Bodies change as they age, and the menopause transition accelerates that process for many of us.

So what do we do when those changes impact our desire for intimacy?

It’s a real issue, so let’s get into it!

But first, a quick recap from the past few newsletters: Low libido is a common complaint during the menopause transition and is a biopsychosocial condition. This means there are biological, psychological and social factors involved.

Most doctors don’t have adequate training in female sexuality and therefore aren’t generally a great resource (three cheers for awesome doctors who are stepping up to the plate). But also, medication to increase desire isn’t going to be helpful if you’re too exhausted to think about sex, resent your partner, can’t stand to be touched because you’re uncomfortable in your body, or the sex is painful. Thankully, there are resources to help which is exactly why I’ve sent this newsletter series!

Alright, back to body confidence.

A few ideas you might find helpful as you work to make peace with your changing body:

Recognize that your capacity to experience pleasure hasn’t changed. Sexual satisfaction isn’t limited to people with “perfect” bodies. Never has been, never will be. Your body may have changed, but its capacity to feel pleasure is the same.

Practice gratitude for your body. You may have big feelings about how your body has changed, but your body still allows you to live an amazing life in ways that have nothing to do with how your body looks. So start a list of all the wonderful things your body allows you to experience and add to it often.

Find a mantra you love and put it to work. Rewiring your brain takes time and practice, which means you’ll likely need to redirect negative thoughts about your body over and over and over again. Finding a go-to mantra that resonates can be a powerful way to redirect how you’re thinking about your body so you can change how you feel about it.

Take care of your body in loving ways. Eat foods that leave you feeling satisfied and give you the energy you need to do the things you love. Move in ways that bring joy and feel empowering. Work on improving your sleep and managing stress. Because it’s hard to maintain a negative relationship with your body when you’re caring for it in beautiful ways.

Think about your future self. Your 80-year-old self is going to look back at your 50-year-old self and wish you had fully appreciated how strong, capable and beautiful your body was at this age. What advice might she have for you as you navigate midlife changes to your body?

Go to therapy. Because sometimes we need to sort through this kind of stuff with an expert.

The good news is that learning to live fully in your changing body is a skill that will be put to good use throughout the coming years and decades. May as well hone those skills now, right?

Alright my loves. That wraps up our 4-part series on low libido! I hope you’ve found the information as helpful and informative as I have. Sending you all so much love as you navigate the complexities of midlife!

xo, Rebecca

P.S. Low libido installments one, two & three if you’re interested.

P.P.S. Anyone need a good laugh?

A few years ago I attended a menopause conference in New York City where speakers addressed a wide variety of menopause-related topics.

During the conference, one of the speakers polled the audience: Who in the room felt like they had completely honest communication with their partner about their sexual preferences and experiences?

Only about 10 women in a room of 300 women raised their hands.

In that moment, a harsh reality was laid bare: most people are ill-equipped to nurture healthy intimacy.

This is the crux of why addressing low libido is complicated: the causes can be many layered, and those layers are hard to uncover in a 15-minute appointment with a physician who likely received little training in the biological, psychological and social aspects of female sexual health.

Thankfully, there are resources available that can help you troubleshoot low libido, but also have the potential to make an already healthy sex life even better.

Let’s get to it, shall we?

Connection refers to the cultural, social and relationship dynamics that impact sexual satisfaction and desire. And as you can imagine, there are a lot of topics that fall under this umbrella term.

Because it’s impossible to do the topic justice in a single email, I’m going to offer an array of fabulous resources so you can choose the ones that best meet your needs.

Please note: any of these resources is great for troubleshooting low desire AND for up-leveling an already great intimate relationship. I can’t recommend them enough.

Without further ado, here are some resources you may find helpful:

If you want to focus on better communication with your partner read Sex Talks: The Five Conversations That Will Transform Your Love Life by Vanessa and Xander Marin.

If you want to understand the science of female sexuality from the woman who revolutionized how we think about desire read Come As You Are: The Surprising New Science That Will Transform Your Sex Life by Emily Nagoski.

If you want a book that focuses on good sex in a long term relationship read Emily Nagoski’s latest book Come Together: The Science (and Art!) of Creating Lasting Sexual Connections.

If you want to give your male partner a book about female sexuality written by a guy, for guys hand him She Comes First: The Thinking Man’s Guide to Female Pleasure by Ian Kerner.

I’m curious? What resources have you found helpful that are not on this list? Reply to this email or leave a comment and let me know!

xo,

Rebecca

p.s. Missed the first two posts about low libido? No worries - I’ve gotcha! Click on the posts below to catch up:

Share

Subscribe now

March is Colorectal Cancer Awareness Month. So, we’re going to interrupt our regularly scheduled programming (the 4 part series on low libido) so I can beg, plead, ahem, remind you to get your screening colonoscopy.

Last year I shared how I had two precancerous polyps removed during my screening colonoscopy, and my sister had nine highly precancerous polyps removed during hers, despite both of us living super healthy lifestyles and having no risk factors.

In that post I share the different options for colorectal cancer screening, several of which are convenient and easy. So if you’re curious - click over to that post to read about your options.

This year, I want to focus on something I don’t see many people talking about, but I know keeps some people from scheduling their routine colonoscopy: the embarrassment of having someone stick a camera up your butt.

But first, a funny story:

My husband is a doctor, and it’s rare for me to have any anonymity within the health system he works for. Our last name is unusual, and I am often asked if I’m related to Dr. Mudrick. It’s not uncommon for these conversations to happen when I’m partially clothed, feeling vulnerable and would love nothing more than to be forgotten as soon as I leave the appointment.

So anyway, a few years ago I turned 45 and scheduled my first colonoscopy. And then I had to reschedule it … and then reschedule it again. At this point I felt like I was tempting fate by postponing the procedure multiple times, so that third time I opted for the soonest appointment anywhere in the Columbus metro area. Which is how I ended up getting my colonoscopy in a far reaching suburb about 40 minutes from my house.

So imagine my surprise when the randomly assigned gastroenterologist walks in to say hello before my procedure, and he and my husband both do a doubletake, followed by a bunch of warm exclamations and “It’s been so long!” and “I had no idea you lived here!”.

The guy who was just about to put a camera up my butt was one of my husband’s friends from residency in Boston. They had worked and trained together for three years, lost track of each other as they pursued different specialties and then both randomly ended up in Ohio working for the same health system.

WHAT ARE THE ODDS???

But also, of course.

Sigh.

But here’s why it didn’t matter: I knew this guy had seen thousands of rear ends before seeing mine, and would go on to see thousands more in the years after. I took comfort in knowing that my butt was in no way remarkable to my doctor because he had seen it all by that point. Seriously.

So if shame or embarrassment is keeping you from scheduling your routine colonoscopy, it’s totally unnecessary. Your GI doc isn’t judging you or grossed out by what they find - if they were they would have picked a different specialty.

Trust me when I say they’ve seen bigger butts, flabbier butts, dimplier butts, smellier butts, hairier butts, bonier butts, wrinklier butts, and so on. They. Have. Seen. It. All.

And to them, your butt is totally and completely unremarkable. Truly! Which means you can stop feeling self conscious and get the procedure scheduled. Okay? Okay.

Still not convinced? Follow my friend Laurie’s advice and dedicate the effort to your loved ones:

“Life is short. It’s fragile and precious and hard and there really isn’t much in this life you can control. So why not take advantage of the little things you can control to try to make your life as rich, meaningful and long as possible? It’s a small thing in the grand scheme of things that could literally save your life. I can promise any discomfort you experience would be a drop in the ocean of how cancer can upend your life - and not just for you, but for all of your loved ones as well. If nothing else, do it for them.”

