Dr Lisa Savage Archives - Gennev: Expert Virtual Menopause Care

Menopause is the permanent cessation of menstruation and a natural part of a woman’s life. However, for some women, menopause doesn’t happen naturally. Surgical menopause is the removal of a woman’s ovaries, which results in immediate menopause. Though symptoms of menopause are similar whether it occurs naturally or surgically, the experience is often more difficult following surgical menopause”but there are ways to make it more manageable.

Menopause typically happens gradually, with hormones fluctuating and symptoms waxing and waning. It’s a transition that can take anywhere from about four to ten years and begins with perimenopause. During this time, estrogen and progesterone, the primary reproductive hormones, are declining, which causes irregular periods, one of the first signs of perimenopause. Other common symptoms include hot flashes, trouble sleeping, mood swings, and brain fog.

What is surgical menopause?

Surgical menopause occurs when both of a woman’s ovaries are removed, a procedure known as an oophorectomy. “There are some very good reasons to remove both ovaries,” says Dr. Lisa Savage, board-certified OB/GYN, and Gennev clinician. The most common are a cancer diagnosis, a high risk for cancer, and endometriosis. Removing both ovaries is a bilateral oophorectomy and can be lifesaving for some women with cancer or a high risk of developing it, or in the case of endometriosis, it could significantly improve a woman’s quality of life. (The removal of only one ovary is a unilateral oophorectomy.)

The ovaries produce estrogen and progesterone, so when they are removed, these hormones are gone, too. “Surgical menopause is this abrupt cessation of those ovarian hormones, whereas naturally-occurring menopause is more of a transition,” says Dr. Savage. “The transition may not be a picnic, but an abrupt cessation can be more intense, especially in younger women.”

Risks of surgical menopause

After the removal of your ovaries, you may experience more symptoms that appear immediately following surgery and are more severe, compared to perimenopause, where symptoms ebb and flow over a longer time period. So instead of your body being gradually weaned off of estrogen and progesterone, it’s like going cold turkey. The withdrawal can be tough. Suddenly, you could be hit with hot flashes, sleeplessness nights, mood swings, and low libido all at once or some combination on top of recovering from your surgery. And the intensity of these symptoms may be higher than if you gradually entered menopause. Like natural menopause, though, the types of symptoms and their severity vary from woman to woman.

Surgical menopause also has long-term effects that differ from natural menopause. When you go through menopause, you lose the protective effects of estrogen that particularly benefit your heart, bones, and brain. Heart disease risk increases. Bone loss may be accelerated. Cognitive function can be affected, and your risk of dementia and Alzheimer’s may rise. The average age of natural menopause is 51, and it’s after menopause that these problems tend to arise. If you have surgical menopause at an earlier age, things happen sooner.

“It’s double jeopardy if you lose your ovaries at a young age,” says Dr. Savage. “You have more years to live without estrogen and more time to develop those problems. More time of estrogen deficiency is worse than less time of estrogen deficiency.”

But there are ways to minimize the effects if it’s necessary to remove both ovaries. Sometimes you can have only one ovary removed (unilateral oophorectomy) or keep them both, based on your personal situation. That’s why it’s essential to talk to all of your doctors about your options and consider getting a second opinion whenever you’re having surgery.

What happens after a hysterectomy?

“A hysterectomy does not directly induce menopause,” says Dr. Savage. A hysterectomy is the removal of the uterus. Just because you had a hysterectomy doesn’t mean your ovaries were removed.

In the past, a hysterectomy often included an oophorectomy for women nearing menopause, partly to prevent ovarian cancer. The latest research, however, shows that ovarian cancer more likely originates in the fallopian tubes, and there are benefits to keeping the ovaries. “Now, we may routinely remove the fallopian tubes at the time of a hysterectomy for benign indications but leave the ovaries because they may not be the primary source of “ovarian’ cancer,” says Dr. Savage.

If your uterus is removed, but you still have your ovaries, you’ll stop menstruating, but your ovaries will continue to produce hormones. That means you won’t experience perimenopause until ovarian function declines. For some women, who’ve had a hysterectomy, the decline will follow a similar timeline as women who still have their uterus. However, sometimes it occurs sooner.

“The blood supply to the ovaries can be compromised during a hysterectomy because some of the blood supply is common to the area,” says Dr. Savage. “That doesn’t mean anything was done wrong. It can be a natural consequence of a hysterectomy that ovaries cease functioning earlier than they might have otherwise.”

Communication with your physician is key

No matter what type of surgery you’re having, you should understand the procedure, your options, possible side effects, and the recovery process. It is even more critical if your doctor recommends removing your ovaries. “It’s very important that women talk to their surgeons in detail as to exactly why they want to remove the ovaries,” says Dr. Savage. “Make sure there’s a good indication for removing them, and there may be. If not, advocate to keep your ovaries.” You might even want to get a second opinion. “I tell patients if they need a hysterectomy for a benign condition go to the mat to keep their ovaries,” Dr. Savage says. One ovary is usually sufficient to produce enough hormones to prevent you from going into menopause early.

If your ovaries have to go, the conversation with your doctor should shift to managing the impending menopause. “Have a plan in place preoperatively,” says Dr. Savage. “Don’t wait and be reactive. Knowing what to expect ahead of time is so empowering.”

How to manage surgical menopause

Just like natural menopause, some women who have surgical menopause have an easier time than others. Even if your symptoms are mild, surgical menopause requires management, especially the younger you are. “It’s not just about hot flashes,” says Dr. Savage.

Estrogen plays a role in nearly all your body systems, including your skin, hair, and vaginal tissue. More important is its effect on your heart, brain, and bones. Estrogen protects the heart, fuels brain activity, and strengthens bones.

When you no longer have estrogen, your risk of heart disease increases, cognition may decline, mental health issues like depression and anxiety are more common, and bone loss increases. It can also have a significant impact on your sex life. Vaginal dryness and a loss of libido can be more pronounced following surgical menopause. And the longer you are estrogen deficient, the more problems you can have. “With life expectancy into your 80s, you must take care of those body systems to carry you through,” says Dr. Savage. “You want them working well for the rest of your life.”

Here’s how to manage surgical menopause and stay healthy as you age.

Ask about hormone replacement therapy (HRT). Talk to your doctors to find out if you’re a candidate. The answer will depend upon your individual situation, including the reason for having your ovaries removed. There are some contraindications, for example, if you have estrogen-dependent breast cancer. Discuss your options with all of your doctors. “Any replacement that you take up to the age of 51 is just replacing what you should have had anyway,” says Dr. Savage.

Start HRT quickly. If you are a candidate for hormone therapy, you want to start as soon as is safe following your surgery. “You shouldn’t have to wait to feel terrible to be put on replacement therapy,” says Dr. Savage. “It’s like having your thyroid out and getting replaced quickly.” Dosages might need to be higher in younger patients to achieve physiologic levels of premenopausal estrogen. If you still have your uterus, you’ll also need progesterone to prevent an overgrow of the uterine lining which could become cancerous.

Explore other medications. If you’re not a candidate for hormone therapy, there are other options. Some SSRI (selective serotonin reuptake inhibitors) anti-depressants like Effexor and gabapentin, an anti-epileptic medication, have been shown to help with menopause symptoms, especially hot flashes and night sweats. A new, nonhormonal drug Veozah was recently approved to treat these symptoms. Other medications can reduce your disease risk.

Monitor risk factors. You’ll want to be proactive about disease prevention, so talk to your doctor about prevention strategies and screening tests. You may need cardiac evaluations or bone density tests at an earlier age. If your risk increases, for example, your cholesterol or blood pressure levels rise, or your bone density decreases, quickly addressing those issues will be critical.

Make lifestyle changes. All of the advice that can help with natural menopause, such as exercising, staying hydrated, eating more fiber, taking supplements, and reducing stress also apply to surgical menopause.

Take care of your mental health. Sudden menopause can be more intense psychologically, so seeking helpis essential. Mood swings, anger, and anxiety are common with any type of menopause. With surgical menopause, these symptoms can be more severe, and you may be dealing with other issues like a possible a cancer diagnosis that can add more stress.

Surgical menopause requires management by a trained menopause specialist. Speak with one of Gennev’s board-certified OB/GYNs to learn more about managing symptoms, and stay healthy as you age.

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“My uterus went to the Dark Side.”

That’s how Ann-Marie Archer described life before discovering she had fibroids. “It was horrendous,” she told us: period flow so heavy, she had to plan around it, vaginal pain, incontinence.

And the worst of it was not knowing what was going on or if her experience was normal. Her doctor kept brushing off her concerns as “just menopause,” and searching the Web didn’t really help as there just wasn’t much information out there. But when she twice bled hard enough to soak her surroundings, she knew she had to push for answers.

It turns out she had uterine fibroids. Fortunately, the vast majority of fibroids are benign (not cancerous), and many women don’t even know they have them. However, even the benign ones can cause unpleasant and sometimes debilitating symptoms, depending on location and size, so if you have them, it may be worthwhile to investigate your options.

To get more information on fibroids, their causes and treatments and what to look out for, we talked with Dr. Suzanne Gilberg-Lenz, ob/gyn, integrative medical doctor, and Clinical Ayurvedic Specialist.

What are uterine fibroids?

