Feel like saving a life this week? If you read and share this article with all the women you know, you just might.
Your mission is simple, no paramedic training or medical school required. All we need you to do is to take in the information we’re about to share about women and cardiovascular disease, then pass it on. Send it to the group chat, bring it up at book club, forward it to friends and family—you never know who might need to hear it, but considering the statistic that by age 45, one in nine women will have heart disease, increasing to one in three by age 65, the odds are good that someone you care about will be grateful for the information.
We need all the messengers we can get, since heart disease remains the number one cause of death for adults in the United States and affects more than 60 million women, but only about 44% of women today recognize their risks (which, as we have written elsewhere, increase after menopause).
That means more than half of American women are missing out on critical information about how heart disease presents in women, what our unique risk factors are, why heart disease risks increase after menopause, and how to self-advocate for essential care.
That’s not going to be you.
Today we’re sharing insights from a conversation between Gennev’s Chief Medical Officer, Dr. Rebecca Dunsmoor-Su, and cardiologist Dr. Sarah Speck, Director of Cardiac Rehabilitation at Swedish Medical Center in Seattle. They shared invaluable tips about what women over 40 need to know about heart disease and lowering the risk of a cardiovascular event.
While there are different types of cardiovascular disease and different interventions to address them, in this article we’ll focus on the following:
1. Risk factors for common types of heart disease in women
2. Presentation (e.g., the signs and symptoms of acute events like heart attacks)
3. What to ask your doctor about your health history and risks
4. What kinds of lifestyle and clinical adjustments you can make for a healthier heart before and after menopause.
In healthcare terms, a risk factor is something that may signal a higher likelihood of developing a disease. Risk factors can be modifiable (for instance, habits that can be changed, like smoking) or non-modifiable (like age or genes). They don’t necessarily cause diseases, but can be a red flag that conditions are in place for future illness or dysfunction.
Some risk factors for common types of heart disease are well known because they affect men and women, have plenty of research behind them, and are widely publicized. These include:
All of these factors can contribute to inflammation and damage to the endothelium, or the layer of cells that line blood vessels and help them expand and contract for optimal blood flow. Damage to these cells can make veins and arteries less flexible and encourage plaque made of cholesterol, fat, calcium, and other substances to form along blood vessel walls. Too much plaque buildup causes those blood vessels to narrow (a condition called atherosclerosis) which can reduce and even block blood flow to the heart, brain, and other organs.
These “big 5” factors, says Dr. Speck, are just as common in women as they are in men, and just as preventable. They’re the ones you’re likely to encounter when you first start looking into taking care of your heart health. However! There’s a massive knowledge gap when it comes to heart disease causes, prevention, presentation, and treatment specifically in women. Though there’s been medical and scientific progress on that front in the past few decades, awareness of women’s unique risk factors hasn’t kept pace. We can change that.
Below is a list of other factors that can increase a woman’s risk of developing cardiovascular disease or having a cardiovascular event. Knowing more about them is a great first step toward understanding your options for prevention and treatment, even—or especially—if you have no obvious symptoms.
It’s particularly important to keep these factors in mind during menopause. While some heart disease risk factors can affect women well before midlife and plaque can begin developing as early as our twenties and thirties, we do know that estrogen has an anti-inflammatory effect on blood vessels. It helps to keep them flexible, functional, and less likely to accumulate plaque. This may explain why women’s cardiovascular disease risks go up after menopause; we lose estrogen’s protective effect on our arteries as well as its influence over metabolic functions that help manage inflammation and process substances like LDL cholesterol and triglycerides, which accelerate plaque buildup.
Now that you’re aware of these risk factors, what can you do with that information? Well, the more you know, the faster and earlier you can act if you think you or someone you love is at risk of a cardiovascular event. And that brings us to our next point: cardiovascular disease can look different in women.
We’re not about to ask you to forget everything you know about typical heart attack symptoms, but we now know that women in cardiovascular distress often experience it differently than men. This can lead to missed diagnoses and care delays if women, their loved ones, and healthcare providers don’t know what to look for.
Dr. Speck explains that while women can have the crushing, elephant-on-the-chest type of pain that might be the first thing we think of when we imagine a heart attack, they may also (or instead) experience:
It can be difficult to connect the dots about women’s heart disease symptoms, because they may only have one or a few of the symptoms above. Even if they do feel classic chest pain, it may not be as severe as it is in men, or it may present more as indigestion. Dr. Speck has seen this before: “I’ve met women in the emergency room who swear that if they just burp, they would feel better and they’re having inferior myocardial infarction (heart attack).” Point taken: don’t wait for the crushing chest pain before seeking care for a potential heart attack.
If you’re reading the list above thinking, “Wait, I’ve had heart palpitations…” or “How would I know if my fatigue was unusual?! I’m going through menopause!” there’s good news and, uh, less-good news.
The less-good news is that menopause symptoms and heart disease symptoms can sometimes overlap. This doesn’t mean that one condition is causing the other or that the same mechanism is necessarily behind them, but it does add another layer of concern and confusion to this time of transition. It’s a really good reason to know what’s normal for your body, understand your family history, and have a healthcare provider you trust. If you’re experiencing concerning symptoms, it’s worth keeping track and mentioning them to your doctor.
The actual good news is that we can manage many risk factors for heart disease, and knowledge is power when it comes to taking care of your body.
Here’s what you need to know to be an active, informed participant in your cardiovascular healthcare at any age.
As a cardiologist, Dr. Speck investigates several markers of cardiovascular health, family history, and lifestyle. She particularly wants to know about:
As for the tests women over 40 should consider to understand their cardiovascular risks, she suggests starting with the following:
If you have a family history of heart disease or other risk factors like diabetes, Dr. Speck advises diving even deeper to understand your cardiovascular health profile. The tests she might recommend to higher-risk patients include:
What you should do with all the information from these tests is something to discuss with your doctor. They should help you assess your risks and advise how to lower them, whether through diet, exercise, medication, or a combination. In her practice, Dr. Speck works with a nutritionist and an exercise physiologist who can counsel patients about the many ways to incorporate heart-healthy lifestyle habits.
Of course, if you’re eager to make heart-healthy tweaks to your nutrition and exercise habits, no matter the state of your cardiovascular health or risk factors, it’s always a good time to start. Gennev’s team of Registered Dietitian Nutritionists are a fantastic resource for menopause-specific nutrition, fitness, and lifestyle guidance (including sleep and stress management, both important for heart health), tailored for your individual needs, health history, and goals. No referrals necessary”you can sign up and book with a Gennev RDN directly.
Want a quick cheat sheet for talking to your doctor? If you’ve never asked these questions, it’s worth jotting them down for your next appointment.
So, you know the risk factors for heart disease. You know the signs and symptoms. You know what tests you might need. What else can you do right now to minimize your risk of a cardiovascular event after menopause and be your own best advocate?
Understand the misconceptions
You’re already savvy about some of these, like how women may not have chest pain as their first sign of a heart attack. You should also know that women are less likely to be prescribed statins to lower cholesterol or blood thinners to address blood clots or some types of abnormal heart rhythms. There’s a misconception that statins don’t work as well in women as they do in men, but Dr. Speck and Dr. Dunsmoor-Su confirm that this is false. If your situation calls for a statin, know that it can be a safe and effective way to lower your cholesterol.
When it comes to menopausal hormone therapy and cardiovascular disease, be aware that just as hormones are not an automatic no-go, they’re also not an automatic must-try for everyone. There is strong evidence that MHT can be protective against heart disease during and after menopause for some women, in some forms, under the appropriate conditions” but not as a first line of defense. And for some women, especially those with a history of estrogen-provoked blood clots, hormones are not a safe option when it comes to cardiovascular health. Whatever your situation, your doctor can help you weigh the risks and benefits of using hormones during and after menopause.
Know your numbers and your history
Even if you haven’t had a blood test in a long time, the use of electronic medical records makes it easy to track down past results. If you can access old test results through your online patient profile, jot down the numbers from your lipid panel and nudge your doctor about getting another one if it’s been a few years.
