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Menopause, marriage and mood swings. Those three Ms don’t always mix well. Moodswings in menopause seem somewhat inevitable — but add marriage to that combo? It’s hard enough to deal with your own emotions, never mind your partner’s feelings about your feelings (here’s our tips for menopause help for husbands).

Why menopause and marriage problems might happen

We hate to break it to you, but there’s more than one reason that menopause might have an impact on your most intimate relationship. Below is just the shortlist of the menopausal problems that have been known to get in the way of romance:

If you haven’t entered the glorious phase of menopause, we promise: we’re not trying to scare you. We just want you to be prepared for what you could expect. (To be honest, nothing is written in stone, so don’t go out shopping for a bigger marriage lifeboat just yet.)

But if you are menopausal and are experiencing any of the above, we’ve got some hot tips to help you over the hump (but not so hot they’ll cause night sweats).

The link between menopause and mood swings

Why does menopause cause mood swings? Researchers believe there is a correlation between the fluctuation of hormones and the resulting sharp changes in mood. 

Some researchers believe that mood swings are related to other factors of menopause. If you can’t sleep because you’re awakened each night drenched in sweat, you might be a little cranky the next day. 

Some studies have suggested that female hormones may help regulate stress, and losing them could also affect the body’s ability to deal with stressors. 

And of course, your mood might not just affect your marriage. Northwest University found that menopause also forces women to take sick days at work. When mood swings are high, productivity drops. And stress over worrying about your job certainly doesn’t make things easier at home.

Irritability symptoms

If you’ve already entered perimenopause or menopause, you’ve probably already started experiencing one or more of these symptoms of irritability (though not all women do).

Sometimes these symptoms are tied to each other and sometimes they arrive a la carte. The important thing to remember is that you aren’t going crazy. All of these emotions are completely normal.* 

The bad news is that your partner might not care if they are normal or not. If you’re in a relationship with a man (or a woman who hasn’t experienced menopause yet), your partner might make you feel like you’re being irrational or oversensitive. And accusations of overreacting have never, in the history of relationships, actually helped someone to calm down.

It’s not me, it’s you

We’re going to let you in on a little secret: sometimes “mood swings” aren’t your fault at all! They might be a completely understandable reaction to a situation or stressor. However, because you’re going through menopause, your partner may be more likely to blame every argument or spat on your hormonal fluctuations. This is not OK.

Do you remember when you were a teenager and everyone assumed your meltdowns were the result of your changing hormones? (OK, maybe that had something to do with stomping to your room and slamming the door).

Yet just because your body is going through some changes, that doesn’t mean your partner gets a free pass to assume you’re simply overreacting.

In fact, some doctors believe that women often downplay situations, staying calmer than the situation warrants, thanks to the calming effects of estrogen. Menopause might actually balance out your hormones enough to help you see what’s “really going on here.”

So the next time you’re so mad you feel your head is going to pop off, first check that head-popping anger really isn’t necessary. If it’s not, take a deep breath and try one of the below exercises.

How to keep emotions and mood swings in check

Whether or not your emotions are justified, in most circumstances, you probably want to keep them in check. The tumult of the menopause transition isn’t forever, but it can do lasting damage to a marriage if ignored. Plus, your actions are still your actions. You’re the only one in charge of your reactions and emotions (not your partner or even menopause for that matter).

1. Take a deep breath – Before doing anything, just stop and take a deep breath when you feel your mood starting to shift. Our brains are wired to think that being attacked by a tiger and being on the receiving end of a few poorly chosen words deserve the same reaction. An adrenaline-fueled response may be more than you need.

We also sometimes mis-hear or misinterpret things. A sticky note on the fridge asking you to do the dishes doesn’t mean, “you’re a lazy bum, why don’t you ever do anything around here?” Probably it just means, I need you to do the dishes. 

So before you react, choose to act by taking a deep breath to calm the flood of chemicals that is pulsing through your body.

When we’re in fight-or-flight mode, our breath gets very shallow. This only intensifies those “out of control” feelings. Taking a deep breath can lower blood pressure and reduce stress hormones.

2. Don’t do anything – Don’t react to anything. In fact, don’t do a thing. Sometimes the best reaction is no action at all. Instead, skip to the next step.

3. Repeat what just happened – You’ll never find out what actually just happened if you react in anger or aggression. The best way to get someone on the defensive is to position yourself on the offense line. 

Repeat what the other person just said or say something along the lines of, “So what you’re saying to me is”¦” and then repeat what you’ve heard. Try to do this with as much curiosity and as little judgment as possible. Be open to the response “” you might not get the one you expect.

4. It’s OK to cry – Women are often “expected” to cry. While men may feel as though they can’t be vulnerable enough to cry, women are shamed because we’re doing the thing everyone expects us to do. But, if you need to cry, go ahead and cry. 

That being said, if crying all the time is just too much for you and you find your lip quivering at everything (in front of your boss, in line at the grocery store and when you see a photo of puppies crawling over babies), you might want to consider booking an appointment with a doctor to help you through the menopause symptoms rough patch.

When mood swings kill the mood

In addition to your mood swings, you might also find yourself struggling with a tired libido or vaginal dryness. We don’t know about you, but the terms “tired libido” and “vaginal dryness” are two sure-fire ways to kill the mood. Add a mood swing to that? Kiss intimacy goodbye!

If you’re having a hard time feeling the desire to connect sexually with your partner, you might try:

What experts don’t recommend? Faking interest or suffering through painful intercourse. Both of these methods generally lead down a one-way street of disaster. Instead, talk to your partner to discover some positions that make both of you feel good. 

After all, if it’s too painful to listen to your favorite songs, what better excuse is there to throw some new ones into the playlist?  

Generally, strong emotions around menopause are normal; however, if you feel your emotions are rising to the level of clinical and could have lasting impacts on your life or the lives of others, please get professional help. 

We can help you get the answers you need

 

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.

 

 

So, you didn’t sleep so well last night, you’re feeling a little irritable today, lunch left you with the ole’ menopause bloat and you’re seriously eyeing the space under your desk for a little snooze. Want to hit the gym?

Yeah, me neither. But you might want to drag yourself in anyway. Menopause is a time when a lot of women gain weight. That may partly be due to a slowing metabolism as hormone levels decline, but it may also be that at this time we tend to eat more (due to decreased sleep and increased anxiety) and exercise less (thank you, bloating and fatigue).

First, we want to say we think you look terrific. Seriously. And a little extra weight may actually be protective. But if you want to get more fit for health reasons, or just stay in shape for the coming zombie apocalypse, we’re here to help.

Why worry? Comparing apples to pears

Why worry about your weight? It’s a legitimate question. Many women embrace aging as it puts less emphasis on their looks and figure and more on their wisdom and experience. But the truth is, too many extra pounds in midlife can be hard on your health because of the way our bodies accumulate fat as we age. Before menopause, fat tends to be stored on hips, thighs, and buttocks, resulting in a pear shape. During and after menopause, fat is more likely to accumulate in the midsection, turning pears into apples.