Womenshealth.gov describes uterine fibroids as “muscular tumors [i.e. made up of muscle cells] that grow in the wall of the uterus.” A woman may have one or many, and they range in size from apple-seed small to grapefruit, though in rare cases, they can grow much larger.

How do I know I have them?

For women like Ann-Marie, the symptoms are extreme enough to prompt further testing. Other symptoms include heavier, longer, more painful periods, pain during intercourse, incontinence, constipation, pelvic, back, and leg pain, and fertility issues, so women experiencing these should talk with their doctor.

For women with lesser symptoms or no symptoms at all, fibroids may initially be discovered (or suspected) when a gynecologist detects an enlarged or irregular contour of the uterus during a routine pelvic exam. Often an ultrasound will then be used to confirm, map, and measure the fibroids.

How common are uterine fibroids?

According to Dr. Suzanne, they are the most common benign tumor in women. Prevalence rates vary from 5-25 percent, with a lifetime risk of 70 percent for women. However, fibroids are approximately three times more common in African American women than white women.

Are they hereditary?

Dr. Suzanne tells us there does seem to be a familial inheritance pattern and some racial differences. Based on those tendencies, newer research is focusing on possible genetics as a target for therapies, but the exact cause of fibroids remains elusive.

What should I do if I think I have uterine fibroids?

The treatment depends on the symptoms, says Dr. Suzanne, as well as on the location, size, rapidity of growth, and number of lesions.

For instance, a large fibroid in the anterior wall of the uterus may put pressure on the bladder and cause urinary symptoms; fibroids growing into the uterine lining can cause irregular or very heavy vaginal bleeding. In these cases, women may opt for a hysterectomy. And indeed, fibroids are the number one reason for hysterectomies. However, Dr. Suzanne says, you should talk with your doctor about all your options: minimally invasive outpatient surgical options like myomectomy (removal of only the fibroids) are available and an excellent option for many women, especially if fertility preservation is important.

Although cancer in a fibroid is rare, says Dr. Suzanne, occurring in approximately one in a thousand fibroids, rapidly growing fibroids in post-menopausal women should be managed by hysterectomy, as the risk of cancer increases substantially in that situation.

Uterine fibroid embolization (UFE) is a procedure done by an interventional radiologist in which the blood supply to the fibroids is blocked resulting in shrinkage. The recovery time is shorter than with surgery.

For women experiencing heavy bleeding, there are hormonal options such as birth control pills or progestin-containing IUD. Other medical options, both injectable and oral, may be used for up to two years to shrink fibroids. The primary indication for these medications is to shrink fibroids preoperatively since they tend to regrow after medication is stopped.

When it comes to using power morcellators to break up fibroids, Womenshealth.gov cautions against their use as they could spread cancer. And, according to Dr. Suzanne, the American College of Obstetricians and Gynecologists (ACOG) and other professional guidelines at this time do not recommend the use of power morcellators. However, she adds, “I think that in the hands of skilled and experienced laparoscopic gynecologic surgeon, the morcellator with a bag attached is an option. If you have already had the procedure, and the pathology on your tumors was benign, there is nothing to worry about. For added peace of mind, you could consult with a gynecological expert in fibroids or a gynecological oncologist.”

Once I’ve had fibroids removed, is there a chance they’ll come back?

“Yes,” says Dr. Suzanne, “especially if you are pre-menopausal. Fibroids are notorious for re-growing, and there are often tiny seedlings that we cannot see or feel at the time of surgery deep in the uterine wall that can grow over time.”

Can I do anything to minimize my risk of getting fibroids (or getting them again)? Diet, exercise, HRT, etc.?

There are no proven strategies that prevent fibroids from growing or returning, Dr. Suzanne says; many lifestyle studies have been conducted, and none have demonstrated any efficacy from abstaining from alcohol, changing diet, increasing exercise, and so on.

Should all fibroids be removed or otherwise treated? Is it dangerous to leave them untreated?

If fibroids are not symptomatic or rapidly growing, they really don’t need any treatment, Dr. Suzanne reassures us. “Watchful waiting is a reasonable strategy; as we pass through menopause, they often shrink, and symptoms disappear or diminish,” she says.

Fibroids are quite common, often problematic, rarely dangerous. If you suspect you may have fibroids, especially if you’re experiencing symptoms and you have a family history, mention it to your gynecologist. While the chances are high any fibroids discovered will be harmless, they can still cause discomfort and annoyance. Plus, you will have some peace of mind.

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.

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You may be surprised to find out that you have prediabetes. Many people think of type 2 diabetes as afflicting people who are older and overweight. In reality, more than 10 percent of people with type 2 diabetes are a healthy weight, and more young people are developing the disease. Most people are diagnosed with prediabetes and diabetes during midlife, so it’s not surprising that a prediabetes diagnosis may accompany your symptoms of menopause.

Once you accept that you have prediabetes, you should consider yourself lucky. About 38 percent of adults have prediabetes, but more than 80 percent don’t know it. “You have the opportunity to reverse this and avoid developing type 2 diabetes,” says Gennev health coach Monika Jacobson, a registered dietitian nutritionist. Diabetes affects your metabolic health, increasing your risk for heart disease, stroke, and cancer. Use this opportunity to allow this prediabetes diagnosis to kick yourself into some lifestyle habits that can support your overall health and help lower your blood sugar.

The menopause-diabetes connection

While menopause is a risk factor for some conditions like high cholesterol, the connection with diabetes isn’t so clear. “As we age, we are more likely to experience weight gain or become less physically active, which are both known independent risk factors for developing insulin resistance [a precursor to diabetes],” says gynecologist Ghazaleh Moayedi, D.O. “Many women describe an increase in abdominal fat during menopause, and increased abdominal fat can also lead to insulin resistance and increased blood glucose levels.” Other symptoms of menopause, like poor sleep and increased stress, can also contribute, making it difficult to figure out menopause’s specific role in the development of diabetes. Regardless, diabetes and menopause often intersect during this stage of life.

Prediabetes, defined as having a fasting blood glucose level of 100 to 125 mg/dL, develops when your body becomes less effective at regulating glucose. Your pancreas produces insulin which enables cells to absorb glucose and use it for energy. As you age, your body becomes less sensitive to insulin, a condition known as insulin resistance and a precursor to prediabetes. Instead of being stored in cells and used for fuel, glucose builds up in your blood, resulting in prediabetes and diabetes (a fasting blood glucose level above 125 mg/dL). In addition to age, weight gain, inactivity, abdominal fat, and other issues mentioned above can also affect your body’s ability to regulate blood sugar.

How to lower your blood sugar and avoid Type 2 diabetes

The good news is that lifestyle changes like exercising and improving your diet, along with weight loss, can reverse the typical pattern of prediabetes leading to type 2 diabetes and its many complications like heart disease, nerve damage, kidney disease, and eye problems. In the National Institutes of Health-sponsored Diabetes Prevention Program trial, people with prediabetes who followed the prescribed lifestyle program reduced their risk of developing Type 2 diabetes more than those who took medications”58 percent compared to 31 percent.

Lifestyle changes can help you avoid Type 2 diabetes, and maybe even erase your prediabetes diagnosis

Watch your weight. You probably are already aware that losing weight can be particularly hard during menopause. Some days it may seem like simply looking at a slice of cheesecake adds pounds. But when it comes to prediabetes, losing even small amounts of weight can improve your health. Losing as little as 5 to 7 percent of your weight”about 8 to 12 pounds if you weigh 170″can prevent prediabetes from progressing to full-blown diabetes.

If you’re not overweight, check your waistline. Abdominal fat is more dangerous than fat in other areas of your body and can contribute to diabetes, heart disease, and cancer, even if your weight is healthy. It can be common for body fat to be centered around the belly during menopause, and nutrition and exercise habits can help support a healthy body shape and size.

Look for hidden sugars. Obviously, the sugar you eat is going to affect your blood sugar levels. You know the biggest culprits like, cake, candy, and soda that you should eliminate entirely or eat only occasionally. But you may not be aware of all of the places that added sugars may be lurking”yogurt, pasta sauce, ketchup, energy bars, and salad dressings. The American Heart Association recommends that women consume no more than six teaspoons or 25 grams of added sugars a day. Check your food labels and tally up how much you’re getting a day, and then start to cut back. Most people get significantly more than the recommended amount so even if you can’t get all the way down to 25 grams, any cuts you make will likely be beneficial.

Favor fiber over refined carbs. Not all carbohydrates are created equal. Refined carbs like white bread, white rice, and white pasta act exactly like sugar when they get into the body. Instead of eating those types of carb, load up on whole grains, vegetables, and fruit. (Yes, you can still eat it, but avoid fruit juices and fruit in sugary syrups.) Whole fruit is loaded with fiber which will keep you feeling full longer and level out spikes and dips in blood sugar levels. Erratic blood sugar levels increase your chances of developing full-blown diabetes. Aim for at least 25 grams of fiber a day.

Replace sugary beverages. It’s one of the easiest ways to bring down your intake of added sugars. A grande vanilla latte has more than eight teaspoons of sugar. A can of soda has nearly 10. Smoothies can have even more. Replacing sugar-sweetened beverages with no sugar drinks such as water, tea, seltzer, and sparkling or infused water can be highly effective in reducing the glucose load and work on the pancreas, says Jacobson.

