Many of us going through menopause at the moment were the latchkey kids of Generation X, who came of age without a whole lot of supervision and (though it certainly wasn’t all bad!), more than our share of angst, body image issues, eating disorders, and cultural BS about how women were supposed to look and behave. It wasn’t always easy, but it also taught us how to fend for ourselves, be resilient, and forge our own way–qualities that are very helpful as we navigate the menopause transition and beyond. This week’s guest, Jody Trostler, owner of Just Train, has been through all of it and is committed to helping women get fit and strong, find their power, advocate for themselves, and be the best version of themselves right now. She also walks her talk, competing in her first CrossFit event at age 48, and is still hitting PRs in the weight room at 55.

Jody Trostler, owner of Just Train Personal Training, is a Certified Personal Trainer and Group Fitness Instructor, Certified Online Coach and Master Health Coach and has completed Stacy Sims Menopause For Athletes course. Her practice features a 16-week Online Group program called Ignite the Fire! for women entering their perimenopause years and beyond. Her current personal fitness passion is Obstacle Course Racing and trail running with friends and her dog Charlie. You can learn more about her and her work at justtrain.net.

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Many of us grew up with implicit–and sometimes explicit–messages to be small, both in our physical selves and in our power. Now, as we hit midlife, we’re increasingly rejecting those BS limitations and seeing just how powerful we can be. That’s exactly what two-time Olympian Gabrielle Rose did in her mid-40s when she set her sights on the 2024 Olympic Trials, were she achieved personal bests in both the 100- (1:08.32) and 200-meter breaststroke (2:30.13), advancing to the semifinals as the oldest competitor on deck at age 46, exactly 20 years after her last Olympic Trials in 2004. We talk all about her history in the sport and how her training has evolved over the decades, as well as what led to her comeback and how it has completely lit a fire for her future.

Gabrielle Rose competed in the 1996 games for Brazil. In 2000, at the age of 22, she swam for Team USA at the Games in Sydney. She pursued her Olympic dreams through 2004, but unfortunately was struck by mononucleosis and missed a spot on the US team, leaving her swimming dreams on the table, until 20 years later. Rose is a mom of a 9-year-old daughter and coaches swimmers in California where she resides. She is the executive director of The Rose Foundation, which invests in athletic facilities and educational opportunities in her hometown of Memphis, Tennessee, particularly aimed at benefiting at-risk populations in the city. 

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Gynecological surgeries are extremely common. More 600,000 women get a hysterectomy each year in the US alone, and more than one-third of women will have had one by age 60. And often a woman is told that she’s “good to go” after a few weeks, when in reality, when it comes to her sport, she’s anything but, and she can struggle for months–or longer–because no one properly helped her rehab to return to powerlifting, doing double-unders, running 13 miles, or many of the activities we take for granted as part of regular life. That’s where this week’s guest, Dr. Jocelyn Wallace comes in. Using her professional as well as personal experience, Jocelyn devotes her practice to helping women rebuild strength after surgery and bridge the gap back to their active and athletic lives without prolapse, pain, or peeing themselves. We talk all about her work there as well as dealing with common pelvic health concerns, especially pain and incontinence.

Jocelyn Wallace, PT, DPT, CF-L2 is a pelvic health physical therapist who helps women get back to the things they love after gynecological surgeries, specializing in hysterectomy, myomectomy, and excision surgery recovery. She has firsthand experience navigating recovery as an athlete, having her first open myomectomy a few weeks after her first powerlifting meet. After seeing how little support is given to women after major abdominal surgery, she vowed to fill that gap. Since then, she has had 2 more abdominal surgeries, with 54 fibroids removed, and is a Level 2 CrossFit Trainer, combining the skillsets of physio + fitness to help women fully return to their active lives. You can learn more about her and her work at drjocelynwallace.com.

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The good news: we are finally talking about menopause! The not so good news: we still have a long way to go, especially in the realm of research, says this week’s guest Dr. Stephanie Faubion, who is on the tip of the spear leading the way forward as the Medical Director of The North American Menopause Society (NAMS). When it comes to dealing with menopause openly in our culture, especially in the workplace, Dr. Faubion believes we are where we were with pregnancy 30 years ago. And she has some ideas on how we can all help accelerate progress and bring our doctors and culture up to speed. 

Along with her role as Medical Director of NAMS, Dr. Faubion is Professor and Chair of the Department of Medicine at Mayo Clinic in Jacksonville, Florida, and Director of the Mayo Clinic Center for Women’s Health. Her expertise is in women’s health, clinical research, education, and clinical practice. You can learn more about her and her work at mayo.edu.

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We are celebrating our 100th episode…and the fact that we have surpassed one million downloads in just two years’ time! Our community is growing by leaps and bounds and you’re the reason why. So this week, we are also celebrating YOU! 

Host Selene Yeager sits down with Hit Play Not Pause producer Carrie Barrett to share listener messages, talk about what we’ve learned, our hopes for the future, and to give you a little peek behind the curtain on how this show comes together week after week. We hope you enjoy it! Let’s shoot for another 100 and millions more!

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Bloating, hot flashes, night sweats, disrupted sleep, irritability, restlessness, brain fog…this week’s guest Michelle Hay treats them all, as well as the stress that can exacerbate them, with acupuncture. This week’s show is all about this Traditional Chinese Medicine practice, how it works, what to expect, and the specific benefits for menopausal women.

Michelle P. Hay, is Co-Director of Acupuncture at Boston IVF in Waltham, MA.  She has been working in women’s health since 2006 and is committed to helping women improve their quality of life by using Traditional Chinese Medicine. Her previous career as a respiratory therapist allows her to take an integrated approach to healthcare understanding both Eastern and Western Medicine.  https://thehayclinic.com/

Sources: BMJ study on the benefits of acupuncture for menopausal symptoms here

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Most of us, even if we’re very active, are not moving our bodies the way nature designed them to move. We exercise plenty. We also sit plenty. We wear shoes that don’t help keep our feet strong or our posture properly aligned. That can set the stage for aches, pains, and injuries, especially during this time of life when our joints are more vulnerable. This week we talk with movement coach Petra Fisher about the small daily adjustments we can make and exercises we can do to enhance mobility, decrease pain, and improve performance.