And apple shapes are more likely to suffer from heart disease, making it a very good idea indeed to avoid gaining too much weight in midlife.

Finding your weigh

So how much should you weigh? Excellent question to which science has no easy answer. Your weight can vary significantly from day to day depending on hydration, and, if you’re still having periods, on where you are in your cycle. You can use BMI (body mass index) to give you a ballpark figure (ha ha), but BMI doesn’t take into account your fat-to-muscle ratio, and it measures excess weight, not excess fat.

Better indicators of ideal weight may be as simple as gauging how you feel. Are you able to walk and talk comfortably without gasping? Can you climb stairs, garden, chase children or grandchildren? Are your clothes comfortable or snug? Instead of fretting over numbers on a scale, decide as in consultation with a doctor or physical trainer as what your fitness goals are, and shoot for those instead.

PEBGAW

You’ve assessed your fitness level, determined some healthy goals, and you’re ready to shed some unhealthy pounds.

Now what?

You know “now what” as boost the fruit and veggie intake, get your full allotment of sleep, drink plenty of water, reduce low-nutrient foods like white breads and processed foods, cut back on sugar, and exercise. While human bodies are way too complex and variable for the reductive “calories in/calories out” idea, I’m guessing most of us have an idea or two how we can improve our diet and make lifestyle changes.

But here’s the issue: getting it done.

Perhaps it’s different for you, but for me, the problem isn’t necessarily knowing what to do as it’s having the discipline to do it. Tech support folks use the acronym “PEBKAC” (“Problem Exists Between Keyboard And Chair”) for when the issue isn’t the software or hardware, it’s the user. I’m going with “PEBGAW”: Problem Exists Between Goals And Willpower.

Again, the idea of “willpower” is too simplistic as there’s so much more going on than simply strength of will as but let’s concentrate on that portion we can control.

Rethinking the shrinking

Part of the mental and emotional problem of dieting is the notion of subtraction, of doing without, and that can be demoralizing. What if, instead, we focused on adding in, on increasing fullness and richness and variety?

  1. Add in gut-friendly foods. Kombucha, sauerkraut, miso, kimchi, kefir and yogurt, natto beans”¦ all of these are great for the digestion, which can help you feel better generally. Probiotics may play a very significant role in weight management, and when digestion is easier, life is easier, including exercise.
  2. Feast on fiber. Not only does fiber fill you up and keep you feeling fuller longer, it also helps reduce risk of heart disease, high blood pressure, and high cholesterol. Fiber helps people control their diabetes and may reduce the risk of developing type 2 diabetes. On a personal level, I had roasted broccoli for dinner last night, and it was a revelation.
  3. Embrace water. It’s just good for you. While upping your water alone may not promote weight loss, if you’re subbing water for sugary soda or juice, that’s a great way to trim out extra pounds. And there’s some evidence that gulping a glass of H20 before a meal reduces the amount you eat, but the jury is still out on that. Consider adding a couple of tablespoons of apple cider vinegar if you want to try something trendy.
  4. Gorge on camaraderie. Friends can be a great support system as you work to lose the weight. They can help you stay accountable, join you in exercise that would be lonely or boring otherwise, advise you on great recipes or restaurants that won’t wreck your progress, and break out the pompoms when you reach that next milestone.
  5. Find your sweaty passion. The best exercise is the one you’ll do. Consistently. OK, so running’s not your thing, but walking or hiking might inspire you, especially if you have a dog or camera to take along. Love problem solving? Consider rock climbing. If your body mechanics are better for low-impact, swimming and biking can be great fun. The trick is to find that thing that doesn’t feel like punishment. Personally, when I get bored with my routine, I get a new (or used but new to me) piece of gear. Gear is fun and more motivating than you might expect.

Weight gain in menopause isn’t inevitable. And combating it can actually be a pleasure, with the right ideas and attitude. Most importantly, don’t beat yourself up. Beating yourself up does not burn calories or build muscle, so cut it out (if you can). Perfection is not the goal; taking steps toward feeling better tomorrow than you do today is. Defeat PEBGAW by focusing on adding, not subtracting, and celebrate the victories as they come, whatever size they come in.

We’d love to know what you’re doing to be healthier, so please share triumphs, fails, and everything in between on Facebook and Twitter!

 

Grip strength: it’s not just about handshakes and pickle jars. The strength of your hands and forearms is actually a pretty decent predictor of future health.

Grip strength defined

According to Ruth Litchfield of Iowa State University, “Grip strength is a measure of muscular strength or the maximum force/tension generated by one’s forearm muscles.”

If you have your grip strength tested by your PT or doc, chances are they’ll hand you a device called a dynamometer. Squeeze the device three times, as hard as you can, and your result is the average of those three squeezes.

A good result for women over 40, according to a 2010 article in the Journal of the American Geriatric Society, was at least 44 pounds of squeezing strength. (For comparison, human gecko free climber Alex Honnold squeezed over twice that at the Oscars).

Be aware that conditions such as carpal tunnel syndrome and arthritis can impact grip strength, so if you have either or both of those conditions, your numbers may well be lower.

Why do we care about grip strength and longevity?

Turns out, grip strength is cheap, quick, and pretty accurate predictor of future health.

A study done in the UK from 2007 to 2010 followed over half a million participants to see how well grip strength did as a measure of overall health and wellness. Participants ranged in age from 40 to 69 at the outset, were 54% female, and included a range of ethnicities, body mass indices, socioeconomic statuses, pre-existing conditions, and lifestyle behaviors such as smoking, physical activity, and diet.

Translation: it was a pretty good as though not perfect as sampling of the general population.

 

 

The aim of the study was to see if there was a correlation between grip strength and mortality and disease. Researchers wanted to determine if poor grip strength was associated with higher risk of cardiovascular disease, respiratory disease, COPD, all cancers as and in particular breast, prostate, colorectal, and lung cancers as and mortality overall.

Turns out, as a predictive measure, grip strength is pretty accurate. For both men and women, they found, a lower grip strength of 5 kg (11 pounds) “was associated with a higher hazard for all cause mortality and incidence of and mortality from cardiovascular disease, all respiratory disease, chronic obstructive pulmonary disease, all cancer, and colorectal, lung, and breast cancer.”

The association between grip and wellness declines a bit with age, perhaps because other factors can weaken muscles as we age, not just illness.

Why does this measure work?

It’s probably not the strength of hands and forearms that determine longevity; instead, it’s that grip strength is a good stand-in for overall health and wellness. Retaining muscle strength overall often leads to better health outcomes.

As Darryl Leong of McMaster University told The Washington Post, “Muscle strength is an indicator of your ability to withstand diseases. When you are stronger and you become ill, you have reserves that you can draw on to help fight the disease. Without muscle strength, your odds are significantly poorer.”

I struggle with pickle jars. Am I doomed?

Of course not, unless you depend on pickles for survival.

