Do you urinate just in case? Stop JICing

Written By: Veronica Lane, PT

Let’s put an end to just in case urinating, or JICing we like to call it.

You were probably taught to do it growing up, mom said, “Go to the bathroom before we leave.” Then you rolled your eyes and did it.

Now it’s a habit: you pee before you leave to go anywhere, “Just in case”…

I too was that mom. Do you think I let 4 pre-schoolers leave the house without trying to pee first? Never.

JICIng repeatedly will teach your bladder it should empty at first signal when only 1/4 to 1/2 full. You go before the bladder is completely full. This is not good for your bladder at all!

The bladder is made to stretch like a balloon. Repeatedly emptying before the bladder is full may cause you to lose the stretch factor and then you may never completely empty. Issues such as urinary urgency, frequency, and other bladder and pelvic floor problems may follow.

Try to make it 3-4 hours between urinating during the day. Ignoring the early signals is tough, but you can re-train the bladder and I can help you.

NO MORE JICING…MIND OVER BLADDER…

Bladder re-training is one of the most important goals of pelvic floor physical therapy if needed.

Veronica Lane is a Physical Therapist and Personal Trainer. She earned a Bachelor of Science Degree in Physical Therapy from Rockhurst University in Kansas City, MO. She earned a Master of Health Science Degree in Physical Therapy from Washington University in St. Louis, MO. She is a NASM certified personal trainer.

Veronica has 30 years of experience as a Physical Therapist. She has worked in outpatients/orthopedics, sports medicine, acute care, and home health. She has a specialization in Pelvic Floor Physical Therapy. She received her training through Herman and Wallace Pelvic Rehabilitation Institute.

Veronica has a passion for educating and helping women understand Pelvic Floor health and wellness. She has been a speaker around St. Louis numerous times promoting Pelvic Health and educating that pelvic floor dysfunction is “common not normal”. She has a mission to empower women with the knowledge and tools to live life fully with a healthy pelvic floor!

Veronica is a wife and Mom to 4 teenagers. She enjoys everything fitness and nutrition and spends time working out in different gyms, running, hiking and walking. She loves being outdoors.

Call us today to schedule! 314 934-0551

Sex Drive: am I normal?

Factors That Affect Sex Drive

What’s Normal vs Not?

Talking about sex drive is still as taboo as discussing politics at Aunt Karen’s birthday party.

That’s because sex drive is complicated to say the least. So many factors play into a woman’s desire to have sex including:

• Hormones

• Relationship factors

• Communication styles

• Emotional attachment

• Chronic medical conditions

• Fatigue

• Anxiety

• Depression

• What your family taught you about sex

• Pain during sex

• Children

 And many more. 

 Now, the first step to improving sex drive is awareness that sex is a normal, healthy part of life and that sex drive is going to look different for everyone. In fact, sex drive wades along a large spectrum. Nonetheless, there are a few ways to determine if your sex drive falls within a healthy range within the present chapter of your life. Let’s dive right in!

Hormones

Perhaps the greatest driver of sex, we must discuss the monumental impact of hormones and how their shifting levels affect the desire to have more or less sex. 

Testosterone, prominent in males, is the main hormone of desire. Hence why men are known as being more sexually driven. Women also make testosterone but to a much lesser extent than men. This is largely a good thing because if we did make as much as them, we’d grow beards, sport big muscles and talk deeply.

But it’s certainly still important to produce enough. There are many factors that can affect a woman’s testosterone level. One of the most common contributors to low testosterone is the birth control pill.  The pill is often prescribed for acne because it lowers testosterone levels. However, this can drastically decrease sex drive in the process. In turn, low testosterone can lead to vaginal dryness which can lead to painful sex, and if sex hurts, you’ll likely avoid it! Luckily, there are various non-oral birth control options that won’t decrease sex drive. Talk to your doc about other methods of birth control  if you believe your current one could be diminishing your sex drive.

Painful sex

There are many reasons why sex could be painful, but one of the more common is endometriosis.  Endometriosis occurs when there are bits of endometrium (the tissue you shed each month during your period) that implant outside of the uterus in the pelvis, like on the ovaries or your colon.  It causes inflammation and scarring which can lead to pain. In fact, one of the most classic symptoms of endometriosis is pain with deep penetration.

Unfortunately, one in ten women will develop endometriosis, but it takes on average up to seven years to get properly diagnosed. Endometriosis typically presents with terrible menstrual cramps; ones so painful women may vomit, faint or regularly miss school/work each month. The treatment for endometriosis ranges from hormonal suppression to surgical removal of the implants to hysterectomy. Just know, that if you have it, various treatment is available, and if you can stop having painful sex you are much more likely to be in the mood when it comes time!

Another common reason for painful sex is vaginal dryness due to menopause, otherwise known as genitourinary syndrome of menopause.  When the ovaries produce less estrogen, the vaginal tissue becomes thin and dry and loses elasticity. This leads to sandpaper-like sex, aka misery. This is where hormones arrive to help! Low dose hormones are very low risk and can rejuvenate the vagina to make lubrication, increase blood flow and stretch properly.

