Stop the Leaking! 13 strategies and solutions to reduce or eliminate stress urinary incontinence.

Ah, the joys of getting older and/or having babies. During these times in a woman’s life, it is not uncommon to develop stress urinary incontinence.

What is stress urinary incontinence?

Stress urinary incontinence (SUI) has nothing to do with how stressed you are about leaking urine. SUI develops when either the tissue that supports the urethra is weakened or when the pelvic floor muscles that support the bladder and urethra become weakened or don’t work right. If you leak with cough, sneeze, heavy lifting, running or jumping on a trampoline, you may have stress incontinence. Stress incontinence can be embarrassing or prevent you from doing the activities you love.

How can I stop the leaking? 

There are many things you can do to prevent the leaking. It is always a good idea to start by seeing your physician to make sure your leaking is truly due to SUI and not a bladder infection or anything more serious. Once you have been diagnosed with SUI, there are a variety of options for treatment.

Home Remedies

 1. Weight Loss

If you are overweight or obese, losing weight can lessen how often you leak urine by up to 70%.

2. Reduce Fluids

Stop drinking too much. Reducing your fluid intake is an easy way to stop leaking. Excessive fluids lead to a constantly full bladder, which makes you more likely to leak. A good way to gauge your hydration is to look at the color of your urine. A light yellow means you are well hydrated. If your urine is barely yellow at all, you are likely drinking more than you need.

3. Timed Voiding

Timed voiding means you make yourself empty your bladder at regular intervals even if you do not feel like you have to go. This prevents your bladder from getting too full which can lead to leaking urine.

4. Can the cough

If you are constantly coughing, try using cough drops or treating whatever is causing you to cough, like allergies (note: asthma or smoking can also cause frequent coughing). You would be amazed how much this helps.

5. Kegel exercises

Kegel exercises are pelvic floor-strengthening exercises. The pelvic floor muscles help support the bladder and the urethra. To prevent leakage the pelvic floor musculature and the sphincter muscle that surrounds the urethra need to contract. When your sphincter and pelvic muscles are weak, they don’t contract strongly enough to prevent leakage. (Kegels work about 50% of the time and need to be done daily to maintain the benefits).

6. Pelvic Floor Physical Therapy

If you have trouble doing your kegels, or your kegels aren’t working, consider seeing  a pelvic floor physical therapist. They can help you isolate the pelvic floor muscles and learn how to strengthen them.

Medical devices and medication

If the home remedies do not work, or you are looking for a more immediate solution, consider one of these:

7. Try an incontinence pessary.

A pessary is a small device that goes in the vagina and compresses the urethra, which prevents you from leaking. It can be worn all the time or just during the activities that cause you to leak. Your provider can fit and place it for you, or you can purchase some types online and  can place it yourself.

8. Low dose vaginal hormones

Estrogen revitalizes the tissue that supports the urethra. When estrogen declines, the amount of collagen in the tissue decreases, which can lead to less support of the urethra and other organs like the bladder, bowels or uterus. Low-dose vaginal estrogen can improve the surrounding supportive structures, increase the collagen content in the tissue and help with stress incontinence. Despite what you may have heard in the past, low- dose vaginal estrogen does NOT increase your risk of breast cancer, blood clot, heart attack or stroke and it can decrease your risk of bladder infections, also known as UTIs.

9. Duloxetine

Duloxetine is a drug used to treat depression and/or nerve pain. It also has been shown to decrease stress incontinence. Due to its side effects, and the many other options for treatment, Duloxetine isn’t used that often to treat stress urinary incontinence.

Hi-tech remedies

10. Vaginal laser treatment

Vaginal laser procedure is a newer procedure that treats vaginal dryness and incontinence without the need for daily medication or use of a medical device. It works by strengthening and increasing the collagen level in the vaginal tissue that supports the urethra, which will prevent leaking.

Several studies have shown vaginal laser treatment to be effective at treating stress urinary incontinence. The benefit of laser is that it is done in 3 simple treatments, no need for nightly medicine, and is a good option for women who don’t want or can’t use hormones.

11. High Intensity Focused Electromagnetic Field (HIFEM) Therapy

HIFEM is a relatively new technology that has been cleared by the FDA for treatment of urinary incontinence. This procedure uses an electromagnetic field to contract and relax the pelvic floor musculature for you while you sit on a chair. The contractions are consistently stronger than most women can do on their own and up to 11,000 contractions can be done in 28 minutes. This may be an excellent choice if other treatments haven’t helped or you are searching for a more immediate solution. The treatment is done in the doctor’s office and is noninvasive, meaning you stay fully clothed and there are no internal exams.

Surgery

If all else fails, there are a variety of surgical procedures designed to treat stress incontinence. Slings and suspension  procedures are two of the most common surgical ways to treat stress incontinence.

