supplement ourselves out of a healthy diet or regular exercise, but this packet, combined with healthy lifestyle choices, focuses on helping women feel better while also addressing common health conditions associated with menopause. The doses were chosen based on my own clinical experience with these nutrients, but I also used clinical research to correlate specific doses for reducing disease.

Nutrient requirements for a 40-50 year old female are very different then the requirements for a 25-year-old male. For example, vitamin D has a recommended daily allowance of 600ius for males and females between the ages of 51-70. The RDA is defined as “the estimated amount of a nutrient per day considered necessary for the maintenance of good health by the Food and Nutrition Board of the National Research Council/ National Academy of Sciences.”

We all have different levels of absorption based on our age, sun exposure, where we live, etc. At this time in life, 600ius is often not adequate for all aspects of health, thus I chose 2000ius for this nutrient. It is a safe daily dosage, and this amount offers a better therapeutic value across the board for a number of conditions including improved mood, bone density, cancer prevention, overall energy level, as well as immune support.

Why this formulation?

The approach for this formulation was chosen based on the most common physical complaints I have observed in women 40+ in my clincal practice, while also considering the leading causes of disease in women as they approach or reach menopause. This formula also takes into consideration the research around increased nutritional demands for the peri / post-menopausal female.

You can find links to research consulted at the end of this article.

Who made them, and why did you choose them?

We formulated the women’s Vitality pack based on clinical experience and research and collaborated with a chemist who understands the importance of quality ingredients in supplements.

We follow the cGMP practices, which is a process that ensures we are getting a pure product, sourced from responsible suppliers, and contains the nutrients listed on the label. This is voluntary, and is not required by the FDA.

We want to be sure our supplements are pure and maintain their potency over time. Although it would be nice to have one capsule that covers all of our nutritional needs, all vitamins, minerals and herbs have a different molecular weight as so we need to keep the size of the nutrient in mind so the capsule count is reasonable!

Why this combination of meds?

This combination of meds was based on the nutritional and clinical needs that research and clinical experience show are the most beneficial to women as they approach and go through the menopausal transition.

Calcium was not included in this formula because it is a very large molecule, and would require a significant increase in capsule count to reach the 1200mg dose recommended by the FDA. Many women get a significant amount of calcium in the diet as and if osteoporosis is a concern, then women should consider the addition of a bone specific supplement.

Do you have advice on the best way to take them? (With food, at morning or night, same time every day, with other supplements, etc.)

Most people prefer to take supplements in the morning with food to avoid stomach upset. Food also increases acidity in the stomach, thus the absorption improves with food. Vitamin D can negatively affect sleep as well, so this packet is better taken with breakfast or lunch. If you are on thyroid medication, it’s best you avoid taking the packet within 4 hours of your thyroid dose, as some nutrients can decrease the absorption of your thyroid medication.

Any potential drug interactions?

Fish oil, CoQ10 and vitamin E should not be taken, or taken with caution with blood thinners. Ask your doctor about taking these supplements if you are on a blood thinning medication.

If you are on thyroid medication, you should avoid taking your vitamins within 4 hours of taking your thyroid meds. Minerals in this Vitality pack may reduce your absorption of your thyroid medication.

B6 may decrease the absorption of levadopa or carbidopa, medications used for Parkinson’s disease. Doses higher than 200mg may have greater impact on some medications.

B12 may interfere with a specific antibiotic called chloramphenical. Otherwise, this nutrient is considered quite safe.

Folic acid may interfere with sulfasalazine or methotrexate.

Biotin as there do not appear to be any medications that biotin interferes with, though there are some medications that may increase your need for biotin. Taking biotin may afffect some lab tests, so discontinue this two days before having labs drawn, especially thyroid labs.

NAC as should not be taken with nitroglycerin.

Curcumin as this can act as a blood thinner, and should not be taken with blood thinners. It can also interfere with the effectiveness of some acid blocking medications and can cause some medications to lower your blood sugar. Talk with your doctor if you are on any of these medications.

Vitamin A as can be toxic when taken in high doses, though when given as beta carotene, it has a slower conversion to vitamin A. If you are on verteporfin, beta carotene may reduce the effects of this medication.

Any potential side effects?

Supplements should be taken with food to avoid gastic upset. Magnesium, if taken without food, may increase the risk of diarrhea.

As mentioned, biotin may interfere with some lab results.

Is there a concern about taking a multivitamin along with these?

It really depends on the strength of the multivitamin. If a multivitamin has significant amounts of magnesium, it may increase the risk of loose stools if taken with the women’s Vitality pack. Otherwise, this should be fine taken with a multivitamin.

Are there some women who shouldn’t take these? (heart condition, thyroid, cancer, etc)

This should be safe for all women to take, unless there are drug interactions that should be considered.

Are there warning signs of overdose I should be aware of?

Although we aim to provide therapeutic doses in our Vitality pack, the doses in our pack are well below any toxicity concern.

Should I get a blood test to check my levels before taking these?

A general CBC will often provide information on needs for B12 or folate. The same goes for vitamin D. Unfortunately, there are not many reliable tests that assess for nutrient deficiency. That’s why we consider the health of the individual or increased nutritional needs in the average pre/post menopausal female based on clinical data.

Resources:

https://www.cdc.gov/women/lcod/2017/all-races-origins/index.htm

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6372850/

I love hearing from you.

Sometimes you respond to my requests for feedback, and other times I receive articles, media bits and links that speak to my love of caring for women in menopause.

Little did you know that we are taking your input, your shares, and your feedback to heart as we evolve how the Gennev clinic for menopause represents you: a beautifully diverse community of people of varying ages, ethnicity, countries, identities and social views.