No more painful sex, no more lack of sex.

Depression and Anxiety

When mental health suffers, sex drive drastically decreases. It makes evolutionary sense, because nature doesn’t want stressed women to reproduce. Stress wreaks havoc within the body and creates an unfavorable environment for nearly all bodily functions, let alone reproduction. Instead, nature wants depressed or overly anxious women to focus on healing themselves first and foremost. Even if the goal isn’t reproduction, it’s still important to facilitate a healthy sex drive by addressing mental health concerns. 

We can’t go without acknowledging that these past two years have been especially difficult for many women due to the pandemic, home schooling children, caring for sick family members, not being able to socialize and the like. Plus, many women are natural caregivers and tend to put their own needs last. But mental health is just as important as physical health, and they’re also inextricably linked. So if you’re feeling down or depressed, it becomes that much more important to take care of yourself, especially if you are responsible for taking care of others.

Although some women are able to overcome their depression and/or anxiety through methods such as journaling, meditation, exercise, yoga or decreasing responsibilities, many need extra aid in the form of therapy. This is your encouragement to seek counseling, coaching or therapy, because you don’t have to do this alone. 

With that said, there are some medicines that can affect your sex drive and one of those is a class of antidepressants. SSRI antidepressants like Celexa, Lexapro, Prozac, Zoloft, and Paxil can lower your sex drive and/or make it harder to reach orgasm. Unfortunately, many women aren’t told this when first prescribed, which can lead to feelings of inadequacy, low self esteem and extra stress. 

However, there are several antidepressants that don’t affect your sex drive or are less likely to affect it.  Wellbutrin is one of those. In fact, there are a few small studies that show that Wellbutrin can improve sex drive, even in women who are not depressed.  If you think one of your medications, but especially antidepressants are contributing to your lack of sex drive, it’s OK and even encouraged to talk to your provider about changing medications.  

Strength of Relationship

Take a minute to ponder how you’re really feeling about your relationship.

Do you feel loved, heard and appreciated?  How attracted do you feel to your partner? Are there major underlying problems in the relationship that could be contributing to your lack of desire?

If there are big stressors and strains, sex drive can plummet. Once again, nature doesn’t want us to reproduce with someone incompatible. This is not to say your relationship is doomed, as no relationship will be perfectly compatible one hundred percent of the time. However, if relationship issues are the reason for having less sex, it may help to seek a therapist. Having a non judgemental third party help you work through some of these issues might just be the spark that rekindles sexy time.

Fatigue

If you’re a new mom, well, need I say more? But even if you’re a long time mom, a fulltime mom, or a mom with a full time career, fatigue plagues us all. Our current culture and society practically idolize it! Yet, humans, and especially women aren’t robotic machines with energizer bunny battery life. To mitigate fatigue, be sure to practice self care, take naps as needed, eat a nutritious diet, exercise, ask for help and manage responsibilities well.

In addition to addressing the one or many root causes of fatigue, it’s also important to consider how fatigue may affect timing of sex. Although late at night seems to be the most popular time for sex, it may not be the best time for busy parents who go, go, go all day and then crash in the evening. In reality, this formula often equals no sex at all.

Thus, it’s worth it to talk to your partner about better times to have sex that fit into your current lifestyle. Having sex releases happy hormones, so perhaps it’s time to switch to the morning. It’s also completely encouraged (and normal) to plan sex dates. Pick days and times that work the best and schedule them on the calendar. Truly!  

What is normal?  What is not?

Spoiler alert: there is no “right” amount of sex drive. All of the above factors and more interact with each other to dictate baseline sex drive. Sexual desire also tends to shift throughout the lifecycle, and not necessarily linearly. Thus, consider creating your own unique spectrum to gauge your unique healthy sex drive level. And when it wanes, take healthy measures to address the root causes because sex is important… and fun when you want to do it!

Again, awareness of the above factors is the first step to improving and enhancing sex drive. Consider how each is affecting you at this point in your life and then brainstorm ways to address the limiting factors. You can also reach out to a sexual medicine specialist in your area. The International Society for the Study of Women’s Sexual Health (ISSWSH) is another great resource for information if you are worried about your drive. So go ahead, have drive, have sex and thrive!

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. She is also a fellow of the International Society for the Study of Women’s Sexual Health(ISSWSH) and a former board member. Her practice is located in Chesterfield just outside of St. Louis, Missouri. Dr. Lynn offers a comprehensive midlife wellness program helping women lead healthy, happy and fulfilling 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

Urinary Incontinence in Female Runners

Female runners and other athletes that frequently pound (think crossfit, plyometrics, jumping, powerlifting) have increased risk of urinary incontinence. This is because running/repetitive pounding is one of the risk factors that can lead to pelvic floor damage. When running, the entire body endures the impact of that repetitive movement for a prolonged period of time and every single stride puts pressure on the pelvic area.