12. Sling procedures

Sling procedures use either your own tissue or a synthetic mesh to create a “hammock” under the urethra or the bladder neck to support them.  The sling keeps the urethra closed with anything that increases pressure in the abdominopelvic cavity like cough or sneeze. There are a variety of different types of sling procedures.  You and your surgeon can discuss which one might be best for you.

13. Suspension procedures

A bladder neck suspension is another type of surgery that can be done to treat stress urinary incontinence.  This procedure uses stitches to support the urethra and bladder. The sutures lift the bladder and secure the urethra to nearby structures like the pelvic bone thereby helping to prevent urinary leakage.

There’s no need to suffer any more!

Stress urinary incontinence is common, but can also be embarrassing and uncomfortable. Fortunately, there are many treatments available to help solve this issue. So go ahead, jump on that trampoline!

Dr. Becky Kaufman Lynn is a gynecologist and the founder of the Evora Women’s Health. She is a North American Menopause Society Certified Physician who has been treating menopausal women for over 20 years. Her practice is located in St. Louis, Missouri. Dr. Lynn offers a comprehensive midlife wellness program helping women lead healthy lives. Go to evorawomen.com for more information about her practice or to schedule an appointment or send us an email at info@evorawomen.com. Dr. Lynn offers telehealth visits in illinois and Tennessee.

Hormone Balance: what you need to know about your hormones and your weight

ACSM Certified Personal Trainer Rachael Lewis interviews Dr. Becky Lynn, gynecologist and menopause specialist on hormonal balance, how hormones affect your metabolism leading to weight gain.

Rachael: Hi Dr. Becky, we are so excited to learn more about your business, Evora! Can you briefly explain your background?

 Dr. Lynn: Yes! I am a board certified gynecologist and a specialist in menopause and female sexual health with over 20 years in practice. I am also a North American Menopause Society(NAMS) certified physician and a certified sexual counselor.

  Rachael: What do you specialize in?

Dr. Lynn: I specialize in menopause and sexual health and these commonly go hand in hand.  Menopause encompasses everything from preventative care and cancer screening, to treatment of hot flashes, weight gain, mood swings, brain fog and sleep disorders.  When it comes to sexual health, we treat low libido, painful sex, orgasm and arousal difficulties in women of all ages. Couples counseling is another service I provide as often patients need help explaining the process to their partner, discussing sexual concerns, and maybe working through difficulties or communication issues in their relationship.  Because weight gain is so common in menopause, I also offer a weight management program.  I help women lose weight in conjunction with you and our nutritionist Katie.  We have had many happy customers.

 Rachael: How are our hormones affected as we age?

Dr. Lynn: Our hormones change throughout our lifespan and this can significantly affect how we feel.  Estrogen levels starts to change in general in your 40s.  This can lead to irregular periods, mood swings, sleep problems and weight gain.  Our testosterone levels start to decline in our late 20s, and early 30s, leading to fatigue, low libido and a decrease in muscle mass.  Getting your hormones in balance can help with these symptoms.   

Rachael: Why are so many women today at younger ages already experiencing hormone imbalance symptoms?

Dr. Lynn: We always think of menopause happening at age 50 but the symptoms can start in your early 40s and for some women it starts even earlier. 

Rachael: How does diet and lifestyle relate to hormone imbalance?

Diet and exercise can sometimes help rebalance certain hormone levels. For example, some women have polycystic ovarian syndrome(PCOS).  Their ovaries may make too much testosterone and estrogen not enough progesterone if/when they don’t ovulate.  People with PCOS are more likely to have insulin resistance, meaning your pancreas has to put out more insulin to get glucose into your cells.  Insulin makes you deposit fat and gain weight.  When you gain weight, you become more insulin resistant and you fall into a vicious cycle of more weight gain.  Lifestyle changes, like a healthy, protein-based diet and exercise can help break the cycle. Many times, when women with PCOS lose weight, their hormones go back into balance. 

Rachael: Is there a relationship you find between metabolic rate (ability to burn calories/expend energy) and Hormone Balance?

Dr. Lynn: Absolutely! This is so important to menopausal women because when you go through menopause your ovaries stop making estrogen. Low estrogen levels lead to insulin resistance.  Similar to PCOS, insulin resistance leads to your body making more insulin which makes you gain weight.  Hormone replacement therapy in women has been shown to improve insulin resistance, which is so important to a healthy body weight. 

 Also, when estrogen levels decline, women’s bodies tend to be less muscular and more fat than when their hormones were at normal levels.  This leads to a lower metabolic rate than previously, making it harder to lose weight or making it so you have to eat fewer calories to maintain your weight.

 Lastly, after menopause, women tend to deposit more fat around their middle and less on their hips and bust.  This leads to a higher risk of cardiometabolic diseases, like diabetes and high blood pressure. 