With this in mind, we have been working behind the scenes on some exciting changes to Gennev. You’ll come to learn more about those in the months ahead.

For now, I want to share some of the “forwards” that I’ve received over the past few weeks. Thank you for making sure I’m in the know. Seriously, we’re trending.

Thanks to Dawn for sending me the latest from Kristin Scott Thomas in Flea Bag and her monologue on how “”¦menopause is the most wonderful f-ing thing in the world”.

Joanne sent me the latest on CBD and menopause at Ellementa.

And then there’s Deborah Copaken’s entertaining article “Exploring the Link Between Menopause and Alzheimer’s” (it’s more entertaining that the title sounds and it casts a light on our favorite Alzheimer’s researcher and friend Dr. Lisa Mosconi).

In other news, a couple weeks back I asked you, What do we call “women in menopause”?

Here’s a handful of the responses I received. Thank you for being so opinionated.

“I like to be referenced first as a person, second as a leader, and third, if my reproductive organs must shade my entire identity, as a woman.”

“Primetime”

“I am a 55-year-old woman who finds the phrase ‘the change’ so impossibly simplistic, it almost offends me. “¦I like to think of it as a ‘regeneration.'”

“”¦the Shifters, the Transitionals or (my personal favorite) the Sublimes. These would also be great all-female rock band names, but that’s another story.”

“Age-EMBRACING”

“I’m a Gennev-er. Feels easy on my tongue. I’m also a GenXer.”

“As someone who went through menopause at 30, I really hate the terminology ‘midlife’ as it assumes, we are a homogeneous category all of the one age bracket which is clearly not the case. I have no problem with calling myself what I am: ‘menopausal’ or ‘post-menopausal.'”

My takeaway is that we’re women. We’re beautiful and we have some time and experience under our belts, and we know who we are.

Thank you for keeping me current. Thank you for your creative thinking. And thank you for being part of the Gennev tribe.

Keep it coming”¦

Feeling stiff or achy when you get up in the morning or after sitting for an extended period of time? Do you have sore knees? Tight hips? Achy fingers?  Back pain?  Joint pain is one of those symptoms that can make you feel old overnight, and unfortunately it strikes more than half of women during menopause. In fact, a study of more than 100,000 middle-aged female veterans found that going through menopause raised their risk of experiencing chronic pain by 85 percent. But you don’t have to suffer and feel older than you are. There are a variety of ways to get relief from menopausal joint pain.

What’s happening when you experience joint pain

Though the precise cause-and-effect of menopause and joint pain hasn’t yet been established, there’s evidence that there is one. Pain, swelling, and inflammation in the joints is often a signal of osteoarthritis (OA), the wearing down of protective tissue between bones. Since OA disproportionately affects women in menopause, it is likely that hormone changes may contribute to arthritis symptoms.  Beyond hormones, carrying excess weight, leading a sedentary lifestyle, dehydration, poor diet, smoking and stress can all trigger or worsen joint pain.

Because estrogen is a natural anti-inflammatory, one possibility is that when it dips and ebbs, inflammation can occur more easily. Plus, estrogen regulates fluid levels throughout the body, so just as your skin is drier and less elastic, the tissue of your joints may be, too. Another theory is that estrogen reduces pain perception so when levels decline, you’re more sensitive to pain.

What to do to relieve joint pain

Unlike many signs of menopause, joint pain may not diminish when hormones level out after menopause. But there are many lifestyle changes that can help ease the pain and prevent it from getting worse.

Fill up on anti-inflammatory foods. Some foods tamp down inflammation while others spur it on. For the right balance, eat more of these inflammation fighters: berries, broccoli, avocado, tomatoes, green leafy vegetables like spinach and kale, citrus fruits, cherries, fatty fish like salmon, olive oil, nuts, dark chocolate (in moderation), olive oil, green tea, turmeric, and ginger. And avoid foods that contribute to inflammation such as refined carbs like white bread and cake, fried foods, red meat and processed meats like hot dogs, soda and other sugary beverages, and foods with trans fatty acids like margarine.

Get some exercise. Regular movement keeps joints lubricated so they flex and extend more easily and with less pain. Low-impact activities like yoga, walking, swimming, and cycling are gentler on the joints than high-impact sports like running.

Keep tabs on your weight Excess weight puts stress on your joints as you move, so losing even a few pounds (weight loss is tough during the menopause transition) can mean exponential relief for weight bearing joints like hips and knees. 

Lift some weights. Strengthening the supporting muscles around a joint provide stability. When joints are stable, they function better, and you have less risk of damage or an injury.

Stay hydrated. Drink plenty of water to keep tissues moist and supple. In menopause, your body doesn’t retain water as well as it used to, so it’s important to replace the lost moisture. Water””not sports drinks, sodas, or coffee””is your best choice. If you need variety, add a few pieces of fruit for flavor. 

Build in stretch breaks. Too much sitting? Too much computer time? At regular intervals, for instance every 20 or 30 minutes, stop what you’re doing and move. On a computer, stretch your forearms, do some wrist circles, or squeeze a soft ball. Get up from your desk and march in place and then stretch your legs and hips. The motion will help to keep your joint lubricated and minimize stiffness and pain.

Strengthen your core. Your body is one long chain of joints and muscles, and weakness at one part affects others. When the core muscles in your abdomen, back, hips, and buttocks are strong, it can help to take pressure off your knees and ankles.