As for your health history, if you have vague memories of a relative who died much too young of a heart attack or know a parent has struggled with their blood pressure (or was it their cholesterol?), get to chattin’! Ask family members how old they were when they started getting abnormal markers, what medications they’ve tried and for how long, and what they can share about other relatives’ cardiovascular conditions. This information can help you know what to watch for and plan your own approach to cardiovascular health.
Change the factors in your control
You can’t change your age, your genes, or the fact that you’ll lose your natural estrogen after menopause, but there are plenty of things you can do to reduce other cardiovascular risk factors. Dr. Speck advises patients to “try to be vegetarian twice a day and eat the Mediterranean diet,” which she likes because it has anti-inflammatory benefits, offers a low saturated fat-to-protein ratio while offering plenty of protein, and champions at least 10 servings of fruits and vegetables a day for heart-healthy fiber.
In terms of exercise, she says, “anything that moves the big muscles between your waist and your knees for 150 minutes a week is beneficial for reducing inflammation and reducing your cardiovascular risk.” Exercise is key for keeping the heart strong and improving metabolic function, so it’s absolutely worth finding a few moderate-to-vigorous workout routines you like to do and can follow consistently.
Find a provider who takes you seriously
Finally, we know that seeking healthcare as a woman can be a frustrating, sometimes even demoralizing, experience. There are gaps in research, lack of awareness about women’s health concerns, fewer opportunities for patient education, and sadly even medical biases standing between many women and quality healthcare. As common as cardiovascular disease has become, it’s of the utmost importance to keep pushing for care if you feel like something’s wrong. You deserve to have your concerns taken seriously, and if you find yourself feeling dismissed or unheard, you deserve to find another provider—one who will listen, ask questions, and help you understand what’s going on with your health.
Something you should know about Gennev is that we’re not afraid to go there. We’ve covered topics many people are tempted to talk about in whispers, if they talk about them at all: Vaginal atrophy. Lichen sclerosus. Ovarian cysts. Inverted nipples. You may never have thought to search for those phrases, and you may never want to, but if you ever need to, you deserve evidence-based, expert-backed information. Women’s healthcare has long been under-researched, under-served, and under-funded (you could even say it’s under siege…), but that’s all the more reason to have a trustworthy source of accurate answers to your most important questions. This is no time to be coy about our health.
Today, we’re going there to unpack a topic with a lot of chatter around it: the skyrocketing popularity of GLP-1 drugs, a class of medications gaining attention for their use in treating obesity and diabetes.
These drugs are no secret, and weight is not a shameful topic, but we want to acknowledge that not everyone wants to read about weight-related matters for a range of totally valid reasons. If this is not the post for you, that’s okay.
At Gennev, we believe that healthy bodies come in all shapes and sizes, and that if weight management is something you’re interested in, it should be one part of a comprehensive plan to have the kind of healthy life you want, regardless of your age, where you are in menopause, and what’s going on in your world.
That said, we live in a culture that talks a lot about weight: how to lose it, how to keep it off, how to manage it safely and sustainably, why we gain it back. The messaging is hard to miss, and during menopause, it seems to get even louder, as women wonder what’s behind the mysterious “meno belly“ and try to figure out why they seem to gain weight overnight. It’s no wonder, then, that weight loss drugs with a high success rate are getting so much airtime in the cultural conversation.
Since so many are curious about GLP-1s, and Gennev MDs can prescribe them in appropriate circumstances as part of our weight management program, we want you to have all the information you need about this potential option in your menopause weight management toolkit.
But first, some science.
Let’s make the proper introductions: this drug class is broadly known as Glucagon-like Peptide-1 Receptor Agonists. You may know them by their generic pharmaceutical names, like semaglutide, or their commercial brand names like Ozempic or Wegovy (FYI: both Ozempic and Wegovy are brand names for semaglutide, but the drugs are approved and formulated to treat different conditions, so they get different names. The more you know!).
In the body, these medications mimic GLP-1, a naturally occurring hormone that helps manage blood sugar and regulate the appetite. When you eat, the small intestine secretes GLP-1, which signals to other cells that it’s time to perform several digestive and metabolic functions.
The signals that GLP-1 puts out can:
And what about “receptor agonists”? If that sounds like a job title for a secret agent in a spy movie, well, they do kind of act like undercover operators when the body’s systems aren’t working as they should be.
An agonist is a manufactured substance (in this case, synthetic GLP-1 molecules) that binds to a compatible receptor site in or on the surface of a cell. This triggers the effects of the naturally occurring substance (the GLP-1 hormone the body should produce) and tells that cell what to do next (carry out the digestive and metabolic processes the body may struggle to perform on its own).
GLP-1 Receptor Agonists, or just GLP-1s, as you may see them called, have been approved for the treatment of Type 2 diabetes to help regulate blood sugar since 2005. Researchers took notice when patients taking GLP-1s for diabetes also experienced significant weight loss, and in 2014, the FDA approved the first GLP-1 to treat obesity.
Since then, multiple GLP-1 drugs approved for obesity and diabetes treatment have hit the market, with more in development. They also show some promise for treating or lowering the risk of other conditions; while much more data is needed, it’s unsurprising that the drugs have become such a hot topic given all their potential applications.
Before we go much further, let’s get specific about some terms. With full acknowledgement that GLP-1s are casually called “weight loss drugs” in headline after headline, we’ll mostly refer to “obesity” and “weight management,” rather than “weight loss” in the rest of this article. It’s important to anchor the conversation around GLP-1s on the fact that they’re indicated for something specific: Managing weight concerns, like obesity, associated with metabolic dysfunction and chronic disease”not the normal, gradual weight gain associated with aging (and yes, sometimes menopause).
Gennev’s Chief Medical Officer, Dr. Rebecca Dunsmoor-Su, says this is an important distinction.
“GLP-1s are for obesity, not menopause weight gain. In general insurance companies will not cover these medications for those with a BMI of less than 30, or 27 if they have medical comorbidities related to obesity [like diabetes or heart disease]. We tend to follow these guidelines, as the medications are very expensive if not covered.”
As effective as they are, she says, GLP-1s are not a quick fix, and they’re not for people who need or want to lose the 10-15 pounds that can accompany the transition into midlife (for those folks, Gennev’s menopause-trained MDs and RDNs have many weight management strategies that can be tailored to patient goals). GLP-1s do come with some risks, and can be expensive, subject to shortages, or not covered by insurance, so it’s wise to make an informed decision about whether they’re the right choice before starting them.
That said, there’s always nuance to consider. We know that the hormonal havoc of menopause can raise the risk of metabolic syndrome emerging in those who are genetically predisposed to conditions like high cholesterol, insulin resistance, high blood pressure, and obesity. Sometimes, it does make sense to consider GLP-1 drugs for menopausal patients dealing with metabolic dysfunction identified via lab work.
In an upcoming paper, Gennev physicians Dr. Hana Mikdachi and Dr. Rebecca Dunsmoor-Su note that as popular as GLP-1 drugs have become, they haven’t specifically been studied in peri- or post-menopausal women. This is a major opportunity for further study for a few reasons: many women report that weight gain during menopause feels harder to manage and less responsive to their usual eating and exercise habits, and some anecdotally cite GLP-1s as the most effective intervention they’ve tried.
Also, women in midlife may have other health concerns alongside weight, such as bone health, cardiovascular health, and loss of muscle, which could affect how they respond to GLP-1s. More research on the use of GLP-1s for weight loss during menopause will help both patients and providers understand what kinds of risks and benefits to expect.
The decision to start a GLP-1 should be made with your doctor, who should take a thorough medical history and current health status, including your weight, metabolic profile (for example, cholesterol and blood glucose levels), and consider additional health conditions like heart disease, Type 2 diabetes, or even pre-diabetes”the drugs’ effectiveness at regulating blood sugar levels can help lower the risk of developing more severe metabolic disease.