Get screened for yourself, for your loved ones, or in honor of Laurie who would have loved nothing more than to have a few precancerous polyps removed before moving on with her life. Whatever your inspiration, please just get screened.

XO, Rebecca

P.S. Absolutely making this salad.

Share

Leave a comment

Subscribe now

Last week I posted the first of four articles addressing various aspects of low libido, which is a common and often complicated issue both during and after the menopause transition.

Why is it complicated? Because libido can involve biological, psychological and social factors. This means low libido can be the result of a biological issue like low hormones or non-biological factors like chronic stress, lack of connection with an intimate partner, self-esteem issues due to changing mid-life bodies, and today’s topic: pain.

Alright, let’s get into it!

So here’s the deal: you’re unlikely to want sex that’s painful.

If you’re experiencing low desire and unwanted discomfort during sex, addressing the discomfort is a great place to start addressing issues of low desire.

What does menopause have to do with painful sex?

Genitourinary Syndrome of Menopause (GSM) is the medical term for changes to the tissues of the vulva, vagina and urinary tract due to declining estrogen during the menopause transition, and low estrogen post menopause.

Estrogen is lubricating and keeps tissues plump, healthy and happy. As estrogen declines and eventually settles at low postmenopausal levels, our natural lubrication decreases and tissue can become dry, fragile and painful. As a result, sex can become very uncomfortable.

So what can I do to troubleshoot painful sex?

First, make an appointment with a menopause specialist or gynecologist to discuss the possibility of genitourinary syndrome of menopause. Vaginal estrogen cream is inexpensive, safe and effective at restoring vaginal tissues. As one person recently told me: this stuff works miracles. Having used it for the last several years, I wholeheartedly agree.

Second, start using lube every time you have sex.

In addition to making sex more comfortable, studies show lube enhances pleasure and increases the likelihood you’ll orgasm. So it fixes the problem of “sandpaper sex” and can make for a better overall experience.

Not quite convinced? Read this quote from Heather Corinna’s book titled, “What Fresh Hell is This?”

She says,

“In the event you’re not already a lube superfan, and shame has gotten in your way of using a slippery vat of lubey goodness, hear this: Lube is not a bummer or something to be embarrassed about. Lube is gravy on potatoes, pomade on a pompadour, or warm, melty syrup on pancakes for crying out loud. Lube is a glorious thing that can make a potentially already good thing anywhere from a little better to downright magical.”

Okay, I’m sold. What kind of lube should I use?

There are three types of lubricants: water based, oil based and silicone based. What type you prefer is highly personal.

A few things to consider:

According to Dr. Jen Gunter in her book “The Menopause Manifesto”, women with GSM symptoms tend to do well using silicone based lubricants like Astroglide X and Über Lube. But silicone lube can be harder to get out of sheets and isn’t compatible with silicone toys.

Doctor Gunter says water based lubes tend to have more ingredients that you have to worry about. You need to look at both pH and osmolality so that the product doesn’t draw water out of vaginal tissue, causing even more irritation. Sound too complicated? Just go with what Dr. Gunter recommends: Good Clean Love, Yes Baby Vaginal-Friendly lubricant and Yes Water-Based Intimate Lubricant.

Oil based lubes can’t be used with latex condoms but can be a good option otherwise. Some women even use plain coconut oil or olive oil as lube and have found it works well.

With any lube, you want to avoid any products that are scented, warming or flavored which are often irritating to vaginal tissues.

What if sex is still painful?

Using lube and still experiencing painful sex?

Go see your gynecologist or menopause specialist. Again, you may need prescription cream to repair tissues, or you may need to see a pelvic floor physical therapist to troubleshoot the problem.

And if your gynecologist says to just “deal with it” (you wouldn’t believe the stories I’ve heard), find a new gynecologist. Your sexual experience matters, and you deserve to experience as much pleasure as your partner.

Anything else I should know?

Communicating honestly about your sexual experience can feel scary and vulnerable. But open communication is key to developing authentic intimacy with your partner, and that intimacy is an important puzzle piece to feeling a healthy amount of desire.

So if you’re experiencing any pain or discomfort during sex, talk about it and keep talking about it. Sex should be a collaborative experience. Talking about pain is a great place to start working together toward a better, more intimate and fulfilling experience for you both.

xo,
Rebecca

P.S. I can’t believe I just learned this!

P.P.S. Gorgeous painting by one of my favorite artists: John Singer Sargent, Nonchaloir (Repose), 1911, National Gallery of Art, Washington, DC, USA

Subscribe now

Share

Leave a comment

Hello from Columbus, Ohio where the whiplash between winter and spring is a thing of wonder. Last Monday we woke up to a very unexpected 4 inches of snow (surprise!!!) and now it’s sunny and deliciously warm. Since I seem to be solar powered, I’ll be out soaking up as much warmth as possible before it gets cold again in a few days.

I was chatting with a friend recently who told me her libido has taken a major hit since turning 50. Our conversation was the motivation I needed to revisit the email series on low libido I sent out a few years ago and get it posted to Hot & Bothered.

As always, my goal is to provide helpful foundational information and then to point you to experts in the field. Thankfully, there are some amazing resources I’m excited to share with you.

But first of all, let’s get to some basic information I think all midlife women should be know:

What is low libido?

Low libido (officially known as Hypoactive Sexual Desire Disorder) is defined as a prolonged decrease in your baseline level of sexual desire that you find bothersome.

Basically, you’ve lost that lovin’ feelin’ and you want to get it back. If low or nonexistent libido doesn’t bother you, you don’t need to treat it.

It’s important to understand that low libido can involve biological, psychological and social factors. In other words: there are a lot of puzzle pieces to consider when troubleshooting low libido, not just hormones.

What pharmaceutical options are there?

Flibanserin is FDA-approved to treat low libido in both pre and post menopausal women.

Bremelanotide is FDA approved to treat low libido in pre-menopausal women only.

Testosterone is not currently FDA-approved for treating low libido in women, although many doctors will prescribe it off-label. The Menopause Society does recommend testosterone therapy for low libido in appropriately screened postmenopausal women.

*Please note that testosterone dosing in women needs to be VERY carefully considered (the dosing is a fraction of what would be prescribed in men) and hormone pellets are not a safe way to take testosterone.

Are there any resources you recommend if I want to know more?

Menopause expert Dr. Lauren Steicher has a podcast series focused on the biological factors involved in post-menopausal libido, which you can listen to here when you subscribe to her Substack. The small subscription fee is worth it, especially since you’ll gain access to the rest of Dr. Streicher’s menopause-focused content, which is an excellent resource for midlife women.

Anything else I should know?

Yep. A few things:

Medication to increase desire isn’t going to be helpful if you’re too exhausted to think about sex, resent your partner, can’t stand to be touched because you’re experiencing body confidence issues, or the sex is painful. This is why The Menopause Society talks about recommending testosterone in “appropriately screened” women vs. all women with low libido.

That said, if you’re experiencing low libido, there is every reason to hope. There are so many aspects of low libido you can explore/troubleshoot with great rates of success - so stay tuned!

xo, Rebecca

P.S. Do it for her.

P.P.S. Happy International Women’s Day!

Subscribe now

Share

Leave a comment

Hi all,

Women Living Better is a website dedicated to educating women about the menopause transition, primary through explaining menopause research in ways that anyone can understand. It’s a great resource, and I recommend signing up for their newsletter.