Destress. We know, we probably sound like a broken record, but when it comes to joint pain, stress is especially problematic. Stress raises cortisol levels, and cortisol can cause additional inflammation in joints. Do what you can to keep stress in check. If stressed, consider taking a walk “” in nature is best for a triple crown of stress- and joint-pain relief: nature, time away, and moderate exercise.

Consider supplements. Magnesium may help. According to the Arthritis Foundation, “Magnesium strengthens bones; maintains nerve and muscle function; regulates heart rhythm and blood sugar levels; and helps maintain joint cartilage.” Other good options are glucosamine and chondroitin.

Apply ice and/or heat. Which you choose may be a personal preference. Generally, ice helps when there’s obvious inflammation (swelling, redness). It may also ease achiness after exercise, or you might simply find that it numbs your pain anytime. Heat loosens muscles, enhances flexibility, and increases circulation. For these reasons, heat (heating pad, warm shower, paraffin wax) may be helpful when used before exercise. Apply either for no more than 20 minutes at a time, and protect your skin by having something like a thin towel between your body and the ice pack or heating pad.

Rub on relief. Topical pain relievers like Arnicare and Biofreeze can tame the pain. In addition, simply touching and massaging the area, even with regular lotion, may help desensitize you to the pain. 

When to get help for your joint pain

If you’re not getting relief, the pain worsens, or you have other symptoms such as swelling, redness, rashes, fever, fatigue, dry eyes and mouth, or painful urination, you should see your doctor. There are other causes of joint pain that can be more serious than a drop in estrogen, such as Lupus, Lyme disease, gout, septic arthritis, gonococcal arthritis, thyroid problems, and rheumatoid arthritis (RA and Lupus are autoimmune disorders that affect women more than men; they differ from OA, which is more closely related to aging and wear).

Learn more about joint pain

The Facts About Menopausal Arthritis and Movement

Menopause and Aching Joints

Getting to the Bottom of Knee Pain in Women

We can help you find relief for joint pain

• Visit with your primary care physician for a physical exam, history and possibly diagnostic tests including X-rays and labs. Occasionally a referral to a musculoskeletal specialist (orthopedist) may be indicated.
• Meet with a Gennev Doctor – our menopause specialists can help you understand hormonal fluctuations and how they relate to joint pain, along with their impact on your overall health throughout menopause

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. 

Are you just not getting the results you want from your exercise program? Maybe it’s time to find a personal trainer who can help you understand your midlife body better so you can reach your fitness goals.

Debra Atkinson

Learn how to pick your perfect training partner from fitness expert, author, and professional speaker Debra Atkinson. Debra is the host of The Flipping 50 Show podcast and Flipping 50 TV show. With more than 30 years experience in the fitness industry, she is also America’s Boomer Babe Fitness Expert. This article by Debra is reposted here with permission from PRiME WOMEN. 

We are going to show you how to choose a personal trainer who’s right for you by asking the right questions. Whether you’ve got goals of a starting line or you need to exercise safely with arthritis or osteoporosis, there’s a trainer for you. When you first meet a trainer, remember you’re interviewing them as much as they may be interviewing you. Here are a few questions you should ask:

Are you certified as a personal trainer and by which agency?

Among the 500 different certifications and certificate programs, there are still only a handful of agencies I would preference even as the National Commission for Certifying Agencies (NCCA) accreditation attempts to create higher standards in fitness certification. Fitness is still a self-governed industry.

Top-tier certifications include American College of Sports Medicine (ACSM), American Council on Exercise (ACE), National Academy of Sports Medicine (NASM), and National Strength and Conditioning Association (NSCA). Within each of these agencies there are certification options. Someone may be certified as a group fitness instructor, for instance, not as a personal trainer, and therefore lack the knowledge to design a custom exercise prescription.

Certified as an NSCA Strength and Conditioning Specialist, a trainer has more specific expertise for sports conditioning. An ACE Medical Exercise Specialist is more focused on designing around the needs for special conditions.

Trainers might reference CPR, AED and First Aid certifications. While this is good, it’s actually mandatory to be currently certified by a national agency. This can tip you off to the fact that they are less experienced and/or are searching for anything to use as a credential.

Is your certification current?

Confirm it. I’ve had mature employees not see value in achieving industry standards by taking an exam once they’ve gone through a training course. Her attitude was “What’s it going to change?” when she was already earning the highest percentage paid and was as full as she wanted to be.

That attitude is poison in the personal training industry. It implies a trainer’s willingness to train a client although they lack the confidence to feel they could pass an exam. That, reader, is backwards. Trainers and clients alike can be guilty of assessing trainer skills by popularity. They must be “the best” if they are the most full.

To remain current with a credible certification, a trainer must take a minimum of Continuing Education credits annually or every two years, depending on the certification. Ask about the most recent continuing education course taken and the content. I would favor a trainer updating their knowledge in a topic area I would benefit from if I were shopping them.

Do you have a degree in Exercise Science?

A unique combination of academics, certifications, years of experience and testimonials will determine whether a trainer is qualified. There may be no degree in exercise science, but a combination of other components might be so great that someone becomes your trainer of choice. Fewer people made the decision to become trainers 20 and 30 years ago when they were in college.

If you discover proof that other forms of preparation allow him or her to make decisions commensurate with those who do have a degree, then you may still feel confident in your choice.

How much experience do you have?

Don’t discount a new trainer, but ideally, age-friendly trainers have at least two years of experience in the industry according to the International Council on Active Aging. I would suggest based on industry standard that a trainer is still a rookie if they’ve worked three or less years.