Petra is a movement coach, body nerd and recovering lawyer. She is certified in Restorative Exercise, MovNat and Functional Range Conditioning. Petra’s mission in life is to help women reconnect with their bodies so they have less pain, more joy & get to do more of what they love for the rest of their lives. You can learn more about her and her work at www.PetraFisherMovement.com

Resources from this podcast: 

Free Your Feet - free foot program to get started restoring healthy foot function - here

Step-by-step guide on how to transition safely and well to barefoot-style footwear - here

Joints For Life 2.0 - foundational CARs joint mobility program - here 



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Heavy lifting, HIIT training, and explosive exercises like plyometrics do a menopausal body good. So, CrossFit can be the perfect workout for women in this stage of life…provided they scale it to their needs. That’s because CrossFit also has elements that may not work with our physiology and can leave us feeling tired and beat down instead of strong and built up. That’s why this week’s guest, CrossFit coach Shawna Norton of Competitive Female Training created “Level M” CrossFit programming for women peri and post-menopause. We talk all about the benefits of CrossFit, how to scale workouts to work with your physiology, and how to fuel it all for the best results. 

Shawna is an L1 Certified Nutrition Coach through Precision Nutrition, with a B.S in Kinesiology. She holds her L1 with Crossfit and actively coaches athletes through her women’s only coaching program–Competitive Female Training. She loves helping women fuel their training and focus on what their bodies can do! You can find more about her and her work at competitivefemaletraining.com/level-m/

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What would happen if you tossed out all your premenopausal notions about how you are “supposed to” eat and train for your best performance and tried some new tricks to work with your changing physiology? If you’re like this week’s guest, you might just win a gold medal. Ashling Smith is a runner from Ireland who recently won a gold medal at the World Masters Athletics Championships in the 4 x 400 relay. She also ran to a career-high 4th place in the 1,500-meter race at the same event. She did both shortly after turning 50, recovering from Covid, and as she puts it being “smack bang in perimenopause”. How did she do it? Lifting, sprint training, plyometrics, and changing her relationship with food. We dive into all of that, her newfound love for being a menopausal woman, and more this week.

Along with being a competitive elite runner, Ashling is a personal trainer, a Pilates instructor, and a deep tissue massage therapist. She helps women pursue sustainable fitness for life and have fun with their body at every age. You can follow her here. You can read all about her gold medal run at the Independent.ie. The research on iron supplementation we discuss can be found here. 

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How do you know if menopausal hormone therapy (MHT) is for you? What should you expect if you start hormone therapy? How long does it take to work? What should you do if you don’t feel like it’s working? We dive into the ABCs of starting MHT this week with menopause doctor Heather Hirsch, MD. This is a good one for active menopausal women whether or not you are taking or plan to start MHT because we speak to all the things we should be doing, such as taking inventory of how we’re feeling and being proactive about our care, to feel and perform our best. 

Dr. Hirsch is board certified in internal medicine and completed advanced fellowship training in women’s health at the Cleveland Clinic. She performs menopause consultations at the Brigham and Women’s Hospital in Boston Massachusetts and is faculty at Harvard Medical School. Her practice has a focus on perimenopause and menopause symptom reduction, hormone therapy, genitourinary syndrome of menopause, sexual health, breast, and bone health. Her academic work centers on enhancing midlife women’s health education for fellows, residents, and medical students. Dr. Hirsch also teaches at the local, regional, and national level on various midlife topics. You can learn more about her and her work at www.heatherhirschmd.com/

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The only thing women tend to do better than men after having a heart attack is die. That’s a sobering mic drop. It’s also a fact and one that this week’s guest Dr. Martha Gulati is making her life’s work to change. We dive into the special heart disease risk factors women, especially menopausal women face, even if they’re active and fit, what you need to know about your cardiovascular health, and how to prioritize your heart health and cardiovascular care. 

Dr. Gulati is the President of the American Society for Preventive Cardiology and the author of the best-seller, “Saving Women’s Hearts”. She is the principal investigator of the St. James Women Take Heart Project, a study examining cardiac risk factors in women, which set standards for women’s fitness levels and heart rate response to exercise in women. She also is a co-investigator on the Women Ischemic Syndrome Evaluation (WISE) and previously served as a co-investigator on the Women’s Health Initiative (WHI). She has published articles in peer-reviewed publications, including The New England Journal of Medicine, Circulation, and Journal of the American Medical Association (JAMA).  She has also been featured on Oprah. Her practice is exclusively women, including many active women and she is a runner herself. You can learn more about her and her work at https://drmarthagulati.com/ You can find the MHT and cardiovascular research referenced in the intro here. 

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From femtech apps to menopause telehealth, tracking rings to cooling bracelets, and even cryotech surgical services designed to prolong ovarian function, menopause is having a moment in innovation and enterprise. This week we dig into it with Alyssa Dweck, MD, FACOG, who is an avid runner as well as a consultant, key opinion leader (KOL), and medical advisor in the women’s health device, pharmaceutical, product, and medico-legal industry. 

Dr. Dweck is a practicing gynecologist in New York where she provides care to women of all ages and has special interest and expertise in female sexual health and medical sex therapy. She is also an Adjunct Assistant Professor of Obstetrics & Gynecology at New York Medical College, the co-author of three books, including the newest release The Complete A to Z for Your V, ​​and is the founding chief medical officer at Bonafide. You can learn more about her and her work at https://drdweck.com/

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One in eight women will have their ovaries removed before the natural age of menopause. Five percent of women naturally go through early menopause between the ages of 40 and 45, and 1 percent experience premature menopause before age 40. That’s a lot of women. And a large percentage of these women are not getting the counseling they need to optimize their well-being and long-term health, says menopause management specialist Corinne Menn, MD. This week she’s here to help as we dive into the unique challenges of surgical and early menopause and what women need to know.

