Category: postmenopause

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Join the 4 percent! There’s help for vaginal dryness

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Join the 4 percent! There’s help for vaginal dryness.

During my recent webinar on vaginal and urinary health, I encouraged women who avoid sex because vaginal dryness makes it uncomfortable and painful to share this fact with their partners.

I asked them to put themselves in their partner’s shoes:  “How would you feel if your partner doesn’t want intimacy and sex anymore? What would you think? That your partner is no longer attracted by you? Doesn’t love you anymore? Has a lover? That you don’t turn him/her on? You’re no longer sexy?”…

The next day I received an email from a woman who attended the webinar, thanking me for suggesting she explain to her partner why she’s been avoiding sex. She said that after the webinar “I shared with him about my discomfort and dryness issues and told him that I do love him and that I am not having an affair.  I think he was really relieved. Good advice”!

It may be difficult to start this conversation and to explain what you are experiencing, so here are some tips to “Talking with your partner”.

You can watch the recorded webinar free with a WHIM (Women’s Health in Midlife) Network 2020 membership, which is now on sale.

Vaginal dryness is more likely to happen when estrogen levels are low.  This can happen due to natural menopause (including during perimenopause), and due to induced menopause such as surgery to remove the ovaries and certain cancer treatments that affect the ovaries.  Vaginal dryness can also occur while breastfeeding, during periods of stress, when using certain medications for the treatment of fibroids or endometriosis, and when taking antidepressants and some cold and allergy medications.

You may notice lack of lubrication, decreased arousal, and difficulty achieving orgasm. Penetration may cause pain because the vaginal opening has become narrower, the lining of the vagina is thinner and less elastic, and the vulva and clitoris may even shrink without estrogen. This cluster of symptoms is called vulvovaginal atrophy (VVA).

Around 50% of women are bothered by these symptoms but only 4% receive treatment. Why do you think that happens?

Several reasons come to mind:

  • Women assume this is part of aging and there’s nothing they can do about it; it’s just something they must put up with
  • Women don’t know help is available
  • Women don’t know where to go for help
  • Women don’t know what to buy to alleviate their symptoms
  • Women suffer in silence and don’t complain to their doctors about their symptoms

Vaginal discomfort affects a woman’s sexuality and self-esteem, upsets the relationship with her partner, and decreases intimacy, sexual desire, and quality of life.

It’s not only sexually-active women who are bothered by vaginal and vulvar changes due to decreased estrogen. Many women feel uncomfortable riding a bike, sitting for prolonged periods, or wearing tight clothes.

Don’t be one of the 96% of women who receive no help for their vaginal symptoms. Join the 4 percent!
There are many therapies to help VVA symptoms:

Regular sexual stimulation

This increases blood flow and lubrication. Remember, if you don’t use it, you lose it!

Over-the-counter products

  • Vaginal lubricants (non-hormonal) can be used during intercourse to add lubrication, reduce friction, and improve pleasure. They can be water-based, silicone-based, mineral oil-based, or plant oil-based.
  • Vaginal moisturizers (non-hormonal) are designed to adhere to the vaginal mucosa, allowing cells to retain moisture. They are applied regularly to the vagina and vulva, and are longer-acting than lubricants. An example is Repagyn, an ovule containing hyaluronic acid, a substance that provides moisture and a soothing effect. This product is behind-the-counter meaning you must ask the pharmacist for it.

Do not use products that have added flavours, a warming sensation, or are scented, because these can cause irritation. As with many things in life, but especially with products you use on your vulva and in your vagina, less is better.

Pelvic floor therapy

Sometimes the pain is caused by very tight pelvic muscles rather than by thin and dry vaginal tissues. A physiotherapist specializing in pelvic floor therapy (PT) may be very helpful. Even during COVID you can book a FREE Virtual Discovery Pelvic Health appointment.

Low-dose vaginal estrogen

Lubricants and moisturizers may not be helpful, or they may stop being helpful, because they add lubrication and moisture to the area but do not treat the thinning of the vaginal tissues which tends to worsen over time. The most effective treatment for VVA is local estrogen, which is available on prescription as a cream or a vaginal ovule.