Remember that they’ve worked with all ages and abilities and probably have not specialized in midlife and older adults. It’s important to ask how many hours a week they’ve worked. Trainers who say they have 4 years of experience of training 10 hours a week don’t have any more experience than a trainer who trained 40 hours a week for a year.

Have you worked with someone with my needs before?

Have you worked with someone my age before? Do you have two or three references I may contact? Age alone shouldn’t be your question. Two 50-year-olds can have very different needs, histories and goals and likewise, with two 80- or 90-year-olds. If your hormones have changed everything, be sure to ask if the trainer is experienced with that.

The response will tell you whether the trainer will relate to you well or not, and you’ll gain insight about the trainer as you talk. When you contact the reference ask open-ended questions and those that pertain to your greatest concerns. “Is there anything else you’d like to add?”

Why are you interested in working with me?

What do you have in mind for me?

Make sure you get an enthusiastic response! Get his or her recommendations. You want to know he or she is confident and hear that he or she has the beginnings of a plan that makes sense to you before you hire.

Which professional organizations do you belong to?

Most certification agencies have a corresponding professional membership group. Similar to other professions, participation in industry associations means your trainer is serious about networking, improvements in the industry, access to recent research and legal aspects of their business.

IDEA Fitness Connect is the largest fitness professional directory, connecting 200,000 fitness professionals verified by 160 certifying and training bodies with consumers. Whether or not your trainer is a member of IDEA, he or she could be listed in this directory.

Together, these questions and your observations of trainer responses can help you determine if a trainer is right for you. Does the trainer listen completely and convey an understanding of what you said? Did you enjoy the trainer’s personality and sense of humor? Can you see yourself spending one to three hours a week with this trainer?

Do you need to choose a personal trainer to watch your repetitions? The internet provides you access to a world of trainers and coaches. You can “meet” via Skype or phone and get weekly plans that meet your needs.

Knowing how to choose a personal trainer is important to the ultimate success of your health and fitness routine. Take the time to find the right one for you.

This post is an excerpt from Navigating Fitness After 50: Your GPS for Choosing Programs and Professionals You Can Trust.

Do you have a personal trainer you adore and can’t live without? How did you find him or her, and what makes your trainer all that and a bag of low-calorie, sustainably sourced, high-protein soy chips? 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.

When it comes to health, many people take a piecemeal approach, focusing on one behavior change at a time. That can be a smart move, so you don’t feel overwhelmed with making lots of changes. However, “there’s nothing in our bodies that exists in isolation,” says Gennev health coach, registered dietitian, and exercise physiologist, Stasi Kasianchuk. When you start to change one area, for example, your level of physical activity, it can affect your nutritional needs such as needing more nutrient-dense foods and more fluids. If you’re not meeting these new needs, it can affect the quality of your workouts. Likewise, what you are eating can either support or sabotage your workouts. Here are seven eating habits that may be sabotaging your workouts and how to fix them.

#1 Eating too few calories. Calories are a unit of energy, and the number of calories in food is the amount of energy you can get from eating that food. So, the fewer calories you eat, the less energy you’ll have for your workouts. Unfortunately, at midlife when extra pounds become an all-too-common phenomenon, trying to find the right balance can be challenging. Strategies like skipping meals and cutting out certain foods or food groups can result in eating fewer calories, which in theory should help prevent weight gain, but it can backfire. Depriving yourself can leave you feeling hungry and tired throughout the day, resulting in lackluster workouts and often overeating at night. And when your body feels like it’s being starved, it conserves calories, making it easier to gain weight.

What to do: To minimize weight gain while ensuring that you have enough fuel to power your workouts, focus on eating nutrient-packed, fiber-rich calories like lean meats, fish, poultry, whole grains, fruits, vegetables, and healthy fats. These foods will fill you up faster and keep you satisfied longer so you don’t overeat. They’ll also fight fatigue, so you have more energy for your workouts. You should also make sure that you’re eating throughout the day, about every three to four hours, recommends Kasianchuk. Skipping meals and loading up on empty calories like those in highly processed foods such as baked goods, chips, cookies, and sugary drinks can tip the scales in favor of weight gain and leave you feeling tired all the time. These strategies should help you to balance your energy needs without having to count calories. Calorie requirements vary based on several factors such as age and activity level, but a general guideline for women in midlife is 1,600 to 2,200 calories a day, according to the Dietary Guidelines for Americans.

#2 Being dehydrated. As estrogen levels decline in midlife, your body doesn’t store as much water as it used to, so it’s even more important to make sure you’re drinking enough water. Fluids support your body’s metabolic processes that produce energy. When your fluid levels are low, it can slow those processes and leave you feeling sluggish. And who wants to exercise when they’re feeling fatigued? Hydration also plays an important role in regulating your body temperature. As you exercise your body temperature rises. If you’re not properly hydrated, it’s harder to keep yourself cool and comfortable as you work out.

What to do: Aim to consume about half of your body weight in ounces of water. So, if you weigh 150 pounds, you should drink 75 ounces of water a day. This includes herbal or decaffeinated teas, calorie-free seltzers, and infused waters like those with lemon or strawberries and mint. Caffeinated beverages like coffee and colas can contribute to your overall fluid intake, but they don’t have the same hydration benefits as water, so aim to make water your primary beverage choice.

You also want to spread your intake throughout the day. “Your kidneys are the size of your fists,” says Kasianchuk. “Chugging a large amount of water at once can overwhelm the kidneys. Smaller amounts consumed throughout the day allow your kidneys to process and utilize the hydration more efficiently.”