Dr. Dunsmoor-Su says that patients who come in with questions about the drugs usually want to know about the risks and side effects, and whether they can use them for a short period of time, or if they’re a lifelong commitment.
We’ll break it all down below.
Most GLP-1 medications are administered via injection with a small dosing pen that patients can learn to use at home. As with any drug, GLP-1 side effects can range from mild to severe, and will vary from patient to patient.
More common side effects:
Severe but less common side effects:
The FDA recommends that patients with certain conditions avoid GLP-1s. Some of these contraindications are due to known serious risks, and others are out of an abundance of caution based on early or inconclusive studies.
These conditions include:
The answer to this is quite complicated and may depend on the patient and why they’re taking the drug. The medical community is still learning about the long-term outcomes of GLP-1 usage for weight management, and what happens when the drugs are discontinued.
Here’s what we do know:
We promised you real talk, so let’s touch on another important topic in the GLP-1 conversation: compounded drugs.
Compounded drugs are not generic versions of brand-name formulas, but custom-made compounds assembled in pharmacies or independent labs. They’re sometimes used when a patient can’t tolerate an ingredient in a generic or branded drug, and are often cheaper to purchase and not subject to ingredient shortages that can make drugs harder or more expensive to make.
The catch? Compounded drugs aren’t FDA-approved, and the standards of the facilities that produce them vary widely. This makes it virtually impossible to guarantee the safety, effectiveness, quality, or dosage accuracy of compounded formulas and the ingredients used to create them.
Compounded semaglutide for weight loss can look like an appealing option to those starting to explore the GLP-1 landscape. It’s custom-made, may be more widely available and more affordable than prescription medications like Wegovy, particularly when insurance won’t cover them, and comes tidily marketed by direct-to-consumer companies with slick branding. Some companies even make it easy to buy compounded semaglutide online without an in-depth conversation with a doctor”sounds fast and simple, but this can be dangerous.
Another thing to watch for is murky labeling issues, since some companies describe their compounded GLP-1 formulas as “generics.” This is misleading, since generic drug formulas are FDA-regulated and must meet the same ingredient, safety, dosing, manufacturing, and quality standards as their brand-name counterparts. As of February 2025, when we’re writing this, there is no approved generic formula for any GLP-1 drug”anywhere. What this means is that any medication being marketed as “generic” semaglutide is, in fact, a compounded drug using unregulated imported ingredients. That’s a significant ethical and health concern, since there’s no easy way to know what these ingredients are, how much of them the formula actually contains, or what risks they present to patients.
We don’t want to scare or shame anyone for being curious about compounded semaglutide or other compounded GLP-1 drugs, but the unfortunate truth is that these formulas can come with serious safety concerns, so we at Gennev do not prescribe or recommend them. The FDA issued a statement in December 2024 about the risk of using unapproved GLP-1 formulas, and all North American obesity medicine societies recommend against their use as well.
It’s an incredible time to be in women’s healthcare, breaking taboos and giving women the information they need to make responsible decisions about their well-being. We know everyone has a unique relationship to the topic of weight, shaped by decades (okay, an eternity) of cultural conditioning and personal experiences, but that’s why we speak candidly about it”particularly during times like menopause, when our bodies start pulling stunts we’ve never seen before and it’s hard to know what advice to trust.
We’ve created a patient-focused, evidence-based weight management program (eligible for self-referral under some insurance providers) meant for exactly that situation: your body’s changing, you’re not sure how to feel about it, and you want to protect your long-term health. GLP-1 medications may or may not ultimately be part of your strategy, but the good news is you’ll have plenty of ways to reach and stay at a healthy weight, overseen by our menopause-trained Registered Dietitian Nutritionists and MDs.
Dr. Dunsmoor-Su sums it up: “We designed the program to focus first and foremost on lifestyle changes and the support to make those [by] working with an RDN. These are the changes that will over the long term make the most difference. When thinking about medications (GLP-1 or others) we consider other medical conditions, other symptoms and what medication interactions might be an issue. Even if GLP-1 medications are inaccessible due to cost there are other medications that might help, and we can discuss risks and benefits of these.”
So if menopausal weight gain is on your mind, and the chatter about semaglutide and other GLP-1 medications has you curious, please don’t be shy. We hope we’ve given you plenty of information to consider about these drugs and the variety of options for healthy, body-positive weight management through Gennev. If you have more questions or are ready to try something new, book your intake to get started.
Real quick”off the top of your head, can you name everything you’ve done today? If you’re reading this over your morning coffee, your list might be short: woke up, walked the dog, made breakfast, and sat down to catch up on Gennev’s blog. If you’re reading this on your commute home from work, it’s fair to say your list might be a little longer. No matter what’s on it, we’re going to guess there are a few things it probably doesn’t include:
And thank goodness, right? If we had to add biochemical bodily functions to our to-do lists on top of everything else we juggle, we just might lose it. Luckily, we all come with built-in programming that handles many of those processes for us without any extra planning on our part: our metabolism.
Wait, how does the metabolism work again?
Think of the metabolism as a sort of engine that runs two complementary processes:
Catabolism, in which your body breaks down nutrients to create energy (a process that includes burning calories)
and
Anabolism, which uses that energy to build and repair molecules in the body. These can go on to become new or healed tissue (for example, muscle growth after exercise).
When these processes are in sync, your body can do everything it needs to: breathe, digest food, circulate blood, regulate hormones, eliminate waste”all the things you’re glad to not have to put on your daily to-do list, because if all’s going well inside, they’re already getting done.
What’s going on with my metabolism during menopause?
To understand what can happen to your metabolism during menopause, it’s helpful to frame overall metabolic health as “the balance of nutrients and activity that supports the fundamental systems that run your body,” says Gennev’s Chief Medical Officer Dr. Rebecca Dunsmoor-Su. She emphasizes that metabolic health is highly variable between individuals and depends a great deal on genetics, lifestyle, and personal risk factors. Supporting a healthy metabolism at any age requires understanding and balancing your body’s needs for fuel, movement, and rest.
Midlife ushers in unique circumstances for women, though. As we age, especially during the transition into menopause, the balance between those needs for energy, activity, and recovery starts to shift, and the body reacts accordingly. Dr. Dunsmoor-Su reminds her patients that this is not unusual. She explains that if you’ve noticed changes to your energy levels, appetite, body composition (i.e., where you carry your weight), or bloodwork (like cholesterol and blood sugar levels), you’re not imagining them; they can be a normal part of aging, to an extent, and a consequence of hormonal fluctuations starting even in perimenopause. (Fun, we know.)
If it feels like your menopausal body has a whole new set of demands lately, Dr. Dunsmoor-Su confirms that may not be far from the truth. Reacting to your body’s changing needs is key for staying metabolically healthy, she says, and maintaining that nutrient-activity balance after menopause can require different proportions of nutrients, different types of exercise, and more attention to quality rest for optimal health.
This is by no means impossible, particularly if you’re not genetically predisposed to certain metabolic disorders (we’ll get to those), but you may already know that it can take a little extra patience, creativity, and support to make the lifestyle changes that will keep your metabolism thriving.
If patience and creativity alone aren’t getting you where you want to be on your menopause journey, let Gennev add the support. Make an appointment with a menopause-trained MD or RDN today.
If some changes are normal, what kinds of metabolic changes during menopause should I be concerned about?
While everyone can expect some metabolic changes as they age, some people may be prone to metabolic disorders that can arise or worsen during menopause due to genetic and lifestyle factors. One example is a term you may have heard before: metabolic syndrome.
Metabolic syndrome describes a cluster of disorders, most related to your body’s ability to process insulin, that can raise the risk of Type 2 diabetes, stroke, and cardiovascular disease. It’s commonly indicated by having three or more of the following biomarkers, which are considered out of range for optimal metabolic health:
For those genetically predisposed to metabolic syndrome, menopause may be the time when these conditions begin to show up, affect your health, and become more challenging to treat.