Stroll after meals. Blood sugar and insulin spike after eating. A 15-minute walk improves your body’s ability to regulate those spikes by using some sugar. In a study of people with prediabetes, those who did three 15-minute, post-meal walks had better blood sugar levels than those who did a single 45-minute walk. Don’t have 15 minutes? Walk anyway. Even shorter walks of two to five minutes offer some benefits.

Lift weights. Muscle plays a key role in regulating blood sugar levels and using glucose for fuel. After you eat a meal, your muscles should take up about 80 percent of the glucose in your blood. But as you get older, you start to lose muscle mass which can impair blood sugar regulation. The decline can begin in your 30s and accelerates as you age, especially if you’re not doing any resistance exercise like lifting weights to maintain your muscle mass. The good news: even if you haven’t been strength training, starting now will prevent future muscle loss and may build new muscle to improve your body’s ability to regulate blood sugar. Physical activity guidelines recommend that you do two or three strength workouts a week.

Break up long bouts of sitting. Too much sitting hinders your body’s ability to regulate glucose and increases diabetes risk. Based on the latest research, a five-minute movement break every 30 minutes is most helpful. If that’s not practical, do what you can. When your muscles are working, they use up more glucose and improve your body’s ability to use insulin, lowering glucose levels in your blood. In general, aim for at least 150 minutes of moderate-intensity aerobic activity like walking, jogging, cycling, or swimming a week.

Prioritize sleep. Getting enough deep sleep is essential to regulate blood glucose levels. When sleep is chronically low or disrupted, there is a lower production of insulin and an increased risk for diabetes. While sleep problems are common during menopause, you can improve your sleep by avoiding habits like erratic sleep schedules and too much screen time before bed.

Keep up good dental hygiene. Your teeth are probably the last thing you’d associate with diabetes, but the two are related. Periodontal disease, a chronic oral infection known as gum disease, has been linked to a higher risk of developing type 2 diabetes. To avoid this risk factor, make sure you’re brushing and flossing daily and see your dentist regularly.

Reduce stress. You’re probably thinking, “Yeh, right.” We get it. Stress is unavoidable, but even small efforts to ease stress can break the cycle of its detrimental effects. Repeatedly being in “fight or flight” mode from chronic stress is believed to increase levels of inflammation, which then impairs glucose metabolism and leads to insulin resistance, says Jacobson. There are many ways to relax, so find one that works for you and make it a regular habit.

As you implement these strategies, talk to your doctor or healthcare provider about retesting your blood glucose levels to check your progress. You’ll need to wait at least three months to see any changes. Your doctor will likely recommend a hemoglobin A1c blood test, which determines your average blood sugar over the last three months, a more accurate measurement than fasting glucose, which measures current levels only.

Learning you have prediabetes can be daunting, but don’t let it stop you. It’s a time to jump into action to protect your long-term health. Following a healthy diet and getting daily exercise can help you reduce your risk for type 2 diabetes. And Gennev’s integrated care team can guide you with a personalized wellness plan and the support you need to help you stay on track. Schedule a one-on-one virtual visit to get started today.

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^{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.}

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The fresh start that each new year brings also offers a chance to renew your commitments to the business of your health. While you are setting your health-first intentions for the upcoming year, this handy “Health Checkup Checklist” may help you focus on the preventive care and screenings that can give you the edge when it comes to your health.

The changes in your body in the years surrounding menopause may cause you to experience not only new symptoms associated with hormone fluctuations, they may also increase your risk for health conditions such as heart disease, diabetes, cancer, and osteoporosis. With regular screenings you will be well-informed of your risk factors, and be poised to implement prescribed preventive or defensive measures.

Getting your appointments on the calendar is half the battle. But many providers have made that easier than ever with online appointment scheduling. So, no excuses! As the saying goes, “an ounce of prevention is worth a pound of cure”.

Make these a must-do every year!

Your Annual Wellness Visits as At the top of your list of important appointments this year will be with your primary care physician (PCP) and your gynecologist for your wellness check-ups. This is where, together with your provider, you will review your current health and risk factors, and determine your personal disease prevention plan.

With your PCP, you can expect to have a blood pressure check and bloodwork, plus advice on vaccinations not only for flu and virus, but also tetanus booster or shingles vaccine. Your PCP can also help you check the boxes on referrals for many of the screenings that you are due (or overdue) for.

Your annual gynecological appointment may include a pelvic exam, cervical cancer screening, and a breast exam. And while some PCPs are willing to perform breast and pelvic exams and do Paps, the focus and expertise of a gynecologist is of benefit and added value when it comes to receiving the most comprehensive women’s healthcare.

Dental Care as Seeing your dentist twice a year for routine cleaning appointment and screening for teeth and gum disease doesn’t just care for your teeth, it also protects your health. Inflammation in your mouth can allow bacteria to enter the bloodstream causing inflammation elsewhere in the body. This is why gum disease is linked to many chronic conditions including heart disease, diabetes, respiratory illness, osteoporosis and rheumatoid arthritis.

Eye Checkup as Depending upon your individual health history, a routine eye exam is recommended every one to two years. An optometrist or ophthalmologist will check for signs of eye disease including glaucoma, cataracts, and age-related macular degeneration.

Skin Cancer Screening as Individuals with average risk will want to plan for a yearly visit with the dermatologist for a skin cancer screening and examination of any moles, spots or lesions. If you have a family history of skin cancer or have other underlying risk factors, your doctor may recommend more frequent visits.

Start these screenings at age 45 (if not before)

Menopause Check-up (Gennev refers to this as the M-check) – Starting at the age of 45, women’s post reproductive health care begins with a menopause check-up. A board-certified OB/GYN who specializes in menopause will answer the health pains of menopause, determine what state of menopause you currently are in, and may help assess the risks for chronic issues that may arise as your estrogen declines. The incidence of rising cholesterol, depression, sexual dissatisfaction, fluctuating blood sugar levels and more are common after menopause, and it’s best to address these changes before they become health concerns. If you haven’t had your M-check, start by taking the assessment. Then, speak with a doctor and feel better starting now.

Mammogram as The American Cancer Society suggests that women with no prior history, or family history of breast cancer get mammograms each year beginning at age 45, and continue with screenings as long as a woman is in good health and is expected to live 10 more years or longer.

Colonoscopy as Due to the increase in colorectal cancer in younger individuals, The American Cancer Society now recommends that screenings for individuals with average risk begin at age 45. Colonoscopies can detect disease, and may help prevent cancer as precancerous polyps can be removed during the procedure.

Bone Density as Osteoporosis often begins to develop in women a year or two before menopause. For this reason, working with your physician on when a DEXA scan may be right for you is important. The current national recommendation for individuals with average risk is to do a DEXA scan at 65. But for menopausal women with a fragility fracture or strong family history, earlier screening may be recommended.

Put your best foot forward with healthy lifestyle changes

With your health and well-being being top of mind, there’s no better time to recommit to the daily habits that support your body and mind during menopause and beyond.

“Feed your body right – Menopause brings with it many bodily changes, but a well-balanced diet and nutrition can help support you on your journey. Learn more with Nutrition Recommendations for the Menopause Transition.
“Re-examine your alcohol intake as When you reduce or remove alcohol from your diet, the health benefits quickly add up. Find out ways to help curb your urge for cocktails.
“If you smoke, STOP! as Cigarettes can amplify what is already bad about menopause. Check out these tips for how to quit for good.
“Sleep better as A good night’s sleep has restorative powers. Read more with a Woman’s Guide to a Good Night’s Sleep.
“Move every day as Daily exercise can help reduce the risk of diabetes and heart disease and slow bone loss after menopause. And walking is one of the easiest steps you can take to keep moving! Learn more about the Benefits of Walking.

Whether you’re in perimenopause or post-menopause, lifestyle behavior change is a must for managing weight, hot flashes, anxiety, sleep, fatigue and joint pain. Gennev’s menopause specialists work with women of varying levels of discipline, so don’t overthink it, just start by doing something. Put your health first this year, and book an appointment.

Do you go to bed only to find yourself staring at the ceiling with what seems like a million things running through your head? Sometimes it can feel like negative thoughts and worries are on repeat.

Rumination (repetitive thinking) is usually associated with anxiety and stress. You may find yourself worrying obsessively about something in particular during your waking hours to the point where it affects other aspects of your life and possibly your relationships. And when it occurs when you are settling in for sleep, it is also considered a symptom of insomnia.

Why does rumination occur?

Fluctuations in hormones has been linked to anxiety and mood disorders, and is associated with rumination. Women are more prone to increased symptoms of anxiety and mood disorders as estrogen and progesterone decline in menopause.
Medications may also impact your sleep, causing rumination and insomnia.
Caffeine can also make it difficult to fall asleep and in turn cause your mind to race more.
Stress is a major contributor to racing thoughts any time of day. Major life transitions and stress at home, work, financially and more can cause rumination as you try to fall asleep.

How to manage repetitive thoughts

Build your resiliency to counteract stress and its adverse effects. Start with learning what stress feels like in your body. Practicing a body scan can help you become more in touch with your body, noticing areas of tension, and then working on releasing them.