There are lots of factors that can impact grip strength. It has a strong hereditary component, according to the authors of the UK study (about 52%), but grip strength may also be a reflection of lifestyle.

So if a go at the dynamometer shows you have sub-optimal grip strength, there are things you can do to improve your overall health. (Just an FYI, though; simply improving grip strength probably won’t change your risk of developing certain diseases.)

Get at least 10-15 minutes of physical activity a day. Cardiovascular workouts such as swimming, biking, running, and walking are great, but try to add in some weight and resistance training. Not only is exercise good for muscles mass, it’s good for your bones, weight, and mood, all of which can increase longevity.

Improve core strength and balance. Falls and injuries due to falls are one of the leading causes of death among older Americans.

Eat a healthy diet. Older adults may need to keep an eye on their protein intake to be sure they’re getting enough protein to maintain muscle mass.

Don’t smoke. In addition to all the other negative impacts, smoking also affects strength. Even if you exercise, you’ll retain less muscle or add muscle more slowly if you’re a smoker.

Sitting around squeezing a stress ball to increase hand strength probably won’t help you live longer if you’re not also eating well, sleeping sufficiently, and exercising. (Though if it actually relieves stress, keep it up!)

The truth is, crashing fatigue, busy lives, mood issues such as depression, or menopause symptoms can all lead us to give up on those truly healthy lifestyle choices, like getting out for a walk or cooking our own meals. If you need a little encouragement, testing hand strength might be a good incentive, since you can actually see progress over time.

The next time you see your doc or PT, ask if you can take a grip test. Write down your numbers, left and right hand. In 3 months, test it again: have all those good, healthy changes you’ve made shifted the needle?

If you’ve tested your grip, or if you want to take us up on the challenge, let us know how it’s going. 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. 

 

Darcey Steinke has written a wholly original book about menopause. And it’s wonderful.

She starts with her own experience, then leads us on a journey that explores the biological, sociological, and cultural realities women have faced and continue facing during this part of their lives.

And how it’s time those “realities” underwent some real scrutiny.

Flash Count Diary with Darcey Steinke

In Flash Count Diary: Menopause and the Vindication of Natural Life, Darcey Steinke argues that menopause can and should be transformative as a unique opportunity to embrace a new, rich, potentially very altered self.

Once Gennev CEO Jill Angelo heard Darcey on NPR’s All Things Considered, she was eager to meet the woman who spoke so openly and honestly about the changes menopause can have on bodies, sex, relationships, and our own identities as women.

When she learned Darcey was coming to Seattle (home to Gennev HQ) to speak about her book, Jill reached out.

What follows is an incredibly lively, fun, and inspiring conversation. We hope you enjoy it!

Buy the book.

 

Have you read Darcey’s book yet (we hear it’s awesome for book clubs) or will you attend any of her events? We’d love to hear your thoughts. Please join us in our public forums! 

 

Would you characterize yourself as a do-it-yourself type of person when it comes to your health and wellness? If you’re like me, you’ve maxed out your free article options on Medium and The New York Times in an attempt to soak in every suggested treatment or women’s story that will help normalize what you’re going through.

Or, are you the type of person who wants to rely on the knowledge and care of a coach, a trainer or a very hands-on doctor? Someone who can walk you through understanding why you’re feeling lousy, then hold your hand through the behavior changes required to get on the other side of it?

I’m a DIYer. I’m super disciplined about what I need to do to adjust a lifestyle behavior for better health, and then I just do it. Some call it Type A. It comes with its pluses and minuses for sure. Sometimes I can be a little impatient and I’m not always coachable”¦not things that I’m proud to admit.

What type are you?

With the way the health coaching industry is booming, I’d guess that there are a lot of women who want an approach to getting healthy where you don’t have to go it alone. You’ve got a coach, a trainer or a concierge doctor who is there for you when you need someone to keep you accountable and who helps with wellness adherence.

A menopause-certified health coach can be helpful. Book 30 minutes for your personal consultation with a health coach.

Or are you a combo?

You start DIY in the early days but flip to a much-needed relationship (coach, trainer, doctor) to give you  a plan and see you through it?

While I’m typically a DIY when it comes to perimenopause (at this point!), I took the combo approach to running. For my first marathon, I skillfully ripped out the Less is More training from Runners World. And with every marathon thereafter, I would try another plan.

Then I hit a wall. I was super tired and had been diagnosed with Celiac (for a carb-loading runner, hearing that you could not eat pasta or bread prior to a race 10 years ago was sock in the stomach”¦but then eating pasta and bread was a sock in my stomach, literally).

I knew I had an uphill battle to qualify for the Boston marathon so I enlisted my first running coach. He pushed me to the limits; it was painful, and I dreaded the weekly run I had to do with him, because he’d know if I’d been accountable to the plan.

But I got faster. I got healthier. I hit my goals. And I learned to trust the plan.

There isn’t “a plan” for menopause, but I believe there could be a personalized plan for every woman based on her needs.

Do you agree?

How many of you have a plan related to your menopause symptoms or something similar for weight, strength, mental health or even sleep management? And are you working with a coach, a trainer, or a menopause doctor specialist who is keeping you accountable?

I’m intrigued by the idea of taking the idea of a “running plan and/or coach” and applying it to women’s health in menopause.

If it sounds like something you’re already doing or you’ve seen something like it in the glossy world of menopause solutions, send it my way. jill@gennev.com

May is Mental Health Awareness Month, so let’s take a look at a little known, and little-understood, brain disorder: schizophrenia… especially with regard to what often happens to women with this condition during midlife, including potential improved effectiveness in treatment.

Details about schizophrenia

Though treatable, schizophrenia is not curable. When active, symptoms can include some combination of delusions, hallucinations, exaggerated or distorted perceptions, beliefs, and behaviors, challenges in thinking and concentration, and lack of motivation. When this disorder is active, people with schizophrenia are often unable to distinguish between real and unreal experiences. There are several additional symptoms that can occur, and as with any illness, the severity, intensity, and frequency of symptoms can vary. Also, while people with this illness can lead rewarding lives with the help of treatment, some cases of schizophrenia can be disabling.

It’s important to note that suicidal thoughts and behaviors are common among those with this illness, as are high rates of co-occuring medical conditions such as heart disease and diabetes.

It’s a complex condition, for sure. Affecting less than 1% of the U.S. population, misconceptions about this disorder include the ideas that people with schizophrenia:

 

Causes and symptoms of schizophrenia

Per the Mayo Clinic, precise causes for schizophrenia are unknown. Researchers believe that a combination of genetics, brain chemistry, and environment contributes to this disorder. Continued neuroimaging studies show differences in the brain structure and central nervous system of people with this condition, but researchers are not sure about what the significance is of these differences at the time of publishing this post. 

Also, per the Mayo Clinic,  there are risk factors that are thought to increase the risk of developing or triggering schizophrenia.

