By Donna Chalifoux, M.Ed, B.Sc.H.Ec.
Healthy Workplace Consultant –Saskatchewan Health Authority (Saskatoon)
Have you ever had the experience of driving somewhere, and as you reach your destination it occurs to you that you don’t remember how you got there? The actual drive is a blank. You could have been teleported through space and you wouldn’t have known the difference!
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by Dr. Renee Morissette
How to Choose a Lubricant and Moisturizer
Vaginal dryness is a common menopausal concern. The medical term for this condition is Vulvovaginal Atrophy (VVA) or Genitourinary Syndrome of Menopause (GSM). The majority of postmenopausal women report symptoms that fit this condition, including: a sensation of vaginal dryness, pain with sex and vulvar irritation or itching. These symptoms can decrease the enjoyment of sex for women, but can also cause day to day discomfort and decreased quality of life.
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by Nikole Tattrie, RD
Part 2: The Older Years
Our previous article highlighted some unique nutritional needs for women in the menopause life stage. The menopause years often serve as the gateway to a new role, one which sandwiches women between being caregivers for their children/grandchildren and their parents, with demands being placed on them from both the older and younger generations. In this article we we will focus on the older generation. The older adult population can be equally as vulnerable as children - being dependent on others for buying groceries, meal preparation, and maintaining a clean and safe cooking environment.
Saying goodbye to our Office Manager Kathy Leite.
“Mindfulness is awareness that arises through paying attention, on purpose, in the present moment, non-judgementally” (Jon Kabat-Zinn). It means maintaining a moment-by-moment awareness of what’s going on within us and around us including thoughts, feelings, bodily sensations, and surrounding environment.
In practical terms, practicing mindfulness helps return the mind to the present moment. It can reduce our tendency to instantly categorize all experiences as good or bad, and instead encourages us to accept things as they actually are. Through practice, we can gradually learn to maintain and focus our attention, and accept our experience in a more open-minded and curious way. A mindful approach also helps us to turn off autopilot when we get stuck in habitual thinking and ruminating, and instead, to engage in what’s going on right now.
When we slow down and notice what is happening around us -by what we see, hear, feel, touch,and taste; we are able to engage in the actual moments that make up our lives. As we get more in touch with our moments, days, and weeks, we can begin to experience more joy from simple, everyday pleasures and experiences. This all helps to encourage a sense of calm, meaning and purpose, enhancing our ability to perform and succeed at work and home.
The workplace can play an essential part in maintaining positive mental health. We spend about 60 percent or more of our waking hours at work. You may be spending more time with the people you work with than your family and friends. What happens in the workplace ; the relationships you have, the encounters, how the work is organized, even the physical environment, can have a huge impact on our overall sense of health and wellbeing.
Implementing a mindfulness practice at work can be part of a larger strategy to address psychological health and safety in the work environment. It also has implications for productivity management and, in healthcare, improved care and service for clients, patients and families. Studies have shown that practicing mindfulness, even for just a few weeks, can bring a variety of lasting physical, psychological, and social benefits. Learning to be mindful at work has been shown to decrease stress levels, emotional exhaustion and multi-tasking while improving, physical and mental energy, work life balance, job performance and overall quality of life.
Incorporating a mindful practice can help to change the way we think about and manage our emotional and mental wellbeing. Mindfulness supports individuals to manage their attention and focus their minds with intention. This builds resilience, while increasing joy and peak performance in all areas of life. Why not give it a try? You have nothing to lose but stress!
“The little things? The little moments? They aren’t little.” - Jon Kabat-Zinn
References
Jon Kabat-Zinn. 2018. MBSR Training Online. [ONLINE] Available at: http://www.mbsrtraining.com/. (Accessed 24 July 2018).
Aikens, K. A., et al. (2014). Mindfulness goes to work: Impact of an online workplace intervention. Journal of Occupational and Environmental Medicine, 56(7), 721-731.
MindWell U. 2018. MindWell U Healthcare. [ONLINE] Available at: https://www.mindwellu.com/. (Accessed 24 July 2018).
In menopause, as estrogen levels fall, the vaginal walls become thin and inflamed. The vagina also shortens and has decreased blood flow and nerve endings. The vagina is less able to produce natural lubrication.