Practice Mindfulness. Mindfulness is defined as a mental state achieved by focusing one’s awareness on the present moment, while calmly acknowledging and accepting one’s feelings, thoughts, and bodily sensations. For busy, stressed people, this may seem impossible to achieve. But even just a few minutes during the day or before you go to bed, taking several deep, intentional breaths can have a very positive effect on helping you find your calm, control repetitive thoughts, and fall asleep. If you are unsure how to get started, there are many apps like InsightTimer and Headspace that can help you begin your mindfulness practice.

Try yoga nidra. Yoga nidra means “yogic sleep“, and is a deep relaxation technique and a form of meditation. In this practice, the body is completely relaxed and your awareness is turned inward by listening to a set of instructions (much like a guided meditation).

Start a bedtime journal. The practice of writing down your thoughts and feelings from the day can help to lower stress. Research suggests that journaling can help us accept rather than judge our mental experiences, resulting in fewer negative emotions in response to stressors.

Set yourself up for a good night’s sleep. Get started by getting some exercise during the day, be consistent with the time you go to bed, avoid caffeine and alcohol in the hours leading up to going to sleep, turn off screens at bedtime, and keep your room cool and dark.

If your repetitive thoughts at bedtime just won’t quit, you may consider visiting with your doctor or therapist for support. Dr. Rebecca Dunsmoor Su, Gennev’s Chief Medical Officer shares, “We often recommend cognitive behavioral therapy for insomnia.“ Cognitive behavioral therapy is a style of therapy that identifies negative behaviors, and works to manage them in amore effective way. Cognitive behavioral therapy for insomnia very specifically tracks behaviors around sleep, such as when you go to bed, what you do when you wake in the middle of the night, what things you include in your bedtime ritual, as well as what you do when you wake in the morning. Ultimately the therapy will work to adjust those habits to improve your sleep.”

You may also try working with a menopause specialist to learn about prescription and natural treatments, optimize your wellness (nutrition, movement, mindfulness) and identify lifestyle modifications (such as a new sleep ritual) that will support better sleep.

^{The information on the}^Gennev^{site is never meant to replace the care of a qualified medical professional. Hormonal shifts throughout menopause can prompt a lot of changes in your body, and simply assuming something is “just menopause”can leave you vulnerable to other possible causes. Always consult with your physician or schedule an appointment with one of}^{Gennev’s telemedicine}^{doctors before beginning any new treatment or therapy.}

With all of the knowledge, self-awareness, and confidence that we gain as we age “about ourselves, our bodies, our turn ons and turn offs “ sex after 50 can be some the best sex of our lives. I know that can be hard to believe. We’ve all heard the negative messaging around menopause as the period of time when we lose our libido as well as our physical ability to enjoy sex. As a physical therapist who helps patients maintain their pelvic health, at every stage of life, I can tell you that it doesn’t have to be true for you.

Yes, menopause brings about significant changes as your ovaries stop producing estrogen. But, by focusing on your pelvic health, you can not only prevent and improve pelvic floor issues that put a damper on sex, you can also connect with your body in new and pleasurable ways.

Low Estrogen & Sexual Functioning

Several menopause-related changes can impact the way your body feels and functions during sex. As estrogen levels decrease, blood flow to the tissues of the vulva decreases, which can affect the size of the clitoris and its sensitivity to stimulation. The tissue of the vagina can become thinner and less flexible, and you may produce less natural lubrication which can lead to pain during sex. The same dryness that affects the tissues of the vagina can also affect the tissues in your mouth, which can make oral sex and even kissing a challenge.

These changes also tend to coincide with age-related muscle and sensory shifts, which can pose even more challenges to maintaining and enhancing one’s sex life. For many people, weakness in the muscles that surround the vagina, bladder and bowel can lead to urinary leakage, constipation, sexual dysfunction and pelvic organ prolapse. All of these things can contribute to how we feel about, and how we experience sex.

But changes in your body are nothing new. Through every menstrual cycle since puberty, your body has changed. If you were ever pregnant, your body has changed. If you’ve dealt with major illnesses or injuries, your body has changed. This is not to say that going through menopause is easy or to minimize the impact that these changes can have on your life, but you’ve experienced major physical changes before “ and both you and your body are incredibly resilient.

There’s clear evidence showing that addressing pelvic floor muscle function, in conjunction with improving overall muscle strength and physical wellbeing, can help to reduce and even prevent many of these symptoms related to menopause. Which brings me to the power of your pelvic floor.

Tap into the Power of Your Pelvic Floor

The pelvic floor refers to the multi-tasking group of muscles and connective tissues that make up the bottom of the pelvis. These muscles run from your pubic bone to your tailbone and wrap around the vaginal and anal openings. They also support and bring blood flow to the clitoris, vulva, and vaginal walls; and they are critical to maintaining and elevating your sexual function!

It’s important to keep all of your muscles strong and healthy as we age, and the pelvic floor muscles are no exception. During penetrative sex, the muscles that wrap around the anal and vaginal entrances, lengthen and open for pain free penetration and stretch, but they can also be squeezed for increased friction and sensation. Your pelvic floor is also important in orgasm with research showing that, during orgasm, the pelvic floor muscles will actually contract involuntarily.

Strong, healthy muscles have better blood flow, and during arousal, your pelvic floor helps to prepare your genitals for sex by bringing blood flow into your tissues, helping with tissue engorgement, and increasing nervous system activity and sensitivity in all of your pelvic erogenous zones (your clitoris, labia, vagina, anus, cervix, and lower abdominals for example).

This is why one of the most physically important things you can do for your sex life is maintain your pelvic floor health. If you are unsure of where to start, try these tips below.

Make sex a habit. The “use it or lose it” principle is particularly important after menopause. While it’s not uncommon for sex frequency to slow down, it’s important to consider that if you aren’t having sex, or if it’s less frequent, the vagina may begin to narrow with less flexibility and increased atrophy of the tissues, which can lead to more pain and dysfunction during penetrative intercourse. If partnered sex isn’t an option or isn’t something that interests you, this is a great time for solo sex. Masturbation with a penetrative sex toy can be a great way to encourage blood flow to your vulvovaginal tissues.

Explore different kinds of touch. You may also choose to focus on outercourse, if your vaginal tissues feel pain during penetration. As your nervous system, and tissues of the pelvic floor change, what may have felt pleasurable before could start to feel irritating and unwanted. By focusing on touch and sexual activity that is pain free and pleasurable for you now, you can avoid taking part in the pain cycle that so commonly surfaces in menopause. Consider reaching out to a sex counselor, if you are looking for further guidance on how to explore different kinds of sex.

Maximize your pelvic floor muscle health. Even as we age, research shows that people who are sexually active and able to achieve orgasm tend to have healthier pelvic floor muscles. Since healthy pelvic floor muscles can encourage blood flow to where you need it most, you may consider learning strategies to improve your pelvic floor health, such as strengthening your pelvic floor or increasing the pain free flexibility of those muscles by using dilators or beginning a stretching program to address overactive and irritable muscles. It may even mean working on your ability to properly coordinate these muscles during sex.

To learn more about your pelvic floor and how it can improve your sex life, ask your gynecologist or primary care physician for a referral to a pelvic floor physical therapist. Your therapist will evaluate your pelvic floor muscle functioning and create a personalized treatment plan to address and prevent symptoms “ and help you feel good in your body right now, which may be the biggest sexual turn on of all.

Celestine Compton, PT, DPT is a doctor of physical therapy at Origin with a board-certified specialization in women’s and pelvic health. She continues to expand her knowledge and capabilities within the field of women’s health PT to provide her patients and community with the best care, advocate for her profession on local and national levels, and support the advancement of women’s health through contributions to research, public awareness, and education. As part of the Origin team, she hopes to do her part to raise the standard of care that all women receive at every stage of life and to improve patient access to quality care so that no individual, regardless of location, race, identity, education, sexuality, or economic status is left behind.

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Menopause information and advice is available everywhere now, and literally at your fingertips. And with a quick search with Doctor Google, you could either find some very valuable resources, or be taken down a path of misinformation. Gaining reliable advice as well as evidence-based treatments to manage your symptoms is what we are all about here at Gennev. So, we tapped into Dr. Lisa Savage, board-certified OB/GYN, to answer questions from our community about menopause, and help dispel the myths and share the facts surrounding symptoms and treatments.

Will my migraines disappear after menopause?

Headaches are very common, and what happens during menopause is highly variable. I’ve had plenty of patients whose migraine headaches do get better, others who got worse and many who stayed exactly the same. It’s not predictable and it’s very individual.

Some women have a cyclic component to their headaches (menstrual headaches) that come on as a prelude to menstruation, and lift after your period is over. Those types of cyclic headaches generally get better with menopause when cyclic hormones are not playing a role. Ultimately, I think it probably takes about a year after that last menstrual period to really know where your headaches have ended up – and even after that, there may be some change that can go either way.

How long does it take to feel better on HRT?

Time to symptom relief is a really gratifying part of starting HRT because it doesn’t take long. It’s not delayed gratification. I always tell my patients I don’t want to overpromise, but typically results can be seen anywhere from 48 hours to a couple of weeks.

How long can you take HRT?