These include: 

 

Middle-age onset schizophrenia: MAOS

This paper from 2009 is particularly interesting as it shares details about middle-age-onset schizophrenia. It gathered and reviewed several studies targeting early-onset and middle-age onset of this illness. Findings share that there is a higher proportion of women among MAOS patients and that there is a tendency for MAOS patients to have “…less severe negative symptoms and better neuropsychologic performance (particularly in learning and abstraction/cognitive flexibility)…” This isn’t to say that what’s called “positive psychotic symptoms” are not present, only that the symptoms categorized as “negative” are less severe.

It’s thought that while middle-age-onset schizophrenia is predominantly neurodevelopmental, it is also a distinct neurobiological subtype of schizophrenia. It seems that more research and shared findings are called for on this front.

 

Connect with medical support while at home with our online clinic. Learn more about having a better menopause.

 

Women with schizophrenia entering menopause

There is a hypothesis that endogenous (growing or originating from within an organism) estrogen may have a protective effect against schizophrenia. This has to do with the difference in when men and women experience peak onset. In men, the age of schizophrenia onset peaks between ages 15-25 years. 

In women, peak onset is between 20-35 years, with an additional smaller peak around the time of menopause. We already know (and continue to discover) fluctuating and decreasing levels of estrogen, that mighty hormone, affects the skin, vasomotor function (hello hot flashes and night sweats), sleep, and mood. It seems this could be more intelligence about how estrogen works throughout the entire body, and most definitely affects the brain.

 

Preexisting schizophrenia? 

This is critically important for health and wellbeing: 

“Women with preexisting schizophrenia frequently experience a postmenopausal exacerbation of psychotic symptoms and a resultant need for an increase in antipsychotic medication.” 

Consider proactively checking in with your doctor as you’re approaching perimenopause or menopause, and absolutely call into the office for a video call or appointment if your symptoms are increasing and/or worsening. Ask about potential needs for a change in your medication, including potential mode of your medication delivery.

In an interview with Amnon Brzezinski, MD, from the Department of Obstetrics and Gynecology at The Hebrew University – Hadasssah Medical Center in Jerusalem, Israel:

“Around the time of menopause, women with schizophrenia often require antipsychotic dose increases. This is because several changes occur in the absorption and metabolism of drugs at the time of menopause. It has been reported that the variability in drug response that exists among individuals with psychosis increases at menopause and is greater for the oral route that goes through the liver than for intramuscular injection. This may be why, for some women with schizophrenia at this time of life, oral medications appear to lose effectiveness, whereas depot injections of the same antipsychotic continue to be effective.”

When you connect with your doctor, try to make it a collaborative, solution-finding conversation. Consider asking about potential increased adverse effects if a higher dosage of antipsychotic medication is needed too. 

Absolutely! Ask about hormone replacement therapy (HRT), and note how it may either work or react with your existing, personal treatment medication. Uncovering and discovering more information and avenues to better wellbeing during steady, consistent treatment is key.

 

Same but different

Changes in sleep, mood, and changing body temperatures (both hot and cold flashes) may happen in menopause whether a woman has schizophrenia or not. A sense of loss may be felt with the loss of infertility  and the perceived loss of sexual desirability may compound already-challenging feelings.

There may be additional impacts and challenges if a woman is going into perimenopause or menopause while living with aging parents who require more or different care. Children moving away, parents passing away may also introduce challenges and feelings of loss or grief at this time. 

Staying with your medication and protocol for treatment is important, now more than ever. If you’ve got a sense that it’s less effective or that symptoms are worsening, it’s time for a call to your doctor. Let them know what’s going on: more support (even if temporary) may be really helpful, necessary, and a good source for care and encouragement at this time.

 

Our Gennev Community Forums may prove both useful and supportive if you’re entering perimenopause or menopause. Learn from other women about their experience and how they are taking control of their menopause. 

 

Does using birth control delay menopause? Does it increase the risk of breast cancer or heart disease in menopausal or perimenopausal women? After many years on the Pill, how will I know it’s safe to go off it?

Birth control and menopause: what do we need to know?

For answers to our birth-control-and-menopause questions, we turned to Dr. Sherry Ross, award-winning OBGYN and author of the book >She-ology, a look into women’s health beyond the doctor’s office.

talk with Dr Sherry

Dr. Sherry Ross

For those in perimenopause, should we stop taking the Pill?

“First,” Dr. Sherry told us, “be sure you understand this: until you’ve had no periods for a year, you can still get pregnant.

“Part of the confusion is around definitions: The true definition of “˜menopause’ is when you don’t have a period for one full year, but many women suffer from disruptive symptoms for a few years leading up to full cessation of periods””that’s called “˜perimenopause.’ As I said, until you are officially in menopause””meaning no periods for a full year””you can potentially get pregnant, so be sure to use some form of contraception. If you are single and dating while in menopause, you may not have to worry about getting pregnant, but you do have to protect yourself against sexually transmitted infections, so make sure your partner wears a condom.”

So, re: birth control, keep on keeping on until one year with no periods, and re: condoms, always always always outside of committed, monogamous relationships. Check.

Do birth control pills or using a hormonal IUD help with perimenopause?

” Oral contraceptives and an IUD like Mirenacan mask some of the symptoms of perimenopause and menopause,” Dr. Sherry told us. “That’s one of the benefits. Women on the Pill may have fewer, less-intense hot flashes, more “˜normal’ periods when other women are all over the menstrual map, and they might have more modulated emotional swings, which can be a huge benefit in their personal and professional lives. That’s why many doctors””myself included””prescribe low-estrogen birth control pills women having a rough menopause and don’t smoke or to make the transition into menopause easier.”

Does birth control delay menopause?

Short answer: No. Here’s why:

“Menopause is a time when your ovaries stop producing estrogen and your female hormone reserves are depleted. Known factors that can affect what age you enter menopause include your genetic predisposition, knowing when your mom went through the change, chromosomal abnormalities such as Turner Syndrome, very thin or obese women, long smoking history, needing chemotherapy or radiation therapy, those with autoimmune diseases and epilepsy.

“It’s clear that short- and long-term stress, such as extreme weight loss and weight gain, can offset your hormones, causing irregular periods. The extent this type of significant stress has on your endocrine system, causing hormone adrenal depletion and possibly affecting menopause, is not as clear.

“There is an association between extreme and long-standing exercising causing weight loss which can offset your hormones and cause early menopause. Excessive exercising creates a hormonal imbalance, causing irregular ovulations. It’s less likely short-term exercising mixed in with months of not exercising could cause a cascade of events leading to an early hormonal depletion.

“So there are some things that can bring on early menopause, but being on the birth control pill does not affect when you begin menopause. The Pill can mask the symptoms of menopause and, as I said, many women depend on it to help ease the transition into menopause.”

If we’ve been taking oral contraceptives for 20+ years, how will we know if perimenopause has started?

“The best way to know if you are in menopause while taking the birth control pill is to check your hormonal levels at the end of the pill-free week. Some women may even notice hot flashes during the pill-free/placebo week since they are not taking estrogen that’s normally in the active pills. Your doctor can conduct a simple blood menopause test that determines if your follicle-stimulating hormone level (FSH) has reached menopausal levels.”