 Rachael: What do you wish all women knew related to our health or hormones specifically?

 Dr. Lynn: I feel like there is still so much misinformation concerning hormone therapy out there.  Women don’t know who to trust or what to believe.  I want women to know that hormones have incredible benefits to your health.  Like all medicines, they have side effects and risks too and they aren’t the answer for everything or everybody. 

This is why it is so important to find a physician who is a hormone specialist and a NAMS certified one! 

Rachael: What made you decide to start your own business?

Dr. Lynn: I love taking care of patients, especially women in midlife. There are many important topics to cover during a visit that are important to your overall health, well-being and quality of life. I feel strongly that women need more than a 10 minute visit with their doctor in order to meet their health needs.  I found that I could not do this as an employed physician working in a large practice.  My schedule was always over booked and I would be running behind.  Starting my own business has allowed me to limit the number of patients that I see and give my patients all the time, information, and discussion that they need during a visit.  At Evora, we never rush.  We listen, evaluate the issues and then come up with a plan personalized just for you. 

 Rachael: How does your service differ from a traditional doctor office visit?

 Dr. Lynn: We differ from traditional medicine in numerous ways:

1. My practice focuses on your overall health and well-being, not just your symptoms. 

2. We spend an hour with you on the first visit so we can address both prevention and all of your concerns. We always give you the time that you need.

 3. We devote all of our time directly to you. Because of this, we do not accept insurance for doctor visits.  You can still use your insurance for any testing or imaging that we order.  You can always submit to your own insurance for reimbursement or you can use a health savings account or flexible spending account to pay for services.  We give you all of the documentation that you need to submit. This way all of our resources are devoted to you, not to collecting from insurance. 

 Rachael: Last one, what is your favorite thing to do when you’re not at the office treating patients?

Running! I love running.  It takes me to my happy place, not to mention exercise is so good for your moods and it keeps my weight in check.  My family knows, early in the mornings if mom is not home, she is out running!

Dr. Becky Kaufman Lynn is a gynecologist and the founder of the Evora Women’s Health. She is a North American Menopause Society Certified Physician who has been treating menopausal women for over 20 years. Her practice is located in Chesterfield just outside of St. Louis, Missouri. Dr. Lynn offers a comprehensive midlife wellness program helping women lead healthy lives. Go to evorawomen.com for more information about her practice or to schedule an appointment or send us an email at info@evorawomen.com

Rachael Lewis is a fitness professional who has touched the lives of countless women - helping them move forward in their health and wellness. Rachael currently is an American College of Sports Medicine Certified Personal Trainer who has worked for ten years in multiple sports, corporate and community settings. Rachael believes that every body adapts and responds to exercise differently. Her goal is to create a sustainable exercise regimen that you are able to maintain through the rest of your life. Rachael is the founder of A Perfect Fit, a concierge culinary service. Offering in home cooking and personal grocery shopping, A Perfect Fit allows you to stop stressing over preparing whole meals for you or your family. A Perfect Fit takes care of it for you!

Bioidentical Custom Compounded Hormone Therapy: 3 reasons you should stop using these.

Don’t get me wrong.  I am a big believer in hormone therapy.  Hormone replacement therapy does a world of good.  Starting hormones in your 50s or within ten years of your last menstrual period, treats hot flashes, keeps your bones strong, your skin soft, the vagina healthy and decreases your risk of cardiovascular disease.  These are proven benefits.  Proven through meticulous research on the benefits of hormones, their safety profiles and how well they work. 

What does the evidence tell us?

 In the early 2000s, standard hormone therapies got a bad reputation- namely a specific combination of hormones called Prempro(estrogen + progestin) and Premarin (estrogen alone).  A large study, called the Women’s Health Initiative (WHI), showed that women on Prempro had an increased risk of blood clot, breast cancer, heart attack and stroke.  This scared multitudes of women and many abruptly stopped their hormones.

 The bad reputation deserves a do-over. The researchers continued to collect data and followed the study participants. It turns out that over the next 20 years, when the results of the WHI were reevaluated and broken down by age groups, women in the 50-59 year old age group actually had a decreased risk of heart attack, a decreased risk of dying and no increased risk of stroke.  The risk of breast cancer was not dependent on age.  Women on estrogen and progesterone together (Prempro) had an increased risk of breast cancer but women on estrogen alone (Premarin) had a decreased risk of breast cancer.  Is it the progesterone in Prempro that caused the increased risk of breast cancer?  We don’t know.  What we do know is that a progesterone called Prometrium was not shown to increase the risk of breast cancer in a metanalysis over a 5 year time period.  Women with a history of hormone sensitive breast cancer should not use hormones. 

What does bioidentical mean?