If low-dose estrogen vaginal therapy is recommended for you, do not be put off by the warnings and precautions on the accompanying product insert. Due to their low dose, the systemic (affecting the whole body) absorption of the estrogen is very low, much less than if you were taking an oral pill, for example, and the adverse effects are less likely too. But, for many reasons, the information in these low-dose vaginal products doesn’t reflect that difference and instead lists the same warnings and precautions as for the oral products. It doesn’t make sense. I, and many other experts, believe these warnings do not reflect the best scientific knowledge. Many groups advocating for women’s health are trying to get the FDA and the manufacturers to change the information in these pamphlets.

Prasterone

This is a non-hormonal vaginal ovule therapy, and a new therapy in Canada.

Ospemifene

This is a a non-hormonal oral tablet expected to be available in Canada sometime in 2020.

Laser

This treatment is done in the doctor’s office and is fairly expensive.

Which therapy should you choose?

Usually, unless VVA is severe, lubricants and moisturizers should be used first.

If these products do not help—or they stop helping—then your next therapy options should be based on the severity of symptoms, contraindications for therapy, medical conditions, medical history, and your personal preferences. A ten-minute physician’s visit usually isn’t enough to go over everything that needs to be addressed.

During my 45-minute Vaginal & Sexual Health Care Package we go over your challenges, symptoms, concerns, what you are experiencing, what you expect from treatment, your preferences, and what the best therapy for YOU and your symptoms will be.

Women’s self-esteem, quality of life, and relationships suffer when vaginal dryness and painful sex aren’t addressed. Stop suffering alone and in silence. Join the 4 percent! There’s help. I can help you!

Teresa Isabel Dias is a pharmacist and a menopause practitioner (NCMP) certified by the North American Menopause Society (NAMS), she lives in Toronto but all her services are available online – one-on-one consultations, live workshops, and webinars. Sign up for her free biweekly MenopausED Newsletter to learn more about menopause and women’s health.

Are you aging well?

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Are you aging well?  A long time ago I worked in a pharmacy and many of my patients were senior citizens. They often told me “Oh dear! You don’t want to get old!” to which I always replied, “Yes I do. The alternative isn’t very good!”

Aging isn’t appealing and in a society that seems to value looking young over wisdom and experience we try to hide our aging in many ways. (BTW, I stopped colouring my hair!) The reality is, we can’t stop aging. Don’t let the anti-aging commercials for expensive products trick you into thinking that you can. We can’t stop aging but we can choose how we age.

Our choices include the food we eat, how much we move, how long we sleep, what thoughts we put into our heads, and how much stress we allow in and out of our lives.

A healthy lifestyle before old age helps us to age well. Proper nutrition, enough sleep, and exercise on a regular basis are for our senior health what RRSPs are for our retirement income, an investment.

The earlier we start investing the better the benefits. But it’s never too late to adopt healthy lifestyle habits. Habits are hard to form but if you keep at it you’ll get into the habit. Do you ever have to force yourself to brush your teeth before bed? No! Because your parents, probably, instilled that habit in you when you were young and now it’s routine, you don’t even have to think about it, you just do it. Many other good habits can become as regular as brushing your teeth. You just have to repeat them often enough until you do them naturally.

Eating nutritious food, exercising, and even positive thinking can be learned and incorporated into your lifestyle slowly and steadily until they become…a habit, a part of your daily and weekly life.

I’m not saying it’s easy. I’m saying it’s possible, if you want it to be! If you put in the effort. It’s an investment you can choose to make now in order to live better later.

To find out more about what you should be doing to age well, join me and Dr. Vivien Brown on Tuesday, September 17, at 6:30 PM.  Dr. Brown will be talking about her book “A Woman’s Guide to Healthy Aging – Seven essential ways to keep you vital, happy and strong”.  You can learn more and register here.

Dr. Vivien Brown is a family physician in Toronto, a well-known national and international speaker, and author of A Woman’s Guide to Healthy Aging – Seven essential ways to keep you vital, happy and strong. Dr. Brown is past President of the Federation of Medical Women of Canada, Former Chair of the Consumer Education Committee for the North American Menopause Society, board member of the Women’s Brain Health Initiative, and Health Choices First.

Let’s break the menopause taboo. Let’s talk about menopause.

Need help? There’s help. I can help you!
Would you like to become a member of my WHIM (Women’s Health In Midlife) Network?

We are a group of women who enjoy

  • knowing more about our midlife health and well-being;
  • socializing, interacting, and connecting with women going through similar experiences;
  • venting and being understood by women that “are/have been there”;
  • supporting and being supported by other midlife women.