If you need a trusted opinion, determine if medication is right for you, and possible prescription support. Book an appointment with one our Gennev menopause-certified gynecologist doctors here.

“

Are there health risks to continuing to take the Pill?

Says Dr. Sherry: “As long as you’re not a smoker over the age of 35, and you don’t have any contraindications of being on the Pill (high blood pressure, a history of blood clots, liver disease, breast or uterine cancer, strokes or migraine headaches), there are no health risks to taking the Pill during the first couple of years of menopause. The birth control pill stabilizes your hormones and keeps you physically and mentally balanced.”

And, according to Dr. Sherry, there’s even more good news.

Wait. There’s good news? About menopause?

“There’s evidence that taking birth control pills reduces the risk the risk of ovarian and uterine cancers. It may also help with rheumatoid arthritis.”

OK, that’s all terrific, but there have to be drawbacks.

What are the risks?

Said Dr. Sherry: “As I said, hormonal birth control is not for women who smoke, particularly if they’re 35 or older. Birth control pills may increase your risk of strokes and blood clots, and that risk is exponentially higher for smokers over 35. Yet another reason to quit!”

We completely agree. Anything else?

“Studies are still being conducted into hormonal birth control and breast cancer. But unless a woman has a history of breast cancer or other factors that make her high risk, she should feel comfortable taking low-dose birth control pills to control perimenopausal or menopausal symptoms,” Dr. Sherry told us.

“The best first step is to have a frank and open discussion with your menopause doctor. And don’t be embarrassed or shy””I can tell you from personal experience that almost nothing shocks a doc! Menopause is a normal, natural process and part of life, though women may experience it differently. Your doctor is here to help you understand what’s happening and alleviate symptoms that are interfering with your quality of life. There are solutions. You can feel better. And that’s the best news of all.”

Sheryl A. Ross, M.D., “Dr. Sherry,” is an award-winning OBGYN, author, entrepreneur and women’s health expert. The Hollywood Reporter named her as one of the best doctors in Los Angeles, Castle Connolly named her as a Top Doctor in the specialty of Obstetrics & Gynecology, and she was selected as a 2017 Southern California Super Doctor. Dr. Sherry continues the conversation of women’s health and wellness in her monthly newsletters and on DrSherry.com.  

Dr. Sherry Ross blogs for Huffington Post, Maria Shriver, Greatist, SheKnows, HelloFlo, Today Show, All Things Menopause, and Gurl, and we are thrilled to welcome her to the Gennev community!

We can help you get your questions answered about 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.

Seldom does a podcast recording stick with me like the one I recorded this week with Darcey Steinke.

Author Darcey Steinke is the author of the memoir Easter Everywhere and five novels: Sister Golden Hair, Milk, Jesus Saves, Suicide Blonde, and Up Through the Water.

In her latest book, Flash Count Diary; Menopause and the Vindication of Life, she chronicles her personal journey through menopause.

Our pre-podcast routine started like most of my interviews. Questions are emailed in advance, instructions given for the video-based zoom meeting, and mics readied for recording.

After a few minutes of figuring out the tech, our interview got underway. But not in the sort of formulaic intro I often use to warm up the conversion. We just dove right in. Like I was talking to a friend about her journey through menopause”¦and not just menopause, but life.

I inquired into aspects of the book I found peculiar or even overly assuming with regards to “women’s identity being tied to our fertile selves.”

I, for one, have never birthed a child nor do I long to, so I haven’t thought much about the importance of my fertility. I realize I’m probably in the minority on that one. Nonetheless, I was deeply curious about this departure of identity and how post-menopausal women reported feeling like neither female or male, or in some cases 100% male.

The book stretches from Darcey’s personal menopause stories of experiencing an orb pre-hot flash, to how whales experience menopause, to changing identity, sex, and social acceptance, to a dedicated chapter on anger.

I loved this most about her expression of an angry woman [and I paraphrase], “”¦an angry woman is scary and un-professional, while an angry man is just being a man.”

To say the least, I’m underselling the complexity with which she has researched and documented her spiritual journey through “the change,” and I recommend giving it a listen.

I highly recommend downloading the e-book. Hearing Darcey herself read her account of menopause brings a poetic, intimate feel to the story. It lessens the darkness and emphasizes the human.

In The New York Times review of Flash Count Diary, Jennifer Szalzi comments, “”¦the book still left me wanting more: more voices, more works about this transformation. The subject feels truly fresh and transgressive, while nubility is beginning to seem like, well, old hat.”

I think the conversation around menopause and this transformative part of our lives is just beginning. Thanks to women like Darcey for having the courage to approach it in the fullest expression of themselves.

Jill

P.S. Did you know Gennev has an entire podcast series that highlights interesting people working with women in menopause? Check it out here.

 

Yesterday was the day; my day for experiencing what decades of women have shared, grieved and suffered through for years.

I had my first hot flash.

I was out for a morning run. It was 46 degrees, overcast and windy. I headed up a slight incline. The same path I take every day.

I suddenly burst into a raging sweat, oddly on my back. I felt faint. Thought I was going to pass out, and that my heart was going to explode out of my chest.

I kept running, thinking that I just had to “run it out,” (like most runners, I assume this is an effective means of addressing a bad cold, chest cough, or even a temperature).

But this was different. The flash lingered on for about a block, and just as I was about to stop and take a walk break, it disappeared.

It was sort of like a sweaty, high feeling. I didn’t like it one bit. Fortunately, it was nothing like the topless woman at book club in the latest article on menopause in Oprah’s O Magazine.

But I did feel like I had crossed the chasm. Like I’d earned a right of passage into perimenopause as the thing that I talk about daily in my life as Gennev CEO and founder.

I sort of smiled. Remember when you got your first period? It was an experience you’d likely prepared for. Many young women search and look for the first signs of blood, and when it comes, it’s almost a mark of womanhood. I had to wait till I was 15 years old before I earned my womanly stripes.

And with yesterday’s hot flash moment, I felt like I had reached another milestone. While I’m years from menopause, the hot flash felt slightly epic.

I’m not trying to romance something that so many of you suffer from. I’ve never had a hot flash in front of an audience, a work meeting, or someone I’m trying to impress.

In fact, my virgin experience occurred when I was going to get sweaty anyways”¦on a run, no less.

But it did mark a milestone in my womanhood. And rather than feeling like my sexy was being stripped away, I kind of felt like I was more woman than ever.

The hot flash came at another interesting crossroads at Gennev. We’re starting to produce programs related to the symptoms of menopause, programs that will bring education, solution options and lifestyle behavior recommendations to help women find relief. Think 6-week programs designed to help you manage things like Hot Flashes, Insomnia, Weight and Fatigue.

Our first program is all about Hot Flashes, and we’re currently testing it with a small group of women steeped in hot flash flux.

If you’re interested in being part of a select group of Gennev community members who will receive FREE access to the inaugural Hot Flash program, send an email to info@gennev.com, and we’ll put you on our list for a Nov/Dec launch.