Studies show 40% of elite female athletes and runners have urinary incontinence and these athletes have 177% higher risk of presenting with urinary incontinence when compared with sedentary women.

This is not to demote running or other pounding exercises to off limits, but it is important to be aware of how running affects the pelvic floor down the road. Awareness and prevention are key!

What is The Pelvic Floor?

The pelvic floor consists of muscles at the bottom of the pelvis that uphold the bladder and close off the bottom of the abdominal cavity. The pelvic floor muscles work similarly to a trampoline in that they can relax and stretch down as well as lift for contraction. However, problems arise when it becomes overused and overstretched, also similar to a rubber band that’s been pulled too far too often.

Pelvic organ prolapse (POP) is also very common in female runners and urinary incontinence is the most common symptom of POP.  Because the pelvic floor muscles act like a trampoline, when it starts to weaken and/or has increased pressure and pounding repeatedly over time (as when running) this support is lost.  It results in organs shifting downward and pushing into the vaginal canal.  Besides urinary leakage this can lead to: a sensation of "insides falling out"; rectal, vaginal, back or pelvic pain; abdominal bloating; constipation; and rectal or vaginal pressure.

Another issue that may add to risk of urinary incontinence is hip weakness.  Unfortunately, a lot of runners don’t do specific hip strengthening exercises.  Hip weakness can cause instability and can lead to compensation from other muscles such as the pelvis. Again, this contributes to overuse or overstress of the pelvis.

Pelvic Floor Therapy

Pelvic floor physical therapy is the answer!! Through bowel and bladder fitness education, exercises specifically designed for you to address your deficits, manual treatment options and more:  you can avoid these issues!  And you don’t have to have a symptom to receive therapy. Prevention is key to staying healthy and being able to run without worry!

Pelvic floor muscle exercises can help:

• Improve bladder and bowel control

• Reduce risk of prolapse in women

• Promote better recovery from childbirth and surgery

• Promote better recovery after prostate surgery in men

• Increase sexual sensation

• Increase confidence and quality of life

Furthermore, pelvic floor therapists will help identify exactly which muscles need strengthened or balanced in order to create an individualized plan for you and your needs.

So, is there really any reason not to try it?!

Call Evora Women’s Health to schedule your pelvic floor assessment today! 314 934 0551. Schedule a FREE 15 minute visit with Veronica Lane, pelvic floor physical therapist.

Veronica Lane is a Physical Therapist and Personal Trainer. She earned a Bachelor of Science Degree in Physical Therapy from Rockhurst University in Kansas City, MO. She earned a Master of Health Science Degree in Physical Therapy from Washington University in St. Louis, MO. She is a NASM certified personal trainer.

Veronica has 30 years of experience as a Physical Therapist. She has worked in outpatients/orthopedics, sports medicine, acute care, and home health. She has a specialization in Pelvic Floor Physical Therapy. She received her training through Herman and Wallace Pelvic Rehabilitation Institute.

Veronica has a passion for educating and helping women understand Pelvic Floor health and wellness. She has been a speaker around St. Louis numerous times promoting Pelvic Health and educating that pelvic floor dysfunction is “common not normal”. She has a mission to empower women with the knowledge and tools to live life fully with a healthy pelvic floor!

Veronica is a wife and Mom to 4 teenagers. She enjoys everything fitness and nutrition and spends time working out in different gyms, running, hiking and walking. She loves being outdoors.

Staying Healthy at Midlife

Staying Healthy Through Midlife

 Our culture largely emphasizes the negative experience of natural aging. While many aspects of aging are inevitable, the associated symptoms can be mitigated through healthy lifestyle habits. Whereas the body is quite resilient throughout our twenties and even thirties, it’s much less so come forty and especially fifty. This means it’s doubly important to lead a healthy lifestyle throughout midlife.

What Causes Symptoms of Aging for Women?

For women, many hormonal changes occur at midlife thanks to the ovaries. This reproductive organ slows the production of estrogen, testosterone and related metabolites like DHEAS. When a woman hasn’t had a period in 12 months, she is considered menopausal, which means her ovaries aren’t producing estrogen. However, fat cells continue to produce some estrogen.

 Nonetheless, symptoms of low hormone levels include:

 ●      Hot flashes

●      Night sweats and sleep problems

●      Weight gain (especially around the midsection)

●      Increased risk of heart disease

●      Increased risk of dementia/memory problems

●      Decreased sex drive

 Let’s take a deep dive into some of these symptoms and how to properly manage them through healthy lifestyle behaviors.

Hot Flashes and Night Sweats

Those pesky hot flashes and night sweats are referred to as vasomotor symptoms, forms of temperature dysregulation thanks to changes in reproductive hormones. Normally, core body temperature remains within a controlled range based off circadian rhythm. Disruption of this mechanism results in exaggerated heat loss responses. Not only can these symptoms be embarrassing, but night sweats can disrupt sleep and lead to negative health consequences.