Become a member here!

What is Vitamin D Good For?

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Vitamin D is an essential nutrient for overall health.  Our bodies produce vitamin D when our skin is exposed to ultraviolet (UV) rays in sunlight. And vitamin D occurs naturally in some foods, is added to others, and is available as a supplement in the form of a pill or a drop. In order to use vitamin D, our bodies must first process it:  first in the liver into 25-hydroxyvitamin D [25(OH)D], also known as calcidiol, and then in the kidneys into 1,25-dihydroxyvitamin D [1,25(OH)2D], also known as calcitriol.

Vitamin D is very important for our health. It helps the gut absorb calcium, and the two together promote bone health and help prevent osteoporosis. It also helps with cell growth, neuromuscular and immune function, and reduces inflammation.

25(OH)D is the form of vitamin D that can be measured in the blood to identify deficiencies. The experts haven’t yet completely agreed on the levels that are associated with deficiency.  But they have determined that persons are at risk of vitamin D deficiency if the level of 25(OH)D is below <30nmol/L. This blood test is very expensive in Canada and not routinely done unless there’s a suspicion of a deficiency. Testing should be done in people who are home-bound, those living in a long-term care facility (e.g., nursing home), persons with a medical condition that increases the risk of vitamin D deficiency or insufficiency, and those with osteoporosis, a history of a low-trauma fracture (e.g., fracture after fall from standing), or low blood calcium.

Intake of Vitamin D

Sun exposure

 

Even though most people produce some vitamin D from sun exposure, in Canada we don’t get enough sun to produce adequate levels of vitamin D. Factors affecting UV radiation exposure and vitamin D synthesis include:

  • a person’s age (as we grow older our skin becomes less able to make vitamin D);
  • the season (which determines both the hours and intensity of sunlight);
  • the time of day;
  • cloud cover (clouds reduce UV rays by 50%, shade by 60%);
  • smog levels;
  • skin melanin content; and
  • the use of sunscreen. As we know, science is always evolving: In May, 2019, a British Journal of Dermatology study found an increase of vitamin D in participants during a week of cloudless weather in Tenerife, with a very high UV index, even when sunscreens were used properly and prevented sunburn. Sunscreens are necessary to prevent sunburn and skin cancer but I do not wear them in the early morning or late afternoon when the sun’s rays are less intense. I hope I get my dose of vitamin D for the day this way!
Food

There aren’t many food sources of vitamin D, so Osteoporosis Canada recommends supplementations for adults all year long.

Recommended doses of vitamin D:

  • 400 – 1,000 IU daily for healthy adults 19-50 years of age
  • 800 – 2,000 IU daily for healthy people over 50 or those younger adults at high risk (with osteoporosis, multiple fractures, or conditions affecting vitamin D absorption)

This table from Osteoporosis Canada lists some good food sources and their vitamin D content:

Food                                                   Serving Size      IU's per Serving
Swordfish, Baked or Broiled                                 75 g                  761
Salmon, pink, Canned, Drained with solids and bones         75 g                  435
Cod Liver Oil                                             5 mL/1 tsp              426
Salmon (Sockeye), Baked or Broiled                          75 g                  394
Snapper, Baked or Broiled                                   75 g                  392
Milk (all types)                                         1 c/250 mL             103-105
Soy Beverage, Enriched                                   1 c/250 mL                86
Yogurt, Plain, Vitamin D Added                              175 g               82-113
Egg Yolk, cooked                                           2 Large                 64
Tuna, canned in water, drained unsalted                     75 g                   60
Orange Juice, Fortified                                 1/2 c/125 mL               50
Margarine, fortified                                     5 mL/1 tsp              25-36
Mushrooms, white                                       125 mL/ 1/2 c                4

 

Supplements

In supplements and fortified foods, vitamin D is available in two forms, D2 (ergocalciferol) and D3 (cholecalciferol).  Some experts recommend vitamin D3 rather than vitamin D2 because it is the naturally-occurring form and it may be more effective at raising vitamin D levels in our bodies.

The amount of vitamin D in multivitamins varies so read the labels carefully to ensure you’re getting the amount you need.  And add up all the sources of vitamin D you ingest in a day to avoid taking too much. Just because some is good for you doesn’t mean 10 times more is even better! It is hard to overdose on vitamin D but very elevated levels of 25(OH)D can cause complications such as high blood calcium levels and can increase the risk of developing kidney stones.