Menopause strikes again. Why does this happen?
There’s a lot we’re still learning, but from a physiological standpoint, some conditions that contribute to metabolic syndrome during menopause can be due to hormonal changes. Hormones like estrogen, progesterone, testosterone, and insulin are just a few of the key players in the metabolic processes that your body needs to function. When their levels fluctuate during perimenopause and menopause, it can lead to a cascade of consequences that can include:
These changes also often come along just as midlife throws its curveballs: you hit a career high with a big promotion, but it leaves less time to fix healthy home-packed lunches. Your kids and aging parents are somehow both keeping you up at night. Staying active has gotten harder as your family’s schedule has gotten busier. You have global news, celebrity gossip, and life updates from everyone you know at your fingertips 24/7. And you’re supposed to be able to clear your mind and de-stress just like that?!
Between the onslaught of hormonal changes, physical symptoms, and lifestyle stressors that can make those symptoms tougher to manage, it’s no surprise that menopause is the time when disorders like metabolic syndrome may start to come out in full force. This is concerning because without intervention, conditions like insulin resistance and inflammation can get worse. These in turn can raise the risk of cardiovascular disease, stroke, diabetes, thyroid disease, and even cancer”all good reasons to take metabolic syndrome seriously.
It’s important to keep in mind that menopause doesn’t automatically come with a side of metabolic syndrome despite the increased risks due to hormone changes, and there are steps you can take to start improving your health and metabolic function at any time. This is true during perimenopause too, when many women first notice body composition changes or get unexpected results from lab work”sometimes the first signs that metabolic shifts might be taking place.
It can be disconcerting when these changes and symptoms come along, so we always encourage women to seek support from providers who are knowledgeable about menopause.
If you have specific concerns, or want some guidance about what to prioritize, chat with a doctor or Registered Dietitian Nutritionist. They’ll help you make a plan that might include diet, regular exercise, and lifestyle changes to reach your desired goals. Your doctor may also discuss hormone therapy and medication, if appropriate, and both providers can discuss the impacts of the various treatments that may be available to you.
Gennev clinicians in action
Helping patients find long-term solutions for their unique health concerns during menopause requires thoughtful detective work from Gennev MDs and RDNs. Like other Gennev clinicians, Melissa Burton, RDN, looks well beyond standard lab work to take a holistic look at all factors that could be contributing to her patients’ symptoms.
Though Gennev RDNs don’t order lab work, they work closely with MDs and patients to get all the necessary information for a thorough intake. When Melissa begins working with a new patient, for example, she may recommend they have their doctor order labs like a complete cholesterol panel, which measures LDL cholesterol levels alongside HDL and triglycerides, and tests that measure glycemic control over a period of months instead of hours, which may give her more information than a single fasting blood glucose test.
She’ll consider vitamin and nutrient deficiencies; low levels of Vitamin D, Vitamin B12, and iron”to name a few”are common culprits of many symptoms that can crop up during midlife. She’ll also ask her patients about stress, sleep, and other lifestyle factors, and have them keep a thorough food journal to keep track of what they eat and when. All these details help Melissa get a complete picture of what may be going on for her patients metabolically, so she can craft a plan to help them manage their symptoms and health conditions.
Dr. Dunsmoor-Su adds that Gennev patients can talk with an MD about their risk for diabetes and cardiovascular disease, particularly if there’s a family history of those conditions to consider. She also encourages patients to explore whether hormone therapy could play a role in reducing certain troublesome symptoms during menopause and the long-term health risks associated with them.
I’m ready to support my menopausal metabolic health. Where do I start?
Feeling motivated? You don’t have to figure it out alone. Check out our tips for the best exercises for metabolic health, read up on dietary tips for hormonal weight gain from Gennev’s Registered Dietitian Nutritionists, or incorporate more delicious anti-inflammatory foods for a simple change you can make right away.
Your metabolic health wasn’t determined in a single day, though sometimes it can feel like menopause wreaked havoc on it overnight. Whatever you’re going through, even small adjustments are worth it for your long-term well-being. If you’re eager to learn more about how to keep your metabolism healthy during menopause, reach out to a Gennev menopause specialist to get started with a personalized care plan.
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While the world has woken up to the menopause conversation, most of that conversation revolves around defining the problem. And when it comes to the workplace, the problems are real. The Mayo Clinic recently published a study showing menopause symptoms cause an estimated $1.8 billion in lost work time per year in the U.S., and $26.6 billion when medical expenses are added.
For women experiencing menopause, unsupportive working environments can lead to major career interruptions. One survey found nearly 20 percent of women in menopause have quit or considered leaving a job because of their symptoms.
In the UK “ despite the government stopping short of introducing legislation to protect the rights of women in menopause “ employers are enacting workplace policies.
The groundswell is growing, and US employers will also be under the menopause microscope as this conversation continues. While there are many ways an employer can support employees in menopause (including adding Gennev as a benefit), a clear policy is an ideal place to start. We brought together a team of HR professionals, medical experts who specialize in menopause, and seasoned executives to give employers a starting point.
When addressing menopause, there are several places to begin. In this guide, we’ll discuss how to consider women in menopause in all your conversations; how to integrate menopause into your existing benefits ecosystem and/or add new benefits and policies; physical improvements you can make in your facilities; and how to start a conversation that goes beyond the HR team.
Step one: Consider her
In many companies, we don’t create menopause benefits because we aren’t thinking about women in menopause. Creating a mid-life female persona can help with that. Here’s a sample persona:
When we present this persona for open-enrollment scenarios, we gain insights into how she navigates through the benefits ecosystem that already exists to support a menopause journey. Her uses may include:
And while menopause is often framed around cisgender women, it’s important to note that transgender women can experience symptoms too. To assist in their medical transition, trans women are typically prescribed estrogen and sometimes progesterone, and can take hormone replacement therapy as well. If these therapies are reduced or interrupted, the ensuing hormonal fluctuations can lead to menopausal symptoms like hot flashes. (Just as trans women taking hormones can experience PMS-like symptoms in their younger years.)
Step two: Think about whether some policies or benefits should be augmented, or new ones created
As you go through Mona’s journey, we may also come upon areas where we aren’t supporting her as much as we could. In some companies, we may have the ability to add new policies. Of course, these aren’t one-size-fits-all, but rather thought starters for companies seeking to augment their current benefits. These could include:
Step three: Train staff
Once you have identified existing benefits and policies, or created new ones, it’s important to train HR business partners, or key HR contacts, in menopause support. Ensure they understand what is in the benefits package and company policies. Gennev offers webinars that can educate HR teams on menopause symptoms, how to respond sensitively to requests and how certain accommodations can help.
Step four: Communicate widely to your employees
If Mona doesn’t know what tools are available to support her, she can’t take advantage of them. Consider adding to your benefits documents or company policies a section specific to menopause, entailing how Mona can take advantage of existing benefits and policies, and including any new ones.
When you present the benefits package to the company, call this out specifically. Consider a slide detailing the benefits and policies that apply to her.
It’s not always possible to improve physical space, but even small changes can be a big help for women in menopause. Some potential steps to take:
Discussing menopause carries a great stigma. Women themselves are not always educated on what’s happening. It’s also important that people managers are prepared to support employees “ not just the HR department.
Consider the following resources for women in menopause:
For the company as a whole, some potential actions are:
Companies today are embracing inclusivity, which comes in many forms “ and ages. The most happy and high-performing workplaces proactively support their employees’ well-being, and are generously understanding. Providing support services for women experiencing menopause is not just kind, it’s smart business. Addressing menopause will increase employee collegiality, productivity and retention, and help all employees to maintain the full potential that they strive to achieve.
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When our bodies change in menopause, our desire for sex often changes as well. With declines in estrogen, many women experience a lower sex drive, vaginal dryness and painful sex. But all too often, they are ashamed to share with their partners why sex has become less appealing, and this can lead to relationship issues.