 Bioidentical means that the hormone you are taking is the same chemical structure as your own ovaries make.  Compounded means a medicine is made in a pharmacy from scratch.  Not all bioidentical hormones are custom compounded. In fact, there are 16 “bioidentical” hormones that are standard FDA approved prescriptions. The North American Menopause Society and the American College of Obstetrics and Gynecology recommend that women use FDA approved prescriptions because they have been studied in large clinical trials and have been proven to be safe and effective. Custom compounded hormones have not.

Compounded Bioidentical hormones- BUSTED

 When it comes to custom compounded bioidenticals, women have been led to believe that these were “better, safer and more natural” than standard FDA approved hormone formulations.  There is absolutely no proof that this is true.  Also, custom compounded hormones are not required to come with a package insert delineating the risks of use, which may lead some women to believe they are safer. 

Don’t increase your risk of uterine cancer!

 Women who have a uterus need to take a progestin when they take estrogen for symptoms like hot flashes. Taking estrogen alone increases the risk that a woman will develop uterine cancer (unless she has had a hysterectomy). Standard prescription FDA approved hormones have to prove to the FDA that women who take them get enough progestin to prevent them from developing uterine cancer.  Compounded bioidenticals have not proven that the amount of progestin they contain is enough to prevent uterine cancer.  Why risk it when there are formulations that have been shown prevent the risk of uterine cancer?

You don’t know how much hormone you are getting.

 Compounding pharmacies are not regulated by the FDA.  This means that their products are not tested for quality, purity or strength.  The doses from compounding pharmacies can vary batch to batch.  If there is a regulated prescription bioidentical available, choose that one.  You know exactly how much you are getting with each dose. 

Compounding Pharmacies are not bad.

 I am not saying compounding pharmacies are bad.  They are great!.  They fill a niche when a medicine doesn’t exist in an FDA approved product or for people who are sensitive or allergic to some of the ingredients in an FDA approved product.  I use a compounded pharmacy for testosterone replacement because there is no FDA approved product. You can also use an FDA approved formulation for men-which is recommended by an International Consensus panel on the use of testosterone in women.  Women need 1/10 of the amount of testosterone that a man needs, so with products designed for men, it may be hard to measure out the correct dose and they tend to be expensive because they are not covered by insurance. This is why I chose to use compounded testosterone for my patients.

The North American Menopause Society (menopause.org)

 It is difficult to sort through all of the information on the internet and know what to believe.  Thankfully, the North American Menopause Society is a nonprofit organization dedicated to promoting the health and quality of life of women at midlife.  Hormone replacement is not a one size fits all or the answer to every problem.  With that said, there is definitely a role for hormones for some women.  Just make sure to choose the safest way to use them. 

Dr. Becky Kaufman Lynn is a gynecologist and the founder of the Evora Women’s Health. She is a North American Menopause Society Certified Physician who has been treating menopausal women for over 20 years. Her practice is located in St. Louis, Missouri. Dr. Lynn offers a comprehensive midlife wellness program helping women lead healthy lives. Go to evorawomen.com for more information about her practice or to schedule an appointment or send us an email at info@evorawomen.com. Dr. Lynn also sees patients via telehealth in Illinois and Tennessee.

Yoga: a women's health best friend

Yoga- a women’s health best friend.

 I recommend yoga to my patients quite often.  I never did it myself. For years I said I was too busy for yoga.  My excuse was that it didn’t burn enough calories and I am already flexible.  Until a girlfriend invited me to join her and I actually had the time to do so.  I was amazed at how much I enjoyed it! It was difficult at first, learning to find my breath and use it while at the same time trying to bend over, balance and put my body in challenging yoga poses.  But I kept coming back.  Fast forward 5 years, I am a true yogi and I recommend it to many of my patients.  Yoga has so many benefits for women’s health specifically and especially for those dealing with pelvic pain, struggling with anxiety or just wanting to stay healthy, toned and fit. 

Benefits of yoga at midlife

 In your 40s and then in to your 50s, your body changes.  Women gain fat and lose muscle.  Our joints become less flexible and we are weaker than we used to be in our earlier years.  We may spend hours hunched over a desk staring at a computer.  Our bones thin.  (Isn’t menopause fun!). Our lives may become stressful at midlife, dealing with teenage children, aging parents, financial stressors and now Covid 19.  Yoga, in one simple hour class, takes care of all of these in one fell swoop. 

Yoga builds strength. 

 Strength training maintains your metabolism and helps you lose weight (muscle burns more calories at rest than fat).  Strength also helps you maintain your balance and avoid falls. Any sort of weight bearing exercise also helps reduce your risk of osteoporosis or osteopenia (thinning bones).  Grab your yoga mat and start strength training! 