In recent years, the team behind WLB have conducted their own menopause research and have published seven papers with their findings. I wrote about their most recent research paper last May, which you can read here:

The good folks at Women Living Better are working on a few exciting research projects that I wanted to pass along, because I’m not going to complain about the lack of menopause research and then pass up an opportunity to be part of the solution.

First - and this one is time sensitive - there is an anonymous survey you can take about how the menopause transition impacts mood. The survey closes March 1st - just a few days from now - so click this link ASAP to fill out the survey. The survey takes 10-20 minutes and is open to women ages 35-55.

Second, Women Living Better is doing a pilot study looking at fitness wearables and how they can better understand changes to the body leading up to menopause. Here is the info from the Women Living Better newsletter:

An exciting pilot study using wearables to capture the lived experiences of 250 women ages 35–55 is launching soon.

Aim: To address a significant knowledge gap by documenting the many unique pathways through the menopausal transition, beginning with the earliest changes.

Design: Participants will use an Oura Ring, a Fitbit Sense 2 and a custom mobile app to track physiological data and personal experiences.

Data privacy: All data will be fully anonymized. Participants will be able to compare their own experiences with aggregated, anonymized data from other participants.

Recruitment: Initial recruitment will be announced in a future Women Living Better newsletter. Please consider forwarding this newsletter to women ages 35–55 who may be interested in participating in this wearables study.

How cool would it be to participate in this study??? I’m planning to apply, and think you should too.

xo,

Rebecca

p.s. Can you imagine? No thank you.

Last spring I decided enough was enough. I was ready to see a menopause specialist and talk about menopause hormone therapy.

Six months later I finally got off the waiting list at my local menopause clinic but the earliest appointment wasn’t for another 5 months. Sigh. By this point I was growing impatient and decided to also book a telemedicine appointment with an online clinic. Depending on how that went, I could either keep or cancel my local, in-person appointment.

I initially tried to book an appointment through Gennev - I like that they don’t create any conflicts of interest by selling supplements or compounded drugs like many of the menopause-focused telemedicine companies do. But I couldn’t get the Gennev online scheduler to work so I ended up scheduling with Midi. I was able to book with a nurse practitioner licensed in Ohio for an appointment just a few days later. Hallelujah!

Logging on to the patient portal and into the video call was easy and the nurse practitioner was friendly. She listened to my symptoms and then made recommendations for starting a low dose estradiol patch and confirmed that I didn’t need progesterone because I have a progesterone IUD to protect my uterus.

And then things went a little bit off the rails when she asked, “And would you like to start testosterone or a GLP-1?”

It felt like she was asking, “And would you like fries and a drink with that?”

I replied that I didn’t have any weight concerns or symptoms that would justify starting testosterone, so no thank you.

She countered with the potential benefits of testosterone (information she told me she got from a menopause influencer she follows on Instagram, who I’m familiar with and who unfortunately spreads misinformation about testosterone for midlife women) and said that I might like how I feel on it, so I should consider trying it.

I reiterated that I wasn’t interested in taking any medication that I didn’t need and risk dealing with potential negative side effects. After that we closed the call.

We met again via video call a month later so we could talk about how I was tolerating the estradiol patch and talk through next steps.

And at this second appointment, she again offered me testosterone as well as oral progesterone.

I declined both. My uterus is already protected by my Mirena IUD - something she had confirmed during our first visit - and I have no symptoms that indicate I need additional progesterone or to start testosterone.

Her argument again was that while I didn’t technically need to take either of them, I simply might like how I feel while taking them.

After going back and forth several more times, I realized that I wasn’t a patient with medical concerns so much as a customer she wanted to keep happy. She was metaphorically handing me a menu of prescription drug options to sample, and giving me her recommendations based on what she thought I might like, rather than based on the symptoms I had hoped to treat.

I ended the video call flustered and frustrated. This isn’t how medicine is supposed to work, right?

I’ve had 8 weeks since that last telemedicine visit to process my experience before sharing it with all of you. And here’s where I’ve landed:

I think it’s important to recognize that for much of the past 25ish years, most clinicians were unwilling to prescribe menopause hormone therapy at all, even to women with severe, debilitating symptoms. The fact that I could make an appointment, meet with a clinician 2 days later and have a prescription in hand a few hours after that feels miraculous.

But I also worry that the pendulum has swung too far in the opposite direction. Now we have online telemedicine clinics that are designed to make menopause care as quick and easy as possible, with a very customer-forward approach. Because happy customers return, and happy customers tell all their friends.

I keep thinking about my husband, who trained for 60-80 hours a week for thirteen years and had to pass a sixteen hour exam to become a board certified cardiologist. Can you imagine if patients came to see him with a list of cardiac symptoms and he said, “And how about a statin or a beta blocker? You don’t have any symptoms or conditions that either of those drugs treat but you might like how you feel when you take them. A doctor I follow on TikTok says all patients should at least have the option of taking these medications, so if you want to try them I’m happy to write the prescription. It’s up to you.”

That would be utterly absurd right? It’s bad medicine.

Call me crazy, but I want to be shepherded through this process by a competent, knowledgeable provider I can trust. Because I recognize the vast limitations of my own knowledge and value the expertise that comes with a bajillion years of medical training and clinical experience. I want to be a patient, not a customer

Thankfully, I have an in-person appointment in a few weeks with a physician who is certified through The Menopause Society. Here’s to hoping she can better guide me through what truly feels like the wild world of menopause hormone therapy.

So after all that, would I recommend telemedicine?

Yes, but with reservations.

I would absolutely go into the experience having read through my menopause hormone therapy series and/or The Menopause Society’s Position Statement on Hormone Therapy (or their patient handout). That way, if your telemedicine provider asks, “And would you like fries and a drink with that?” you’ll at least have some idea how to answer.

Have you used telemedicine? I’d love to know what your experience was like. Reply to this email or better yet - leave a comment so we can all learn from your experience.

Until next week,

Rebecca

P.S. Once you hit a certain age …

Subscribe now

Share

Leave a comment

I had a totally different post queued up for this week, but decided to switch things up given current events and the state of my nervous system lately. Because I can’t pretend like life is normal right now, and I would imagine many of you can’t either.

What to do when everything feels like one big giant dumpster fire? How can you regulate your nervous system so you have the energy and focus to do something useful, rather than feel frozen in a state of shock and dismay?

I recently finished the book How to Winter: Harness Your Mindset to Thrive on Cold, Dark, or Difficult Days by Kari Leibowitz. Within a few chapters I knew this book was going to influence my mindset about a whole lot more than just winter, so I returned my library copy and bought my own so I could mark it up to my heart’s desire. And mark it up I did!

So much of the positive psychology in How to Winter is applicable to the menopause transition, but also helpful for approaching any challenging circumstance. And since challenges abound, I figured now was the perfect time to write about the power of wonder and awe for providing a much needed nervous system reset.

There is so much I could say about my own history cultivating wonder and awe. But the gist of it is this: cultivating these two potent emotions helped sustain me through years of intense stress and anguish.

So you can imagine my delight when Leibowitz wrote about study findings that confirmed what I already knew to be true in my own body: cultivating a sense of wonder and awe can indeed be helpful for calming your nervous system during times of stress.

She quotes Virginia Sturm, a professor at UCSF who led a study to test whether people can purposefully cultivate wonder and awe by taking one 15-minute “awe walk” a week. And the results were astounding.

The participants who took weekly awe walks (vs. those in the regular walking group) didn’t just report an increase in positive emotions, but also reported a decrease in daily distress. Sturm says that “awe sets us up to deal with stressors more effectively, and gives us more space to respond without having a full blown negative emotional reaction.”