Over the counter products, such as lubricants and moisturizers, are the first things to try for relief. Unfortunately, not all products are created equally. The pH, osmolality and additives in a product matter, because the already sensitive vaginal tissue might be unintentionally irritated further if any of these characteristics are imbalanced.
Lubricants are typically applied just before sex. They act rapidly and provide short term relief. There are water, silicone, mineral oil or plant oil-based lubricants. Water based lubricants are commonly used because they are non-staining and less messy, but as mentioned, the pH and osmolality of the water-based lubricants need to be taken into consideration. Oil and silicone-based lubricants do not have a pH or osmolality value, because they contain no water, so any oil or silicone-based product can be used without worry. Additives are also sometimes added to lubricants to increase viscosity and prevent bacterial contamination, but these may also have unwanted effects.
Moisturizers are used to rehydrate the skin on a day-to-day basis. They provide a bit more long-lasting relief than lubricants. Moisturizers absorb into skin and adhere to the vaginal lining, mimicking natural vaginal secretions. Relief is achieved by increasing the fluid content of the skin and lowering the pH of the vagina. Most of these products contain water and additives as well.
In a healthy adult, the normal pH of the vagina is 3.8 to 4.5. Many lubricants and moisturizers have a pH that is much too acidic. The effects of this are not fully understood, but overall, a pH under 3 is considered unacceptable for human use.
Osmolality relates to how concentrated a product is. When the osmolality is high or too concentrated, too much water can be drawn out of the body, causing a drying and cell damaging effect. The World Health Organization recommends that the osmolality of a lubricant or a moisturizer not exceed 380 mOsm/kg. Unfortunately, most available preparations do not meet this strict criterion, so a generally accepted upper limit for osmolality is 1200 mOsm/kg. An osmolality that is too high can cause increased genital irritation, burning, heat or itching. If a woman is trying to get pregnant, she should be aware that high osmolality can cause sperm to be less motile and lose their DNA integrity. Additives can negatively affect a product’s pH or osmolality too. Some additives are also linked to cell damage, such as nonoxynol-9 and chlorhexidine. Glycols, like glycerine and propylene glycol, can kill healthy Lactobacillus bacteria, thus increasing the chance of unwanted vaginal infections, including HSV (herpes), yeast and bacterial vaginosis.
Products known to have an ideal pH and osmolality (<380 mOsm/kg) include: Yes Vaginal Moisturizer, Yes Baby Vaginal-Friendly Lubricant and Yes Water-Based Intimate Lubricant. Products with an ideal pH and acceptable osmolality (<1200 mOsm/kg) include: Sylk Natural Intimate Moisturizer and Astroglide Ultra Gentle Sensitive Skin Lubricant. Lastly, products with an ideal osmolality and borderline acceptable pH (very near 3.8 to 4.5) include: Balance Activ Menopause Vaginal Moisturizing Lubricant, Good Clean Love Lubricant and System Jo Personal Lubricant.
If lubricants and moisturizers do not seem sufficient to relieve the symptoms of vaginal dryness, consider speaking to your doctor about vaginal estrogen or vaginal DHEA.
Source: D. Edwards and N. Panay. Treating vulvovaginal atrophy/genitourinary syndrome of menopause: how important is vaginal lubricant and moisturizer composition? Climacteric, 2016. 19,2: 151–161.
Responsibility for this often falls to their adult children. When facing one’s own life stresses and needs while caring for aging parents, focusing on adequate nutrition can become less of a priority. The requirement for certain nutrients actually increases as one ages. However, overall food intake usually lessens over time. Therefore, attention to a few key nutrients can be important when helping aging parents shop for and prepare food.
1. Protein - With age comes a gradual loss of muscle mass and function, which can lessen the ability to perform activities of daily living such as eating, bathing, dressing, grooming, and leisure activities. Researchers have found that consuming adequate protein is a promising way to maintain muscle mass, in combination with physical activity. Meat, fish, and poultry are great sources, but not always easy to cook and chew for older adults. Other more manageable protein foods include nuts, legumes, eggs, cottage cheese, and Greek yogurt.