Yoga lessens anxiety

 Times are tough.  We have so much to worry about.  Midlife is particularly difficult as our hormones take us on a roller coaster ride.  Some women feel as though they have lost their identity once the kids grow up and leave the house.  Others may be in stressful work situations or have relationship troubles.  There is nothing better than yoga for lowering anxiety.  Those deep belly breathes calm your sympathetic nervous system.  They lower your blood pressure and relax your mind.  For that 1 hour, you can leave your worries aside.  As they say in yoga, throw your worries away, let your mind be empty and when negative thoughts come, don’t judge, just push them away. 

Yoga tones and strengthens the pelvic floor muscles.

 The pelvic floor muscles are the muscles that surround the vagina and rectum. They help to prevent your pelvic organs from falling out when you are standing up.  They also play a role in urination and defection. Keeping your pelvic floor strong can help prevent urinary leakage and prevent constipation.  Don’t have time to do your kegels? Yoga works too!

Pelvic floor and orgasms

 Many midlife women say their orgasms are either non-existent or are just “meh”.  A strong pelvic floor will contract during orgasm, making orgasms feel more powerful.  Who wouldn’t want that?

Yoga helps heal pelvic pain

 If you suffer from vaginismus or pelvic floor muscle spasm, then yoga is just the thing for you.  Sometimes the pelvic floor musculature forgets how to relax.  This leads to either painful penetration or the inability to have penetration.  Women describe it as “s/he/they are hitting a wall” during penetration attempts.  Also, big deep yoga breathes, the ones that fill up your lungs so much that they push your belly out, make it impossible for you to contract your pelvic floor muscles. This means the muscles can’t tighten up, creating that barrier to penetration.  Pelvic floor physical therapy works great to relax the pelvic floor too but your physical therapist can’t be with you all the time.  Yoga can be done at anytime, anywhere- thanks to the internet.

Go ahead, make a commitment to do something healthy for your mind and body.  No excuses, no buts or whys.  I personally like Offbeat here in Chesterfield, Missouri.  Or open up YouTube and check out Yoga with Adrienne or Yoga by Candace (my personal favorites).  If you are new to yoga, be sure to choose a class for beginners, listen to your body and go easy.  Build up to more difficult classes or poses.  If you aren’t new, be the warrior-hit the pose and namaste!

Dr. Becky Lynn is a gynecologist, menopause and sexual health specialist in St. Louis, MO.  She is licensed to practice medicine in Missouri, Tennessee and Illinois.  She she sees patients in her St. Louis office and offers telehealth consults to Illinois and Tennessee.  Call today to schedule your appointment.  (314) 934-0551 or click here to schedule.

How to lose weight during menopause! Meet Katie Heaney, RD.

 Link: https://www.youtube.com/watch?v=9s9UNax-QQ0

 Dr. Lynn: Hello, I’m Dr. Becky Lynn. I am here with Katie Heaney, RD. I’m a gynecologist, and a menopause and sexual health specialist.

 Katie: I am Katie Heaney. I’m a registered dietitian working with Dr. Lynn. I specialize in weight management, obesity interventions, nutrition for the whole family, and some sports nutrition.

 Dr. Lynn: Well, fantastic! One of the reasons I wanted to bring Katie here today is because I see so many menopausal women who tell me that when they go through menopause, their metabolism slows down, and they’re gaining weight. They tell me that they watch what they eat, they make healthy choices, they exercise, and they just can’t lose weight.

 Katie: This can be really frustrating because menopause is a big transition in life. I see many menopausal women struggling with those last 15 pounds! As women journey through the lifecycle, their bodies naturally shift in response to hormonal changes that usher them out of the fertile phase of life.  Menopause is frequently accompanied by weight gain, muscle loss, and lack of energy, making it challenging to achieve a healthy weight.  Many women who have gone through menopause or are going through menopause come to us to help them with weight loss and muscle gain. 

 When people see me and want to make healthy changes and lose weight, I start by getting as much information as I can about their current eating habits. I discuss what healthy weight loss looks like and realistic timelines.  There is so much that goes into healthy eating and weight loss.  It isn’t just about calories in and calories out. I do a deep dive into what they’re eating, when they are eating it, do they exercise, and if they are getting enough sleep. Sleep is so important. It is one of the first things we talk about. We are more likely to make unhealthy choices when we are sleep deprived.

 Dr. Lynn: During the years before your periods stop (the perimenopause) and then for a few years after they stop, many women have night sweats and they can’t sleep at all or have awakenings in the middle of the night. This is not good for those carbohydrate cravings!

Stress

 Katie: Stress plays a role too. Having a lot of stress in your life affects how hungry you feel.

 Dr. Lynn:  Stress hormones like cortisol increase, which leads to insulin increase which makes you deposit fat and crave carbohydrates.   So, how would you define healthy weight loss?