#3 Skimping on carbs. Carbohydrates have gotten a bad rap lately, causing many women to cut them out of their diets. But that can negatively impact your workouts. “When you start restricting carbohydrates, you lose fuel that’s so important for any exercise,” says Kasianchuk. “That can lead to low energy and feeling fatigued prior to and during exercise, which is going to make the workout feel harder. If it feels harder, returning for subsequent sessions is going to feel even more challenging.”

What to do: Not all carbs are created equal, so you want to make sure that you’re choosing the right ones to fuel your workouts. Instead of refined carbs like white bread, pasta, rice, crackers, and baked goods, choose whole-grain options which have more fiber and nutrients and provide longer-lasting fuel. Refined carbs are broken down quickly, resulting in a spike in blood sugar and burst of energy, but it doesn’t last and can leave you feeling even more wiped out afterward. A better option is to eat more vegetables, beans, and fruits which are high-fiber carbs. Aim to get about 25 grams of fiber a day. In addition to fueling your workouts, carbs also boost levels of serotonin, a feel-good hormone. That combo can make it easier to start exercising, give you the lift you need to push yourself to go a little farther or faster, and leave you feeling more invigorated after your workout.

#4 Not getting enough protein. This nutrient is one of the building blocks of your body and is involved in both growth and repair, especially for muscles. As you age though, you lose muscle mass and strength, which can make exercise and even everyday activities feel more challenging. Your body also requires more repair as you get older. If you’re not getting enough protein, you may not be able to recover from your workouts as well. “You may notice more soreness which may hinder you from getting back out there,” says Kasianchuk. Most women in midlife are not meeting their protein needs.

What to do: Eat some protein at every meal, including snacks. In addition, to giving your body the protein it needs for repair, this practice also provides more sustained energy. “When women incorporate more protein, they’ve told me that they feel more energized throughout the day, especially in that late afternoon slump,” says Kasianchuk. “That’s going to work in your favor if you’re an afternoon walker.”

To ensure you’re energized anytime you walk and have an adequate amount of protein for recovery, spread your protein intake throughout the day by including a protein source with all meals and snacks. Aim to eat at least 20 grams of protein with each of your three meals. This can be a palm-size piece of animal protein, a combination of nuts, hemp seeds, and soy milk in oatmeal, or ½ cup beans with quinoa. For snacks, worry less about the exact grams of protein and just focus on making sure to include a protein source. Have some cottage cheese or peanut butter with fruit, bean dip or hummus with veggies or on whole-grain crackers, yogurt with fruit, or tuna or chicken with mixed greens.

#5 Starting on empty. If you haven’t eaten in about two to three hours, you might find it harder to get yourself moving and less inclined to push your intensity while you’re working out. While you’re still getting benefits from any activity at any intensity that you do, if you are looking for a higher intensity workout, you’ll do better if you fuel beforehand.

What to do: Have a small carb snack with a little bit of protein 30 to 60 minutes before exercising.  Good choices include half an apple or banana with nut butter, yogurt, whole-grain crackers with bean dip, or carrots with hummus. You want to keep it small, so you don’t feel full when you’re exercising. The combination of protein and healthy carbs stabilizes blood sugar levels, fuels you with less, and provides more sustained energy.

#6 Too much sugar. Even if you’re avoiding things like cookies and candy, you may still be getting more sugar than you think. There are lots of hidden sources of sugar, such as cereals (even the healthy-looking ones), yogurt, condiments, energy bars, coffee drinks, and other beverages. These added sugars, not the natural kinds that are in fruits and vegetables, may worsen some menopause symptoms like fatigue, weight gain, and hot flashes””all issues that can disrupt your workouts. Sugar also increases inflammation in the body which may increase joint pain, especially if you have arthritis.

What to do: Read labels and limit the amount of “added sugars” to five teaspoons or 20 grams a day. In the past, it was difficult to separate “added sugars” from naturally occurring ones in foods, but nutrition labels now distinguish between the two, making it easier to track your intake. If a label doesn’t specify the amount of added sugar, check the ingredient list for one of the many aliases that sugar uses, such as ingredients ending in -ose, agave nectar, barley malt, brown rice syrup, dextrin, and malt syrup. The higher up the ingredient list it is, the more sugar is included in that food. Curbing your sugar intake should help prevent dips in your energy, keep off pounds, and may ease hot flashes and joint pain, making exercise more enjoyable.

#7 Lack of variety. Another effect of restricting what you’re eating is that you tend to eat the same things. Different foods provide different nutrients. So, for example, a restrictive diet is going to limit your intake of antioxidants and anti-inflammatory nutrients, which can help combat joint pain, says Kasianchuk.

What to do: Don’t limit natural, whole foods, especially fruits and vegetables. The more colorful your diet is the more vitamins and other phytochemicals you’ll be getting. “Making sure that you get a variety of nutrients from a variety of foods can help to increase anti-inflammatory nutrients that can support joint health and decrease joint pain,” Kasianchuk says. If you’re going to limit anything, it should be highly processed foods with lots of added fat and sugar.

The next time you’re not feeling up for a workout either because you’re feeling tired or your joints are achy, think about what you’ve been eating. “Movement and what we eat have a synergistic relationship. Most people feel better if they’re moving and nourishing their bodies,” Kasianchuk says. A few simple changes in your diet may improve your workout performance””and perhaps more importantly, how you feel overall in midlife and on your menopause journey.

We can help you maximize your health in midlife

• Meet with a Gennev Doctor ““ our board-certified physicians are menopause specialists. They will answer your questions, help you understand your symptoms and develop a personalized treatment plan.
• Vitality ““ boost your energy and your workouts with a nutrient-packed multi-vitamin daily supplement that supports your whole body including joint pain and inflammation, mood, stress response and immune health.