 Getting enough high quality sleep– generally 7-9 hours per night- is crucial for metabolic health. One night of poor sleep disrupts hunger and fullness hormones, increases cravings specifically for refined carbohydrates and high fat foods, enhances feelings of depression and anxiety, makes it difficult for your brain to assimilate new memories and increases the stress hormone, cortisol. Multiple nights and chronic poor sleep patterns greatly increase the risk of weight gain and obesity and many chronic diseases like cardiovascular disease and type II diabetes.

 Luckily, there are excellent treatment options for vasomotor symptoms that are safe and effective. Another one of my blogs discusses the benefits (and risks) of hormone therapy https://evorawomen.com/blog/healthy-hormone-balance-for-a-healthy-life . In addition, you can improve the quality of your sleep by:

 ●      Creating a wind-down/bed time routine

●      Shutting off screens and blue light two hours before bed

●      Eating your last meal three to four hours before shut eye

●      Consuming a dinner high in lean protein, healthy fats and fiber (from veggies and whole grains)

●      Drinking a calming tea like chamomile

●      Reducing stress in the couple hours before bed

●      Taking supplements like melatonin, chaga or lavender tea or using essential oils like lavender or peppermint

Weight Gain

Behind hot flashes and night sweats, weight gain is typically the next most undesirable consequence of hormonal changes. And although not fully understood, the most weight gain tends to occur in the midsection, an already vulnerable part of the body for many women. However, weight gain associated with aging in general is quite misunderstood.

 Most people believe that substantial weight gain is inevitable in later adulthood. However, this isn’t necessarily true. The natural aging process decreases lean body mass, which is the most metabolically active tissue. As a result, metabolism down shifts, and adults require less calories to fuel metabolic reactions. Although some of this is unavoidable, you can prevent large losses of metabolic tissue through proper exercise (to be discussed in a little bit) and healthy eating.

 In addition, cells stop working as well in mid to later life, especially when someone has led an unhealthy lifestyle in early life. It’s a wonderful privilege to be young and make unhealthy choices with few consequences, but it undoubtedly affects your health down the road.

 Unfortunately the combination of poor food choices and decreasing estrogen make women more susceptible to insulin resistance. In fact, insulin resistance is a root cause of many health struggles, as it leads to more weight gain and a harder time losing weight. Insulin is considered an anabolic hormone that promotes the storage of fat, sometimes irregardless of caloric intake. This means someone could theoretically be eating in a caloric deficit, but if they’re choosing the wrong kinds of foods, a poor insulin response will still tell the body to convert their fuel into fat.

 To better understand this concept– insulin resistance means the body over produces insulin. When cells become resistant to insulin, they can’t uptake glucose and it remains in the blood. This is undesirable because glucose then essentially attaches to the outside of cells and organs and greatly decreases their functionality. In addition, chronically elevated blood glucose levels signal the body to continue releasing insulin. High insulin levels tell the body to store more fat, but the more fat you have, the more insulin resistant you become. It’s a vicious cycle. Eventually, the pancreas tires and can’t produce enough insulin, which is technically considered diabetes at that point.

 Breaking this cycle always involves nutritional intervention, typically includes a consistent exercise plan and may warrant medication.

Increased Risk of Diseases

The trifecta of genetics, natural again and poor lifestyle choices raises risk for chronic disease usually beginning around midlife, although it’s becoming earlier and earlier nowadays. For women, certain diseases are more common, also related to the decreased hormone production.

 Did you know blood vessels (think arteries and veins) have estrogen receptors on them? When less estrogen is produced, it gives plaque the opportunity to build up and clog the blood vessels, leading to a higher likelihood of stroke and heart attack. In fact, heart disease is the number one killer of women. Luckily, estrogen replacement can help prevent the development of these atherosclerotic plaques depending on when started. If started within 10 years of the last menstrual period or before the age of 59, it is largely preventative, but if started after this time, estrogen hormone replacement can potentially destabilize the plaque and make it more likely to rupture (heart attack). Of course, diet and exercise are also vitally preventative. Focus on:

●      Reducing refined carbohydrates to less than 10% of calories per day (cakes, donuts, pastries, crackers, chips, processed/packaged foods)

●      Consume proportionally more omega-3 fatty acids (wild caught fatty fish, walnuts, chia and flax seeds) to omega-6 fatty acids (refined/hydrogenated vegetable oils like canola and safflower) in a ratio of at least 4:1

●      Reduce LDL cholesterol levels by consuming 25- 35 grams of fiber from colorful fruits and vegetables and high quality whole grains (*Navy beans and oats reduce cholesterol most!)

●      Increase HDL cholesterol by including moderate to vigorous cardiovascular activity 3-6 days/week

 In addition, certain types of cancer risk increase as well. 1 in 8 women are diagnosed with breast cancer. Overweight and obesity are associated with an even higher rate of breast cancer. Regular screening is important, but screening catches cancer once its already developed. Thus, maintaining a healthy lifestyle and a healthy weight is vital for prevention.