Whether you are paired up or unpartnered, having regular sex is good for you. According to the North American Menopause Society, regular vaginal sexual activity is important for vaginal health after menopause because it stimulates blood flow, helps keep your vaginal muscles toned, and maintains your vagina’s length and stretchiness. And other studies have shown it can even help boost the immune system.
Yes, sex is good for you. But how can you even think about having sex when your libido is at an all-time low, and intercourse is accompanied by pain and discomfort? Dr. Rebecca Dunsmoor-Su, board-certified OB/GYN and Gennev’s Chief Medical Officer, gets this question from many of her patients. She shared three tips she frequently discusses with her menopause patients.
In midlife, shifting from spontaneous desire to responsive sexual desire is key for aiding arousal. Responsive sexual desire starts with your brain instead of your genitals. Responsive desire can be triggered with touching, kissing, and other forms of intimacy. And by establishing a schedule (like Tuesdays at 9pm) for when intimacy and sex are welcomed, couples can restart the desire cycle by making intimacy a priority, and ensure both partners are open to where it may lead.
Painful sex in menopause is very common but is also very fixable. There is no need to suffer when there are evidence-based treatments that can relieve your symptoms. From vaginal estrogen to pelvic floor therapy, there are medical interventions that can help treat the underlying cause.
Your changing body is likely hard for you to fully understand, so it is very unlikely your partner will realize the impact menopause is having on you. Share with your partner what gives you pleasure as well as what doesn’t feel good. And remember, whatever works for you both is completely fine – whether it’s sexual intercourse, clitoral stimulation or just cuddling.
Book a virtual visit with a Gennev doctor today to learn about the evidence-based treatments that will help relieve vaginal dryness, painful sex and support your libido. Our team of menopause-trained, board-certified OB/GYNs will discuss your symptoms and help you determine the therapies that are right for you.
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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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Feelings of increased anxiety, depression, anger, rage, and panic are not uncommon for women to experience during the peri to post-menopausal transition. Estrogen and progesterone play a role in our brain chemistry, so as these hormones change, there can be downstream effects to the regulation of the brain chemicals which regulate mood and emotions.
While these hormonal changes can absolutely impact mental health status it is important to recognize that they are never the only component playing a role. The hormone changes alone that occur in peri and post-menopause do not by themselves cause anxiety, depression, or other mental health conditions. Rather it is the hormonal shifts which have a tendency to exacerbate underlying symptoms such as anxiety and depression that have existed previously, even if not as intense.
The “convenient” timing of the menopause transition should also not be ignored. This often aligns with a time of life when women have aging parents, teenage children or an empty nest, greater work demands, relationship challenges, or also happen to be living through a Pandemic, just to name a few of the convoluting factors that also impact mental health. To say that the relationship between menopause and mental health is complicated, is an understatement. Given this complexity getting the support needed often takes a collaborative approach involving multiple healthcare providers.
The extremes at which these feelings are experienced exist on a continuum and can vary person to person. Regardless of where someone falls on this continuum, these feelings are real, uncomfortable, and for most women overwhelming, disconcerting, and deserving of getting support.
In cases of severe anxiety, depression, personality disorders, trauma, and derealization, it is important that you are working with a credentialed mental health provider who can provide the specific support you need. If you are experiencing any of the following symptoms, you may need support from a mental health professional:
Finding a therapist that is right for you, and that you can bond with, can have a major impact on your progress. Need help finding a mental health provider?
Many women feel increased moodiness, anxiety, and even symptoms of depression throughout the menopause transition. However, it’s important to not just brush off lingering symptoms to menopause.
Together with LifeStance Health, one of the nation’s largest providers of virtual and in-person outpatient mental healthcare, Gennev offers access to menopause-trained OB/GYNs, psychiatrists, psychologists, licensed therapists, and dietitians who provide guidance, prescription support, and lifestyle therapies for your mind and body through this important stage of life.
“Learn more about how Gennev patients receive integrated care that addresses both the physical and mental health symptoms associated with menopause.
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If your concerns feel too heavy to handle, there is no shame in seeking professional help: Call, text, or chat 988 to reach the National Suicide Prevention Lifeline, and you will be connected to trained counselors that are part of the existing Lifeline network. You can also dial 800-273-8255 or chat via the web at 988lifeline.org/chat/.
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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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A new hot flash treatment is on the horizon! The FDA recently approved Veozah (Fezolinetant) for the treatment of hot flashes for women in menopause. This is the first drug treatment of its kind, and represents a viable option for those who are not able to receive hormone therapy.
Hot flashes are one of the most common symptoms of menopause, and can range from mild to severe. In the United States, 70-80% of women experience hot flashes during the menopause transition, and for many of them, they significantly impact their quality of life. “We have known that hormone replacement therapy (HRT) is an excellent treatment for hot flashes, however there are a subset of women who are not appropriate for HRT, or who choose not to use it,” says Dr. Rebecca Dunsmoor-Su, board-certified OB/GYN, and Gennev Chief Medical Officer. “Up until now, in these women we have used other medications such as anti-depressants with minimal to moderate reduction in hot flashes. With the approval of Veozah that changes today!”
According to the FDA statement, Veozah works by targeting and blocking a receptor in the brain which regulates body temperature.
Dr. Dunsmoor-Su shares, “To understand how it works it helps to know how the brain and ovary interact, and why menopause causes hot flashes (or temperature dysregulation). When we are having regular cycles there are neurons in the brain that release a pre-hormone called gonadotropin releasing hormone (GnRH) which stimulate the pituitary to talk with the ovary and develop one or more eggs for ovulation. This GnRH is released in a pulsing pattern, and different pulses signal different parts of the cycle. The pulses are regulated by feedback from the estrogen made by the ovary as it develops eggs. When the ovary runs out of eggs and does not respond to the pituitary, it does not release estrogen, which means the pulses go unregulated and are constant. The KNDY neuron connects this part of the hypothalamus to another part called the “warm sensing neuron”, which regulates what is a normal temperature range for your body. If the pulsing is constant, and constantly being transmitted to the warm sensing neuron, then the range of normal temperatures becomes very small, and any time you sense yourself to be outside that narrow range and you have a hot flash!”
Simply put, when a patient takes Veozah, it blocks one of the transmitters in the KNDY neuron, specifically neurokinin 3 (NK3), which means the body does not tell the warm sensing neuron about what is going on in the GnRH neuron, and the “normal” temperature range does not shrink. Thus, no hot flash is triggered.
Astellas Pharma US, Inc., the company that makes Veozah, did several large-scale studies which looked at effectiveness and safety to the drug. They reported that use of the medication reduced hot flashes by 50% or more over the 12 weeks of use compared to a placebo drug. Patients who continued the medication for a full 12 months saw continued benefits during that time. Because of the effectiveness of Veozah, they showed an improvement in quality of life due to hot flashes. There was also some noted improvement in sleep, though research was inconclusive to the drug’s impact on this symptom.
The most common side effect reported was headache. While there is no significant impact on the liver in the safety trials, because of previous concerns the FDA is recommending liver tests in the first year of use.
“Hormone therapy is still the best medicine for hot flashes,” says Dr. Dunsmoor-Su. “If you are not a good candidate for this medication, we are soon going to have a new medicine that is much more specifically targeting hot flashes with fewer side effects than our previous options. This is an exciting development and is going to be helpful for so many women who have not been able to find relief!”
Veozah is anticipated to be available for patients by early June. A potential downside? According to Astellas, a 30-day supply is expected to cost $550 a month.
Don’t let hot flashes negatively impact your quality of life. Visit with a Gennev doctor to address the role that hormonal shifts play in the symptoms you are experiencing, and access the treatments that are right for you.
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You are not going crazy! You may feel as if you’re going crazy at times”or most of the time”but you’re not. Whether you’re experiencing more angry outbursts, down-in-the-dump moods, frazzled thinking, or more severe distress, know that it is not just in your head.