Dr. Menn is a board certified OB/GYN with expertise and a special interest in menopause management and female cancer survivorship health. She is a 20-year survivor of breast cancer and has a passion for using her medical expertise and personal experience to help women navigate these complex health issues. She is an active contributor and volunteer with the Young Survival Coalition, serves on their Council of Advisors, and moderates the Healthcare Provider-Survivor Support Group. Dr. Menn is also an active member of the North American Menopause Society and a Certified Menopause Practitioner. She devotes her professional time to her female-focused telehealth practice and is working on a website and blog chronicling her experience as a doctor and survivor of breast cancer, premature menopause, and everything in between! You can learn more about her at https://linktr.ee/drmennobgyn

Resources:

Instant Help for Induced Menopause

NAMS 2022 HT Position Statement 

NAMS Patient Handout “Deciding about HT

POI: Beyond the Basics

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Supplements get a bad rap. And to be fair, there is a lot of trash out there. But there are some treasures, too, especially for midlife and menopausal women who often can use some extra help building bone, recovering from injuries, and hitting it hard during training and events. This week we break down the best ergogenic aids for active women in and beyond the menopause transition with Kristen Arnold of Sports Nutrition for Women. 

Kristen Arnold MS, RDN, CSSD is a board-certified sports dietitian, cycling coach, retired professional athlete, and team sport director for USA Cycling and professional cycling teams. Her private practice is centered around empowering women through evidence-based sports nutrition coaching and information, and she has done research on improving postmenopausal women's health through nutrition strategies and counseling. You can learn more about her and her work at sportsnutritionforwomen.com.

Resources

The JUMPFOOD study: additional effect of hydrolyzed collagen and vitamin C to exercise treatment for patellar tendinopathy (jumper’s knee) in athletes—study protocol for a double-blind randomized controlled trial here

Specific Collagen Peptides Improve Bone Mineral Density and Bone Markers in Postmenopausal Women—A Randomized Controlled Study here

How collagen could help heal your torn rotator cuff, Achilles tendon, meniscus and more here

The effects of collagen peptide supplementation on body composition, collagen synthesis, and recovery from joint injury and exercise: a systematic review here

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Women have traditionally been ignored in sleep medicine (shocking, we know). That means our sleep issues can be misunderstood and misdiagnosed, especially during menopause when sleep disruptions rise. This week we investigate how hormones and menopausal symptoms impact sleep, as well as dive into sleep issues like sleep apnea (which shows up differently in women), restless leg syndrome, hypervigilance, and more with Dr. Andrea Matsumura, a holistic sleep medicine physician and a partner at the Oregon Clinic in Pulmonary, Critical Care, and Sleep Medicine.

Dr. Matsumura’s personal passion is helping women and women athletes understand their sleep and its key role in personal health, wellness, and performance. She has been the guest speaker for The American Academy of Sleep Medicine, numerous podcasts, and has been quoted in myriad articles about sleep and wellness. You can learn more about her work at https://www.oregonclinic.com/our-team/andrea-matsumura

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Hit Play Not Pause is on a quick summer break during the weeks of July 18th and 25th, 2022. While we're out, we are excited to share two episodes from Feisty Media's excellent limited Title IX series.

Not to pick favorites, but here at Feisty - this is definitely a favorite. With almost 50 years of experience as an athletic director and inductions into seven different halls of fame, Joan Cronan has A LOT to say about Title IX and gender equity in sport. Graduating college in 1966, Joan was part of intercollegiate sports before women had the federal right to equally compete. This week, our co-host of Girls Gone Gravel, Kathryn Taylor, interviews Joan and asks her about what she calls "her journey."

Joan shares the story of her life so far, beginning at the age of twelve when she decided she was going to create change for women in athletics. To do so, in 1972 Joan made a cold call to the president of the College of Charleston and left his office as the women's basketball coach, volleyball coach, tennis coach and overall athletic director. From there, she made innumerable changes to women's athletics that will forever go down in history. If that isn't feisty, what is?

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Hit Play Not Pause is on a quick summer break during the weeks of July 18th and 25th, 2022. While we're out, we are excited to share two episodes from Feisty Media's excellent limited Title IX series.

This week, Haley Chura - co-host of Ironwomen - interviews the renowned Wendy Mink. Wendy is a professor of politics, women's and gender studies, as well as the daughter of the very first woman of color in congress - Patsy Mink. Patsy was the co-author of the Title IX legislation and paved the way for women's participation in sports. 

Wendy shares her mother's journey and the reasons that prompted her to fight for change. Haley and Wendy discuss what Title IX was created for, and they give us the groundwork for the rest of the series.

Click here to purchase a copy of Wendy's new book!

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If you’re feeling more injury prone, you’re not alone. Many women who have led active, athletic lives without a lot of injuries and “itises” suddenly find themselves sidelined more often during the menopause transition. Fluctuating and declining hormone levels directly impact your musculoskeletal system, as do your lifelong movement patterns, exercise habits, recovery practices, and nutrition–all of which become increasingly important during this time of life. This week’s guest, sports medicine physician and endocrinologist Kathryn Ackerman, MD, MPH, dives into what we know, what we’ve yet to learn, and what we should be doing right now to dial it all in to stay strong through menopause and beyond.