The risk of uterine cancer also increases if you are overweight or obese. Because fat cells produce estrogen, an overabundance of them will produce too much estrogen (much more than estrogen hormone replacement therapy) and overstimulate the uterus. Again, maintaining a healthy weight is the single best preventative measure for risk reduction.

 Women already have a higher risk of developing dementia and Alzheimer’s, but menopause heightens it further. Although mechanisms aren’t completely understood, researchers believe that estrogen exerts function in an area of the brain called the hippocampus, which is responsible for memory and certain types of learning affected by Alzheimer’s. Thus, decreasing estrogen levels reduce hippocampus activity. Furthermore, estrogen is protective against a build-up of amyloid-B proteins implicated in the disease as well. Hormone replacement therapy is way to reduce risk of dementia and associated Alzheimer’s, but eating a brain healthy diet full of omega-3 fatty acids, lean protein, colorful fruits and veggies and fiber from whole grains (aka a Mediterranean-like diet) and consistently exercising (aerobic and anaerobic) is equally protective.

Decreased Sex Drive

Midlife is already a difficult time of life for many women. Empty nest syndrome can contribute to a feeling of lost identity; societal standards of beauty begin to fade; family members might be sick; divorces; you name it. On top of this, libido decreases due to lower levels of hormones. Sex is not only healthy for the physical body because it releases “happy” hormones (dopamine and serotonin), it’s important for maintaining positive relationships. While hormone replacement therapy is usually the most effective treatment, there are other options as well. In addition, maintaining a healthy weight can help you feel empowered and more likely to want to have sex. Thus, taking care of your body through diet and exercise is vitally important, once again.

How to Stay Healthy Through Midlife

Now that you know how decreasing hormone levels associated with menopause increase risk of certain conditions and diseases, let’s discuss how to best prevent them or mitigate their side effects. Already sprinkled throughout this article, hopefully it’s evident diet and exercise are the answers!

Consume a Healthy Diet

Consuming a healthy diet not only reduces the risk of many chronic diseases like the ones already mentioned along with diabetes, but it helps to maintain a healthy weight. This is vital because being overweight or obese increases health risks that aren’t always so obvious.

 Overweight and obesity keep the body in a chronically inflamed state. This is often referred to as metabolic syndrome, a group of conditions characterized by increased weight and waist circumference, high blood pressure and/or cholesterol and insulin resistance. In essence, inflammation decreases metabolism and generally weakens every bodily function. This is what further leads to chronic fatigue, the inability to lose weight, hormone imbalances, autoimmune conditions, joint, muscle and bone pain, mood problems, a decreased motivation to exercise and ultimately a lower quality of life.

 However, consuming a healthy diet greatly reduces the risk of these complications, can reverse conditions (like type II diabetes) and/or treats these issues. Healthy foods aren’t healthy because they’re low in calories, although they are typically lower calorie than less nutrient dense foods, but because they contribute nutrition in the form of antioxidants, polyphenols, fiber and other beneficial compounds. These nutrients fuel cells and maintain healthy metabolism.

 So, what does a truly healthy diet look like?

1. 5-9 servings of colorful fruits and veggies/day

   1. Non-starchy for fiber and antioxidants

   2. Cruciferous veggies for hormone and thyroid health

   3. All different colors for a variety of vitamins and minerals

2. 1-3 servings of high quality whole grains (sprouted whole wheat breads, whole wheat pasta, brown rice, quinoa, oats)

3. A few servings of healthy fats/day

   1. Omega-3 fatty acids (EPA and DHA)

   2. Avocados, nuts/seeds, unrefined oils like olive, avocado and sesame, high quality, grass fed meat and hormone/antibiotic free poultry, organic, free range eggs

4. Plenty of lean protein to preserve muscle mass

   1. High quality, grass fed meat and hormone/antibiotic free poultry, organic, free range eggs

   2. Legumes, beans, nuts/seeds

   3. Plant-based products like tofu, tempeh, seitan (avoid modern meat alternatives as they’re filled with additives [i.e. the beyond the burger trend])

5. Practice moderation with “fun foods”

   1. Generally follow the 80/20 guideline

   2. Save desserts for special occasions

   3. Portion foods rather than eating straight from the container

   4. Read nutrition labels and eat appropriate servings

   5. Work with a professional (like a therapist) to determine root causes of overeating/binge eating

Consistently Exercise Enough

Behind a healthy diet, exercise is undoubtedly valuable. Aerobic exercise like walking and jogging helps prevent heart disease, diabetes and stroke and keeps brain blood vessels flexible, which improves blood flow. In turn, this improves memory capacity and reduces risk of dementia and Alzheimer's. Aerobic exercise also improves depressive and anxious feelings because it releases “happy” neurotransmitters, responsible for the commonly known “runner’s high.” I can certainly attest to this effect!