Vitamin D Deficiency

Rickets (softening of the bones during childhood) and osteomalacia (softening of the bones in adults) are less common nowadays since many foods are now fortified with vitamin D. But deficiencies can result from certain diets (dairy allergy, lactose intolerance, ovo-vegetarianism, and veganism), not taking enough supplements, limited exposure to sunlight, poor absorption of vitamin D by the gut, and kidneys that cannot convert vitamin D to its active form.

Who’s at risk of vitamin D deficiency:

  • Older adults and persons with dark skin – they have less ability to synthetize vitamin D from sunlight;
  • People spending long periods of time (living or working) indoors with consequent limited exposure to sunlight;
  • Persons with inflammatory bowel disease, celiac, ulcerative colitis, or Crohn’s Disease – they may have impaired gut absorption of vitamin D;
  • People who are obese or who have undergone gastric bypass surgery.
Can we prevent diseases with vitamin D supplementation?

There’s good evidence that vitamin D helps prevent and treat bone-related disorders, but there’s now some conflicting evidence on the role of vitamin D in the prevention of falls and fractures.

Our bone isn’t static:  at any given moment old bone cells are being broken down and new ones are being formed. As we age, and especially in women in postmenopause with decreased estrogen levels, the rate of bone breakdown is higher than the rate of bone formation. This can lead to low bone density (weak bones) and osteoporosis (porous bones), which in turn increases the risk of fractures.

Osteoporosis is most often associated with inadequate intake of calcium, but since vitamin D is needed to help calcium absorption into the bones, insufficient vitamin D also contributes to osteoporosis.

Vitamin D was thought to prevent fall and fractures in the elderly but this finding is being contested by the Health Research Council of New Zealand which has been looking at the literature published in the past on the role on vitamin D in fall and fractures. The authors say

Our findings suggest that vitamin D supplementation does not prevent fractures or falls, or have clinically meaningful effects on bone mineral density. There were no differences between the effects of higher and lower doses of vitamin D. There is little justification to use vitamin D supplements to maintain or improve musculoskeletal health…

These results aren’t being accepted by all in the field. Some say that “The results of the new meta-analysis do not contradict the beneficial effects of combining vitamin D with calcium supplementation for older patients”, and that “Bolland and colleagues included studies that used very high bolus doses of vitamin D, which are known to increase the risk of fractures or falls, also biasing the results”.

It is unclear if taking vitamin D supplements reduces the risk of cancer or cardiovascular disease. Dr. JoAnn Manson and her VITAL (VITamin D and OmegA-3 TriaL) research group conducted a trial that examined the effects of 2000 IU of vitamin D3 with or without 1000 mg of marine omega-3 fatty acids compared with placebo in over 25,000 people made up of men 50 and over and women 55 and over. The authors conclude that “Supplementation with vitamin D did not result in a lower incidence of invasive cancer or cardiovascular events than placebo”.

Diabetes is a disease caused by the body’s not being able to produce insulin, or to utilize properly the insulin it does produce, resulting in high blood sugar (glucose) levels. Recently, a study in Brazil suggested that vitamin D may promote insulin sensitivity (the increased ability of the body to utilize insulin) and possibly lower blood sugar levels. In this trial, low levels of vitamin D were not proven to cause diabetes but may play a role in diabetes (type2). According to Dr. JoAnn Pinkerton, former Executive Director of NAMS (North American Menopause Society), my certifying body, “Vitamin D supplementation may help improve blood sugar control, but intervention studies are still needed”.

As a healthcare professional who believes in preventive care, I strive to provide advice based on the latest and most accurate evidence-based medicine, including for vitamin D and your health. With ongoing research sometimes what to recommend isn’t all that clear. For now I follow the advice of the Canadian Osteoporosis Society:  “[vitamin D] …It helps build stronger bones by increasing the absorption of calcium. It also improves the function of muscles, which can improve your balance and decrease the likelihood of falling and suffering a fracture.”

I am a registered pharmacist with over 20 years of professional experience in community pharmacy and drug information in Toronto.  I founded MenopausED to educate and support women in midlife, especially during the menopause transition, to raise awareness about menopause, and to break the menopause taboo.

Remember, there’s help, I can help you!

If you have questions about menopause definitions, or anything else, do not hesitate to ask, email me, or book a free 15-minute call with me.