Egg freezing is still a relatively new fertility planning option for women and couples wanting to delay pregnancy for a few years.

We wanted to know more about this fascinating procedure that younger women are opting for to freeze their eggs, then have babies, safely, at a later date.

So we sat down with Dr. Lorna Marshall of Pacific NW Fertility. Dr. Marshall, practicing specialist in Reproductive Endocrinology & Infertility, co-founded the clinic back in 2005 and has been helping couples start or build their families ever since.

In the first part of our conversation with Dr. Marshall, we learned more about the science and history of in vitro fertilization (IVF), fertility medicine, and her own path to reproductive medicine. In part 2, we talked about the cultural changes that come with women and couples having more family planning power.

1:07 as vacation days, corner office, egg freezing: fertility planning as benefit

The number of women seeking family planning options has “shot up through the roof,” Dr. Marshall says, at least in part because some large companies are offering egg freezing as a benefit of employment. How has that changed the demographic of women who are coming in to ask about egg freezing?

2:08 as I’m 43, what do I do now?

Dr. Marshall tells us about the realities of egg freezing. Big one: ya gotta do it when you’re young.

3:29 as It only happens in the movies

Or to movie stars. Dr. Marshall says not to be confused by celebrities having babies in their late 40s or even early 50s; chances are they used donated eggs, not their own. It’s important to understand the realities of science and bodies, including their limitations.

4:05 as I’m here; what’s next?

When  woman comes to the clinic, what happens? Dr. Marshall talks about testing, gives us the egg supply explanation, and details the options women have when the results are in.

7:19 as Answering patients’ questions about fertility planning

When it comes to fertility, it’s critical to manage expectations. Doctors may not be able to give a woman an answer to the question, “Will I be able to have a baby with my own eggs?” as there are often too many factors. Find out what impacts fertility and how docs work with women to best reach their goals.

9:19 as Have my eggs been frozen too long?

Because the science of vitrification of eggs is still so new, Dr. Marshall says, some things just aren’t known yet, like, do frozen eggs have as for want of a better term as an “implant by” date? What stresses the egg? How long are vitrified eggs viable, and does the faster-freeze process put eggs at risk?

11:14 as Egg storage: what does it look like, how does it work?

Big tanks hold racks and racks of eggs, sperm, and embryos at the Pacific NW Fertility clinic, Dr. Marshall says. Some fertility clinics don’t store on site, but Dr. Marshall’s clinic has chosen to.

12:25 as The nitty gritty: how much does it cost?

As you can imagine, egg freezing isn’t cheap. And many insurance companies won’t cover “elective” egg freezing. With egg retrieval and the medications it takes to do the process, women can expect to pay $14 as 15,000 for a single cycle. That’s not the cost of establishing a pregnancy, Dr. Marshall reminds us; just the process of freezing.

14:07 as Not a decision to be made lightly “¦

The best age for freezing eggs may be a woman’s 20s, which is not usually when women have the money to have their eggs frozen. The cost may be changing for cancer patients, at least, Dr. Marshall says, with some state legislatures working to require insurance companies cover fertility preservation. Will insurance ever cover truly elective fertility preservation?

17:08 as Making babies: what do you love most?

We wanted to know what made Dr. Marshall want to come back to work every day. Her biggest reason probably won’t surprise you, but, she tells us, the growth and changes in the field have also kept her engaged in her work. “I’m in the heart of society, doing this,” she says.

19:15 as Egg freezing is still in its (wait for it) infancy, so do your homework

Because this procedure is still so new, it’s important to work with a clinic that’s actually made some babies from frozen eggs, Dr. Marshall says. There are lots of clinics that simply haven’t gotten to the “thawing eggs and making babies” part yet. She lists some questions women should ask before choosing their clinic.

22:00 as By the numbers: your chances of making egg freezing work

Like much about a woman’s body, her chances of making a baby may be wildly different from another woman’s chances, even at the same age, says Dr. Marshall. She shares with us some estimates of the chances of success based on age of mom and number of eggs retrieved.

Would you consider freezing your eggs in order to delay pregnancy? Why or why not? We’d love to hear your thoughts; please share in the comments section, email us at info@gennev.com, or let us know on Gennev’s Facebook page or in Midlife & Menopause Solutions, Gennev’s closed Facebook group.

Be sure to stay tuned to Gennev.com for that conversation, or subscribe to Gennev on iTunes, Stitcher, or Google Play, so you never miss an episode.

At Gennev, we love to celebrate female entrepreneurs

Melody, we couldn’t agree more.

Everything was perfect: the cozy/cool venue of SIFF Cinema Uptown, that wonderful smell of movie theater popcorn, SIFF’s outstanding staff doling out wit and wine. You know it’s going to be a good night when the laughter starts in the lobby.

Generous sponsors had provided all sorts of goodies, so by the time everyone had filled up their goodie bags and made their way to the theater, the lights were starting to dim.

Jill, CEO and head Gennev-er welcomed everyone as we settled into our seats. Several folks mentioned it later, that you could feel the energy in the air. It wasn’t the excitement of knowing you’re about to see a really great movie, though that was certainly present too. It was the excitement of being on the cusp of something big. Of being a participant in something important and powerful and meaningful.

The Dream, Girl documentary explores the challenges of being a female entrepreneur: difficulties landing investment capital, lack of role models, even the well-intended but not always helpful advice from risk-averse friends and family. The women featured in the film are extraordinary for what they’ve accomplished, but they are also wonderfully, gloriously, human, mistakes and all. And this makes their success seem attainable for anyone willing to work hard and dream big.