Till then, my hot flash sisters, send me your remedies for managing the flash, and I’ll post up your recommendations in the Gennev community.

Jill Angelo

 

We’re doing some celebrating at Gennev!

This week we announced a major investment in the company from investors who believe women’s health in menopause and the second half of life is worth investing in.

They care. We care. And there is a lot of work to be done to bring real solutions to you.

BlueRun Ventures, Maven Ventures, Startup Health and one awesome angel investor came together to invest $4 million in Gennev to improve how we care for you.

I can’t get the smile off my face as not only because we get to grow the team of people working to deliver better products and services to you as but because women’s health in the second half of life is on the map!

No longer are “post-baby” women assumed to be invisible or irrelevant. Rather, we’re a hot investment “¦ and we matter when it comes to being the best we can be.

However, money only works when you put it to use the right way.

This is where you come in.

Regularly, we’ll be asking you, the Gennev community, direct questions about what you need. If we want to bring trusted experts, products and education to 500,000 women in the next 12 months, we need your involvement to get it right.

With half a million women giving us feedback, we’ll have enough data to bring you more predictive recommendations to head off new symptoms before you’re at a place of suffering.

Here’s what I need from you today: have you taken the Gennev menopause assessment? If you haven’t, please do. Then answer this question: if you had the option to speak with a health coach to review your results and create a plan for the symptoms you’re experiencing, would you do it?

Send your response to jill@gennev.com. I want to hear your opinions on how best we can deliver to you a personal plan for mastering your menopause.

You’re going to see some amazing improvements from us in the months to come, so now is the time to forward this email to two women you care about.

We’re doing something completely new and it’s going to take women everywhere to make the changes we need!

 

We at Gennev get a lot of questions about testosterone levels in menopause and testosterone therapy. Women are (rightfully) confused as some providers tout it as the missing link, and others are giving them dire warnings. Is the truth somewhere in between?

Yes and no. First, I think it helps to know a bit about testosterone in menopause and what happens. And as I often counsel patients to “know your sources” when it comes to health information I will tell you who my sources are:

Why do I tell you this? Because these organizations have huge panels of research along with physicians who analyze all of the available data to make recommendations. They have no vested interest and make no money from their recommendations.

First, physiology: What happens to testosterone in women? It is an important hormone, but is at a relatively low level compared to men. In women and men testosterone gets lower over time at a slow steady pace. There is no sudden change in testosterone at menopause. We know this by testing and because we see a big drop in testosterone if women have their ovaries removed, even after menopause. It is also good to know that testosterone is made by ovaries, but also the adrenals, and some is made in the “target tissues” such as the vulva and breasts.

It is also important to know that the general testosterone levels sent to a lab are not sensitive enough or reliable enough at female levels to be useful. They may show no testosterone. This isn’t diagnostic and is unrelated to wellbeing or sexual function. There are much more sensitive tests, but most doctors don’t know to send them and they are hard to find.

Many people advertise testosterone therapy as a “fountain of youth” or “great for weight loss”, “improve your sex drive”. Testosterone is an anabolic steroid. It is banned in sports. Why? It does temporarily increase performance, but you require more and more to maintain effect and as the levels go up it has cardiovascular harm.  What other side effects do women see with too much T?

Is there a role for T in women? Yes, sometimes. There are small studies showing short term low dose T with careful monitoring can improve sexual function in postmenopausal women. It showed an increase from 2 to 3 sexually satisfying encounters per month.

As there is no safe and FDA regulated women’s dose T in the US, this has to be done in person with an experienced provider using male products or compounds (not our favorite at Gennev) with every 3-6 month blood levels to be safe. T is also a controlled substance so you need a local doctor with a DEA license to prescribe it. The biggest bang for the buck in terms of sexual function is to use books such as A tired woman’s guide to passionate sex by Dr Laurie Mintz and apps like our friends at Rosy to work on the underlying issues behind the loss of desire.

The last caution I would give is to stay far, far away from pellets for T (or any hormone). These are unregulated compounds with a lot of problems and reported cancers, which the FDA has warned against using. The levels of T from they tend to be very high and we see a lot of side effects. The people who sell them promote them as safe and effective, but really all they are is a money maker.

I hope that helps to explain testosterone in women. We are always happy to talk about it at Gennev, but it would be inappropriate to prescribe this via telemedicine. If you think you might need testosterone therapy, the NAMS physician finder can help you find a local NAMS certified physician to discuss it with.

We can help you find menopause therapies that are right for you

 

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.

With the lack of clinics for menopause, many women already face inadequate or difficult-to-access care for their transition issues. And for women in much of the US, that OB/GYN shortage problem is only going to increase.

An Ob/GYN Shortage in the U.S.

The US could face a shortage of 8,800 ob/gyns in 2020. Because the current population of ob/gyns is older (16 percent below the age of 40; 36 percent over 55), and ob/gyns tend to retire younger than other docs (at age 59, on average), the problem is likely to get worse.

In this podcast, Gennev CEO Jill Angelo and Gennev Director of Health ob/gyn Dr. Rebecca Dunsmoor-Su talk about the potential impacts of the shortage on women’s health, and how it disproportionately affects women in menopause.

If you need an OB/GYN’s help, 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.

Filling the health care gap for women in menopause

Enter technology, innovation, and passion for women’s health: led by Jill and Dr. Rebecca, Gennev is helping fill the health care gap via our new telehealth service. Affordable, private, convenient video and text conferencing will give many more women access to healthcare practitioners who specialize in helping women manage menopause symptoms.

 

 

We’d love to know your thoughts about our telehealth offering. Are you excited about the possibility of having focused conversation with a menopause specialist? Eager to start getting answers via telehealth? Concerned about privacy?

Share your questions and concerns with us in the comments below, in our g forums, on our Facebook page, or in Midlife & Menopause Solutions, our closed Facebook group. 

Transcript

Jill: A June 2018 article in Fortune claims that by 2020, the US will be short 8800 OB-GYNs. Why is that a problem?

Dr. Rebecca: So I think that’s a problem for a couple of reasons. OB-GYN training is focused specifically on women’s health and it’s focused on all aspects of women’s health from really adolescence through to old age. And there is no other specialty where women’s health is the primary focus, where that is all we learn.

So for women, OB-GYNs are key during the years of puberty. They’re key for birth control provision. They’re key for childbirth and they’re key for managing GYN concerns through adulthood and through menopause. And really menopause is a key time in the life of a woman and OB-GYNs are the ones best trained to help a woman through that time of life whether it be with advice or whether it be with medication, whatever that is.

So it’s a problem that a good portion of women in this country really won’t have access to these women’s health specialists. I know that primary care doctors do provide some of this care for women, and they do a good job within what they can do. But they have so many other things that they need to focus on, and I feel like there are times when you just need a specialist and women deserve to have a specialist just like men deserve to have a specialist.