Leibowitz also explains that awe not only helps us feel less bogged down by day-to-day challenges, but it also helps us feel more connected to humanity. Which is, in my opinion, exactly what the world needs right now.

So how can we more purposefully cultivate a sense of wonder and awe?

I suggest doing what Sturm had study participants do: take one 15-minute “awe walk” a week. As you walk, try to tap into a childlike sense of wonder and see things with fresh eyes. Use your five senses, slow down, and look at things up close if possible.

You may notice that the positive emotions you feel on your awe walks bleed into time outside your walks and help create what’s known as an upward spiral of well-being. This is a state where positive emotions - like awe - lead to other positive emotions and the sum total of that upward spiral is a better quality of life overall.

Pretty amazing, right?

I want to leave you with one final thought:

Resistance takes all kinds of forms. It’s writing letters, making phone calls, donating, boycotting, taking to the streets in peaceful protest and it’s purposefully cultivating positive emotions like joy, wonder and awe especially when things feel bleak. Because joy, wonder and awe fuel hope. And hope? Hope is what sustains long term action. Hope is a powerful thing indeed.

Sending you the biggest, warmest, most comforting hugs.

xo, Rebecca

P.S. Asking for a friend.

Subscribe now

Share

Leave a comment

Are you one of the 200 million Americans who will be impacted by winter storm Fern this weekend? We’re forecasted to get 10-12 inches of snow, but I’ll believe it when I see it - Columbus rarely gets as much snow as forecasted.

If you’ve been hanging around long enough, you’ll know that I love soup and make it year round. Mostly because I’m lazy and making a pot of soup for dinner one night and then having leftovers to eat for lunches over the week is the easiest formula I’ve come up with for healthy eating without a lot of effort. But also, I just really love soup. I can think of worse qualities.

I’ve been making this Quick Green Chicken Chili recipe monthly since Cynthia Winward posted it on the At Last She Said It Substack ages ago. It comes together quickly, just dirties one pan, has got a ton of flavor, a decent amount of protein and fiber, and can be eaten as is or dressed up with toppings depending on your mood/energy level/what you have on hand. Basically, it’s a menopausal woman’s dream come true.

Here’s the recipe:

Quick Green Chicken Chili

1 tablespoon oil (I usually use avocado oil or EVOO)
1 onion, chopped (frozen works great here to save time/clean up)
1/4 tsp black pepper
1/2 tsp salt
3 garlic cloves, minced
2 tsp ground cumin
4 cups (1 quart) chicken broth
2 - 15 ounce cans cannellini beans, drained and rinsed
1 cup jarred green salsa (I usually use the trader joe’s salsa verde and just dump in the whole jar)
3 cups shredded chicken (rotisserie works great)

In a soup pot, heat oil over medium heat and add onion, pepper and salt and cook until the onion is soft and translucent.

Stir in the minced garlic and cumin and cook until fragrant, about an additional minute.

Stir in broth, beans and salsa. Bring to a boil and simmer for 15 minutes. If you want a thicker broth you can mash some of the beans against the side of the pot with a big spoon (I’m too lazy to do this, but you do you). Stir in chicken and cook until warmed through.

Eat as is or top with fresh cilantro, crumbled tortilla chips, sour cream, cheese (cotija, sharp cheddar or whatever sounds good) and avocado or a scoop of guac.

Make a double batch if you’re feeding a family and still want soup for leftovers. Also, the soup freezes really well if you’re into that. I like freezing individual portions in these for a hot meal at a moments notice.

Stay warm and safe!

xo, Rebecca

P.S. She’s not wrong.

Subscribe now

Share

Leave a comment

First things first - did you survive the holidays?

I’m happy to report that I cruised through thanks to some seriously amazing helpers and a few McDonalds runs for a Diet Coke pick-me-up. However …

The day before our houseguests arrived I was suuuuuuper emotional and I couldn’t figure out why. I was on the verge of tears or actually crying THE ENTIRE DAY. It was so ridiculous I laughed with my husband about it and then cried because, of course.

And then I woke up the next day and my period had started, which is a very rare occurrence for me since I have an IUD. Clearly the perimenopausal hormone roller coaster had been taking me for a wild ride. Sigh. Hormones. I can’t even.

Also, can we stop for a moment and appreciate this amazing gift my sister gave me from the famous New York City bookstore, The Strand?

She picked it up off their “Blind Date With a Book” table and we were so excited to see what book they had wrapped in this ridiculous paper. And oh my goodness, the title (and cover art, and description on the back cover) did not disappoint. I’ve never wanted to read horror and yet I can’t wait to dive in!

Alright, can we talk about New Years resolutions? I feel like I’ve landed on a very casual, low pressure, surprisingly effective way to handle annual goal setting that feels particularly appropriate for midlife.

A few important details to get out of the way first:

First, I don’t set goals if I don’t want to. Most years I enjoy the process but some years I just can’t go there. So that’s my first tip: if you don’t want to, don’t. I can’t think of a better time to say, “Good for you, not for me” than midlife.

Second, I no longer set goals with the hope of completely transforming something I don’t like about myself. I just can’t be bothered anymore, which I consider a huge perk of becoming older and wiser.

With that out of the way, here’s the goal setting practice that’s been working really well the past few years.

I take as much time as I want (sometimes days, sometimes weeks) to mull over a few questions and write my responses in a google doc. This year, I used Suleika Jaolaud’s questions to guide my goal setting:

1. What from the last year are you proud of?

2. What did this year leave you yearning for?

3. What’s causing you anxiety?

4. What resources, skills, and practices can you rely on in the coming year?

5. What are your wildest, most harebrained ideas and dreams?

When I feel like my written responses are complete, I use them to guide my goals for the coming year which I also write in the google doc.

And then - and this is where the magic happens - I cut and paste my goals into the notes section of a recurring event I put on my calendar.

Once a month, I see that calendar event and take a few minutes to re-read the goals I set. And if I have the capacity, I jot a few things on my to-do list related to one or several of my goals. And if not, that reminder will be on my calendar again the next month.

Why is this so magical?

Because most years I’ve completely forgotten about my New Year's resolutions by the time February rolls around. Having that monthly reminder - which takes about 30 seconds to set up - has been a total game changer.

But also, this process allows me to let my focus ebb and flow depending on what’s going on that month. Rather than trying to focus on all my goals all the time (something I’ve consistently failed at in the past), I can focus on one or two during the months that make the most sense. Or let them all go until I have the capacity and desire to start chipping away at them again.

Did I accomplish all my goals last year? Nope. But the things I did accomplish felt shockingly effortless rather than effortful, and that feels a little miraculous. And in this wild and crazy stage of life, I’ll take all the wins I can get.

Sending you lots of love as you navigate this fresh new year.

xo, Rebecca

P.S. Menopause: Myth Vs. Fact

Share

Leave a comment

Hello, loves. How’re you all holding up now that we’re just a week out from The Big Day?

We celebrate both Hanukkah and Christmas (my husband is half Jewish) so I’ve been baking up a ton of challah this week to give as gifts and also to feed the twenty or so young adults we’re hosting for our annual Hanukkah dinner.

As I’ve been braiding loaf after loaf after loaf, I’ve been thinking about my well-honed holiday survival strategies and thought I’d share what’s working for me right now. Feel free to steal whatever ideas resonate and say “no thanks” to the rest!

Wear comfy clothes. My tolerance for anything tight, itchy or uncomfortable is extremely low right now (thank you perimenopause). So, until life calms down I’m pulling my hair up and opting out of clothes that make me want to crawl out of my skin.