2. Fibre - helps maintain bowel regularity, which is important for all people but can be of particular concern for older adults. Small amounts of fibre throughout the day can add up. A general rule of thumb is to choose food items with a minimum 2-4 grams of fibre when shopping. High fibre cereals are an easy way to help meet fibre needs. Whole vegetables and fruit, legumes, nuts and seeds also provide good sources of fibre.
3. Fluid - maintains normal blood pressure, protects and cushions organs and joints, controls body temperature, and prevents urinary tract infections, among other roles. The thirst sensation can decrease with age; therefore, it is important to encourage older adults to drink regularly, even when not thirsty. Ensure drinks are available in the home. Purchase a water bottle and encourage filling and drinking from it every day. Offer sips of a beverage while out shopping, running errands, or simply spending time together.
4. Vitamin B12 - has a key role in brain and nervous system function, as well as in the formation of red blood cells. Good food sources of Vitamin B12 include meat, chicken, fish, and dairy products. However, up to 30% of adults over age 50 do not absorb Vitamin B12 well and therefore may require supplements. A simple blood test can be performed to check Vitamin B12 levels.
Weakened appetites and a loss of interest in food are common as one ages. Sometimes taste changes can also occur. At this stage, it may become more important to focus on improving intake of foods that are enjoyed rather than restricting foods that are high in salt, sugar, or fat, even when these foods have previously been restricted because of chronic diseases or conditions (diabetes, high blood pressure, high cholesterol, etc.). Long term care facilities call this a liberalized diet approach. It may be difficult to change you or your parents’ mindsets and disregard past food rules that were put in place, but it may help to improve energy and nutrient intake overall if you do. If you are unsure whether it is the right time to start thinking about this transition, talk to a health care provider such as a dietitian.
Lastly, consider other challenges older adults may be going through. Do their dentures fit well? Do they remember to check expiry dates and store food in a safe manner? Do they have enough food in their house that can easily be prepared? Keep in mind that older adults are often hesitant to bring up
issues or concerns and do not want to be a burden on their children. Though you may have a lot on your plate already, you can show your love by helping to keep their plate full, too.
Below is a recipe that will help your loved one fill up on fibre and protein.
Country Lentil Soup
Prep time: 25 minutes
Total time: 1 hour & 15 minutes
1 tbsp vegetable oil
1 cup diced onion
½ cup diced carrot
½ cup diced celery
4 cups vegetable or chicken broth
1 cup dried red lentils
¼ tsp dried thyme
½ cup chopped fresh parsley
Salt and pepper, to taste
1. In a large saucepan, heat oil over medium heat. Sauté onion, carrot and celery until softened, about 5
minutes. Add broth, lentils and thyme; bring to a boil. Reduce heat, cover and simmer for 20 minutes or until lentils are soft. Remove from heat.
2. Working in batches, transfer soup to blender. Purée on high speed until creamy. Add up to 1 cup (250 mL) water if purée is too thick. Season with salt and pepper to taste. Return to saucepan to reheat, if necessary.
3. Ladle into bowls and garnish with parsley.
Tips:
- Use sodium reduced broth to lower the sodium content.
- Substitute green or brown lentils for the red. Increase cooking time.
- Use canned beans instead of lentils.
Rinse well, to remove the salt.
The Women’s Mid-Life Health Team would like to take this opportunity to wish our Office Manager Kathy Leite all the best as she leaves our team to focus on her business. Kathy has been a wonderful ambassador and colleague since 2011. Not only has Kathy been responsible for a very efficient, organized clinic – she has a been a resource person for all. Her contributions are too many to list and Women’s Mid-Life Health as well as its team are all the better because of her. From all of the Women’s Mid-Life Health Team “THANK –YOU KATHY!” All of the work that went above and beyond the scope of your job description was not missed. We wish you health, happiness and prosperity with your business and new adventure.
Mid-Life Matters Series
Watch for Dr. Renee Morissette on CTV News at Noon with Jeff Rogstad. A series of short segments, Midlife Matters, on women’s health topics will be presented on some Tuesdays during the noon show. Each topic will have a handout which will be on our website www.menopausecentre.org.