Kathryn is the medical director of the Female Athlete Program in the Sports Medicine Division at Boston Children's Hospital. Her interests include female athletes, rowing injuries, endocrinology, relative energy deficiency in sport (RED-S), optimizing performance and health in athletes with diabetes, exercise-associated hyponatremia, and exercise and bone health. She is also a former national team lightweight rower, chair of the US Rowing Medical Commission, member of the World Rowing Medical Commission, and the course director for the Female Athlete Conference, held biennially at Boston Children's Hospital. You can learn more about her here and the paper she references on the Effect of Estrogen on Musculoskeletal Performance and Injury Risk by Keith Barr here. 

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Women often stop going to the high mountains when they reach menopause. The reasons why–hot flashes, unpredictable periods, anxiety, and fear, to name a few–will resonate with all of us, whether or not we ever step foot above sea level. This week’s guest, high altitude mountaineer Jeannette McGill is currently navigating the menopause transition herself and is determined to help women manage their menopausal symptoms and continue their journey of exploration in the outdoors and beyond. 

Jeannette is the first South African woman to summit Manaslu and the first-ever South African to climb Dhaulagiri - two of the 14 8,000-meter (26,000 feet) mountains in the world. She is passionate about supporting others to achieve their outdoor goals through her mountain mentoring and leads bespoke adventures in the Australian Alps and Nepal. Her portfolio career also includes industrial technology management, and she has a PhD from the Colorado School of Mines. You can learn more about her and her work as a mentor and guide at https://www.mcgillsmountains.com/

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The menopause transition can throw a lot of obstacles in your path. Training for and participating in obstacle course races can help you overcome them both physically and mentally, as you lift heavy loads, strengthen your grip, and hone your mental toughness and problem-solving skills. Plus, it’s super fun, says this week’s guest, obstacle course race enthusiast Laura McElduff, 52, who credits obstacle course racing with helping her get through perimenopause. 

Since completing her first obstacle course race in 2012 at age 42, Laura has competed at every distance from 3K to 50K ultras, raced in Canada and UAE and throughout the USA, placed top 10 in the F50-54 age group in the 2021 Spartan North American Championship and in the 2021 Spartan World Championship in Abu Dhabi, UAE. She is the mom of a young adult daughter and son and is vice president of a fragrance company in New Jersey. You can follow her OCR adventures on Instagram. 

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As active women, we train our strength and our endurance. But we don’t clean that barbell, we don’t cross that finish line, we literally don’t accomplish anything in life without first having the mental ability that comes from our brain. And as we age, our brains become vulnerable to decline. They physically change during the menopause transition, as our hormones fluctuate and taper off. But there is no point in time that we can’t take concrete action to build a stronger, better functioning brain, which is where this week’s guest, neurophysiologist Louisa Nicola comes in. We talk all about brain health, brain training, and how to maintain your mental acuity for life.

Louisa is the founder, head performance advisor, and CEO of Neuro Athletics, a company designed to optimize mental performance and to help educate, train and unlock human performance through science and data. She consults with some of the biggest names in the NBA and MLB and sits on the scientific advisory board for Tonal. Louisa was a world championship triathlete and raced both nationally and internationally for Australia and competed at London, Beijing and Auckland. After retiring in 2012 Louisa followed her dreams and went to Sydney Medical school for neurophysiology. You can learn more about her and follow her work via Instagram, her Neuro Athletics Newsletter, and her The Neuro Experience Podcast. Check out the research on adult neurogenesis here. And the ketone research here. 

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As women are living longer, pursuing higher education, and chasing athletic goals well into midlife, the decision if, when, or even how to have a baby has become increasingly complex, because the old formula of graduate, get married, have kids just doesn’t work the way it used to. So this week’s guest, Liz Carlson, created her own formula and after her decades-long pursuit of professional and athletic excellence, had her first baby at 43 and her second last year at age 52.

Liz is a former elite bike racer who was setting records and pushing U.S. women’s track cycling to the next level at an age when most track cyclists have long retired or hit the master’s circuit. She made the first-round cuts for the 2008 Olympic team in her late 30s, made the U.S. team again at age 41 and pursued a spot for the women’s team sprint at the 2012 Olympics. The Olympic dream wouldn’t come to fruition, but she broke records and discovered hidden talents and learned life lessons that stick with her to this day. You can read about that journey here. We talk about how our upbringing and adult life trajectory was affected by Title IX and the women’s movement of the 70s and (of course) menopause and what it’s like to have a baby in your fifties!

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Breaking a sweat is generally a good thing–a sign of healthy exertion–unless you’re working out in temperatures more suited to penguins than people. In those conditions, it can quickly lead to hypothermia, frostbite…or worse. So how does a perimenopausal woman (hello, hot flashes) make a 1,130 kilometer trek across Antarctica while pulling a 175-pound sled? That’s exactly what this week’s guest George Gilbert, co-founder and team leader of the Antarctic Fire Angels, a team of 5 female firefighters who are on a mission to ski to the south pole to raise money for charity and to show women that they are limitless, is in the process of finding out. We talk all about how she handled her first hot flash, persistent low moods, erratic periods, and other perimenopausal issues, as well as her adventures in underwater hockey, mountaineering, firefighting, and more.

George has been a firefighter for over 22 years and currently serves with South Wales Fire and Rescue service. She is an ambassador for gender equality and has an ambition to see more women striving to do whatever job they want to do in life; always ensuring she is visible as a role model for girls, young women, and women who are experiencing peri menopause and menopause who may be considering a career that doesn’t fit society’s gender stereotypes. You can learn more about her and follow and support the Antarctic Fire Angels mission at https://antarcticfireangels.co.uk/ Follow them here on Instagram to see photos of their training, including cold plunges and more. 

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The menopause transition can leave a minefield of body image issues in its wake. Some research shows that as few as 12 percent of us are satisfied with our bodies at this time of life. That’s a problem, as poor body image is also linked to mental health issues like depression. We can’t wave a magic wand and make them go away, but we can equip ourselves with tools to make them a whole lot better. This week we build that toolbox with menopause fitness expert Maria Luque, PhD.