Eat high protein, high fiber meals with a wide variety of flavor profiles. I’ve been cooking a lot of Lillie Eats and Tells recipes since Thanksgiving, and a friend just sent along this recipe for Honey Harissa Chicken Bowls that I can’t wait to make this weekend.

There’s something about the variety of flavor profiles and abundance of vegetables that makes indulging in a rich holiday meal or sugary holiday treats feel less consequential, if that makes sense. Like, I can indulge and still feel good in my body because everything else I’m eating is fresh, light and novel.

Move in any way you can, for any amount of time. Not to burn off holiday calories, but to burn off holiday stress. Even a quick walk about the block or kitchen dance party can feel like pressing the reset button on both mind and body.

Get outside. I get that some people are just straight up indoorsy, and I respect that. But I need time outside to stay mentally healthy, even when it’s downright depressing out there. Which is why I take a lot of night walks in the winter.

A few years ago, we discovered that night walks are the antidote to the gray, depressing winter days. Instead, they are absolutely cozy and magical - especially when Christmas lights are up. So we try to bundle up and take nightly walks with whoever is home. And they are a great way to reset and reconnect at the end of the day.

Thinking about enjoying a night walk? Please make sure you’re visible in the dark. My husband was nearly hit by a car a few years ago (it was such a close call) - so one of us always wears a light up vest when we walk at night.

Schedule time with someone you can debrief with. Is there anything better than sneaking out to spend a quick hour with someone who gets it? I can’t recommend this enough.

Make up an errand if you need to get away and breathe for a bit. Bonus points if you find an empty parking lot and scream into the void.

If all else fails, renew your commitment to the We Do Not Care Club. Watch some posts, read the comments, and remember that you’re in good company. Also, congrats to Melani for being named PEOPLE’S Creator of the Year!

Alright, so this is what’s working for me right now. I’d love to know what’s working for you!

Big hugs and good luck these next few weeks - Hot & Bothered is going on holiday and will resume in the new year.

Until then,

Rebecca

P.S. An important reminder.

Last week, just as we were recovering from Thanksgiving and in the thick of the holiday shopping madness, an email landed in my inbox that rubbed me the wrong way.

The purpose of the email was to convince midlife women not to let important self care habits fall by the wayside during the busy holiday season. And while I agree with the message that you’ll enjoy your holidays more if you take care of yourself in small, manageable ways throughout the season, the argument was delivered with a lack of sensitivity to how hard each of us is already trying to be all the things to all the people - including ourselves. Not to mention it included some ridiculous fear mongering about what will happen if you “slack off” for a few weeks.

So I decided to devote this week’s newsletter to sending a different message:

It’s actually okay to just put your head down and do what it takes to get through the holiday season. It really, truly is.

And while this particular sentiment was born out of feeling extremely contrary after reading the aforementioned email, I actually think it’s a decent holiday mantra.

Because “do what it takes to get through” can mean whatever each of us needs it to mean at any given moment.

Maybe doing what it takes to get through the holidays means finally saying no to the stuff you don’t care about, going to a fitness class even though you don’t have time, and passing a bunch of to-do’s off to your partner or simply opting out of those to-do’s altogether.

Or maybe it means resigning yourself to doing what you’ve always done.

Either way, I trust you to know what the best approach is for you in the context of your life. I trust you to learn what you need to learn from the outcome and to change what you need to change when you’re ready to change it.

And I give you permission to reject any voices telling you that you’re falling short unless you prioritize what they think is best for you.

I believe in you!!!

xo, Rebecca

P.S. “I’m just feeling really down these days and I don’t know why.”

P.P.S. My need-to-think-through-every-scenario brain would like to remind you to use common sense when “doing what it takes to get through”. For example, don’t ignore a lump in your breast. Or signs of a heart attack. And so on and so forth.

Subscribe now

Share

Today marks one week before Thanksgiving, so I thought a quick pep-talk was due before signing off for a few weeks.

Why the break? Because for the next few weeks, every business that you’ve engaged with in any way will be clamoring for your attention.

And as an easily overstimulated perimenopausal woman, I find that when the world gets extra noisy I need to take a step back to preserve my sanity.

Feel free to join me in stepping away from the barrage and spending time doing anything that feels grounding: a outdoor walk, quiet yoga, snuggling up in bed with a good book, or even just quietly ticking off to do’s. I hope to emerge from the Black Friday/Cyber Monday/holiday shopping frenzy feeling calm and cozy rather than completely frazzled. And I hope that you do too!

But for now, I want to repost a Thanksgiving message I sent out in 2021 that I can’t stop thinking about this week. Maybe it’s because I know several extraordinarily resilient women going through some really tough stuff. And I want to remind them to take a few moments to acknowledge how well they’re navigating really difficult circumstances. And maybe you need that reminder too?

Without further ado … the pep talk I figure we could all use about right now:

I’m a firm believer in the power of gratitude and have had an (almost) daily gratitude practice for a few years now. But you know who I rarely take the time to feel grateful for?

Me.

Most of my gratitude is externally focused on the people in my life and the extraordinary world we live in. But a friend recently reminded me of Snoop Dogg’s infamous Hollywood Star acceptance speech where he thanked himself for believing in himself, for all his hard work, for never giving up, etc. and I AM SO HERE FOR IT!

Because the truth is, we accomplish amazing feats all the time and rarely stop to acknowledge the deep wells of strength, patience, knowledge, and skills we cultivate as we navigate our daily lives. And I think that’s a shame.

So take a moment this Thanksgiving to be thankful for yourself. To feel proud of the ways you show up for yourself and your people every day. For the incredible gift it is to have a body, through which you can experience so much goodness regardless of age, shape or ability. For the goals you’ve chased, the meals you’ve made, the books you’ve read, etc. And then let yourself marinate in the warmth of your gratitude for yourself, simply because it’s a lovely place to pause and hang out for a bit, and you’re worth it.

With love and gratitude for all of you (and myself, haha).

xo, Rebecca

P.S. Only 150 days to go …

Subscribe now

Share

Leave a comment

You know what I would love? An uncomplicated, drama-free conversation or announcement regarding menopause hormone therapy (MHT). But alas, it’s 2025. I should have known not to get my hopes up. Shame on me.

A little background on this week’s big announcement from Health and Human Services:

When a prescription drug may cause side effects, the FDA requires drug companies to include warnings about those side effects on the product packaging. There are different levels of warnings, and the most serious is the “black box warning”, which is designed to catch your attention to make sure you are aware of the risks of the medication you are planning to take.

After the 2002 Women’s Health Initiative debacle, the FDA changed the labeling on estradiol (the estrogen used in menopause hormone therapy) to include a black box warning due to increased risk of blood clots, heart disease, stroke and breast cancer.

However, two things are important to know here:

1. Vaginal estrogen used to treat genitourinary syndrome of menopause (which nearly all menopausal women will experience) does not carry the same risks as systemic estrogen, since so little of the vaginal estrogen is absorbed into the bloodstream.

2. The risks of systemic MHT vary depending on when you start taking it, the type of hormone you are taking and the delivery method of that hormone (pill, patch, cream, etc.). And that if you account for those factors, the risks of taking MHT go way down.

Clinicians have been asking the FDA for years to remove the black box warning label from vaginal estrogen, which is known to be very safe for most women.

And this past Monday, the FDA announced it is removing the black box warnings from vaginal estrogen and systemic MHT. The updated product labeling will hopefully better reflect current understanding about the risks associated with various forms of MHT.