It’s very individualized, and it depends on how old you are, when you need to start, and how long you want to take it. HRT does not need to be a long-term commitment if you don’t want it to be. Some women will take it for a few years to relieve the worst of the symptoms, and some women will need it longer, especially if they started their menopause transition at a younger age. Usually when a woman is approaching 60, I’m looking to see if we can get her off HRT, assuming she was around average age for menopause”¦meaning she’s been on it for around 10 years. I like to describe the therapy goal as extracting the most benefit while minimizing risk. But again, it’s not written in stone and there’s no hard and fast stopping point. Some women have ongoing symptoms for which they need the HRT. The most recent NAMS statement on HRT has taken away some of the boundaries about duration of treatment, which allows for our favorite way to prescribe medication; that is, with a lot of individualization.

Should I fear using HRT because it can cause breast cancer?

The short answer is no, but the better answer is “it depends.” There’s no doubt that some susceptible women, such as those with certain family history or genetic risk factors, may not be able to or want to take HRT because it may fertilize a propensity to develop breast cancer. It’s true that with longer term use from combined (that is estrogen and progesterone”¦not estrogen alone) HRT, there’s a small increased incidence of breast cancer. It’s about 8 extra cases per 10,000 women, so the absolute risk is very low. The increased risk from two glasses of wine per night or eating red meat is higher, to put it in perspective. You do have to commit to screening mammograms and knowing your body. I put this in terms of risk benefit ratio more than cause and effect. So often the benefits are going to outweigh any potential risk. We consider the individual patient and her individual profile when it comes to HRT.

Can women start having migraines in perimenopause if they’ve never had them before?

I’ve seen women start having migraines in perimenopause, but headaches are so multifactorial, especially vascular headaches. And my sense is that the sleep disturbance that comes along with perimenopause transition may play a big role in headaches. We all know if we’ve had a restless night’s sleep, the next day we don’t feel as well in our body. Maybe more headachy. I believe there’s a real sleep disturbance component to these headaches.

If you are post-hysterectomy, do you need to take the progesterone with the estrogen?

The only job of the progesterone in HRT is to protect the uterus from overgrowth of the lining. So, if a woman does not have a uterus, whether or not she still has ovaries, then she doesn’t need a progesterone. There’s some evidence to show that the combination of the estrogen plus the progesterone (the E + P) is what can cause some additional risk over time.

Is there a connection between autoimmune diseases and menopause?

Autoimmune is highly prevalent in women compared to men, and estrogen plays a role in autoimmune disorders and immunity in general. But immunity is also influenced by genetics, lifestyle and environment, so it’s hard to carve out just the estrogen component. It definitely plays a role in some autoimmune disorders such as rheumatoid arthritis and MS as as they may get worse with menopause. Lupus sufferers may actually feel better with menopause. But this varies greatly as it’s based upon the individual patient.

Is it true that the earlier a woman starts puberty, the earlier they’ll start menopause?

Not necessarily. A lot of women think if they were a late bloomer, they will not go through menopause until later. Or perhaps they started their periods when they were ten years old, and think they’re going to finish earlier. These things are not necessarily correlated. The average age of menopause across the board is 51. The normal age range is 45 to 55, and it’s independent of how old a woman was when she started puberty. Family history may actually be helpful; that is, knowing how old your mother or older sisters were at the time of menopause may be somewhat predictive.

Should I worry if I’m 59 and haven’t hit menopause yet?

This is definitely older than average (by the age of 55, 95% of women have completed the menopause transition), but as long as you’ve been getting medical care from a clinician who is familiar with these things and there is good confidence based on menstrual history and (in this case) labwork, that you are still pre-menopausal and not having post-menopausal bleeding, there are benefits to ongoing ovarian hormone production. There is a silver lining there for your bones, cognition and cardiac health.

Is weight gain a side effect of HRT?

No, HRT does not cause weight gain. But it is true that many women start HRT coincident with the onset of menopause, which does bring metabolic changes. Increased weight around your midsection is very common at this stage of life, even if you have never had it before. It’s the body’s way of compensating for the loss of ovarian estrogen production, since estrogen can also be made in fat. To a certain point (say 5-10 pounds), I usually encourage patients to be accepting of a new normal and not too go crazy trying to maintain a weight that they were five or ten years ago. Some changes in nutrition can be helpful, along with getting adequate sleep, and exercise.

What can I do about hair loss or hair thinning with menopause?

It is true that aging in both men and women can cause hair to thin. I never automatically attribute this to menopause and always encourage patients to see their dermatologist. Thyroid disorders, among a list of other things, can cause hair loss. Depending on the pattern of hair loss on a physical exam, labs and/or scalp biopsy might be indicated. Menopause absolutely can contribute to hair changes, but please see your dermatologist for an examination, blood work and investigation before assuming it’s strictly based on menopause.

Does HRT prolong menopause?

HRT does not extend or prolong menopause. This is a common concern among women considering HRT. Menopause symptoms tend to dissipate over time naturally, and so your symptoms are going to be what they are at that age, whether or not you took any HRT.

Is there a certain age that someone is going to start menopause?

It’s highly variable. I always say 45 to 55, but a lot of women will start to notice changes in their late 30s and I call those prelude symptoms. This is when symptoms tend to come and go. Certainly, into your mid 40s it is very common to start seeing some symptoms, even if they’re not consistent.

Is a woman infertile because her periods have become irregular?

You may still ovulate from time to time until you have gone a year without a period. So even if your period is not regular and predictable, I always tell my patients they still need contraception until they’ve been a year without a period. Irregular periods are not a form of birth control.

Is more painful ovulation a sign or symptom of perimenopause?

It doesn’t seem fair that when we’re trying to end our reproductive years that we have to get more pain with it. But I’ve seen many patients that report more painful ovulation and periods, and more PMS during perimenopause compared with the earlier years of their reproductive life.

If my hormone labs are normal then I’m not in menopause or perimenopause, right?

Not necessarily. Labs indicate levels in a snapshot – a moment in time as and they may vary a lot from one day to the next. If we look at a woman at the right age with classic symptoms, the labs might still be normal, or they may be normal today and not tomorrow. So, it’s good to not to rely on them, as normal labs may not mean that it’s not perimenopause.

What are your tips for relieving increased PMS during perimenopause?

There are a lot of holistic things I go back to like exercise, eating well, and adequate sleep. I have prescribed very low dose birth control pills for women in perimenopause who have a lot of PMS as women who do not ovulate do not have a lot of PMS symptoms. The pill eliminates ovulation so that that can be a nice transitional thing to do.

How do you feel about testosterone pellets as hormone treatment?

I don’t use them. Testosterone is typically prescribed for libido, and in order to make a difference on that, you have to use really high doses of testosterone. I call that trying to make a woman into a man – and there may be some cardiac risk associated with that. So, I am not a believer in the use of testosterone for women. Other doctors disagree, and I respect that, but I’m not a fan of testosterone in any form, whether it’s pellets or creams, patches, etc., and I’ve not found it to be helpful.

If you are in menopause, should you avoid regular Pap smears or have them more frequently?

Menopause really doesn’t influence our Pap recommendations for most women over the age of about 30. If you’ve had normal Paps, you can get one about every third annual. There are some age-based recommendations on how often to get a Pap, but typically we’re going to do Paps up to the age of about 65, assuming normal results over time. Menopause doesn’t influence whether or not to get a Pap smear.

Will all this extra protein in my diet make me fat?

I always promote a diet consisting of lean protein and vegetables, more specifically the Mediterranean way of eating. I think we really have to watch out for the carbs and especially refined sugars. As we age, we’re losing muscle, and estrogen does play a role in maintaining lean muscle mass. So, when your estrogen is decreasing and your muscle mass is naturally decreasing, having that additional protein can help to rebuild, repair, and maintain that muscle.

Are low dose antidepressants effective for hot flashes?

Yes, I’ve had some good luck with this. Especially for patients who cannot take hormone replacement therapy, or don’t want to. We know that certain low dose antidepressants can help with hot flashes. Additionally, menopause frequently brings mood disorders. It can unmask depression and anxiety or make it worse. So, you may get some double coverage by using a low dose antidepressant for hot flashes and moods. But I will say that as helpful as they may be, there’s nothing as effective as estrogen for relieving hot flashes.

What is your trusted advice for women going through menopause?

I always say be aware of “Doctor Google”. Getting your information from Doctor Google can be like drinking out of a firehose and you don’t know what’s reliable and what’s not. Rely on your physician, and specifically in menopause, your OB/GYN physician. Narrow your resources to reliable ones such as gennev.com, acog.org and menopause.org.

You can listen to the “Menopause Myths & Facts” interview with Dr. Savage here.

We can help relieve your menopause symptoms

You deserve the support, education and specialized menopause care that will help you start feeling better now. Learn more about Gennev’s Integrated Menopause Care by clicking here.

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The changes women experience during menopause don’t just affect their insides. Skin and hair also go through a transition. If you’re seeing noticeable changes in the health, texture and appearance of your hair and skin, chances are you can blame declining levels of the hormone estrogen. These unwanted and often unexpected changes can be frustrating, but there are things you can do to protect your skin and hair throughout the menopause transition.

Since estrogen is linked to hair growth, density and fullness, as hormone levels decrease, head hair can become dryer, more brittle, and thinner. And due to a greater proportion of androgens (male hormones), you may begin to notice some hair on your face that’s more like male facial hair, particularly on the jaw line. You may also notice a decrease in body hair, including the pubic area.