Defining Healthy Weight Loss

 Katie: It depends on where we start. Generally, we say half a pound to a pound a week of weight loss. It is a bit controversial with dieticians – like counting calories or not. I like to discuss mindful intuitive eating. We try to figure out how to be mindful of caloric intake. I also calculate women’s resting metabolic rate and their activity level in order to calculate how much or how little they need to take in to lose weight.  Research show that the average weight gain during menopause is a little more than 1 pound per year.  With reduced calorie needs as women age, weight gain is expected if they don’t eat healthfully and increase physical activity.  Lifestyle factors are extremely important to consider when talking about weight gain. 

Measuring Resting Metabolic Rate

 Dr. Lynn: How do you measure the resting metabolic rate?

 Katie: I use an equation called the Mifflin-St Jeor equation. It is based on an algorithm that uses your age, gender, activity level, and height and weight (of course). It is an estimate, but you can also use a special kind of breathing machine. You breathe into it and based off of your oxygen level and carbon dioxide level, it measures how much energy you use at rest just to run your body.  This is your basal metabolic rate.  It is very useful information.

 Dr. Lynn: It gives you the calories you burn each day?

 Katie: Resting metabolic rate is the total number of calories burned when your body is at rest. From there we use the activity level to calculate how many calories you need for healthy weight loss, because the breathing machine only gives us the calories you would need at rest. Also, I have clients that will take multiple measurements over time, because as you lose weight, there is less of you to feed, so your resting metabolic rate decreases. The way you can increase or maintain your resting metabolic weight is to build muscle as you lose weight. I am not a personal trainer or a physical therapist, but I encourage 2-3 days a week of weight training and building muscle because that can really help boost your metabolic rate. Your metabolic rate tends to go down as we age and as women go through menopause.

 Dr. Lynn: So it is funny that you say that because (and I am not a dietitian), but I always think that when you’re trying to lose weight, you need to do aerobic exercise, get your heart rate up and burn calories. And so, I have said in the past, if you have limited time, concentrate on the aerobic exercise. I have changed my tune on exercise over the years. Now I see the value in strength training, especially for menopausal women because menopausal women lose muscle mass when they lose the hormones their ovaries used to make.

 Katie: Resistance training is great for muscle building!

Resistance Training and Aerobic Calorie Burning

 Dr. Lynn: What would be the optimal mix of resistance training and aerobic calorie burning?

 Katie: That is a really good question. I don’t think it’s either or; it is hopefully both. I would start with looking at what you are willing to do. Many times I have clients say, “yeah I’m just not going to lift weights, but I would like to get my heart rate up and start exercising more.” I focus on where the client wants to start.  If I say to someone, “do all of this,” it can get overwhelming, and they may not start at all.

 I just had a client the other day say “I’ll do ten minutes a week and that is all I will do”.  I have another client who is already doing three days a week of Krav Maga, high intensity interval training, and she said, “I’ll go up to four days a week!” So, it just depends on the person, but ideally the recommendation for adults, is 30 minutes a day, or 210 minutes per week. It can be 30 minutes a day or it can be three 1-hour long sessions a week. I try to choose something that works for each person.  If it were up to me, I would say the 30 minutes a day, because then maybe we can incorporate two days a week of strength training for 20 minutes.

Logging Your Data

 Dr. Lynn: Okay, so you talk about sleep habits, you talk about exercise, but then do you have them write down what they eat?

 Katie: Every client is different. Generally, when they come in, I want to know what they’re eating. Some of them come in with a notebook, and many, many, many clients come in using  My Fitness Pal. I think you’re familiar with it?

 Dr. Lynn: Yes!  My Fitness Pal synchs up with our electronic medical record.   

 Katie: Some people come in and they have it all recorded, so we can go through that. Typically, I get a verbal intake of what you are eating on a typical weekday, and I usually get a couple samples of meals and schedules. For the weekend, schedules change. So, I also get a weekend day. From there, we talk about eating habits. For example, “do you skip meals? Do you eat when you’re stressed, bored, angry…” Emotional eating is common.

 Dr. Lynn [humorously]: That’s me!

Emotional Eating

 Katie:  We have to eat all the time and we are always thinking about food. So, there is a lot of eating that goes with emotions. I also ask about binge eating habits or eating disorders, and I usually refer to a specialized therapist for those.

 Dr. Lynn: Yes 

Katie: I am not a therapist. I sometimes introduce cognitive behavioral therapy(CBT) in sessions as a behavior change technique, but I usually refer to a trained counselor or therapist for more detailed training on CBT.   