While this is good news - the blanket warnings absolutely should be reconsidered - the process behind the decision was not what it was supposed to be, which compromises the scientific integrity of the decision. Given the strong bias in favor of MHT during the review process, some menopause experts worry the pendulum will swing in the opposite direction and we still won’t have accurate, evidence-based labeling for these drugs. Instead, we may end up with labels that inappropriately minimize the risks of systemic MHT for some women.

And to add insult to injury, the announcement was rife with misinformation surrounding menopause and menopause hormone therapy.

So let me briefly set the record straight about some of the misinformation given at the press conference on Monday:

• Menopause is not a disease but a normal biological process and it does not lead to early death.

• There is no legitimate scientific data supporting the claim that MHT lowers the risk of heart disease and dementia or that it extends a woman’s life by ten years.

• We have no data supporting the claim that a lack of MHT leads to divorce.

• And finally, you don’t need to get your hormone levels tested before starting MHT (here’s why).

(Excuse me while I go bang my head against a wall.)

The Menopause Society - an internationally respected organization made up of a wide array of menopause experts - responded to the announcement with the following statement:

We agree with the FDA’s decision to remove the boxed warning on low-dose vaginal estrogen therapies used to treat genitourinary symptoms associated with menopause. The boxed warning may have been a deterrent to the use of the low-dose vaginal estrogen, which is a safe and effective therapy for a condition that affects most menopausal women. Systemic estrogen still comes with potential risks in certain individuals that should be reviewed in detail with women initiating therapy.

As stated in The Menopause Society’s hormone therapy position statement, the risks are low for younger, healthy women initiating hormone therapy closer to the menopause transition. Risks are greater when initiated in older women and in those who are further from menopause onset. Medical comorbidities, personal and family histories, symptoms, and personal preferences all need to be reviewed with patients considering the use of hormone therapy for management of menopause symptoms or prevention of bone loss.

Despite problems with both the review process and the announcement from Health and Human Services, by all accounts this seems to be a net gain for women. We still have a long way to go to improve menopause care (like, a really really really long way to go), but a step in the right direction is still a step in the right direction.

So this is me taking some deep breaths and cracking open a cold, crispy Diet Coke - cheers to a future of better menopause care!

xo, Rebecca

P.S. Me vs. Winter

Share

Leave a comment

Subscribe now

October has been expectedly and unexpectedly busy.

On the exciting end of things: for the first time in 20 years I am driving a car that is NOT a minivan which feels like a huge midlife milestone! Also, I was able to fulfill my lifelong dream of taking the witness stand in a court case. You guys, I swore an oath to tell the truth, the whole truth and nothing but the truth! And I was cross examined!!!

(Side note: Lest anyone think I’m making light of a tragic situation, the court case doesn’t involve any injury or trauma to any humans or animals. It is for a property dispute - truly the perfect setting for me to fulfill my dream. Next up on my weird little bucket list: cut a ceremonial ribbon.)

On the not-so-exciting end of things: I’ve been dealing with several broken appliances and replacing them has somehow turned into A Whole Thing. Also, an old injury flared up resulting in a lot of pain, multiple doctors visits, an MRI, frequent PT and terrible sleep. Ugh. And every weekend has been scheduled with something-or-other requiring our time and attention for the majority of the weekend. No rest for the weary indeed!

Needless to say, I’m tired. And my brain feels a bit all over the place.

So, this week’s newsletter is going to be a little of this, and a little of that. Because that’s what I’m capable of today.

Without further ado:

Let’s Talk About the Annual Menopause Society Meeting

Last week was the annual Menopause Society meeting and it’s been interesting to see the information - and misinformation - that has come out of this year’s meeting.

I’ve been enjoying updates from several trusted sources who attended. Dr. Jen Gunter has some great reels on her Instagram but the best updates are the ones on her Substack, The Vajenda. She truly has such a gift for explaining things and dispelling misinformation - I highly recommend subscribing. I also enjoyed science writer Selene Yeager’s updates via the Feisty Menopause Instagram and weekly newsletter.

The most notable piece of misinformation to watch out for:

A research abstract was presented at the meeting that reported a 60% reduction of heart attacks, stroke, and breast cancer for women who started estrogen in perimenopause. And a slight increase in heart attacks, stroke and breast cancer for those who started estrogen after reaching menopause. However, there are several problems with making this claim before the full paper is published. Dr. Gunter goes over all the details in this article.

Why should you care? Because I’ve already seen several social media posts from menopause influencers citing this abstract as evidence that all women should start MHT and start early, and the reality is that it is waaaaaaay too premature to be making those claims.

An Upcoming Book I’m Excited About

I am so excited for the book The Big M - which comes out this January. Here’s the description:

Lidia Yuknavitch teams up with 12 of today’s sharpest writers to change the way we think about menopause. Exploring a variety of themes from freedom and mortality, to sexuality and the patriarchy, The Big M is a kaleidoscope of unique perspectives on a universal experience, each writer navigating the profound changes in their bodies and lives in their own ways. Funny, insightful, subversive, and inspiring, The Big M aims to rebrand--and reinvent--our understanding of menopause.

A note for library users (like me) - The Big M is not coming up yet on my library website or Libby app. Hopefully it’ll be there soon. In the meantime, know that I’ve preordered it and will do a review on Hot & Bothered after it’s released.

Speaking of books …

I’d heard great things about The Correspondent by Virginia Evans, so when it finally came up on my Libby holds list, I was thrilled. And it was the perfect cozy read: well-written, sweet, funny and a little sad but also very hopeful.

Next up on my list is Catherine Newman’s latest release, Wreck. I love how Catherine wrote about menopause and midlife in Sandwich and am excited to dive into this follow up novel.

I’m Finally Seeing a Menopause Specialist!

After being waitlisted for 6 months, I finally have an appointment at a local menopause clinic (insert happy face!). However, the earliest appointment was four months from now (insert sad face). So, I went ahead and scheduled an appointment for the Spring along with a much earlier telehealth visit with an online clinic specializing in midlife women.

My current plan is to use telehealth until my local, in-person appointment in March but that is subject to change based on my telehealth experience. Of course, I’ll let you know about ALL of it. In the meantime, I really appreciated Dr. Gunter’s IG reel on how to save money on prescriptions when using a telehealth company for menopause care.

That’s it from me today. I’m off to go prep for a trip to Utah to spend time with my sister who just finished her fourth round of chemo. I’m packing comfy clothes and plan to spend my time snuggled up on the sofa with her while we watch all our favorite childhood movies. I hope your weekend is equally cozy.

xo, Rebecca

P.S. How to burn off all that Halloween candy.

Share

Subscribe now

Leave a comment

This post has been sitting in my drafts folder for a few weeks now. On the one hand, writing about my midlife whatever-this-is has been wonderfully cathartic. On the other hand, putting my experience out in the world has also felt unexpectedly vulnerable. Long story short: I needed to sit on the post and sort through some Big Feelings.

But also, sometimes the world just feels so noisy. Like, throw-your-phone-and-computer-away-and-live-off-the-grid noisy. And I needed to take a beat to figure out if I felt okay continuing to contribute to that noise.

As the menopause discourse (and, quite frankly, the world in general) gets louder, do I feel okay continuing to vie for your attention? Or should I do you the service of leaving you alone in the way I sometimes want to be left alone?

So, there was a lot to sort through. And in the end, I decided to keep writing about issues pertaining to midlife and let you decide where you direct your attention. If it’s Hot & Bothered, I’m so honored. And if it’s not, trust me I get it.