“Many women are shocked by the mood swings, anger, and anxiety that can start in the perimenopause,” says gynecologist Rebecca Dunsmoor-Su, M.D., chief medical officer at Gennev.
Instead of simply ignoring a quirky habit that your partner has, like you used to do, you now blow. And then, after a heated argument about something that, in the grand scheme of life, isn’t important, you feel guilty and wonder what’s wrong with you. Or maybe the nervousness you used to have about public speaking now becomes a full-blown panic attack. “It is due to the way the brain responds to the hormone swings that happen naturally during this time, but that does not make you simply hormonal,” says Dr. Dunsmoor-Su. “The symptoms can be even worse if you are someone who has these at baseline.”
Mental health issues are real and common in perimenopause and menopause, but there’s help. You’re not alone. And, you don’t have to suffer through it alone.
In general, women experience mental health problems at a higher rate than men”1 in 5 women compared to 1 in 8 men. The incidence increases during the menopausal years. One in three women, ages 50 to 64, reported needing mental health care in the past two years, according to the 2022 Kaiser Family Foundation Women’s Health Survey.
It’s completely normal to feel more emotional or have a harder time controlling your emotions during this stage of life. Along with the usual life stresses, women’s relationships are often shifting at this time. Their kids are leaving home. Parents may require more care. “All those things are going to impact a woman’s mental health,” says Dr. Dunsmoor-Su.
And then add in a rollercoaster of hormones. “The brain is exquisitely sensitive to estrogen and progesterone,” says Dr. Dunsmoor-Su. “It’s had these hormones in a particular pattern its whole life, and now that pattern is broken. The brain is behaving differently because the pattern is different.” And the pattern keeps changing, resulting in different symptoms as you progress from perimenopause to menopause.
Perimenopause is the two- to 10-year transitional period to menopause when a woman stops menstruating. During perimenopause, though, a woman is still getting her periods, but they may be more erratic. Every month, there is a surge of estrogen in the first half of the cycle and a surge of progesterone in the second half. The ovaries are still producing eggs, but more estrogen is needed to stimulate them. Through the cycle, estrogen levels get higher, progesterone levels increase to match the high estrogen, and then all of the hormones drop. “You get really big spikes of hormones,” says Dr. Dunsmoor-Su. “You get really big troughs of hormones. It’s a roller coaster of hormones, and the brain doesn’t like roller coasters. The brain likes nice, sedate walks on a path.”
These drastic fluctuations often predispose women to anxiety, anger, and mood swings. Some women also experience depression or worsening of their symptoms if they already had depression before perimenopause. Those symptoms may also be worse for women who’ve previously experienced premenstrual syndrome (PMS) or its more severe counterpart, premenstrual dysphoric disorder (PMDD). The good news is that these mental health issues tend to be temporary symptoms associated with perimenopause. As your hormone levels decline and fewer fluctuations occur, mood swings and anxiety often lessen. However, depression can be more common after menopause.
Menopause is achieved once you’ve gone 12 months without a period. “In post-menopause, there is very low estrogen and basically no progesterone,” says Dr. Dunsmoor-Su. The decline in hormones tends to level out mood swings, ease anxiety, and tame anger, but can be associated with an increase in depression. In addition to the effect of hormones on your mood, other frequent postmenopausal issues such as hot flashes, poor sleep, body changes, and stress can all contribute to depression. Studies associate increased hot flashes with increased depression. Symptoms are often worse for women who’ve had depression at other times in their lives. And 15 to 20 percent of women may be diagnosed with new-onset depression in midlife.
Unlike anxiety and mood swings, which tend to resolve once you’re postmenopausal, depression may stick around. “If you’re someone who has had depression your whole life, you may get a temporary exacerbation through the menopausal transition, and then it might get somewhat better,” says Dr. Dunsmoor-Su. “These things wax and wane.”
Despite these general patterns in mental health symptoms during midlife, the experience can differ from one woman to the next. “It’s a fluid time,” says Dr. Dunsmoor-Su. “Every woman’s journey is different. They’re going to go through the same hormonal changes, but the way their brain behaves is very different because of the different patterns of estrogen and progesterone receptors in the brain.” And because women’s menopause experiences vary, treatments can vary, too.
Immediately! As women, we tend to take care of everyone else first and often put our needs aside. But this strategy isn’t helpful for anyone over time. Think of it this way, what would be the most effective way of saving your loved ones if you were all in a leaky life raft? You’d wear yourself out and wouldn’t save anyone if you’re madly bailing the water. But if you take the time to patch the leak, you’ll save everyone without sacrificing yourself.
“Menopause is already a stressful time on the body, says Dr. Dunsmoor-Su. “It impacts your long-term health, sense of well-being, cardiovascular health, and longevity. It’s important to care for yourself because this is the beginning of the rest of your life. You’ve got a solid 30 to 40 more years to live, and you want to do it in the healthiest way possible. If you don’t address your sources of stress, mental health being one of them, it can be harder to live a healthy life.”
Now isn’t the time to try to push through it or let the stigma of mental health issues prevent you from seeking help. If you notice that any of these mental, psychological, or emotional issues are impacting your quality of life, you should talk to your doctor or healthcare provider. Common signs that it’s time to take care of your mental health may include feeling less able to manage day-to-day, negative changes in relationships, problems at work, a lack of desire to participate in activities that you used to enjoy, or others noticing a difference in you.
If any of these apply to you, talk to your primary care doctor, gynecologist, or menopause doctor. Let them know that you’ve noticed these changes in your mental health and want to know what resources are available. You can also ask for a referral to a mental health professional.
Sometimes mental health issues can be severe and require immediate attention. According to a European epidemiological study across the reproductive life cycle of women, suicidal ideation increases during the menopause transition. The study showed a 7-fold increase in suicidal ideation in perimenopause versus other women. If you are experiencing any thoughts about hurting yourself or others, seek help right away.
As menopausal mental health problems differ from one woman to another, so do treatments. The course of action often depends on the severity of symptoms and can range from lifestyle interventions or therapy to hormone therapy or medications.
Sometimes treating physical symptoms like hot flashes or sleep problems can improve your mental health without additional treatments. But if you need something more, there are lots of options.
During perimenopause, low-dose birth control pills may be enough to quell mild to moderate anxiety, depression, and mood swings. “There is some good data that in perimenopause hormone therapy is as effective as SSRIs (the most common antidepressants such as Prozac) for managing depressive and anxiety symptoms,” says Dr. Dunsmoor-Su. For postmenopausal women, a combination of estrogen and antidepressants works better than either alone, according to research.
Therapy is another option that may complement other treatments or work on its own. “Having behavioral techniques that you can use when you’re feeling very stressed or anxious can be really helpful during this time,” says Dr. Dunsmoor-Su.
“We have to look at each patient as an individual,” she says. “One patient may need mental health care. One patient may need hormones, and one patient may need both. It’s about taking a holistic look at the patient and her symptoms and figuring out how we can help.”
You deserve the best care for your physical and mental health in menopause. Together with LifeStance Health, one of the nation’s largest providers of virtual and in-person outpatient mental healthcare, Gennev offers access to menopause-trained OB/GYNs, psychiatrists, psychologists, licensed therapists, and dietitians who provide guidance, prescription support, and lifestyle therapies for your mind and body through this important stage of life.
“Learn more about how Gennev patients receive integrated care that addresses both the physical and mental health symptoms associated with menopause.
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If your concerns feel too heavy to handle, there is no shame in seeking professional help: Call, text, or chat 988 to reach the National Suicide Prevention Lifeline, and you will be connected to trained counselors that are part of the existing Lifeline network. You can also dial 800-273-8255 or chat via the web at 988lifeline.org/chat/.
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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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Hot flashes and sleepless nights may get more attention, but issues “down there” can be more uncomfortable and last longer than other menopause symptoms. Vaginal atrophy, or atrophic vaginitis, is a prime culprit that can result in painful itching and burning. It’s also a common cause of pain during intercourse. Most women will start to experience symptoms in perimenopause when there is a significant decline in estrogen. Up to 60 percent of postmenopausal women experience symptoms of vaginal atrophy, yet only about 30 percent seek treatment, meaning too many women are needlessly suffering.