 

Would you like to become a member of my WHIM (Women’s Health In Midlife) Network?

Are you between 40 and 65 years of age and interested in…

  • Knowing more about health and well-being in midlife?
  • Finally putting yourself at the top of your list and looking after your well-being?
  • Mingling, socializing, interacting, and talking to other midlife women?
  • Supporting and being supported by other women like you?

Find out more and become a member here!

 

References for “Vitamin D and Your Health: What is Vitamin D Good For?”

https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/

https://www.menopause.org/docs/default-source/press-release/vitamin-d-lowers-diabetes-risk-1-30-19.pdf

https://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30348-6/fulltext

https://www.sciencedaily.com/releases/2019/06/190619130303.htm

Let’s Talk About Menopause

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Last month I wrote a blog for MOMPRENEURS titled “Let’s Talk About Menopause”.

In the blog, I ask perhaps the most perplexing question of menopause:  If all women go through menopause, why are most unprepared for it?

I take you through my personal journey and I address some of the major symptoms of menopause:

  • mood swings
  • physical, cognitive, and emotional changes
  • brain fog – difficulty concentrating and staying focused
  • irregular periods
  • breast pain
  • anxiety
  • fatigue and lack of energy
  • aches and pains
  • continual headaches
  • hot flashes

And I define a few terms:  perimenopause, menopause, and postmenopause.

My conclusion is happily upbeat:  “Menopause is part of midlife and has some bumps but it doesn’t have to be all doom and gloom. Even though each woman experiences menopause in her own way, we all share many similar experiences.  We are not alone, and there’s help!”

You can read my full post “Let’s Talk About Menopause” here.

And remember, there’s help, I can help you!

If you have questions about menopause definitions, or anything else, do not hesitate to ask, email me, or book a free 15-minute call with me.

Would you like to become a member of my WHIM (Women’s Health In Midlife) Network?

Are you between 40 and 65 years of age and interested in…

  • Knowing more about health and well-being in midlife?
  • Finally putting yourself at the top of your list and looking after your well-being?
  • Mingling, socializing, interacting, and talking to other midlife women?
  • Supporting and being supported by other women like you?

Find out more and become a member here!

Menopause Definitions: (peri)menopause

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Despite so much information about menopause being available online, in magazines, and on other media, I’m always surprised when I give workshops and find that women are still confused about menopause definitions .

We can’t  play a game properly if we don’t know the rules, and today’s blog post focuses on definitions about menopause, so when we talk or read about menopause we know what the terms mean and are able to understand the information better.

To start with, I and many other menopause experts tend to use the words menopause, menopause change, menopause transition, and even perimenopause interchangeably—but each has a specific meaning.

Let’s start with menopause.

What is menopause?

All women will go through menopause if they live long enough and for most it is a normal and natural event.

Menopause is the end of ovarian function, that means the ovaries stop producing eggs, ovulation stops, and consequently periods stop as well. Menopause is the end of ovulation, menstruation, and fertility. The word menopause literally means the end (pause) of menses, the plural Latin for what we medically call menstrual flow.

How do you know when you are in menopause? How do you know it was the last period? Menopause is confirmed when you haven’t had a period for 12 consecutive months.

If you are experiencing irregular periods and want to track them to determine when you reach menopause then I suggest you download or print the Menstrual Calendar. When you haven’t bled for 12 months in a row you’ve reached menopause.  Congratulations! Celebrate this milestone! I can help you throw a Menopause Party!

Menopause usually happens between 40 and 60 years of age, and the average age of menopause in North America is 52. Smokers may experience menopause a few years earlier.

Some women may experience early menopause, before 40 years old.

Induced menopause occurs when a woman undergoes removal of both ovaries and/or chemotherapy and radiation treatments for certain types of cancer that damage the ovaries. Women who experience induced menopause usually experience more severe symptoms due to the very sudden drop in estrogen levels.

A hysterectomy, removal of the uterus without removal of the ovaries, doesn’t cause menopause but the ovaries may end the production of estrogen 2-3 years earlier than usual. Because a woman without a uterus no longer has menstrual bleeding she’s not able to judge if she’s in menopause based on bleeding patterns. For these women other symptoms of hormonal change and decline plus blood tests may be necessary to determine menopause. Otherwise blood tests aren’t necessary or recommended to determine if a woman is in menopause.

What is perimenopause?