Maria is a fitness expert, health science professor, writer, and self-described menopause nerd with over 20 years of experience. She’s the creator of Fitness in Menopause, a company dedicated to helping women navigate the challenges and rewards of menopause. Her course “Menopausal Fitness: Training the Menopausal Client” is a NASM, AFAA, and ACE- accredited continuing education course for fitness professionals. She holds graduate and post-graduate degrees in health sciences and teaches at the College of Health and Human Services at TUI. You can learn more about Maria and her work at https://www.fitnessinmenopause.com/

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Menopause and age raise our cardiovascular disease risk. Athletes and highly active people also tend to have a higher prevalence of coronary artery calcium and atherosclerotic plaque (though it tends to be the benign kind). But what does that all mean? How can we know what’s really going on in those coronary arteries of ours? To find out, host Selene Yeager had a Cleerly-enabled coronary computed tomography angiography (CCTA), which uses AI-enabled software to help characterize coronary plaque composition and cardiovascular disease risk. This week, she sat down with Anita Vadria, MS, PA-C, who is the Director of Medical Science Liaisons and Clinical Education at Cleerly to go over her results, talk about plaque and heart disease risk, and how technology is helping advance our understanding of our personal risk.  

Anita Vadria, MS, PA-C, is the Director of Medical Science Liaisons and Clinical Education at Cleerly. She is a Board Certified Physician Assistant with a focus in Cardiology. She received her undergraduate degree in Molecular and Cell Biology and received her Masters in Physician Assistant Studies from Western University of Health Sciences in Los Angeles, CA.

Resources

Impact of atherosclerosis imaging-quantitative computed tomography on diagnostic certainty, downstream testing, coronary revascularization, and medical therapy: the CERTAIN study, here

Atherosclerosis Imaging Quantitative Computed Tomography (AI‐QCT) to guide referral to invasive coronary angiography in the randomized controlled CONSERVE trial, here

Coronary Artery Calcification Among Endurance Athletes “Hearts of Stone”, here

Physical Activity and Progression of Coronary Artery Calcification in Men and Women, here

Most heart attack patients' cholesterol levels did not indicate cardiac risk, here 

Lipid levels in patients hospitalized with coronary artery disease: an analysis of 136,905 hospitalizations in Get With The Guidelines, here

2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults

A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, here

Heart attacks with no obvious risk factors on the rise, here

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Hot flashes. Sleepless nights. Mood swings. Divorce. The challenges of menopause and midlife came raining down on this week’s guest, Karen Duff, just a few years after she’d taken up mountain biking and was ascending the ranks quickly with her sights set on world-class competitions. She shares how she persevered through training, racing, and community and ended up getting 2nd place in the women’s division at Israel Epic mountain bike stage race the year she turned 50, and 2nd in her age group at the British Columbia Bike Race at 52.

In addition to her racing, Karen is a personal training specialist, a certified mountain bike and skills and tactics instructor, and a brand ambassador for Specialized, Skratch Labs, and 9Point8. Karen is passionate about helping women thrive during the changes associated with menopause. Her workout programs include HIIT, weights, and core, along with guidance and support to help her clients maintain sanity and strength and reach the summit of the menopausal mountain while enjoying the ride. You can learn more about Karen and her work at her training business’ website: www.Fit4Adventure.ca 

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Your pelvis changes during menopause–inside and out. The vaginal and vulvar tissues become thinner; the pH and microbiome in your vagina can shift; and the scaffolding that supports your pelvic organs can weaken, increasing your risk for pelvic organ prolapse. There’s help for all of that, so you can continue running, riding, lifting, having sex, and enjoying an active life free from pain, infection, and injury. We talk about all that and more this week with urogynecologist Kathleen Connell, MD.

Kathleen is chief of Urogynecology and Reconstructive Pelvic Surgery in the Department of Obstetrics and Gynecology at the University of Colorado School of Medicine. She is the co-director of Women’s Pelvic Health and Surgery, a multidisciplinary practice at the Anschutz Medical Campus. Her surgical practice focuses on pelvic floor disorders including pelvic organ prolapse, urinary and fecal incontinence, and reconstructive pelvic surgery. She has done research on genital health and bicycling and genital health and saddle selection. You can learn more about her and her work at CU School of Medicine.

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Menopause is not the end of the line. It is not a “deficiency.” It’s a transition to the next phase of your life–a phase that can be positive, empowering, and powerful. But first, we need to understand what menopause really is; what is happening hormonally during this time, and how it is affecting literally every cell in our bodies. That’s where Dr. Stacy Sims and her upcoming book Next Level: Your Guide to Kicking Ass, Feeling Great, and Crushing Goals through Menopause and Beyond comes in. Next Level shines a light on every aspect of menopause and helps performance-minded women work with their changing physiology to optimize performance. We talk about Stacy’s goals for this book to create an active, positive menopause movement and how we can all foster an empowering culture so menopausal women can keep stepping up to starting lines, trying new things, and thriving in their lives.

Stacy T Sims, Ph.D., is an international exercise physiologist and nutrition scientist who aims to revolutionize exercise nutrition and performance for women. She has directed research programs at Stanford, AUT University, and the University of Waikato, focusing on female athlete health and performance. Her first book, ROAR, challenged the existing dogma for women in exercise, nutrition, and health. This paradigm shift is the focus of her famous "Women Are Not Small Men” TEDx talk. She is the creator of the popular Menopause for Athletes course and author of Next Level. You can learn more about the book and pre-order a copy at www.feistymenopause.com/nextlevelbonus

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Your muscles and connective tissues can get “stickier” and feel stiffer during the menopause transition, and you can find yourself with more aches and pains and niggles than you had before. Massage therapy can help with that. But the benefits don’t end with your muscles. Massage is also good for the menopausal mind. It activates your parasympathetic nervous system to lower cortisol and anxiety. It also can provide a safe space for you to release past trauma, reconnect your physical and emotional self, and let your body rest in a totally safe environment. We talk all that and more this week with massage therapist Rosemarie Rotenberger. 