Declining estrogen also means skin gets thinner and less elastic due to a decrease in collagen. Without their usual supply of estrogen, our bodies produce less of the oil that both softens skin and helps it retain moisture. Menopausal skin loses elasticity and hydration and becomes thinner, dryer, and loose. Many women find they have acne again for the first time since puberty. Skin becomes more prone to rashes and bruising and may heal more slowly during this time.

There are many causes for changes in hair and skin as you age. It’s best to visit with a dermatologist for diagnosis and treatment, as well as to rule out any underlying conditions that may be attributed to what you are experiencing.

Medical interventions for unwanted menopausal hair

If you are dealing with unwanted facial hair in menopause, there are a few options to consider, although they can come with some downside:

Topical treatments as these can be expensive and require continued use or the hair grows back.
Depilatory creams can be bought over the counter, but they may be a bit stringent for the face, particularly as skin gets more sensitive with age.
Lasers shoot beams of light over the skin, overheating the hair follicles and destroying them so the hair doesn’t regrow, but this can take several treatments to become permanent, and it doesn’t work on fine or light-colored hairs.
Zapping hair with electrical current in electrolysis is expensive and slow because it can only destroy one hair at a time. It’s permanent, but can take a long time to complete, hurts, and can potentially scar.

Medical interventions for hair loss

The signs of hair loss in women may include an increase in hair falling out each day, noticing patches of thinner or missing hair, a widening part at the top of your head, or even noticeably smaller ponytails.

Before pursuing hair loss treatment, it’s important to talk with your doctor or dermatologist to learn the cause of your hair loss, as well as treatment options that are right for you . Your healthcare provider will do a thorough history as well as order relevant tests to help diagnose your hair loss:

Blood tests to evaluate ferritin levels, vitamin and mineral levels
Blood tests to evaluate hormone levels including your thyroid and sex hormones
Scalp biopsy or Trichoscopy (non-invasive dermoscopic imaging of hair and scalp)
Hair pull – doctor gently pulls on your hair to see how many hairs come out

If it’s thinning head hair you are experiencing, unfortunately, there are few solutions. The good news is, the loss generally slows as hormones level out.

Minoxidil (Rogaine) can help you regrow some hair, though you have to keep using it. “
Anti-androgens may work for some women for whom Minoxidil is a non-starter.
For some women, an iron deficiency may be partly responsible, so an iron supplement can be helpful. Be sure to consult with your doctor before starting any new supplement regimen.
Hair transplants have come a long way since hair plugs and can be quite effective in filling in patches where hair has thinned.

Medical interventions for changing skin

Before you do anything to aid your age-related skin changes, we recommend locating a dermatologist who has experience with women in menopause, as all skin is different and should be treated with real care. Note that some procedures work best on skin that’s aged from sunlight rather from estrogen loss. Some options include:

Prescription-level retinoid skin creams, made from vitamin A extract.
“Peptide creams use amino acids (though these are likely less effective than retinoids).
“Microdermabrasion encourages new skin growth by removing the top layeras it is time consuming and expensive and the effects only last about 4 weeks.
“Laser resurfacing of the skin uses high-intensity light to tighten loose skin, improving the look of wrinkles.
Newer non-ablative laser resurfacing doesn’t cause wounds to the skin, so recovery is quicker. The heat generated by the laser promotes collagen production which causes the skin to tighten and look younger and healthy.“
Chemical peels remove the upper layer of the skin and encourage new growth.

Lifestyle modifications for healthy skin and hair

Probably the best thing you can do for your skin and hair, no matter what your age, is protect what you have.

Reduce sun exposure, and use SPF every day.
Use gentle products that don’t strip away the remaining moisture.
Hydration is key. Drink plenty of good, nutritious water to hydrate your body from the inside out.
Don’t smoke.
Shower with cooler water for less drying of your skin.
Moisturize skin and condition hair. Replacing the moisture you’ve lost isn’t entirely possible, but every bit helps.

When it comes to skin, we strongly advise getting to know your skin very well. Checking your skin every month for changes can perhaps mean catching a potentially serious problem like skin cancer while still in its early and more treatable stages.

Natural remedies for skin and hair

For unwanted facial hair, sugaring, tweezing, waxing, and threading may be slow and tedious, but they can be less expensive, less potentially damaging to skin, and reasonably effective, if a bit painful.

To preserve head hair, use gentle styling techniques that require less heat and pulling. Shampoo with zinc or selenium might help with a dry and itchy scalp. A shorter hair style might help make hair appear fuller.

Some say eating estrogenic foods such as soy, dried fruits, and flaxseed can help, though there’s no research to back that up. Others take collagen supplements, though currently there’s little evidence to prove the impact on menopausal hair and skin.

The effect of changing hormones on your hair and skin may seem out of your control, but when you prioritize your wellness during this stage of life, you will support your body and your beauty from the inside out. Keep feeling and looking your best in menopause and beyond by maximizing your nutrition with a healthy and balanced diet, staying hydrated as well as exercising each day. And please visit with your doctor or a dermatologist when it comes to concerning hair and skin changes, no matter what your age.

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If you are among the many women who are taking the “grin-and-bear-it” approach to managing your menopause symptoms, you may be suffering needlessly. We know that menopause can feel down right daunting, but it doesn’t have to be that way.

We recently spoke to a few of Gennev’s physicians (who are menopause specialists) for their responses to common questions and concerns that women raise within their practices. You’ll notice much of their advice points back to “speaking with your doctor.” That’s because menopause is a very individual experience, and as such, there is no one-size-fits-all remedy or treatment. Having a comprehensive discussion with a menopause specialist about the symptoms you are experiencing can help uncover the treatments and therapies that will help you find relief, and start thriving again at this stage of life.

Here are 6 tips for managing symptoms as shared by Gennev physicians who are menopause specialists.

For better sleep, treat the symptoms that are keeping you awake

“That may mean hormone therapy for some who have bad night time flashes,” says Dr. Rebecca Dunsmoor-Su. “For others we often recommend cognitive behavioral therapy for insomnia.” Cognitive behavioral therapy is a style of therapy that identifies negative behaviors, and works to manage them in a more effective way. Cognitive behavioral therapy for insomnia specifically tracks behaviors around sleep, such as when you go to bed, what you do when you wake in the middle of the night, what things you include in your bedtime ritual, as well as what you do when you wake in the morning. Ultimately the therapy will work to adjust those habits to improve your sleep.

Be careful about turning to sleep aids. “Sleeping pills are a temporary aid, and generally not the long-term solution,” says Dr. Dunsmoor-Su. Instead, try working with a Gennev Registered Dietitian Nutritionist to optimize your wellness (nutrition, movement, mindfulness) and identify lifestyle modifications (such as a new sleep ritual) that will support better sleep.

Treat the cause of painful sex, not just the symptom

Painful sex can be a real problem with perimenopause and menopause. While there are a number of causes (including acute conditions, which require a physical exam to diagnose), much of midlife pain with sex is due to declining estrogen levels resulting in vulva and vaginal changes. The tissues become dry, thin and fragile over time. Dr. Lisa Savage shared, “This condition is called genitourinary syndrome of menopause or GSM. It is generally progressive; meaning, it gets worse over time. This dry, fragile tissue is inelastic and prone to infection and injury. Pain with penetration can be prohibitive not only because of the tissue condition, but also because of the development of vaginismus, which is an anticipatory, involuntary muscle contraction. Vaginismus makes penetration even more painful, thus a vicious cycle happens.”

While using lube for painful sex is critical and recommended, treating the cause and not just the symptoms is important. “To restore and maintain the tissue integrity, a menopause specialist will recommend systemic or vaginal estrogen,” shares Dr. Savage. “Plenty of patients need both, but in some cases, just one or the other is sufficient. Vaginal estrogen is not absorbed to any significant degree, so it is safe in almost everyone and can be used indefinitely.”

Even with estrogen therapy, lube is usually needed. Silicone-based lubricants tend to work better in mid-life, but couples should try out different kinds and find out what works best for them. And sometimes, a multi-pronged approach, including vaginal estrogen, lubricant and pelvic floor therapy may be necessary to fully restore a woman’s sexual function and enjoyment.

“On the enjoyment note, many women present with a primary complaint of low desire/low interest and when questioned further, they have pain,” shares Dr. Savage. “So, I ask ‘Who would be interested in something that is painful? Our first priority when exploring a complaint of diminished interest in sex is acknowledging and treating pain. Only then can the rest of the multiple facets of desire be assessed and addressed.'”

“If you have pain with sex, don’t accept it as a new normal. Don’t grit your teeth and power through, sacrificing your own enjoyment,” says Dr. Savage. “Don’t minimize its effect on your interest in sex and don’t hesitate to get help. In almost all cases, it can be entirely remedied. Your sex life is important, and it can be better than ever in mid-life, so reclaim it.”

Get to the bottom of why you wake up to pee

We all know how annoying it is to wake up in the middle of the night to urinate. It can be difficult to fall asleep again after a trip to the bathroom. According to Dr. Carol Russell, “To decrease the chances this will happen, try to limit your fluid intake at least 2 hours before going to bed. Do not have any caffeinated beverages 2-3 hours before bed as caffeine is irritating to the bladder and can cause an urge to void, even when your bladder is not really that full. Also, be sure to empty your bladder right before you lie down to sleep.”