Katie: I also talk about hunger with my clients. For instance, I go through the hunger scale. I usually compare fuel for my body to gas for a car, so when the gas is empty, the car stops. When you’re really, really hungry, your body doesn’t work as well as it should. Your brain doesn’t work as well as it could.” I always say 10 is like Thanksgiving Day, when you eat so much, and you can barely move. Ideally, we want to stay between a 4 and a 6, so you don’t allow your body to get too hungry and you stop when you’re at a 6 versus eating until you’re stuffed. Achieving a healthy weight is about eating enough, but not too much. I talk a lot about what people are eating, but I also talk about how much.

Portion Control

Dr. Lynn: Portion control basically. We all know that we have large portions. If you go to a restaurant, there are sometimes a thousand calories in one meal, if not more. I feel like we are used to large portions, so a smaller portion seems too small. If you read labels and look at serving sizes, a serving might be much smaller than the amount you would normally eat.

 Katie: It can be shocking to show what a healthy portion of rice is… it’s half a cup!

 Dr. Lynn: Right, it looks like three bites!

 Katie: Yes! After we calculate your calorie needs, I create a meal plan together with your idea of what that looks like. That way it fits with your lifestyle and habits. I also talk about having all the food groups in a meal, having a healthy amount of carbohydrate, fat, and protein. I focus quite a bit on protein. I try to create meal suggestions that incorporate all the different food groups, like starch (especially whole grains), vegetable, fruit, fat, and a meat or protein.

Katie: Protein is really important in achieving a healthy weight and having energy. If you’re incorporating exercise you have to have enough protein to maintain your muscles, but not too much. I focus a lot on portion size and a tool I have been using lately, which is pretty basic but helps you visualize, is divide your plate into fours.

 Dr. Lynn: I think I’ve seen that before.

 Katie: It is through choosemyplate.gov, which is an updated food pyramid.

 Dr. Lynn: mm-hmm!

Katie: I recommend that women practice mindful eating, control portions, and focus on nutrient-dense foods such as fruits and vegetables.

Fruits and Vegetables

Dr. Lynn: Right. I have a question about that. I tend to eat a lot of fruit, but not as many vegetables. So, if you say 8-10 servings of fruits and vegetables a day and nine of those ten are fruits, am I still missing something? Should I try to balance it out a little bit?

Katie: 2-3 of those servings should be vegetable. You don’t have to go up to 7 vegetable servings tomorrow but try to find some recipes. I see many clients who just don’t like vegetables because the only way they’ve eaten them is boiled or steamed.  I talk a lot about roasted vegetables. They are so much better! If you roast brussel sprouts, asparagus, cauliflower, or broccoli, they don’t quite taste like French fries, but they have a nice crispy texture. Or some people like vegetable soup. Vegetable soup can be store bought or made. If bought, then it isn’t labor-intensive and you still get your vegetable servings.

 Dr. Lynn: We all probably need to eat more vegetables…. Me especially.

 Katie: Amen! I agree!

 Dr. Lynn:  Thank you so much Katie for helping our patients the way you do.  I am lucky to be working with you!

Dr. Becky Kaufman Lynn is a gynecologist and the founder of the Evora Women’s Health. She is a North American Menopause Society Certified Physician who has been treating menopausal women for over 20 years. Her practice is located in Chesterfield just outside of St. Louis, Missouri. Dr. Lynn offers a comprehensive midlife health program including helping women lose those pesky last 15 pounds! Go to evorawomen.com for more information about her practice or to schedule an appointment or send us an email at info@evorawomen.com

Katie Heaney is a registered dietician working with Dr. Lynn at the Evora Center for Menopause and Sexual Health. She holds an undergraduate in Nutrition and Dietetics. She completed her dietetic internship at Yale-New Haven Hospital and then obtained a Certificate of Training in Obesity Interventions for Adults. She is a member of the Academy of Nutrition and Dietetics and the national and local chapter of the Academy of Nutrition and Dietetics. Click here to schedule an appointment with Katie.

Why can't I lose those last 15 pounds after menopause?

Why are the last 15 pounds so difficult to lose after menopause? 

Menopause can be miserable.  The hot flashes, the night sweats, the mood swings.  Of all the menopausal symptoms, for some people the WEIGHT GAIN is the worst! Not only do menopausal women gain weight, they gain around the middle instead of in the bust, bum or hips.  Women who used to have a pear shape, now have an apple shape and apple shaped women have a higher risk of cardiovascular disease and diabetes than their pear counterparts.

Can I blame my hormones?

It happens partly because at menopause our ovaries stop making estrogen, the “female” hormone.  No worries, your fat cells make estrogen too, but not in the amounts that your ovaries did when they were working. When there is less estrogen around, you deposit fat more like men do, the proverbial beer belly.  By the time you have gone through menopause your testosterone is also pretty low.  Testosterone levels peak in your late 20s and early 30s. After that they start to decline ultimately leading to more fat and less lean body mass (muscle).  Testosterone helps build muscle mass, and muscle burns more calories than fat even when you are just sitting around.  Declining levels of estrogen and testosterone around the time of menopause play a role in making it hard to lose those last 15 pounds.