Rosemarie is a Licensed Massage Therapist for 22 years. Her Olympic and World Champion clients span several continents and have competed in every summer Olympics since 2004. She has crewed for the Race Across America (RAAM) record holding team twice. Her work engages both the physical and emotional challenges of higher level sport. She has taught in both entry level and advanced orthopedic massage programs and served on national advisory boards. 

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We know lifting heavy, doing plyometrics, and adding intensity to our routines help us stay strong and powerful as our bodies change during the menopause transition. But where do we start? What if we can’t jump? How do we lift heavy if we don’t have heavy weights? Longtime trainer and now one of the leaders of the Menopause for Athletes Alumni group, Kerry Ann Madden digs into the nuts and bolts of getting started, whether you’re self-coaching or working with clients. 

Kerry Ann is the creator and owner of KAM Fitness and Nutrition. She is a weight-inclusive NASM Master Trainer, a Precision Nutrition Certified Coach, a Corrective Exercise Specialist, and a MedFit Network Member. She has completed Dr. Stacy Sims Menopause for Athletes course and puts her expertise to use with her clients who are in the menopause transition. You can learn more about Kerry Ann and her work at kamfitnessandnutrition.com/

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In the year and a half since we started this podcast, many women have gone from being afraid to take hormone therapy to being afraid not to take hormone therapy, as some in the menopause field are saying that menopause is really a “hormone deficiency” and we can’t age well without it. This week we dive in on what hormone therapy is; what it can do (especially for performance and health); what it can’t do, and what we’re still learning about all of it with Dr. Carla DiGirolamo.

Carla is a Double Board Certified Reproductive Endocrinologist and Obstetrician/Gynecologist specializing in infertility and menopausal medicine. She is also a Crossfit Level 1 trainer, Certified Nutrition Coach, and member of CrossFit Health. She runs an online personal training and nutrition coaching business, FitforLifeMD, specializing in the care of women in all age groups, but with a special interest in the comprehensive care of peri/postmenopausal women. She also writes a regular blog on Athletic Aging. Carla has the distinction of being the only repeat (and now threepeat!) guest on Hit Play Not Pause.

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Kirsten Lewis, at the age of 57, just ran her fastest 5K time–post-menopause, less than two years after she was ready to hang up her racing shoes and walk away from it all while in the throes of the menopause transition. She credits feeling stronger, happier, more grounded, and winning her age group in recent sprint and Olympic distance triathlons to the process of “rewilding menopause”: going back to the roots of what it means to be a woman in menopause; going back to her own roots; and stepping into her power. Now she wants to share her “shero's journey” with others who are feeling like menopause is the end of the line for their athletic lives.

Kirsten is a former Wall Street executive, a triathlete, and triathlon coach. She has a degree in photojournalism and is now using her words and images to tell her story of how rewilding has guided her to thrive. She is making it her mission to help women in midlife and beyond step into their personal power and create their new possible. You can learn more about her and her work at https://kl.life/ and on Instagram.

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If you’re a woman, someone somewhere has a diet to sell you. If you’re a menopausal woman, that diet is likely to paint carbs as the root of all your woes–and the elimination or restriction of them as your midlife salvation. This week we sat down with dietitian and “undiet” advocate Jenn Salib Huber, RD, ND, to dive into the ketogenic diet, intermittent fasting, food phobia, and how diets can have unintended negative health consequences and fuel our food obsession rather than set us free.

Jenn is a Canadian registered dietitian, naturopathic doctor, and Intuitive Eating coach. She helps women navigate the physical and emotional changes that happen in perimenopause and menopause, including their search for food freedom and body confidence. She’s also the host of 'The Midlife Feast' podcast and runs a group support program called Beyond The Scale, which helps women "undiet" their lives after 40 so they can nourish a relationship with food that helps them discover the magic of midlife. You can find her at JennSalibHuber.ca  

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Whether you’re training for a tri, into CrossFit, or just want to be strong for life, barbells are the most effective way to get full-body strong in very little time. Barbell lifting also builds bone and muscle, improves stability and mobility, and makes you feel like a complete badass. This week we talk all about why barbells are the best training medicine and how to get started with coach and competitive strength and rowing athlete, Cassi Niemann.

Cassi is a Barbell Medicine Coach and the lead UCanRow2 Master Rowing Instructor with Concept2. She has certifications as a Precision Nutrition Level 1 coach and as a Pregnancy & Postpartum Athleticism Coach. She trains clients online around the world and in-person at Iron Soul Gym in Albuquerque, New Mexico. She is also the co-host of More Female Strength Podcast. You can learn more about her at www.cassiniemann.com

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Need glasses for the first time in your life? Contacts suddenly feel too tight? Are your eyes dry and itchy? Menopause and midlife can usher in a cascade of vision and eye health changes. Thankfully there are many ways you can sharpen your sight and keep your eyes healthy (and more comfortable!). We dig into all that and more with this week’s guest, Christine Begley, OD.

Christine is an optometrist with Marion Eye Center in Carbondale, Illinois. She’s been treating eyes for more than 20 years and specializes in diagnosing, treating, and managing diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identifying related systemic conditions affecting the eye. She’s also a longtime listener of the show and wants to help us keep our eyes healthy and functioning well so we can keep enjoying our active pursuits. 

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This week we bring you a special live show from UNBOUND Gravel in Emporia, KS, where we sat down with two legends in the sport of gravel cycling, UNBOUND Gravel co-founder Kristi Mohn and seven time world champion Rebecca Rusch to have an open, honest conversation about midlife and menopause, how we view things today, and what we want for the future. Spoiler alert: We’re not hanging it up anytime soon. 