You know, nobody is talking about not needing urologists in this world for men. You know, women need a specialist physician who can care for the things that are very particularly female.

Jill: You know, on the topic of as you brought up general practitioners because I think that’s probably where women have the greatest access is to the general practitioner. Can you talk a little bit about the amount of education that they actually get on this part of women’s health or the lack thereof?

Dr. Rebecca: Sure. It varies very significantly depending on where they trained and whether they’re trained as internal medicine physicians or as family practitioners. Family practitioners probably receive a little more focus on women’s health, and some of them can even do a women’s health specialization. However that’s within the structure of a residency that also covers pediatrics and male health and a lot of other things.

In terms of internal medicine, it’s a three-year residency. But again they focus on adult medicine and all aspects of adult medicine. They have to manage hypertension. They have to manage diabetes. They manage a lot of things. So while they will have some training in women’s health, it is not the sole focus of the training that they get, and when you’re talking about an OB-GYN physician, we spend four years in residency focusing exclusively on women’s health and we do rotations that vary from obviously obstetrics and delivering babies and high risk obstetrics and we do women’s oncology. So GYN oncology which is ovarian cancer and uterine cancer.

We do breast clinic time. We do regular GYN time. We do office hours and a lot of us even get some exposure to adolescent medicine. We do a lot of time worrying about and thinking about birth control and how to best manage that in all types of women and more high risk women and that’s the only thing we focus on during the entirety of our residency over four years.

So while primary care can do a lot of basic women’s healthcare, they are not the specialized provider for that.

Jill: What population of women or what women are most impacted by the shortage of OB-GYNs in your opinion?

Dr. Rebecca: I would say rural women are most impacted. OB-GYNs tend to congregate in larger metropolitan areas and the reason for that is complex. You know, a lot of us do enjoy living in cities. That’s part of it. A lot of it is financial. OB-GYN is one of the poorest reimbursed specialties there is. I’m not going to go into the whole politics of women’s healthcare and why we get paid so badly. That’s a topic for another podcast.

But let’s just say that what we do is not paid well and the thing that is most profitable for OB-GYNs although it is not particularly profitable, it is probably the most reliable is obstetrics, so the delivery of babies. So for OB-GYNs to maintain a practice that is financially viable, they need to deliver a certain number of babies a year and you can’t do that in a rural practice. Often there just aren’t as many obstetric patients in that area.

I think there are a lot of great OB-GYNs who practice in rural areas and they do it for the love of the specialty and a lot of them do it in federally qualified health centers or other ways that they can perhaps make it financially viable. But there’s a certain proportion of patients and deliveries that you need in order to make it worthwhile to be an OB-GYN somewhere. So really rural women are the ones who are going to pay the price.

Jill: This shortage obviously has to impact OB-GYNs as well. What are the impacts that you feel as I’m sure you’re feeling overtaxed. Generally these specialists are busy. Like give it to us from the perspective of an OB-GYN.

Dr. Rebecca: So I think from my perspective, the key things that I feel with this deficit are that I spend a lot of time taking transfers in from as for our rural areas being in the Pacific Northwest. We do have a lot of rural areas and these are patients being transferred in because there is no OB-GYN accessible to them. So their primary care has attempted to do what they can for them but realizes that they need a higher level of care. So we’re spending money on ambulance, helicopter and air flights for these women to get to an OB-GYN. I think that’s a big impact and a waste of healthcare dollars that if we just were able to support OB-GYNs and provide enough, might not need to happen.

I find that women, when they get to me, are frustrated because they’ve been through so many providers who tried to do their best for them. It’s not that these providers are bad at what they do or not doing their best. It’s just they don’t have the same level of expertise and so they’ve been told multiple things and tried multiple things and by the time they get to me, they’re frustrated because they feel either there’s no answer for them or that they’re getting different answers. It takes a lot longer for me to explain that it’s not that the answers they’ve gotten previously are wrong. They were just first steps and that we now need to move to a more specialized level of care and it just takes a lot longer in that situation to care properly for a woman.

Jill: So let’s switch to then solution. We’ve kind of delved into the notion that there’s a real shortage for so many women. Why is telehealth a great answer to this shortage of specialists?

Dr. Rebecca: I think telehealth holds promise for a couple of reasons. I think one of the biggest issues is just you can talk to an OB-GYN specialist who is knowledgeable about the thing that you need to talk about. You can as a lot of what we do is face to face counseling. It’s not reliant on an exam. It’s not reliant on prescription even. It’s just that women need to talk to somebody who understands what they’re going through and can walk them through the process, give them reassurance where needed, talk to them about what things need to be followed up and a lot of that can be done just face to face over the computer.

There are times at which a prescription is needed or exam or even a biopsy type thing might be needed. But that can be referred out or at least a woman then knows that she needs to go find the specialist who may not be available in her community and it might be worth the trip in to see the specialist because she knows that these are the things that need to be done.

Jill: Yeah. Well, and especially for women in perimenopause and menopause, that notion of a conversation is so important. Talk a little bit about that and how video just really makes that an option for so many more women in terms of access.

Dr. Rebecca: Right. So in the perimenopause and menopause itself, a lot of what women are experiencing is natural and normal but it can be frightening if you don’t understand what’s going on and why it’s happening. So a lot of the work I do as a menopause provider is counseling. It’s just talking through symptoms and why they’re happening and how long they may last and if there’s anything that needs to be done about them.

A lot of women just really need reassurance as they’re going through this process. The biggest thing we reassure women about is that this process will end. You know, the perimenopause is not lifelong. It is a transitional time. It can be very crazy. It can be wacky for some women. When your hormones are fluctuating wildly, it can feel very, very different but that that will end.

You will go into a new normal which is different than the old normal and I can talk to them about natural remedies they might want to try. I can talk to them about diet and exercise and how those play into how a woman feels during this time. None of that requires an in-person visit.

If a woman is really struggling and might need to consider hormone therapy, then it’s worthwhile going to see an OB-GYN and she goes in armed with the knowledge that she has tried some of these other things and they’re just not sufficient and she might need hormonal intervention.

Jill: Well, let’s talk a little bit about prescription. How comfortable are you in terms of prescribing medication via telehealth? We see more and more of that happening and especially for women in perimenopause and menopause. We’re talking hormone replacement therapy.

Dr. Rebecca: So I think the ability to prescribe via telehealth is very much dependent on what we are prescribing. In terms of hormone replacement therapy, a lot of the conversations surrounding prescribing hormone replacement therapy relies on history and a woman’s symptoms. It doesn’t really rely that much on physical exam and I am certainly comfortable prescribing a hormone to a woman who I feel I have a complete medical history on, who is getting regular and routine exams by her primary care physician. I don’t need to do a specialized exam for that.

The one thing that a woman would need to understand before getting hormones prescribed online is that there are side effects of hormones and if any of these come up, she will need to see an OB-GYN perhaps for a biopsy. But that’s pretty rare and if she’s using the hormones correctly, it really shouldn’t become a big issue.