Perimenopause is the years leading up to menopause (cessation of periods) and may start in the 30s or 40s. It’s impossible to predict how long perimenopause will last, usually 4-8 years. I also like to refer to perimenopause as the menopause transition because it is a journey.

Most women have regular menstrual cycles, they bleed every 24-31 days and when estrogen production by the ovaries starts fluctuating the time between periods changes and women experience longer or shorter cycles. This is usually the first change noticed in perimenopause.

Women may also experience changes in flow, bleed more heavily or more lightly, have spotting, or miss periods. This unpredictability upsets and frustrates many women. Not knowing when the next period is going to come, when or if ovulation is going to occur, and experiencing spotting can be annoying and upsetting. I jokingly say that if a women in perimenopause wants to know when her next period will come all she has to do is book a beach vacation…!

Women who are sexually active and who do not wish to get pregnant must use a method of birth control until 12 months after the last period – some experts suggest 24 months because ovulation is unpredictable during perimenopause but may happen.

What is postmenopause?

Postmenopause are the years after menopause is confirmed. Since menopause is confirmed 12 months after the last menstrual period, the day after that, and till their death, women are in postmenopause. With the population aging and women living well past their 80s, many women spent one-third of their lives in postmenopause.

It’s important to understand the protective effect of estrogen against diseases like stroke and heart attack, osteoporosis, and diabetes to help us make healthy lifestyle choices to ensure healthy aging and prevent disease.  I’ll be writing about this in a future blog.

I hope I made things clearer than mud!

Now we can talk about this topic and know exactly what we mean when we use words like menopause, menopause transition, perimenopause, and postmenopause. Let’s talk about menopause!

There’s help. I can help you!

If you have questions about menopause definitions, or anything else, do not hesitate to ask, email me, or book a free 15-minute call with me.

Would you like to become a member of the WHIM (Women’s Health In Midlife) Network?

Are you between 40 and 65 years of age and interested in…

  • Knowing more about health and well-being in midlife?
  • Finally putting yourself at the top of your list and looking after your well-being?
  • Mingling, socializing, interacting, and talking to other midlife women?
  • Supporting and being supported by other women like you?

Find out more and become a member here!

 

Events

Menopause Cafe’, Toronto, Canada

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What is a Menopause Cafe’?

The objective of Menopause Café is to start conversations about menopause and to increase awareness of the impact of the menopause on those experiencing it, their partners, children, friends, work colleagues and families.

There is no agenda, no speaker, just lots of conversation. The topics for discussion are chosen by the people who attend. It is a discussion group rather than a support or counselling session.

We usually split into small groups and you are welcome to just listen, although we hope you will join in on discussions.

Menopause should not be taboo, let’s raise awareness, talk about and demystify menopause.

Who is it for?

Anybody interested in sharing their stories, experiences, and questions about menopause. Men and women of all ages.

Menopause Café, Toronto is offered:

On a not-for-profit basis (aside from an investment in a cup of coffee, or tea, or a glass of wine and a snack if you so wish) .

If you have any questions contact me on teresa@menopaused.org or see MC website www.menopausecafe.net

Let’s talk about urinary & vaginal health

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Women need to know more about their urinary & vaginal health in menopause.

Urine leakage during the menopause transition is a common problem, especially in women who’ve had children.

Another problem that women in menopause experience is vaginal dryness and pain with sex, but hardly anyone talks about it.

Studies show that nearly 50% of women suffer from vaginal dryness, which affects relationships negatively, but only 4% of women get treated.

Talking with a partner or your doctor about vaginas and uncomfortable sex can feel awkward and embarrassing.

In this workshop you’ll learn:

  • What to do about urinary incontinence
  • What happens to your female parts when estrogen decreases
  • How to treat vaginal dryness
  • How to decrease pain during sex
  • How to explain to your partner what’s going on down there
  • What to ask your doctor at your next visit

I don’t want you to suffer alone and in silence.

There are several things you can do to improve your urinary & vaginal health.

Come find out.

There’s help. I can help you!

Register here.

Note:
This is the monthly in-person WHIM (Women’s Health In Midlife) Network meeting.
But everyone is welcome to attend.
If you are a WHIM Network member you attend free.
If you are not a member yet then I invite you to become one and be part of this community of like-minded women. If you decide to join WHIM then your cost for this event will be applied towards your WHIM Network 2019 membership fee.

Helping women thrive through every stage of menopause

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