Insulin plays a role too.

Weight gain is not only about your reproductive hormones.  During menopause, women are more likely to have an increase in insulin resistance.  This means it takes more insulin to get glucose into our cells.  Our pancreas starts making extra insulin and insulin helps our body deposit fat.  The more fat we have, the more insulin resistant we may become, which leads us to become more overweight or even obese.  It can be a vicious cycle, and it is a difficult cycle to break. 

Your genes aren’t helping you.

Furthermore, our body is evolutionarily programmed to keep weight on.  Every time we restrict calories and lose weight, our body becomes more efficient at putting it back on.  When we lose weight, the amount of energy it takes just to live decreases. This is part of the reason why many women, despite eating low numbers of daily calories, still can’t lose the last 15! When you are losing weight by restricting your intake, your body also responds by increasing a hormone called ghrelin.  Ghrelin makes you feel hungry.  Studies show that if you have lost weight in the past and gained it back, your ghrelin levels will be higher than they were if you had never lost weight, making you feel even more hungry!

7 things you can do about it.

1.      Eat a healthy diet.

Eat whole foods, with adequate protein, and minimal amounts of processed foods.  The amount of protein you need depends on your size and your exercise level. Protein also helps keep your insulin levels in check.  If you eat a high carbohydrate meal, your insulin will rise much more than if you eat a protein + carbohydrate meal or a protein rich meal.

2.     Exercise!

Exercise decreases insulin resistance and helps to build muscle mass. Building muscle mass raises your resting metabolic rate(RMR). RMR is the amount of calories you burn just being alive. When you restrict your calories, your RMR decreases which slows down weight loss or stops it altogether. Building muscle mass through exercise can increase your RMR. At Evora, we measure your RMR scientifically with a specialized device called the Breezing Pro that calculates your exact RMR. This helps us develop a personalized weight loss plan just for you.

Exercise is hands down the best thing you can do for your body - not just for your weight. Exercise burns calories, builds muscle mass, keeps your bones strong, improves your moods, increases your metabolic rate, decreases brain fog and decreases your risk of a host of medical problems - including decreasing your risk of breast cancer! No excuses here - you have to exercise.  If you hate exercising, try making it social.  Find something you like to do with a friend - even a Zoom friend.

3.     Consider your triggers. 

Are you an emotional eater?  Does stress make you head to the kitchen?  Sit down and make a list of situations that lead you to overeat.  Then think of ways to avoid or change the situations.  Learn to overcome thoughts that give you permission to overeat like, “I had a tough day at work, so I deserve to eat this box of cookies” or “I can’t lose weight anyway, I might as well not even try”.  Consider seeing a behavioral therapist who can teach you strategies to manage triggers and negative thoughts.

4.     Set small goals. 

If you decide you are going to eat 500 calories a day the next six months, you may be setting yourself up to fail.  Try shooting for 1200-1500 calories a day for a week.  Then the goal seems reachable and reasonable in your mind.  You are much more likely to set yourself up for success.  Consider seeing a registered dietician for help with creating a well-balanced low-calorie program.

5.     See a registered dietician. 

Women often ask which diet is the best diet.  The answer is the diet that you can stick to.  There are many choices, from the Mediterranean diet to the Keto diet to intermittent fasting.  They have all proven to help people lose weight, but if you can’t live without bread in your diet, maybe the Keto diet is not the one for you.  A dietician can help you formulate a well-balanced program that you can follow.

6.     Consider weight loss medicines. 

Weight loss medicines like phentermine or naltrexone/buproprion are not for everyone but for some women they work very well.  Depending on how much weight you have to lose, and what other medical problems you have, sometimes these medicines can help you control your cravings or give you a jump start to losing weight. 

7.     Consider using hormones. 

Hormones are not specifically indicated for weight loss, but we know your hormonal milieu plays a role in weight management.  Estrogen can help improve how your body responds to insulin. Testosterone helps to build muscle mass and muscle burns more calories than fat.  Like any medicine, they have many benefits, but they also have risks and side effects. Before starting anything, talk to your provider. Find a provider who is well-versed and up to date with the recommendations and research.

Go to the North American Menopause Society (NAMS) website for more science backed information on hormone therapy or to find a NAMS certified menopause provider.

 Dr. Becky Kaufman Lynn is a gynecologist and the founder of the Evora Women’s Health. She is a North American Menopause Society Certified Physician who has been treating menopausal women for over 20 years. Her practice is located in St. Louis, Missouri. Dr. Lynn offers a comprehensive midlife health program including helping women lose those pesky last 15 pounds! Go to evorawomen.com for more information about her practice or to schedule an appointment or send us an email at info@evorawomen.com