As Dream, Girl producer Komal Minhas told me, the best way to experience the film is with a community, so you can talk about it after. So that’s what we did. We brought in a terrific panel of innovators, educators, and entrepreneurs to talk about their trials and triumphs in launching their business or in preparing the next generation of girls to take over the world.

Dream Girl Screening

The crowd asked great questions, including, “What were some of the mistakes you made?” Ally Svenson, co-founder of MOD Pizza, said her biggest mistake was “not having a healthy male ego.” She had a great idea she knew would work, but it took her three-and-a-half years to move forward. “It should have taken three-and-a-half months,” she said. Not having confidence in herself and her idea slowed her down””but it didn’t stop her. That business was hugely successful, and the next time she had a Really Great Idea, she went for it.

Leah Warshawski, producer and director of Big Sonia, admitted she makes mistakes pretty much every single day. “But,” she said, “as long as I learn something from it, I don’t really mind.” The one mistake she did regret, she said, was “not learning Excel sooner”¦”.

Another attendee asked how female entrepreneurs maintained their networks and did they think it was important to do so? The panel overwhelmingly agreed on how critical it is to find support and be support for others. Many female entrepreneurs face resistance and hesitation from well-intended friends and family, and that can be discouraging. Brenda Leaks, Head of Seattle Girls’ School, spoke about how her school makes it a priority to encourage girls to be support networks for one another from the start.

Jill asked the crowd if everyone who considered themselves an entrepreneur would stand. Between a third and half the crowd did, which explained why there was so much head nodding during the film and discussion, you could feel the draft.

And that’s why the atmosphere was so electric. We all understood the problems; we all saw the possibility of moving forward, together, towards solutions. Connections were made, right there and then, between innovators and entrepreneurs, between potential CEOs and someday-investors, among women who are ready for leadership and others ready for “followership,” as Brenda termed it. Our tribe is out there; now we begin the work of gathering and figuring out how we can make this rising tide lift all the boats.

“Loving the girl power.” We couldn’t say it better ourselves.

Sometimes it’s extra hard to feel grateful for your life. And that “sometimes,” could include tough days dealing with menopause symptoms. Especially when you’re having a brutal hot flash, or series of hot flashes (ugh!).

Luckily, the season of giving is almost upon us, when it’s easiest to experience a sense of gratitude and then also enjoy the benefits of those positive feelings. 

The good news is that you don’t need to stop the gratitude party when you’re at a loss for stuff to feel happy about. In fact, that’s the best time to start feeling warm and cozy about things you didn’t even know you could feel grateful for.

Benefits of gratitude practices

The benefits of gratitude range from emotional to psychological to physical. Starting this type of practice can help you deal with your own sea of emotions as well as navigate the emotions of others. 

Pause any self-pity

When you’re in the thick of things (especially “bad” things), it’s easy to start believing your own negative narrative. 

Why did they do this to me? Why do bad things always happen to me? I wonder if I deserve this?

We’ve all been there, and we all still fall into it from time to time. 

More good news is that it’s pretty much impossible to feel sorry for yourself and grateful for something simultaneously. Don’t ignore your pain. But don’t get stuck in it either. 

How? Acknowledge it, and move on to positive thoughts (perhaps about other things, initially), such as gratitude.

You’ll feel better during menopause

Another one of the benefits of gratitude is that it can even help your body feel better! Studies show that people who practice gratitude daily show fewer signs of stress and anxiety. They sleep better, make better choices, and fewer suffer from depression. 

What does this all mean scientifically? 

Reduced stress and anxiety means reduced cortisol levels. Cortisol is that hormone that can turn your body into a butter churn of stress, which is why it’s called the “stress hormone.” 

One of the best ways to reduce your cortisol? Develop a loving-kindness practice. One such practice is to start writing out what you’re grateful for in a gratitude journal.

You’ll get happier

When you’re grateful for something (or someone), happiness almost always follows. In fact, studies show that patients who take note of happiness triggers feel more optimistic than subjects who were encouraged to journal their stressors. 

Gratitude can even make the recipient of your “thank yous” a little happier. Studies prove that the simple act of gratitude can make your workplace happier and your employees more productive. Better relationships, a happy demeanor, and increased productivity? Let’s do it!

You’ll gain a better understanding of others (and yourself)

Gratitude can even give you some insight into the actions of others, otherwise known as empathy. When you’re grateful for everything in your life, you suddenly start opening your eyes to the lives of others. 

Let’s say you notice that you’re grateful for your morning coffee, and you acknowledge it every day. The beans, the aroma, the extras like cream, milk, sugar, or honey you have and get to enjoy. You love your hand-thrown ceramic mug, and you especially adore that first rich, warm sip of your first cup of the day.

After a time, you may start noticing all things coffee-related, especially if someone is asking for spare change on a cold day to try to buy a hot beverage. You might then just realize that the freedom to buy a cup of coffee every day really is a lot to be thankful for.

You’ll increase your emotional IQ

All of this empathy begets more empathy. Feeling happy, understanding others, and getting healthy can get you in the right mindset to start seeing what changes you can make in the world. 

Emotional intelligence is the ability to navigate emotional relationships with empathy and self-control. It can help you strengthen your current relationships and build new ones. 

How to start a gratitude practice

The good news is that there are no set rules on how to start a gratitude practice. That being said, we’ve put together a few suggestions to guide you in building your own practice and starting to enjoy the benefits. Take a look:

Start small

You’re more likely to stick to a new habit if you don’t go all out in the beginning. Instead of asking yourself to make a list of 20 things to be grateful for each day, just start with one. 