So I think this is one area where telehealth prescribing is actually very beneficial and we see that in other areas of telehealth where people are being prescribed birth control or things like that.

I think the area where it’s not as good is things like antibiotics for infections because that does require more of a physical exam which you can’t do via video camera. So I think there are areas where it makes a lot of sense and this is one of them and there are areas where it really doesn’t make sense and you still need to be seeing a physician.

Jill: You know, obviously many women and people in general but women are understandably nervous about entrusting their care to a video appointment. What would you say to a woman who’s uncertain about telehealth?

Dr. Rebecca: Well, I think the biggest point in establishing that level of trust is the conversation you have with a woman. If you’re involved in conversing with her, if you’ve read her history forms, if you understand the problem that she’s coming to you with and if you listen, then they will feel comfortable and certainly women who think that this is a bad method of healthcare don’t need to use it. They can go and find a physical physician to see. But that’s not an option for a lot of women and I think just having the resource and being able to try it and feel comfortable with it reassures a lot of women.

I think that Gennev, when we do our telehealth, one of the things that we do very well is we ask a lot of questions upfront. They fill out a good health history form so that we know what we’re dealing with and then I explore that with them when we’re face to face on the video camera. So I understand as you know, do they have any risk factors? Do they have medical problems I need to take into account? I think they feel very reassured that I’ve read about them before I come into the phone call and that we can discuss their issues face to face.

It really does feel like a face to face conversation. It’s almost easier than when you go into the office because a lot of times in the office, we’re having to chart while we do things or write prescriptions or do all sorts of different things and we’re not necessarily looking at your face whereas on telehealth, really all we’re doing is looking at you and talking.

Jill: Yeah, that’s true and it’s a private conversation. You’ve obviously been conducting appointments. Talk a little bit about privacy and how a woman as it is a one-on-one exchange but talk a little bit about privacy because that’s probably the most kind of scary aspect of a video appointment.

Dr. Rebecca: Right, and I think the key thing for women to understand is that these video appointments and all the paperwork that goes with them does need to remain HIPAA-compliant. So we have systems in place to keep these conversations private. They’re not recorded and then any documentation or paperwork that we send back and forth between each other is also protected, so that it is kept private between me and the patient. It’s not shared with a bunch of different people and that’s really key in terms of maintaining that compliance for healthcare affordability.

I think women are worried that this is going out to lots of people. It’s not. I’m the only one seeing what they say. They’re the only ones seeing what I’m saying and we do not record these visits for the future. We just as it’s a one-on-one conversation just like you would have in the office.

Jill: Now as Gennev’s Director of Health, you’ve kind of truly been the visionary for establishing a telehealth practice specialized around menopausal care. Talk a little bit about that vision. It has been a dream of yours. You’ve been doing it brick and mortar for a while locally. Talk a little bit about that vision and it’s finally really launching.

Dr. Rebecca: Yeah. I think the vision as from my perspective, I have been an OB-GYN practitioner in the Seattle area since 2005 and I was in Philadelphia before that and I love talking with women and over the years, what has really become a passion of mine is menopause and perimenopausal care and I think it has become a passion of mine because as my patients have aged, I’ve seen that that is the area where they have the least information.

We’re very good at educating women about childbirth. We do a lot of education surrounding birth control because it’s very important. But then we get into the perimenopause and there’s just less out there. It’s a non-reproductive time of life and for a lot of medicine’s history, that’s an unimportant time of life to the medical establishment. I think it’s a very important time of life. Women have a lot more life to live in the perimenopause and the menopause and properly approaching those times of life and those changes and understanding them completely helps a woman to live her best life through that time.

I love doing this face to face with my patients in clinic but there are a lot more patients who need this education and who need providers who are specifically trained in menopause care and there are very few of us in the country.

Many of us have gone through the North American Menopause Society’s certification program and you can find those on their website. But the likelihood of having someone with that certification near you is probably pretty low. It’s just there aren’t that many of us out there. So being able to provide this to women all through the country is just an amazing opportunity.

I know I’ve been doing the telehealth in our alpha testing and one of the women I’ve been speaking with is from a very rural area of Washington and there just isn’t anybody out there who can answer these questions and she’s a little bit more medically complex. Perfect. This system is perfect for her because she can ask questions.

None of them required a prescription. None of them required any testing. She just wanted to talk through some of the things she’s going through and telehealth is perfect for that. I feel like being able to do that kind of good for women all over the country is just an amazing opportunity.

Jill: In that circumstance, what would she typically do in the traditional healthcare system?

Dr. Rebecca: So every area of the country is very different. In Washington, often what we see is these patients need to make appointments in Seattle and so they need to drive three or four or five hours for each appointment and each appointment is maybe 15 or 20 minutes and then if they have more questions, they have to drive back three or four hours in three or four weeks whereas this patient was able to talk to me three times from the comfort of her home and get 45 minutes worth of counselling and not have to go anywhere.

Jill: Yeah, and that’s pretty amazing, the transition or the transformation I think that will have for women like her.

Dr. Rebecca: Yeah, exactly.

Jill: That’s great.

Dr. Rebecca: And it’s not useless to women in cities either. Even though people live in Seattle, there may be plenty of OB-GYNs around. Sometimes you just have a quick 10-minute question that you want to ask an OB-GYN about the perimenopause and your OB’s office is perfectly happy to see you but it’s going to take three or four weeks or you just don’t feel like it’s enough that you want to leave their house and go into the office and do all that.

You can just call into a telehealth service and ask the question and have it answered and if they say, “You know what? You really need to see your OB-GYN about this,” then you go in. If they say, “Nope, your question is answered. You’re good,” then you don’t have to do that.

So there’s a great deal of usefulness for women everywhere in the country. I tend to focus on the rural areas because I’m in an area that’s very under-served up here in the Pacific Northwest but there are a lot of areas where this is helpful.

Jill: Well, that’s I think super encouraging and obviously as a big believer in what Gennev is doing, I’m really excited about the notion of truly being this first ever online clinic for menopause care that makes it affordable to every woman and gives her the care and the access that she needs.

So thanks for being my partner in it, Dr. Rebecca and for bringing your expertise. I just am really excited what this can bring to so many more women and the practitioners who are looking for alternative work opportunities.

Dr. Rebecca: I agree. A lot of the people who will be doing this type of telehealth are people who practice in the traditional office setting. I’m one of those people and it just allows me to reach more women during off hours and times when maybe the office wouldn’t be open or on post-call days when I’m at home anyway and it gives me an opportunity to talk to all sorts of women all over the state of Washington which is really exciting for me.

Jill: Well, good. Well, for more information, women can come to gennev.com. We will be launching telehealth services state by state and we will continue to add more states to our listing. So if your state is not in the states that we report today, sign up to our wait list. Be part of that so that as soon as we do have a practitioner in your region, we can get the word out to you and you can get on to a healthier life.

So with that, thank you, Dr. Rebecca. Here we go. Here we go in launching the first ever clinic for women in menopause.

Dr. Rebecca: Thank you.