Kristi Mohn is one of the founders of UNBOUND Gravel and is an integral member of the Life Time offroad team. She is also a Gravel Cycling Hall of Fame inductee, and is the cohost, along with Kathryn Taylor, of the Girls Gone Gravel podcast. 

Rebecca Rusch is an adventure athlete, seven time World Champion, two time Hall of Fame inductee, keynote speaker, best-selling author of Rusch to Glory, founder of Rebecca’s Private Idaho, and an Emmy award winner for the film Blood Road.

Enter to win a Liv Devote - Be Good™ Edition gravel bike and an entry to Rebecca’s Private Idaho gravel event this summer! Head on over to feistygiveaway.com by June 16 for your chance to win. (You must be based in the U.S. to win.)

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Dim the lights. Pour a drink. Light some candles. And get ready to…row! Yep, row. Indoor rowing can be an exercise in meditation, says this week’s guest and rowing aficionado, Sarah Fuhrmann. It also uses 86 percent of your muscles and can be an ass-kicking workout when you want it to be. This week we dive into the benefits of rowing, especially for women in the menopausal transition who need to HIIT it and chill out equally hard.

Sarah is CEO of UCanRow2, which provides rowing workouts, training programs, and certification to exercisers and fitness professionals worldwide. The author of the bestselling 101 Best Rowing Workouts, she is passionate about creating a world of inclusive fitness where all bodies and all ages are welcome, and every meter matters. In addition to being a certified rowing instructor, she holds certifications with the Functional Aging Institute and Precision Nutrition. When not rowing on a machine or on the water, you're likely to find her playing in the snow - or just shoveling it - from her home in Michigan's snowy and scenic Upper Peninsula. You can find a sample of her workouts at "10 Ways to Kill 10k" 

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Even if you brush, floss, and get regular dental check-ups, if you’re like many athletes—especially those in the menopause transition—you may still struggle with tooth decay and oral health woes. That’s because both athletics and hormone decline can lead to conditions that set the stage for dental disease and mouth discomfort, both of which can put a damper on your performance (and your pocketbook). This week, we help save your smile with dental health expert and avid triathlete Dr. Julie Gallagher.

Julie Gallagher, Ph.D., is an honorary research fellow at University College London, based at the Eastman Dental Institute Centre for Oral Health and Performance. Julie worked in clinical dental practice for more than 30 years before pursuing her interest in epidemiology and sport and embarking on a Ph.D. in 2014. Her Ph.D. project investigated oral health and its impact on performance of elite athletes. She was awarded her PhD in March 2020. She is looking forward to participating at Ironman Italy in September 2022 following its postponement from 2020. You can read more about her work and sports dentistry in the November 2021 British Dental Journal.

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Anyone who’s ever hit the wall at mile 19 of a marathon or fizzled out on a Fran at CrossFit, knows how important glucose (aka sugar) is for energy–both mentally and physically. As women in the menopause transition, we also know that managing generally healthy blood sugar levels can be more challenging as we can become more carbohydrate sensitive and insulin resistant as our hormones decline. This week, we dive into how to eat your carbs and manage your blood sugar, too with Molly Downey, RDN, LDN. 

Molly is a Registered Dietitian Nutritionist (RDN), Licensed Dietitian/Nutritionist (LDN) who specializes in glucose control, metabolism and weight loss. She graduated from Indiana University-Bloomington and currently works as a nutrition manager at Nutrisense, a health technology company which leverages continuous glucose monitors (CGMs) as a way to optimize diet, health and overall wellbeing.

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We all want to belong. That desire can increase during the menopause transition, when having a community to share experiences with helps us feel less alone. But making those connections isn’t always easy, especially when culture doesn’t include you. This week’s guest, long time athlete Elizabeth Allen, who identifies as a Black, plus-sized GenXer (who is also now firmly in the menopause transition) knows all about that.

Elizabeth was recently honored as a “Change Maker in Cycling” by Stamina Racing Collective for helping change the cycling and larger outdoor industry to be more inclusive and welcoming to People of Color. We dive into that, as well as how women of different races experience menopause. Along with being the Associate Director of Organizational Development, Training, and Culture for the Valley Youth House for vulnerable, abused, and homeless youth, Elizabeth is a social media content creator specializing in outdoor activities and social media takeovers for gravel cycling events. She shares her outdoor adventures at Turtle Wandering on YouTube and Instagram. 

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For far too long, many of us have defined ourselves (or worse our self worth) by the size of our thighs and the circumference of our waistline, setting ourselves up for a lifelong battle with our bodies and an underlying discontent with who we are based upon a largely unattainable “ideal.” That can get worse during the menopause transition when our body shape starts to shift. This week’s guest, Kaisa Keranen, AKA KaisaFit, is on a mission to change that. As she says: “What I look like does not define who I am as a woman and what I’m doing in this world.” Amen to that and all the wisdom she dishes out this week.

Kaisa is a longtime athlete and has a Masters in Exercise Science, Sports Performance and Injury Prevention. She is the owner of KaisaFit, and ​​has built a community of over 1 million people on Instagram. She has been featured in digital magazines including Vogue, Shape, SELF, Harper's Bazaar, Oxygen, and ESPNW. Kaisa was named by Greatist as one of the most influential people in health and fitness in 2015, the same year she was asked by Michelle Obama to be one of the go-to trainers for her “Let’s Move” digital campaign. You can find Kaisa on social media as KaisaFit where she educates, motivates, and empowers people to #JustMove.

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Sometimes life sidelines us, knocking us off the path we thought we’d be on forever, or at least for the foreseeable future. Menopause can certainly trip us up. But so can many other random, sometimes terrible, events we never saw coming. And sometimes we end up contending with all of it. This week’s guest, Jennifer Maxwell, knows all about that and talks about how she has maintained her athleticism, passion, and profession while raising six kids after losing her husband unexpectedly. 