Set a timer on your phone for the same time every day. When the timer goes off, write down one thing you’re grateful for. Easy.

If you’re in a rut, you can always keep a few writing prompts in your pocket. Some of our favorite things to be grateful for include:

• Food
• Loved ones
• Pets
• Vacations
• Home
• Songs

Just start writing down stuff you love and why you’re grateful it’s in your life. Or, don’t write it down at all. Make a list in your head on your morning commute or on your lunch break”¦ or while you’re on hold on a call.

Keep a gratitude journal

If you really want to get fancy, you can start writing down your gratitude lists in your journal. Or, buy a special journal or notebook just for this practice. One of the benefits of gratitude journals is that you can go back and remember the good stuff during the rough times. 

A couple of our least-favorite parts in going through menopause are hormonal fluctuations and depression. And as we all know, depression lies. When you’re starting to feel like there was never a time you were happy, crack open your gratitude journal to find the proof you left for yourself.

The important thing is to get really specific about what you are grateful for and also why you’re grateful for it. 

Instead of writing, I’m grateful for my husband, Ted, expound. I’m grateful for my husband, especially when he takes out the trash because he knows how much I hate going out to the cold garage at night. 

Do you see the difference? Writing the why triggers emotional responses in your brain. As you write out your why, all you can think is, “Dang it! I love that Ted. He really goes out of his way for me.”

Find a way to be thankful for the challenging stuff

Let’s face it: it’s easier to be grateful for the good stuff than the bad stuff. We assume right now you’re rolling your eyes at us and saying, “What the hormone is this? How can I be grateful for the crap that’s going on?”

We get it. It is tough. 

But have you ever had something really crummy happen (you lost your job, broke up with a significant other, or ruined your favorite sweater) only to find out that losing that job was just the kick in the pants you needed to start your own company? (Let’s not even get started on that sweater… it was sooo 1994.) 

You weren’t grateful for losing those things in the moment, of course. But when you reflect on the situation now, you may realize that the tough and crummy stuff were necessary evils in order to get you onto the current path to financial, and fashion, enlightenment. 

It’s a very tall order, some days. And as humans, we may not be grateful every single day. We go through some really hard stuff, including menopause.

So, if you can, be thankful and be specific.

Why a gratitude practice works

Don’t just take our word for it. This information isn’t just anecdotal, it’s also quantifiable. 

When we are grateful for something, our hypothalamus and ventral tegmental area are activated. The hypothalamus manages stress, and the ventral tegmental area is our brain’s “pleasure center.” 

That means that the same areas that are affected during sex and eating chocolate cookies are also activated by feelings of gratitude. And while chocolate cookies might give you a greater boost in the beginning, their return on investment diminishes over time as we start to feel the negative effects of weight gain, sugar crashes, and depression.

Ultimately, gratitude practices can transform our bodies and minds, inside and out. But don’t take our word for it: give gratitude a chance yourself. You’ll be so grateful you did.

If depression or anxiety are especially tough to walk through, we encourage and support you in talking it over with your doc (or ours) or bring it to our community forums. It’s important to feel as good, and as well, as you can during this important change in your body and life.

I’m a sucker for the Oscars.

In fact, I prepare for the night of the film awards ceremony and its role in amplifying stories that increasingly shape social views on topics like sexual abuse, racism and inclusion.

I watch the nominated films. I read up on the talent. I even make an awesome dinner and open a bottle of wine with my husband to take the show in.

What I loved most about this year’s awards was the winner of the documentary short category, Period. End of Sentence.

It’s a story about improving access to hygienic menstrual pads in developing markets as part of a non-profit titled The Pad Project. Their tagline: a period should end a sentence, not a girl’s education.

The filmmaker’s acceptance speech started with, “I’m not crying because I’m on my period or anything, I’m crying because a film about menstruation just won an Oscar.”

She said period and menstruation on live television. At the Oscars, no less!

It’s sad that I’m excited about such a small victory, but women of all ages, especially those in the menopause phase of life, suffering in silence because of the stigmas associated with their bodies gets to me.

Question: how many of you have avoided sharing menopause stories or the real reason you’re calling in sick for work or canceling an evening with friends because of a menopause-related symptom?

Is it that heavy menstrual flow that bounds you to the house; hot flashes that spring up in meetings; incontinence that keeps you from outings with your family; or brain fog that makes you feel like you’ve lost your edge?

Three years ago when we started Gennev, we surveyed 1500 women and asked what they needed in menopause. Their response was to “start the conversation” with the goal of lifting the stigma that’s tainted it since before our mothers’ generation.

It’s time we get informed. If you’ve got a symptom that’s nagging you, search on it and learn about what’s happening and what you can do to feel better. If you can’t find what you’re looking for, send us an email.

It’s time we see midlife and menopause as the start of the second half of life. This story about activist Michaela Angela Davis and how she looks at life at age 54 caught my attention as a feisty mindset that’s only possible with midlife confidence.

It’s time we arm men with how they can support the women they love.

It’s time we make it safe to talk about what we’re going through. Forward this email to one or two friends who may be curious about perimenopause or are struggling through it.

It’s time you take care of yourself. If you’ve got questions and feel a sense of concern in your gut, respect it. Take 15 minutes out of our day, book an appointment with a Gennev practitioner as or as join our community.

And maybe it’s time for a documentary on menopause….or maybe I should just stick with serving the women of Gennev.

Jill

P.S. If you see a topic you want me to respond to relative to women 40+ and our health and well-being, email me at jill@gennev.com.

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. ?