It’s time to see your doctor when frequent urination (and possibly bladder leaks) is impacting your sleep and your life. They will rule out any underlying conditions that may be a factor (like diabetes), and can recommend medications, hormones, biofeedback, or devices that may prove helpful. They may even suggest you visit with a pelvic floor specialist to help strengthen muscles and retrain your bladder.

Bleeding post menopause? Go see your doctor

If you are post-menopausal (a year or more has passed since your last menstrual period), seeing blood can be scary. According to Cleveland Clinic, bleeding could be a symptom of vaginal dryness, polyps (noncancerous growths) or other changes in your reproductive system. In about 10% of women, bleeding after menopause is a sign of uterine cancer.

“Bleeding post menopause always requires a visit with your doctor to create a personal plan,” says Dr. Leasa Lowy. “We bleed for lots of reasons that are not scary but require some management. However, most importantly we want to make sure it is not an issue that needs more in-depth exploring such as cancer.” So, if you bleed post menopause, it is very important to connect with you doctor.

Approaching menopause? Take vitamin D

Supplements can be a great, and necessary, part of a woman’s life. But which ones should you take? And where should you get them? Dr. Wendy Ellis shared, “There are some nutrients, like vitamin D, which should be taken by all women as they approach menopause. Other nutrients, like B vitamins or CoQ10 as may be diminished by medications we take (birth control pills, statin medications, etc.). We may also take supplements if we are feeling under the weather and want to kick our immune systems into gear (think Vitamin C or zinc).”

Whether to take them or not is determined by where you live (think vitamin D in colder climates / northern latitudes), your age, and your medical history. Supplements can be an amazing addition to lifestyle choices for optimal health, but we can also take too many supplements as or take supplements that might interfere with our medications as so it’s important to check in with your doctor to determine what’s right for you.

How do you know of your supplement is good quality? Dr. Ellis tells us, “To determine if a product is a good one as you can look for the cGMP stamp. This is a certification of good manufacturing policy as which means that a third party has tested the product and ensures its quality and content is as listed on the label.”

Positive lifestyle changes will help support your body in menopause

To help you feel your best, don’t discount how much making some meaningful lifestyle changes can help. Things like drinking more water to help combat fatigue, dry skin and dry eyes, as well as headaches, and taking a 15 minute walk every day to help lower stress and lift your mood are small changes that can make a big difference. “Adopting a healthy diet, getting adequate exercise each day, and maintaining social connections can go a long way towards feeling your best,” says Dr. Savage. If you need some help adopting a healthier lifestyle, Gennev RDNs will create a personalized wellness plan for you to help with nutrition, movement, mindfulness, and provide some support and a level of accountability along the way.

No matter what symptoms you may experience in menopause, don’t put off getting the support that will help make this transition easier on your physical and emotional health. A 30-minute appointment with a menopause specialist can provide the advice and treatment options you need to take control of your menopause journey.

Sleep may seem more elusive during midlife and menopause than any other time of life – even after having a new baby. Ninety-six percent of women in midlife say that poor sleep is one of their top three symptoms of menopause, according to a recent Gennev survey. To make matters worse, it seems like every day there’s another health problem attributed to a lack of sleep”weight gain, memory problems, decreased immunity, and increased risk of diabetes, heart disease, stroke, and even cancer. No wonder you can’t sleep!

“When sleep becomes a constant concern that a person is preoccupied by, that in itself can make it difficult to become a good sleeper,” says Sound Sleep Guru Meredith Broderick, M.D., who is board certified in sleep medicine and neurology.

So, the first step to better sleep is to stop worrying so much about your sleep. We know, easier said than done. That’s why we’ve created this guide to help you to stop obsessing about your sleep and start enjoying a good night’s rest. You may be surprised to find out that some of the most effective strategies are pretty simple. And even if you’re sleep isn’t perfect, there are things you can do to mitigate the negative effects of poor sleep on your health.

Why is a good night’s sleep so important?

Sleep is your body’s rest and repair time. You may think you’re busy during the day, but a lot is going on inside your body at night. Cells are regenerating. Hormones are regulating. Memories are being stored. Your immune system is reinforcing itself. Muscles are getting stronger. Nerve cell connections are being made. All in an effort so you can perform at your best the next day.

To make all of this happen, your body cycles through two types of sleep throughout the night. If you use a sleep tracker like a Fitbit or Apple watch, you may be familiar with some of this. The first type is non-rapid eye movement sleep (non-REM), which includes light and deep sleep. The latter is a crucial time for growth and repair, and if you awaken during this stage, you’ll often feel groggy and disoriented for a while. The second type is rapid eye movement sleep (REM sleep), which involves more brain activity than non-REM. This type of sleep is essential for the processing and storing of information, including memories, in your brain. Overnight you cycle through the various stages, with each cycle lasting about 90 minutes and the REM stage getting longer the more you sleep.

How menopause interrupts sleep at night

There are lots of reasons women sleep poorly during midlife. Hot flashes. Worries. Night sweats. Restless leg syndrome. Pain. A never-ending to-do list. Urinary issues. Sleep apnea. Even if you don’t have trouble falling asleep, you may find yourself waking up more often throughout the night and having a harder time falling back to sleep. Unfortunately, sleep problems don’t usually disappear along with other menopause symptoms.

But a good night’s sleep doesn’t have to be a dream. Often, when you address underlying issues such as urinary problems or joint pain, you’ll sleep better. Treating menopause symptoms like night sweats and anxiety can also help. That’s why your first step should be to see a doctor with experience treating women in menopause. They will understand what you’re going through and have the most options for helping you. A serious sleep robber that needs immediate attention is sleep apnea. If your partner notices that you’re snoring or appear to stop breathing while you sleep, talk to your doctor about getting checked for sleep apnea. As estrogen levels decline, you’re more likely to snore and even experience sleep apnea, a serious condition that disrupts your breathing. Like other underlying conditions, treating sleep apnea will help you sleep better and wake up feeling rested.

What’s more important: quantity of sleep or quality?

As you’re trying to improve your sleep, you may get fixated on the number of hours you’re snoozing. If you wear a sleep tracker, you might obsess about how much deep versus REM sleep you’re getting. While both quantity and quality are important, Dr. Broderick says the most valuable endpoint is feeling rested throughout the day. “If you feel good, the numbers aren’t as important,” she says. “Feeling good and functioning well during the day are what I care about the most.”

And getting a good night’s sleep, so you wake up feeling rested, starts long before you turn in for the night. “What you do with the time you are awake and the quality of your waking hours has a dramatic impact on your sleep quality,” Dr. Broderick explains. “Being active, engaged, having a purpose, and connection are reasons why you get out of bed in the morning. They also keep you busy and help your body generate the need for deep, uninterrupted sleep.”

8 steps to getting a good night’s sleep

While you address any underlying causes that may be keeping you up at night, here are additional steps you can take to set your body up for a good night’s sleep. Some may even help with conditions like anxiety, joint pain, and hot flashes that can rob you of sleep.

Be active. The latest research shows that exercise can protect against the adverse health effects of poor sleep. All activity levels provide some benefit, and the more you do, the more protection you get. Exercise has also been shown to improve sleep so it’s a win-win.
Adopt a plant-based diet. A healthy diet is even more essential when you’re not sleeping well. A new Stanford University Medical School study found that when you incorporate more plant-based foods into your diet, the decrease in saturated fats and sugar minimized the side effects of sleep deprivation, such as brain fog, poor concentration, fatigue, and irritability. Other research suggests that high-carbohydrate diets may promote better sleep than high-fat diets, and foods like fish, fruits, vegetables, and milk products may also help.
Get out in the sun. Sunlight is one of the most potent ways to reset your body’s internal clock, your circadian rhythms, that dictate your sleep-wake cycle. It tells your body to stop producing melatonin, a hormone that promotes sleep. That’s why it’s best to get a dose of sunlight early in the day. A morning walk is a great way to do this and get some exercise for a double-dose of sleep medicine.
Wake up at the same time every day. It’s best if you have a consistent bedtime and wake-up time, even on weekends, to train your body and brain to know when it’s sleep time. If you can’t be consistent with both, at least keep a consistent wake-up time, which may make it easier to fall asleep at night than if you sleep in the prior morning.
Curb caffeine. You don’t have to cut it out entirely but cut off your caffeine consumption (coffee, tea, soda, chocolate) at least five hours before bedtime. The earlier, the better. Caffeine can stick around in your system for 12 hours or more. And even if you think it doesn’t affect your sleep, research shows that it can shorten valuable deep sleep time.
Pick up some weights. Cardio like walking, running, cycling, or swimming tend to be the go-to types of exercise. But a new study suggests that strength training may have an edge in promoting sleep. Because strength training can be more taxing to muscles and requires more recovery than cardio, it may make your body crave sleep, so you sleep more soundly.
Limit night lights. Bright artificial light and blue light from screens can disrupt your sleep hormones, making good quality sleep harder to get. Turn down overhead lights and limit screen time in the evening to signal to your body that bedtime is coming. Avoid screens for at least 30 minutes before hitting the hay.
Trade in your nightcap. A glass of wine or other alcoholic beverages may make you sleepy, but they can cause you to wake up more and get less deep sleep. Instead, sip golden milk or 100-percent tart cherry juice about 30 minutes before bed, recommends Gennev Health Coach Stasi Kasianchuk.