As for the midlife “crisis”, I’ve decided that I won’t let a little shame get in the way of talking about a very typical midlife experience. Especially if by talking about it I’m able to help ease the process for someone else. So without further ado …

For the last 18 months or so, I’ve been feeling a lot of capital-F Feelings about how I’ve spent the last 25 years of my life and how I want to spend the next 25 years.

And it occurred to me the other day that I think this might actually be a midlife crisis.

(Sidenote: What does a midlife crisis even look like for women? The only cultural reference points I have are the male-centered cliches from movies and tv. And they are not very helpful under the circumstances.)

I married young, and kids came much faster than we had planned. And then for sooooo many years I was in the thick of parenting 4 kids while managing part-time work, significant volunteer responsibilities, tremendous hardship and loss. Meanwhile, I’ve had full-time dreams on the back burner that I wondered if I would ever get the chance to pursue.

And now that I have just one kid left at home and life in general is much less intense, I’m looking back at the choices I made and feeling aaaalllll the feelings.

On the one hand, I am in awe of the life I’ve built alongside my husband. I can say I genuinely love my life.

On the other hand, I’m grieving roads not traveled. Sometimes that grief has been a manageable ache, and sometimes it has felt absolutely gut wrenching.

And then there has been the guilt about the grief. Why can’t I just be grateful and happy, especially when the disappointments of my life are insignificant compared to circumstances other people face?

Thankfully, I’m finally coming out the other side. Here are the two things that have helped me tremendously. Maybe they’ll help you too as you go through your own midlife crisis/reckoning/reconciliation/whatever-this-is.

First, I read this article from Cup of Jo in which the writer, Abigail Ramsey, talks about having to reconcile what she thought her life would look like with what it actually looks like. And the truth of it is that she both loves her life and is disappointed by it.

Abigail explains,

“The other morning, I was blabbering to my therapist about this very thing, about how surprised and sad I was about how so many parts of my life have turned out, all the while being so grateful for a whole lot of it.

She stopped me. “Midlife,” she said, “is all about holding the tension of opposites.”

Unlike in our 20s, when it’s all about the future – getting the job, dating, building a career and/or a family, traveling, doing good in the world – this stage is all about holding the light and the dark, the good and the bad, at once. For most of us, that means there’s plenty we are happy with, and plenty that we are shocked or disappointed by. Perhaps a marriage has ended or we weren’t able to have kids. Perhaps our parents have fallen ill. Maybe we fell into unexpected careers that turned out to give us enormous satisfaction. Perhaps our second marriages are much better than our firsts!

At this stage of life, she explained, we are reconciling how we thought our life would go with how it’s actually going.”

The beauty of Abigail’s essay was that I no longer felt alone in this process. Or like a terrible person for grieving when I have so much to be grateful for. I’m simply going through a reconciliation process that’s actually quite common at this age. Goodness that knowledge was an immense relief.

The second thing that has settled deep into my soul are the final stanzas of Joy Sullivan’s poem Culpable. They read:

I wrote a pep talk recently to myself on a bar napkin:
no matter which road you take, it will be both glorious and unbearable.
Every road is lonely. Every road, holy.
The only error is not walking forth.

Yesterday, a friend in California, when giving me directions,
Told me I could take the trail toward the tall pines or turn left and find a field of poppies,
Growing gold and savage at the edge of the valley.

When I asked which to choose, she simply shrugged and said,
Either way, it’s all heaven.

The line, “no matter which road you take, it will be both glorious and unbearable” healed something in me. Different roads would have simply led to different glorious and unbearable things. But they would still be present, in equal measure.

And “either way, it’s all heaven” was an important reminder: it’s all heaven, simply because it’s mine. It’s the life I have, and it’s a privilege to be here living it despite the disappointments.

So do I have it all figured out? Do I know with certainty what I want the next chapter of my life to look like?

Nope. But I feel like I can finally stop grieving the past and start focusing on how to move forward. And that feels like tremendous progress.

Have you gone through a similar reconciliation process? What helped you along the way?

Also, what does a midlife “crisis” actually look like? I have a feeling it can look like many different things and would love to know your thoughts.

xo, Rebecca

P.S. The older I get …

Share

Subscribe now

Leave a comment

(Question: Is a hiking backpack filled with 3 liters of water considered a weighted vest? Probably not, but it was the closest thing I had so it was either this or a photo of plants. I figured this was at least … weighted vest adjacent.)

It seems like all the middle aged women in my neighborhood (and on the internet) are wearing weighted vests these days. And I’m clearly not the only one who has noticed.

So are these women onto something? Should we all be wearing weighted vests?

But first, how did we get here?

Weighted vests are not a new phenomenon. Athletes and members of the military have been using vests to improve fitness performance for years. Push ups, pull ups and running become extra challenging with an added 10, 15 or 20 lbs, right?

But weighted vests amongst women of a certain age (ahem, 🙋‍♀️) has become a whole thing in recent months after menopause influencers started posting about the benefits of walking with a weighted vest for bone density, which is a big concern for post menopausal women.

Does the claim hold true?

Sadly, no. Walking in a weighted vest doesn’t improve bone density.

And it’s turned into a whole thing online with experts speaking out about what actually does improve bone density and menopause influencers reacting poorly by willfully doubling down on their misunderstanding of the science or outright false claims.

It’s embarrassing to have to tell your followers that those vests you convinced them to buy don’t help with bone density after all. Meanwhile, the affiliate check from all those vests is sitting in your bank account.

And this, my friends, is a great example of how a conflict of interest can impact someone’s ability to communicate truth, regardless of their credentials.

So where does the “data” in favor of weighted vests come from?

The studies quoted most often in favor of weighted vests helping with bone density are studies in which weighted vests were combined with other activities - like traditional weight training - that we already know improve bone density.

And guess what folks? Weight training and walking with a weighted vest is not the same as just walking with a weighted vest. Like, not even close.

But also, you can’t pull out one aspect of the study and say it’s responsible for the whole of the outcome when multiple factors were involved. That’s not how evidence based science works.

Thankfully, we do have studies that isolate the impact of walking with a weighted vest on bone density. And these studies show no difference between the group wearing the vests and the group walking without a vest.

In a stroke of luck, Dr. Lauren Colenso-Semple just published a Substack detailing the scientific studies we have about weighted vests. So I’m going to leave all the nitty gritty details to a bad ass scientist with a PhD. To read her article, click here.

So where does this leave us?

If you’re currently walking with a weighted vest and enjoying it, good for you! It’s a great way to add load to an activity you’re already doing.

But if you’re wearing the vest thinking it’s going to be your bone density magic bullet, it’s important for you to understand that it’s not a useful tool for preventing osteoporosis.

Do I wear one?

Nope. Between weight training and crossfit the vast majority of the exercise I get is under some sort of load. So unless I’m training for a backpacking trip, I feel good about walking without a weighted vest.

But if you want to wear one, go for it! I will always encourage any type of movement that doesn’t compromise you physically or financially. If you’re loving it, keep doing it!

xo, Rebecca

P.S. Should we all join The Midlifer Troop?

Subscribe now

Leave a comment

We did a lot of road tripping this summer.

How much, you ask?

Around 5000 miles.

And while I clearly love a good road trip, I start to lose my mind unless I have a cooler packed with fresh food that leaves me feeling good in my body. So I’m always on the hunt for nutrient-dense foods I can prep in advance and pull out at a rest stop.

This dense bean salad saw us through the 3-day drive from Ohio to Utah and again for the trip home 5 weeks later. What originally started out as a Smitten Kitchen recipe, has morphed into a family favorite that my college kids are now meal prepping to eat during the week. It only dirties one bowl, keeps extremely well in the fridge, and is full of flavor, fiber and nutrients.