 However, strength training is equally important in midlife. The natural aging process innately decreases some muscle mass, but strength training greatly mitigates this. As mentioned earlier, muscle mass or lean body tissue is very metabolically active. This allows one to maintain a higher caloric intake while also maintaining a healthy weight. In addition, strength training protects bones and reduces risk of osteoporosis. Again, the decline in estrogen is partly responsible for the thinning of bones, which can then lead to loss of height, fractures and the dreaded dowager’s hump. Vitamin D and calcium also help maintain healthy bones, but many women are deficient in one or both, so it’s important to optimize them through diet and sometimes supplementation.

The Takeaway

A lot of hormonal changes occur at midlife for a woman and the decline in estrogen production is largely responsible for increasing the risk of many of the discussed symptoms. However, leading a healthy lifestyle highly reduces the risk of the associated diseases and drastically reduces common symptoms of menopause. It’s very possible to lead a high quality life through midlife by eating a nutrient dense diet, exercising regularly, managing stress and optimizing sleep. Make the most of menopause!

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

Healthy hormone balance for a healthy life.

Nowadays, the word hormone conjures insidious imaginings, from pig injections to uncontained weight gain and adult acne. Thanks to the internet and an abundance of opposing opinions, hormones and hormone therapy have wrongly incurred a bad rap. However, for certain populations, like menopausal women, they can actually be a saving grace, with multiple health benefits, or at minimum, a treatment tool to consider. Learn why and how in this article.

What are hormones?

Hormones are communicative chemicals produced by the endocrine system. They send messages throughout the body and influence many bodily processes like hunger and fullness, blood pressure, temperature regulation, sexual desire and so much more. While they can travel freely throughout the body, in healthy individuals, only certain cells have receptors for specific hormones. In essence, hormones and cells work together like a lock and key mechanism.

So if hormones aren’t an evil spawn, why are they so frequently villainized?

Because, when hormones become unbalanced due to the natural process of aging (hello menopause) or a lifestyle factor like eating a highly refined sugar diet, the body wreaks havoc. The unbalance can make you feel and even look differently, so much so, that it can be hard not to blame these chemical messengers. However, hormone replacement therapy can mitigate some of the undesirable consequences of hormone havoc, especially concerning menopause.

Hormone Replacement Therapy History

Hormone replacement therapy, once known as menopausal hormone replacement, is medication that contains female hormones. It’s most often utilized to treat symptoms of menopause like hot flashes and vaginal dryness, but is also implicated in preventing bone loss and heart disease in post-menopausal women.

The dogma surrounding hormone therapy largely stems from the 90’s, when research indicated that the hormones estrogen and progesterone decreased risk of cardiovascular diseases. This prompted the National Institute of Health (NIH) to fund a large study called the Women’s Health Initiative (WHI). The study compared women given oral estrogen and progesterone (prempro) to women only given estrogen (premarin) to a placebo group, and determined the group given both estrogen and progesterone had an increased risk of blood clots, heart attack, stroke and breast cancer. Interestingly, women given only estrogen had a decreased risk of breast cancer.

When this news hit the media, many women stopped their hormone therapy and the study was terminated. Nonetheless, the WHI continued collecting data and arranged the findings by age group. The data confidently determined that women in the 50-59 year-old age group had a decreased risk of heart disease and overall mortality and no increased risk for stroke when given estrogen and progesterone. An increased risk of breast cancer was seen in the group of women who only received estrogen and progesterone (provera) but not estrogen alone.

Since this study, the scientific literature reveals that risk of breast cancer may be dependent on the type of progesterone given. For example, prometrium– a bioidentical progesterone with the same exact chemical structure as progesterone made from the ovaries– hasn’t been shown to increase risk of breast cancer. Because of this, at Evora, I tend to use prometrium when starting women on hormone replacement therapy.

How Can HRT Help With Menopause?

Recall that HRT was literally designed to treat symptoms of menopause, and therefore can greatly benefit women struggling. It basically aims to balance progesterone and estrogen levels as these along with other reproductive hormones like testosterone decrease dramatically after menopause. There are different types that deliver different combinations and amounts of hormones and multiple ways of delivering them too. This actually promotes bio individualism and makes it more accessible to a wider variety of people. 

It’s been shown to help with all of the following symptoms:

• Moderate to severe hot flashes

• Vaginal dryness, itching and burning

• Discomfort during intercourse

• Low libido

• Bone loss or frequent fractures

• Early menopause

• Estrogen deficiency

• Thinning hair

• Sleep problems

• Urinary problems

Furthermore, as mentioned in the study above, estrogen and progesterone are associated with lowering risk of osteoporosis, heart disease, stroke, dementia and mood changes in early post-menopausal women and may help with keeping skin soft and supple, enhanced cognitive function (short-term memory) and decrease the risk of insulin resistance.

According to the research, HRT is safe for women in the 50-59 year-old age range or women within ten years of their last menstrual cycle. Contraindications include those with or a history of: uncontrolled hypertension, thrombosis (blood clots), stroke, breast cancer, gallbladder disease and some types of heart disease.