If you continue to have sleep issues, consider seeing a board-certified sleep specialist or a behavioral sleep specialist. They can provide cognitive behavioral therapy, which has been shown to be effective for chronic sleep problems.

When you notice a change in sleep pattern that may be associated with the menopause transition, especially if body temperature instability is part of the problem, consider an appointment with a Gennev doctor to address the role that hormonal shifts can play in your trouble sleeping.

If you struggled to button your jeans this morning, you are NOT alone. Most women gain about a pound a year on average during the menopause transition. While that doesn’t sound like a lot, the big issue is where those pounds are suddenly going”right to your belly! Belly fat is such a common occurrence that there’s even a name for it, the menopot. Unfortunately, it isn’t just a problem when you’re trying to zip up your jeans, extra weight in this area can lead to a host of health problems.

Belly fat & menopause: What’s happening?

During childbearing years, the hips, thighs, and butt were likely the go-to spots when you gained weight. But once perimenopause arrives, your middle is more likely to be expanding. Estrogen directs fat to the lower body early in life to support childbearing. When estrogen declines, fat instead migrates to the abdominal area, similar to the pattern in which men gain weight.

The location of the fat isn’t the only difference. Weight gained in the hip, thigh, and butt areas is usually subcutaneous, right below the skin. But when you start packing on pounds in your midsection, the fat builds up deeper and around your organs. This fat, called visceral fat, appears to be more active than surface fat, releasing substances, affecting hormones, and increasing your risk of high cholesterol, heart disease, diabetes, and even cancer. According to a study in the Journal of the American Heart Association, women with more central body fat had a 10 to 20 percent greater risk of having a heart attack during the seven-year study than women with more overall body fat. A widening waistline can even be risky if you’re otherwise a healthy weight.

Vanity aside, it’s smart”possibly even lifesaving”to take steps to manage your midsection.

What to do about belly fat

Don’t worry, you won’t have to do dozens of crunches. It’s impossible to spot reduce. Instead, a comprehensive approach to all-over weight loss is your best strategy for shrinking your belly and protecting yourself against future health problems. Here are some additional steps that may target belly fat.

Eat more fiber, especially the soluble kind. This type dissolves in water to form a gel-like substance that helps to lower cholesterol and glucose levels. It also appears to help keep belly fat at bay. For every 10-gram increase in soluble fiber, there was a four percent decrease in the accumulation of abdominal fat, according to a study in the journal, Obesity. Good sources include oatmeal, oat cereals, barley, beans, nuts, lentils, peas, apples, blueberries, oranges, Brussel sprouts, and sweet potatoes. Fiber also helps by filling you up for fewer calories and improving digestion.

Kick up the intensity. All exercise is good for your health and body weight, but pushing yourself a bit could help slim down your middle. When researchers tracked over 1,000 adults for five years, they discovered that those who did some type of vigorous exercise”think jogging, jumping rope, fast cycling, speedy walking”at least a few times a week accumulated less belly fat than those who rarely or never got their heart rate cranking. An easy way to up your intensity is by adding short intervals to your usual workout. So, if you normally walk for exercise, speed up or jog for 30 to 60 seconds, then recover for a minute or two, and repeat throughout your workout. Increasing the speed of any activity or adding some impact”if your joints don’t mind”will ratchet up the intensity.

Skip the cocktails, or at least limit them. Drinking alcohol has been linked to a larger waistline, though it’s not exactly clear why those Cosmo calories seem to be drawn to your middle. Most drinks are high in calories, contain a lot of sugar, and often contribute to poor food choice when you’re indulging.

Pick up some dumbbells. If you’re not strength training, you’re losing vital muscle mass that fuels your metabolism. The decline can start in your 30s and means that you’re burning fewer calories. No wonder it’s harder to lose weight and easier to gain it as you get older. But lifting weight, using resistance bands, or doing body weight exercises like pushups can curb the loss and even rebuild some of the lost muscle. And according to research, it can help shrink belly fat. And just two or three workouts a week will do the trick. You can even pump out some reps while your binge watching your favorite show.

Find a way to chill. We know, we sound like a broken record. But, when you’re stressed, your body pumps out higher levels of the stress hormone cortisol. One of the effects”there are many negative ones“of increased cortisol appears to be a bigger belly. The good news is there’s no right way to relax so pick what works for you. Walk. Meditate. Listen to relaxing music. Take some deep breaths. Do yoga. Sit on the couch and stroke your dog or cat.

Most importantly, stick with these healthy habits. Because visceral fat is so deep you may not notice the changes right away, but research has found that even if you don’t drop any pounds, you’re reducing your risk of future health problems.

When to get help for belly fat

A large waistline puts you at risk for metabolic syndrome, a cluster of symptoms that can lead to heart disease, type 2 diabetes, stroke, and other health problems. If you have any of these related symptoms or are taking medication for any of them, you should see a doctor.

Abdominal obesity (40+ inch waistline for men; 35+ inches for women)
High triglyceride level (150 milligrams per deciliter of blood [mg/dL] or greater)
Low HDL (“good”) cholesterol (less than 40 mg/dL in men or less than 50 mg/dL in women)
High blood pressure (top number 130 mm Hg or greater, bottom number 85 mm Hg or greater)
Fasting glucose (100 mg/dL or more)

Increased belly fat is also a primary risk factor for insulin resistance”a precursor to diabetes, and a warning flag for heart disease, stroke, fatty liver, and vascular disease.

Other warning signs that should prompt a call to your doctor:

A rapidly expanding waistline
Losing weight, but your midsection keeps growing
Belly bloat accompanied by severe pain, spotting between periods, postmenopausal bleeding, blood in your stools, or fever.

We can help you manage belly fat

Explore our weight management program“Get personalized guidance for managing midlife body changes and meeting your health goals from our menopause-trained RDNs and MDs.
Learn more about meeting with a Gennev doctor or RDN“Our menopause specialists can help you understand why you are experiencing belly fat and the impact on your overall health and wellness; here’s how to get started.

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While hot flashes are practically synonymous with perimenopause, some women experience the other extreme: a bone-deep cold that no matter how many blankets you layer on, you just can’t warm up. Or you may be in a warm room and suddenly feel chilled and begin shivering. Sometimes cold flashes come on the heels of a hot flash when damp, sweaty clothes only make them worse. Other times, they come alone and mysteriously. Cold flashes usually pass within a few minutes, but they can last for up to 20 minutes and are more common at night.

Cold flashes are considered an unusual perimenopause symptom, but given the number of women we’ve heard from who are experiencing them, we’re starting to think that cold flashes are more common than doctors realize.

Cold flashes: What’s happening?

Much like hot flashes, cold flashes are likely caused by the hormone havoc going on in your body. As estrogen levels drop, the hypothalamusasthe part of your brain responsible for regulating your body temperatureasgets overly sensitive, and therefore temperature regulation can be unstable.

Cold flashes can also be triggered by a panic attack or anxiety. During a panic attack, your body releases adrenaline and other stress hormones that can affect its ability to regulate body temperature.

Although they’re less common than hot flashes, cold flashes are no less disruptive, especially at night. And given how rare a decent night’s sleep can be during this time of life, learning how to manage cold flashes may give you a shot at some vastly improved rest.

What to do about cold flashes

Here are some steps you can take to help even out your body temperature:

Limit caffeine and alcohol. Not only can they disrupt your sleep, but these substances also influence your body’s temperature regulation system.

Avoid sugar, spicy foods, and nicotine. All can be triggers for cold or hot flashes.

Be prepared. Stash extra clothes at work, in the car, or carry some with you. You can don another layer when a cold flash strikes. If it’s a hot flash, you can change out of damp clothes, which may reduce the chances of a follow-up cold flash. At night, keep extra blankets handy. Moisture-wicking bedding and pajamas can help, too, and keep a spare pair next to your bed for a quick change if needed.

Get active. When you’re in the throes of a cold flash, hop out of your seat and start moving. This will increase blood flow to help warm you up.

Practice relaxing. Easier said than done, right? Especially if you’re thinking that it means meditating for a half hour or taking an hour-long yoga class. It is easier than that. You can start with just a minute or two. Set a timer for every hour or so and when it goes off, stop and take a few deep breaths. Before each meal, do a few stretches. Or every time you’re in your car alone, close your eyes and pay attention to how your body feels”of course, do this before you start driving or once you reach your destination. Even small steps can help to ease anxiety that may precipitate a number of perimenopausal symptoms.

Slip on socks. If cold flashes haunt you at night, keeping your feet warm may help.

Keep in mind that sometimes the things you do to survive a cold flash may trigger a hot one. If that’s your M.O., proceed with caution. Drink warm beverages instead of hot ones. Pile on one blanket at a time instead of half a dozen. Turn up the thermostat a degree or two, not 10.

When to get help with cold flashes

If you’re having disruptive cold flashes, a trip to the doctor is recommended. Poor blood circulation, thyroid dysfunction, anemia, and low blood sugar can cause cold flashes and can be more serious than a typical hormonal imbalance due to perimenopause. If they are strictly perimenopause related, you and your doctor can discuss hormone replacement therapy (HRT),antidepressants, or low-dose birth control pills, which can offer relief.

We can help you manage your cold flashes

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