Jennifer is a nutritionist, food scientist, and the co-founder of the original energy bar, PowerBar along with her late husband Brian. She is currently the CEO and founder of JAM Foods, the maker of JAMBAR energy bars. She is also a competitive runner, the mother of six children, and an accomplished drummer who performs in two San Francisco Bay Area bands. You can learn more about her and her work with JAM Foods at jambar.com. 

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What do you do when menopause turns you into a nearly unrecognizable version of yourself? If you’re Gina Ransom, you pore through every resource you can find, advocate for yourself and others in the same situation, and form a community so you all can keep on kicking ass. 

Gina is a lifelong fitness professional who was blindsided by depression, anxiety, anger, as well as a host of physical symptoms despite “doing everything right.” Eventually she managed to find help, and maybe most importantly she formed a community: The Menoparkers, which is a private Facebook group for menopausal women who do Street Parking—a home strength workout program for people with limited time, space, or equipment. Gina is also a mom of four and a grandmother to one. And she plans to keep on kicking ass for a long time to come. You can learn all about Street Parking at streetparking.com and more about Gina at her member profile here. 

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It’s easy to look at the barriers we face and think, “I can’t.” Leah Goldstein is here this week to show you, you can. Leah won the Race Across America (RAAM) outright last year at age 52, beating the next closest man by 17 hours. But that barely scratches the surface of her myriad accomplishments and the indomitable spirit that we dive into on the show this week.

Leah was the World Kickboxing Champion by age 17. Shortly thereafter, she enlisted in the Israeli Military and became one of the few female instructors of the elite Commando division, specializing in Krav Maga. She later transitioned into Special Forces where she helped combat terrorism and violent crime. At age 30, she became a professional cyclist, and a few years later came back from one of the most horrific crashes in pro cycling history. Her memoir is aptly titled No Limits. You can get a copy and learn more about her remarkable life at leahgoldstein.com/

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Running is a coping mechanism for many trauma survivors. You lace up and put one foot in front of the other for solace and escape. But what happens when you hit menopause and the demons start to catch up? This week’s guest, coach and endurance athlete Athena Farias talks about all that and more this week as she unpacks how the symptoms she’s facing during the menopause transition are magnified by the trauma of her past.

Athena is an RRCA Level 2 Certified Running Coach, NASM Certified Personal Trainer, Corrective Exercise Specialist, Performance Enhancement Specialist, and a Masters in Exercise Science and Health Promotion. She’s an alumni of Dr. Stacy Sims’ Menopause for Athletes and Women Are Not Small Men courses. And she’s a badass athlete in her own right, completing 16 marathons, including 5 Boston qualifiers, 7 ultras, countless half marathons and numerous obstacle races, including many podium finishes. You can find her at MarathonTrainingAcademy.com.

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Menopause can be a wet blanket for competitive athletes. How do you keep showing up to start lines when you’re managing hot flashes, heat intolerance, poor sleep, and watching peers walk away from the sport? This week’s guest has some answers. A lifelong athlete and self proclaimed triathlon addict, Julie Dunkle, now in her mid 50s, has had to navigate a number of physical and emotional challenges related to menopause, but has found a way to maintain her love of the sport and keep her competitive fire burning hot. 

Julie is a 16x time Ironman finisher, with 7 Kona Qualifications and over 25 70.3 finishes. She is a USAT Triathlon coach, Newton Running Coach, USA Masters Swim Coach, and Training Peaks Level 2 coach. She is the Co-Founder of NYX Endurance, a Global Endurance Coaching Company that believes there is no progress without perseverance and no light without some darkness. You can follow NYX Endurance on Instagram and Facebook and check out their services at https://nyxendurance.com/

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As active menopausal women, we get outright bombarded with ads for nutritional supplements. But what do we really need? This week, we take it down to brass tacks and hit the basics with registered dietitian nutritionist Katie Linville. We break it down on what we should know about calcium, vitamin D, magnesium, iron, and the other vitamins and minerals we’re often told to take as a matter of course. While we’re at it, we also venture into cholesterol, blood sugar, and CGMs. You may be surprised to learn that there’s more to these metrics than what you eat.

Katie Linville is a registered dietitian with 11+ years of experience, who received both her bachelor’s and master’s degrees at Florida State University. Katie specializes in nutrition for women’s health, and has experience supporting women in menopause to optimize mental health and their relationship with food and their bodies. Additionally, she holds a specialty certification in oncology nutrition (CSO) and has experience working with cancer survivors through treatment and for prevention. In her spare time, Katie enjoys running, hiking, and spending time at the beach with her family. You can learn more about her and her work at 

www.gennev.com/providers/katie-linville

Resources:

https://www.webmd.com/diet/foods-high-iron-vegans

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Most of us–even the most active among us–are limited in how well we move. Sure we can run or ride a bike or lift heavy sh*t, but can we balance on a beam or jump over fallen logs? Can we move with strength and fluidity in every direction? Can we go over, under, and through obstacles with ease? Unless we practice, the answer is likely no. This week’s guest, Dr. Julie Angel, who has completed the world's first parkour themed Ph.D., is on a mission to change that. She focuses on helping midlife women break free from the negative cycle of extreme workouts, diets, anxiety, and injuries to find sustainable strength and balance in life. By making women 360 degrees strong, she helps them learn the art and methodology of overcoming obstacles–and not just the physical hurdle in front of you, but all the stuff that’s deep inside.

Julie is a movement coach, artist, award winning filmmaker and author. She uses movement snacks, strong resting, positive aging, and tools from parkour, natural movement, animal flow, original strength, the oxygen advantage, and many more methodologies to help people connect to and create a strong body and strong mind. You can learn more about her at https://julieangel.com/ and get a free sample of her movement courses at https://www.courses.see-do.com/course/movemore/

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