Don’t Forget the Vagina

Hormone therapy also directly benefits the vagina. Before menopause, estrogen helps maintain vaginal tissue by keeping it thick, moist and stretchy. It also promotes blood flow to the vagina, which lubricates it and improves sensation during intercourse. Because menopause leads to changes in estrogen levels, the vagina changes too. The tissue becomes thin and dry and less stretchy and lubricated, causing some women have pain during intercourse or to lose their ability to reach orgasm. However, low dose vaginal hormones can reverse these changes, and low dose vaginal estrogen is linked with decreased risk of bladder and urinary tract infections (UTIs) as well! Hormones like estrogen and prasterone (DHEA) carry minimal risks and side effects but can tremendously benefit your sex life.

Women Have Testosterone?

Indeed, women make testosterone in addition to estrogen and progesterone, but to a much less degree than males. Testosterone exerts several functions with a major one involving sex drive. This is exactly why men have a reputation as having higher sex drives– because they make more testosterone! Unfortunately, testosterone production in women begins to decrease in their early thirties. Thus, in post-menopausal women with a decreased (or no) sex drive, research reveals that testosterone replacement improves libido. It also helps improve vaginal dryness and orgasm, maintain muscle mass and may improve some types of fatigue. While there is no FDA approved formulation, numerous studies show it to be an effective hormone for women wanting to improve their sex lives. 

The Takeaway

Hormones are mighty chemical messengers that influence many bodily processes, and especially sexual and reproductive ones. During menopause, changes in estrogen, progesterone and testosterone among others cause undesirable symptoms like hot flashes, decreased sex drive and vaginal dryness. Hormone therapy is a standard treatment approach that can mitigate these side effects and improve your sex life. Research agrees that it’s a safe practice that need not be vilified any more.

If you’re still on the fence about whether it’s right for you, book an appointment with Dr. Becky Lynn at Evora! It could be the exact tool you didn’t know you needed, and we can help you find the right combination for your unique self.

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

The Unrightfully Wronged Macronutrient: Carbohydrate Myths

Not so long ago, fat was the most feared and villainized macronutrient. However, with the emergence of the Atkins and South Beach diet and more recently, the Paleo movement, carbohydrates became the ultimate enemy. But is all the fear mongering hype warranted?

Science and many well respected health professionals say “no.”

In fact, carbohydrates come from plants rich in vitamins, minerals, phytochemicals, antioxidants, and fiber. Furthermore, many studies suggest whole grains and other healthful carb sources are protective against Type II Diabetes and reduce risk of developing other chronic health conditions as well.

What’s more, the brain and red blood cells can only use glucose as fuel. Meaning, without sufficient carbohydrate intake, the body converts fat and/or protein into glucose via inefficient pathways.

Nonetheless, highly processed and refined carbohydrates like cakes, pastries, cookies, crackers, instant mashed potatoes, white breads and pastas, and basically anything packaged pose numerous health risks, spike blood sugar, and increase risk of chronic diseases.

Confusion surrounding carbs stem from these bad apple sources but their implications need not be projected onto carbs as a whole food group.

Finally, the many myths about carbs- their function, how they affect health, and which sources are nutritious- are mostly thanks to diet culture and media efforts. So without further ado, here are fifteen carbohydrate myths a dietitian is busting to elucidate this unrightfully wronged macronutrient.

15 Carbohydrate Myths Busted

1. All carbs are unhealthy for you. To reiterate, whole and pure plant sources of carbohydrate including fruits, vegetables, whole grains, bean, legumes, lentils, and various other grains aren’t inherently unhealthy and contribute to optimal health. Conversely, processed and refined sources and added sugars pose health risks and should be minimized, especially empty calorie, high sugary drinks like soda, fruit juices, and sweetened teas and lemonades.

2. Bread and pasta are the unhealthiest carbs. These foods are obvious sources of carbs, leading many to deem them worst of all. However, whole wheat minimally processed versions of both these foods can fit into an overall healthy eating pattern. Portion control is key, where one slice of bread and ½ cup of pasta is an appropriate serving size.

3. Carbs make you fat. No one food or even food group intrinsically makes you fat. Indeed, a variety of lifestyle factors including but also beyond diet contribute to poor health and obesity. However, research shows a clear correlation between added sugar/processed carbohydrates and increased triglycerides- the stored form of fat. Thus, the quality of carbs definitely matters. Focus on fibrous, colorful fruits and veggies as the majority of carb intake and it will be difficult to hold onto unnecessary fat.

4. All carbohydrates have sugar. This is actually not false, as carbs are synonymous with sugar. But just like mentioned right above, not all sugars are created equally. Sugar is an umbrella term for sucrose, glucose, and fructose found in plant products, lactose found in animal products and all synthetic derivatives like high fructose corn syrup, maltodextrin and molasses. While all types of sugar tout the same nutritional profile (calories, etc.), the other components in healthy carbs like fiber positively affect their digestion, absorption and utilization, and thus, need not be so villainized. 