So why am I sharing it here? Because fiber is sooooooo important as we age and most of us don’t eat nearly enough. Want to lower your risk for colon cancer, have a healthy microbiome and an easier time maintaining your weight through menopause and beyond? Eat 25-35 grams of fiber daily. This salad will help you get there!

Without further ado:

For the salad:

3 15-ounce cans cannellini beans, drained and rinsed

2 large bell peppers (red, orange or yellow)

1 cup Persian cucumber, quartered and sliced

1 cup cherry tomatoes, halved

1 cup radicchio, cut into bite-size pieces

4 ounces very thinly sliced soppressata, cut into very thin strips (optional)

Mini mozzarella balls or feta cheese, to taste (optional)

For the dressing:

6 tablespoons extra-virgin olive oil

4 tablespoons sherry or red wine vinegar

2 garlic cloves

1 tablespoon freshly-squeezed lemon juice

1 teaspoon fine sea salt

1 teaspoons dried oregano

Freshly ground black pepper or red pepper flakes

1/4 cup chopped fresh flat-leaf parsley

Combine all ingredients into a bowl and stir until well combined. Taste and adjust seasonings and lemon juice until you’re happy. Eat immediately or refrigerate and enjoy over the next 5 days.

Happy eating!

xo, Rebecca

P.S. The comments!!!

Subscribe now

We're nearly done with this series on menopause hormone therapy, but I have a few final niggling thoughts about MHT that I need to get off my chest. And if you've hung in there with me for all SEVEN posts - bless you!

I genuinely thought I was done with the series after the last post about risk. But I’ve learned to listen to my intuition over the years, and I’m very much feeling like I need to share a few more thoughts.

But first, a quick story:

My birth plan with my first pregnancy was to “take the pain for as long as I could stand it and then ask for an epidural”. Which was all good until I got to the “couldn’t stand it” part and then received an epidural that didn’t work. As in, I still had total control over my legs and could feel everything.

The brand spanking new anesthesia resident didn’t know how to help me - he was just 17 days out of med school! He simply kept insisting I wasn’t feeling pain when I was. Bless his little gaslighting heart.

My husband didn’t know how to help me. Everything he tried just made me angry so he eventually stopped trying and took a nap.

And I didn’t know how to help me. I was completely panicked and couldn’t figure out how to calm myself down or stop raging at the world through every contraction.

After such a miserable experience, I resolved to never again rely on an epidural as my only strategy for pain management.

For my next pregnancy, I came up with a game plan for managing the pain, practiced it, and went on to have two unmedicated births. And while they were both really hard, the experiences were still better than the complete panic, helplessness, and rage I felt when my only strategy was to rely on a medical intervention that didn’t go as planned.

My fourth pregnancy was different - the pain was much more intense right from the start. I relied heavily on the tools I had to get me through those first few hours and requested an epidural at the hospital. And that epidural was the dreamiest, most magical anesthetic ever. If I could have stood up to kiss the anesthesiologist on the lips, I would have.

(Instead I threw up in my lap while I was professing my undying love for him/whatever drugs he gave me. That’s labor for you.)

So what does any of this have to do with menopause hormone therapy?

Some women just struggle on MHT. It’s not uncommon to need several med adjustments to find the right fit, and even then some women still really struggle with side effects and find that MHT isn’t a sustainable solution for them.

But even if MHT ends up being a good fit for you, it’s rare for MHT to completely eliminate all disruptive symptoms. The goal with MHT is to get to a place where your symptoms are manageable. And that may leave some unwanted symptoms to manage on your own.

So my advice is this: if you’re open to using MHT to help manage difficult menopause symptoms, go for it, but don’t be tempted to put all your eggs in the MHT basket. You may find that it a while to find the right combo of medication before you experience some relief, or that MHT simply doesn’t agree with you and isn’t a sustainable solution.

Working on the foundational pillars of health will give you additional tools to work with, and increase your quality of life in too many ways to count.

Clearly I’m team “prepare for all scenarios”. And when that preparation involves things like better sleep, healing from past trauma, learning to manage stress, letting go of unfair and unrealistic cultural expectations for women, and moving/nourishing your body in supportive, beautiful ways? I just don’t see a downside to that.

xo,

Rebecca

P.S. Both these lists are on point.

Subscribe now

Welcome to the sixth post in my series on menopause hormone therapy. So far we’ve covered MHT from nearly every angle I can think of (as a non-medical person who may be facing my own decision about MHT in coming years) and in this second-to-last post I wanted to have a candid conversation about risk.

Why? Because risk is really difficult to understand and to communicate, and the numbers can be presented in ways that can either reassure or create fear.

I can guarantee - because I’ve seen it - that people from all sides of the MHT debate will manipulate risk to convince you that a) using MHT is bad for you, b) not using MHT is bad for you, or c) using anything but “bioidentical” compounded hormones is bad for you.

When you can better understand risk, you can cut through the fear-mongering and make a more informed decision about what’s right for you and your unique situation.

Let’s get started with an example:

There are approximately 9 million postmenopausal women currently using oral MHT.

The increased risk of developing a blood clot on oral MHT is between 5-15 women for every 10,000 women on oral MHT, per year, depending on age. Let’s split that number down the middle and say that oral MHT causes blood clots in 10 out of every 10,000 women per year.

There are several ways to accurately present that data. Let’s look at how your brain responds to a few of them.

It’s accurate to say that the risk of developing a blood clot due to oral MHT is 0.1% which makes the risk feel miniscule.

It is also accurate to zoom out and look at the risk based on the entire population of women taking oral MHT in which case we can say that 9000 women will develop blood clots per year from MHT.

The risk of developing a blood clot from oral MHT is both 0.1% per year and 9000 women per year. Do you see how problematic this is in terms of understanding risk? One number feels tiny and reassuring and the other feels enormous and scary and yet they are both true.

But how does that risk compare to the normal, everyday risk of getting a blood clot? The baseline risk for getting a blood clot for women in their forties is approximately 5 women for every 10,000 women. So it’s accurate to say that taking oral MHT doubles your risk of getting a blood clot which again, sounds scary. But when doubling your risk takes your chance of developing a blood clot from 0.05% to 0.1%, it feels like the risk is still quite minimal, which is reassuring.

Another way in which determining risk is difficult, is that we take such a broad population-level view that it’s hard to understand what this means on an individual level. Do your genetics and lifestyle make you more or less predisposed to developing blood clots? What is your individual level of risk? If you never develop a blood clot from MHT, it turns out your risk was 0%. But if you do, it's 100%.

Ugh! Determining risk is hard, right?

One final consideration about risk: make sure you also weigh the risks of not taking MHT.

If your symptoms are severe and your sleep is continually disrupted due to night sweats, your risk of heart attack, diabetes, obesity, depression, and stroke all increase. Not to mention the impact that severe symptoms may have on your relationships, work, and overall quality of life - which is, admittedly, much harder to quantify in terms of absolute risk but important to consider nonetheless. Getting clear on the health risks from taking MHT and from not taking MHT in the context of your particular circumstances can help make a decision easier.

There are so many other things we could cover on this topic, but I think you’ve got the gist of it.

Ultimately, what I’d love for you to understand is this: there are few things in life that offer benefit without at least some level of risk. Learning how risk can be used to manipulate your feelings and decisions is an important life skill not just for thinking about menopause hormone therapy, but for interpreting headlines and (mis)information shared and re-shared on social media.

Alright, there is just one final post in this series on menopause hormone therapy. You can read it here:

xo, Rebecca

P.S. Niche, but funny.

Subscribe now