“Vaginal atrophy really can have a significant impact on a woman’s quality of life. It can prevent her from being able to sit comfortably, exercise, enjoy vaginal intercourse, and put her at increased risk of infections. The constant pain can be annoying and irritating and cause an additional emotional burden of feeling like she is unable to enjoy simple things.” –Dr. Yashika Dooley, M.D.
Many women are embarrassed to talk about issues “down there,” even with their doctors. But here’s the thing, there are lots of treatment options, and unlike other menopause symptoms that tend to dissipate once you’re postmenopausal, vaginal atrophy doesn’t go away. “If you don’t treat it, it’s just going to get worse as you have less estrogen,” says Dr. Yashika Dooley, who has a sub-specialty in urogynecology. “It starts off as a small thing, but then it begins to affect so many areas of your life. It becomes all-encompassing, and you don’t want that.” The sooner you talk to your doctor or healthcare provider, the sooner you can alleviate the pain, stop thinking about your vagina, and get on with enjoying life.
When you hear the word atrophy, you may think of it in the context of muscles. If you don’t work out, your muscles will atrophy”or shrink and weaken. But atrophy doesn’t just apply to muscles. And when it comes to “down there”, vaginal atrophy is about the lining of the vagina.
“Before menopause, estrogen causes the layers in the walls of the vagina to be thick and elastic,” says menopause-certified gynecologist and Gennev Chief Medical Officer Rebecca Dunsmoor-Su, M.D. Ample amounts of collagen give the lining elasticity, and lots of hyaluronic acid and blood vessels bring in moisture. The cells in the walls of the vagina create glycogen. Because of the vaginal wall structure, the top layer of the wall regularly breaks away. This attracts good bacteria like lactobacilli which feed on the glycogen to keep the pH of the vagina low. A low pH creates an acidic environment that keeps away harmful bacteria and yeast and reduces your risk of infections.
Declining estrogen levels with menopause are the primary cause of vaginal atrophy. “All of these things that keep the vagina plump rely on the stimulus of estrogen,” says Dr. Dunsmoor-Su. Just like you may notice that your skin and hair are drier during this stage of life, things down there can get drier, too. The lack of estrogen reduces the production of moisture, collagen, and acid, making vaginal tissue thinner, less elastic, and more fragile. Many women notice increased discomfort or decreased sensation due to these changes, making sex painful and orgasms harder to achieve.
The decrease in estrogen that occurs with menopause leads to decreased blood flow and vaginal lubrication (vaginal atrophy). Vaginal atrophy ultimately leads to changes in the pH of the vagina. Lactobacilli can no longer survive, so other bacteria replace them, and these are sometimes not such “good guys,” increasing your risk of infections. These changes can also cause urinary issues, such as frequent urination, leaks, and infections. That’s why vaginal atrophy is often referred to as genitourinary syndrome of menopause, which encompasses both the vaginal and urinary tract changes that occur as estrogen levels decline.
Since estrogen levels fluctuate during perimenopause, you may not notice symptoms until you’re closer to menopause or postmenopausal when estrogen takes a nosedive. Women who’ve never had a vaginal birth are more likely to develop symptoms than women who have, although the reason why is unknown. Women who’ve entered menopause more abruptly due to surgery or cancer treatments also tend to have worse symptoms.
While you can’t stop the decline of estrogen, you can control two common risk factors: smoking and a lack of sexual activity. Smoking can inhibit the effects of any estrogen that you still have. It also affects circulation, decreasing the flow of nourishing nutrients and oxygen to that area. Likewise, a lack of sex can have a similar effect. Sexual activity, with or without a partner, stimulates blood flow and can keep your vagina more elastic.
You can also take steps to avoid aggravating symptoms.
Ditch tight clothing. The restriction can make burning, itching, and pain worse. You also get less airflow, which can increase your risk of infections.
Wear cotton underwear. It’s more breathable to keep you drier and reduce your chance of an infection.
Skip scents. If you use any products down there, stick to unscented varieties. Perfumes, fragrances, and other chemicals can make symptoms worse. The fewer and the more natural the products you use in your vaginal area, the better. And look for products that are pH balanced.
Don’t douche. It can further dry out your vagina and increase your risk of infection.
Sleep au naturel. When you sleep without underwear, there’s no rubbing, and the area can air out. “Having nothing irritating it for six to seven hours at night gives the tissues time to heal,” says Dr. Dooley.
Retire sanitary pads. If you need protection from urinary leaks, use incontinence liners. They wick away moisture and form a barrier to keep the skin drier than menstrual pads. Constant moisture against your skin can irritate like a baby’s diaper rash.
Eat more soy. Soybeans, tofu, soy milk, and flaxseeds are high in phytoestrogens, plant compounds that act like estrogen. Some research shows that eating foods high in phytoestrogens reduces vaginal dryness. Eating more soy may also help with other menopause symptoms like hot flashes.
The strategies above can help ease some of the burning, itching, and pain associated with vaginal atrophy,and for some women, that will be enough to manage their symptoms. However, lifestyle changes don’t address the underlying structural and functional changes in the vagina as estrogen declines. Some women will need to address those issues to get relief. Here are some options your doctor or healthcare provider can offer you.
Moisturizers and lubricants
“Depending upon the severity of your symptoms, using a combination of a vaginal moisturizer during the day and a lubricant when you’re having sex may solve the problem for some women. Here’s what to look for in these products.
If you find products that work for you, use them like hand lotion, putting them on throughout the day. “If you have dry skin, you don’t just put lotion on once a day,'” says Dr. Dooley. “Whenever you notice the dryness, you put on more lotion. It’s not a big deal.” If your vagina is irritated, use moisturizer or lubricant anytime during the day. Do not use petroleum jelly inside of the vagina because it can increase your chances of a yeast infection.
Moisturizers and lubricants are only treating the symptoms, though. They don’t change the tissue in the vagina. So, if they aren’t providing enough relief or stop working, see your doctor or healthcare provider STAT! “It’s easy for doctors to fix, and there are lots of ways we can fix it,” says Dr. Dooley.
Hormone therapy
“Topical estrogen is an effective treatment for many women and comes in various forms. “In terms of hormones, in my experience, treating the vagina directly is key to getting a good response,” says Dr. Dunsmoor-Su. Creams, suppositories, or vaginal tablets are used daily for a few weeks and then one to three times a week to maintain estrogen levels and manage symptoms. There’s also a vaginal ring that your doctor places in your vagina. All you have to do is have it replaced every three months. If other menopausal symptoms are also disrupting your life, your doctor or healthcare provider may suggest oral estrogen or an estrogen patch, depending on your medical history.
Laser therapy
“There are several devices on the market, but the one with the most evidence to support it is the Mona Lisa Touch device. The theory behind the laser is that it stimulates cells in the vagina to start rebuilding and rehydrating the area. It’s like turning back the clock. The tissues become thicker. The pH is rebalanced so healthy bacteria can thrive. In studies that track patient outcomes (but don’t provide comparisons) they show up to 90% symptom relief, however comparative studies are less positive, and there is some question about effectiveness of this therapy. Laser therapy may also help with incontinence and pain during intercourse. Three initial treatments spaced six weeks apart are required, followed by annual maintenance treatments. Unfortunately, insurance doesn’t cover laser therapy for vaginal atrophy. The cost is usually between $600 and $1,000 per treatment. If you choose to try laser therapy, there are a few important warnings:
Like so many menopause symptoms, the severity of vaginal atrophy can vary from one woman to the next. These changes can also affect you both physically, mentally, and emotionally, especially when you consider all the other changes going on in your body while you’re trying to juggle a busy life. The right doctor or healthcare provider”one who is menopause-trained“can help.