5. You’ll feel sluggish after eating carbs. If consuming carbs makes you feel tired and unmotivated, that’s simply an indicator of too big a portion size or an unbalanced meal. When you eat carbohydrates, the pancreas releases insulin to help shuttle it from the blood into cells. This mechanism is responsible for the infamous “sugar crash.” Avoid this crash by eating appropriate amounts of carbohydrate and balanced meals including lean protein and/or healthy fats to slow the digestion and absorption of carbs and minimize insulin surges. 

6. Avoiding carbs helps your workout. Especially amongst the endurance sport community, there’s a misconception that cutting carbs improves performance over time. Yet, experimental and anecdotal research doesn’t support this notion, and also suggests that eating insufficient amounts leads to worsened practice performance. Thus, even if your body adapts to less carbohydrates, it most likely isn’t performing at optimum during training, which translates into race/competition performance. 

7. Carbs are less important and nutritious than fat and protein. Each of the three macronutrients serves an important purpose within the body, deeming them all equally nutritious. Again, quality is important, but that extends to protein and fat too. There are healthy and unhealthy versions of all macronutrients, and focusing on consuming appropriate portions and percentages of each will set you up for most success. Generally, healthy ranges of carbs, protein, and fat are 40-60%, 15-30%, and 15-30%, respectively. 

8. Low carb diets lead to the most weight loss. Research shows that there is little to no difference in weight loss after one year of following a low carb versus low fat diet. At first, following a low carb diet may lead to “more” weight loss, but only because carbs hold more water and much of the initial weight loss is indeed water loss. In reality, the best way to lose and maintain weight loss is through a variety of healthy lifestyle factors including eating a balanced, nutrient dense diet rather than omitting an entire food group.

9. It’s better to eat carbs in the morning. The only instance meal timing matters is before and after exercise. Other than that, it’s best to eat an appropriate serving of carbs with most meals and snacks to balance blood sugar and avoid big spikes or lags. Plus, some research shows that starting the day with quality protein and fat reduces cravings throughout the day and eating carbs but less protein at night contributes to better sleep. 

10. Whole grain carbs make you bloated. Related to the weight loss point, carbs, and especially starchy carbs like grains retain more water. However, eating a small serving should not cause obvious bloating unless there is an underlying issue like an intolerance to gluten or fructose.

11. White potatoes are very bad for you. A favorite misconception to squash, white potatoes are simply a starchy root vegetable that also pack a hefty nutritional punch. And in fact, they are less starchy, meaning they have less carbohydrate than sweet potatoes. However, both versions of potatoes are nutritious and one of the best carbohydrate sources on the planet.

12. Eating fruit isn’t healthy. Thanks to irrational claims, fruit-phobia is a widely used term nowadays. While fruit is simple sugar, similar to the refined version, they also include ample other nutrients like fiber and antioxidants that outweigh the sugar content, especially when eaten alongside a protein or fat. 

13. All simple carbs are bad. Usually, simple carbs do little more than temporarily spike blood sugar. However, before endurance events, eating simple carbs void of fiber is the best fuel. They digest quickly and are thus able to enter the muscle cells about to be hard at work quicker too. Fiber, protein, and especially fat are detrimental to aerobic activities if eaten within four hours of the endurance event. 

14. Eating carbs gives you diabetes. Quite the contrary when there’s a focus on quality, whole food carbohydrates. Type II Diabetes is an endocrine disorder that develops over time as insulin is secreted more and more. Eventually, cells become resistant and glucose remains in the bloodstream. Eating balanced meals consisting of fiber, protein, and/or fat alongside quality carbs easily prevents this.

15. Vegetables don’t have carbs. Last but not least, this is the opposite of the truth. Vegetables are primarily carbohydrates. Some have about 1 gram of protein or fat and the rest is all carbohydrate. Of course, vegetables and fruits for that matter are quality carb options, full of fiber and other phytochemicals. 

The Bottom Line

There’s a lot of misinformation about carbohydrates, largely thanks to skewed marketing ploys and diet culture dupes. However, not all carbs are created equal and while refined, processed and packaged carbs can harm health, whole food sources including bread, rice, and potatoes contribute healthful nutrients.

As important as the quality of the carb is portion control. Although overused, the phrase “everything in moderation” truly applies. Eating appropriate amounts of carbohydrates- usually ½ - 1 cup- doesn’t spike blood sugar or insulin and instead promotes sustained energy throughout the day.

Carbs don’t have to be the enemy and can still be enjoyed as part of a healthy diet with the correct knowledge and empowerment.

References

1. Dennett, Carrie. “Busting the Top 10 Carb Myths - Today's Dietitian Magazine.” Today's Dietitian, Apr. 2016, www.todaysdietitian.com/newarchives/0416p30.shtml. 

By Michelle Tierney, Registered Dietitian

Evora Women’s Health

Learn more about Michelle’s practice at Evora Women’s Health