Gennev’s board-certified OB/GYNS are menopause specialists, and can offer more solutions for the menopause symptoms you’re experiencing. They’ll make it easier for you to talk about embarrassing problems like vaginal atrophy. With the right help, support, and treatment, you’ll feel more comfortable, and more confident. Book your virtual visit now!
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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.
Weighing the benefits and risks of hormone replacement therapy (HRT) related to menopause can be one of the most confusing decisions a woman will make over the age of 50. There is no one-size-fits-all recommendation that can make the choice simple, or standardized chart to reference “if this, then that” scenarios. Every decision about HRT should be individual, and best when made between a patient and her health care provider.
Additionally, the care and treatment of menopausal women is complicated by the varied level of training and specialized experience of health care providers related to menopause. Not all OB/GYN’s or other health care providers have studied the latest research related to the potential benefits and risks of HRT in accordance with personal and family health history – research that increasingly demonstrates a window of time where HRT can provide both symptom relief and, in some cases, delay or ward off disease.
Most problematic is the legacy effect of how providers understand and interpret the seminal research that has been the basis for standardized care for HRT”a study completed two decades ago”called the Women’s Health Initiative (WHI). The 2002 study was conducted with women at an average age of 64- 65, and cited health risks associated with HRT around cancer, blood clots, and heart disease. Many healthcare providers have not kept up with subsequent publications on this data that showed that in women who were younger when they started, the risks are fewer and benefits greater. This has come at a cost to menopausal women suffering from sleepless nights, brain fog, painful sex, and hot flashes.
Thankfully, attitudes are shifting as new research surfaces. Both the Endocrine Society and the North American Menopause Society state that for symptom relief, the benefits of FDA-approved hormone therapy outweigh the risks in women younger than 60 or within 10 years of their last period, absent health issues such as a high risk of breast cancer or heart disease. The menopause society position statement adds that there are also benefits of HRT for women at high risk of bone loss or fracture.
With a bit of education, and having an informed conversation with a doctor, OB/GYN, or a menopause specialist, women are moving beyond the decades-old stigma of the HRT health concerns. They are creating personalized preparedness plans with their doctors as to when hormone therapy, if used as directed, might deliver more benefits than risks.
To evaluate with your doctor whether hormone therapy could be right for you, at what age, for how long, and what type, see the below set of questions and considerations to review in advance of your appointment, or to guide conversations with your doctor.
Based on the severity of how my menopause symptoms are impacting my quality of life and daily routine, would HRT potentially deliver relief?
How might my health history, and that of my family, such as heart disease, strokes, dementia, osteoporosis, etc. factor into the benefits or risks of HRT?
Given my symptoms and family history, why type of HRT is best and for how long?
As research continues to emerge that demonstrates the benefits of hormone therapy for short term symptom relief and long-term risks related to heart, bone, and brain disease, there is no doubt decision making will become easier and standards will shift. Until that time, women at the age of 45 can have a conversation with a Gennev OB/GYN or their physician about how HRT might be considered as they move through menopause, and under what scenarios. This can set a valuable benchmark to inform treatment, if needed, in line with their own personal and family health history, and their individual health goals.
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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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It may feel like your heart is fluttering, racing, even skipping a beat”and it’s not because someone sexy walked by. Heart palpitations and irregular heartbeats called arrhythmia can be symptoms of perimenopause or menopause, but they aren’t talked about much so when they strike it can be terrifying.
According to research in the Journal of Women’s Health, nearly 50 percent of women, ages 42 to 62, who were in the study, reported heart palpitations during a two-week period. Some women experience them along with a hot flash, but many get them separately when they’re sleeping, when they’re sitting on the couch or in their car, or when they’re up and moving.
As with most things menopausal, estrogen is believed to play a role in heart palpitations. Before menopause, estrogen may have heart-protective qualities including keeping arteries flexible. When levels decline that protection declines, too, and reduced blood flow can cause arrhythmia (abnormal heart rhythm). Lower levels of estrogen can also lead to an overstimulation of the heart. More commonly the palpitations are a normal rhythm, just fast, and are associated with mild anxiety, a hot flash, or just all by themselves.
Unfortunately, little is known about menopause-related heart irregularities, but research like the Menopause StrategiesasFinding Lasting Answers for Symptoms and Health (MsFLASH) multi-center study is beginning to offer some clues.
Early research shows that stress, insomnia, and depression may be contributing factors. So, making changes to reduce stress, sleep better, and treat depression may help. Here are some more steps to take at home.
Get a baseline. Find out what your normal pulse rate during exercise and at rest. This will help you calculate how much faster your heart is beating during palpitations. Menopause heart palpitations may increase heart rate by eight to 16 beats per minute; a larger increase may indicate a more serious issue.
The easiest way to check your heart rate is with a fitness tracker like a FitBit or Apple watch or a chest strap monitor like Polar. Sometimes an episode can feel worse than it really is and seeing that your heart rate isn’t as elevated as it feels can be reassuring. It is also helpful information to share with your doctor.
Limit caffeine. It’s stimulant that may contribute to heart palpitations. Remember, coffee isn’t the only source of caffeine. Non-herbal teas, including green tea, contain the stimulant. Even decaf teas have a little caffeine. Chocolate, energy drinks, and soda are other sources.
Read drug labels. Over-the-counter medications, such as antihistamines, decongestants, allergy remedies, and diet pills, often contain ingredients that are stimulants, which may affect your heart. If you’re taking any of these or any prescription meds and experiencing irregular heartbeats, check with your doctor to find out if they may be related.
Pay attention. When your heart starts to race or skip, take note (write it down so you don’t forget) if you feel lightheaded, out of breath, or have pain. What were you doing when it happened”exercising, on medications, working, or sleeping? This is valuable information to help your doctor narrow down possible causes. It will also help you to recognize any warning signs that need immediate attention (see below).
Stop smoking. There are dozens of reasons to quit and here’s another one. Smoking increases your risk of experiencing heart arrythmias. If you’re having trouble quitting, a health coach might help.
Reset your heartbeat. Most episodes last a few seconds or minutes, but it often feels longer. When your heart is a flutter, here are three strategies to get it back in rhythm more quickly.
There are other techniques like the valsalva maneuver, but you should talk to your doctor first to find out if they are appropriate for you and how to properly perform them.
Heart palpitations can have many causes beyond menopause, such as thyroid imbalances, anemia, diabetes, some infections, low blood pressure, and heart problems. While these flutters are usually not serious, when it comes to heart issues, you don’t want to mess around. Heart disease is the leading cause of death in women, and your risk increases after menopause. So, it’s wise to talk to your doctor about this symptom when you start to notice it.
You should also familiarize yourself with symptoms of a heart attack. Heart palpitations aren’t one of the common symptoms, but heart attacks often present themselves differently in women than men. Many women don’t always experience the classic symptoms and delay treatment so it’s important to be proactive when it comes to one of your biggest health risks.
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.
Continuing our conversation with Dr. Erika La Vella, in this month’s Microbiome Series, we’re asking the doc about how food affects our microbiome for good or ill, how we can eat to protect beneficial gut flora, and substances that may impact our gut.
The gut microbiome is sometimes referred to as “the second brain.” Why? Because what happens in the gut does NOT stay in the gut. As science explores gut flora, we’re discovering more and more how microbiome health impacts so many other systems and organs of the body.
That means taking care of the gut is pretty critical to feeling good and being healthy. And like every other organism, beneficial bacteria rely on the right food sources for optimal health.
So what do they eat? They eat what we eat, for better or worse. Fortunately, people like Dr. Erika La Vella have a good handle on what food our good gut bacteria thrive on, and she shared that information with us.
Hint: As our bodies change in perimenopause and menopause, so does our digestion and our gut. Even if you’ve been eating “gut healthy” for years, you may notice differences in how your body reacts to food. If that’s the case, it might be time to reevaluate your diet and if it’s truly suited “ still “ for optimal gut health.
TRANSCRIPT TO FOLLOW