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The Fullness of Midlife

Replay: "Menopause is... unique to each individual..."

Replay: "Menopause is... unique to each individual..."

by Dr. Barb DePree MD

 Like every autumn leaf, every woman is unique in her experience of menopause. Stasi Kasianchuk talks through the many approaches to incorporating movement in our lives.


Stasi Kasianchuk

Stasi Kasianchuk is the director of health coaching at Gennev. She studied exercise and sports science at Ithaca College and Oregon State University, working with the Athletics Department at the latter to develop sports nutrition programs for student athletes. She subsequently worked with clients through Arivale to make healthy behavior and diet changes before taking her current role. On her own time, she finds enrichment in challenging her body through trail running, cycling, swimming, backpacking, or group fitness classes. She enjoys taking time to explore farmers markets, local farms, and restaurants, as well as cooking and baking at home. 

Barb: My guest today is a sports dietitian in exercise physiology. Stasi Kasianchuk is currently the director of health coaching for Gennev, a company that supports women in their journey through menopause in a variety of ways. Stasi herself lives an active life with trail running, cycling, swimming, backpacking, and doing group fitness classes. Welcome, Stasi!

Stasi: Thank you so much, Dr. DePree. It’s really an honor to be part of this podcast today. 

Barb: Feel free to call me Barb as we talk. So let’s start, Stasi, with you sharing about Gennev’s mission, and then move more specifically to what the health coaching offers. 

Stasi: Absolutely. So Gennev’s mission really is to empower women during the second half of life, with the focus being on peri- and post-menopause. Certainly, as you know, Barb, in your work, that this is a challenging transition for most women, and we want them to understand that, and that they have the opportunity, like I said, to gain back confidence, feel empowered through knowledge, and then be able to help manage their symptoms. I think more importantly, know—have an understanding of what the options are. 

Menopause is a challenging transition for most women...

With menopause, while every woman will go through menopause, it is unique to each individual, their experience, and also their lifestyle. So with the coaching piece of it, which is our HealthFix program that I direct, we have registered dietitian nutritionists who also have training in health coaching, behavior change, and menopause. Using our skill sets, we work with women to identify what symptoms for them are most concerning or disruptive to their life. It’s interesting—I’m smiling right now because that can change through each call that we have with them. But the way the coaches help is to really let them know all the different lifestyle options they have available to them to help manage those symptoms. That could be simple routines around exercise, sleep, stress management, to various supplementation, or also just letting them know options they would have with working with a telemedicine physician, or OB/GYN team, if that’s the direction that they want to go. So that coach role is really to provide that support, answer questions—and coming back to that empowerment—a lot of times just knowing what’s going on with the body, knowing what options they have, women feel better in being able to have those choices available to them. 

Barb: In my practice, which is primarily around perimenopause and menopause, I feel like I could have a pre-recorded message that tells women why it is so important to devote more time to being active at this stage. And I’m just wondering, from your perspective, what is it that’s unique about navigating menopause that activity and staying in motion becomes increasingly more important? 

Activity gives women permission to step away from their responsibilities.

Stasi: I would say from the women that I have worked with and our clients in the HealthFix program of Gennev, activity plays a real role in their self-care. I think a lot of women have come during the perimenopause/menopausal transition. A lot of times they are coming off of raising a family, or if they do still have children in the house, they are in their teenage years or transitioning off to college. So they are more independent. And all of a sudden they realize, “Wow, I’ve devoted all of this time to my family” or “to my career.” There’s this desire to figure out how to give back to themselves. And I find that activity gives women—it’s a way to give women permission to step away from their responsibilities. 

Now, that being said, the exercise physiologist in me has to put in the benefits that women get during this time with the changes in hormones that affect their cardiovascular function, it can impact weight, and also the impact on their mental health—the increased anxiety and depression that we see. Physiologically, we also know that exercise of any type can help with all of those factors. But, like I said, I do see more often than not the dedicated time to devote to exercise, being active, and moving really comes more to that self-care piece I find for women during time of life. 

Barb: And obviously, individuals who reach out to you for your services have some degree of motivation just by having engaged you. I’m just wondering what your experience has been in the success of women implementing the recommendations that you have set for them. 

Stasi: Yeah, absolutely. And I think that that’s one of the advantages of working with a dietitian or that coach that you can find options that work best for you. So we get an idea of what the women we are working with like to do, what types of movement have they liked in the past and, right now, what’s accessible to them. So it’s really important that it is realistic for them to implement. And from there we can give them different options; whether it is an online program that we’ve vetted and recommend for safety and to help support them in their goals, or maybe it’s something around even putting something together—some type of walking routine—and holding them accountable to what that looks like in their life right now. And what, again, what feels like inviting; something they are excited to do and not overwhelmed and burdened to do. I think that’s a key component to making things sustainable. 

What I find is that those women who are most successful in maintaining an active routine is that they have found something that they enjoy doing, and that it fits with their lifestyle as it is right now. 

Barb: I’m curious as to how specific you are in setting goals for each individual woman. I know for instance, certain programs like Weight Watchers, you know, have certain goals about “do this,” “don’t do that.” And a lot of times women just do better when they have some structure. On the other hand, more is better when it comes to movement; more is better. So what has your approach been that’s been most successful in helping lead women forward? Is it just “more is better,” or trying to set very specific goals that women are trying to achieve as they move through the program?

Stasi: So usually it starts… it’s definitely looking at “specific” rather than “more is better,” because of the other piece we need to balance, too. I do have some clients who are women who have been driven all of their life, and it’s a balancing act. Because sometimes that drive that might lead to chronic stress long term we know is not beneficial. And same thing with exercise. Exercise is a stress on the body. When used in a productive way, it’s a positive stress. But if someone is exercising so much that it creates—because of this “more is better” mentality—and it creates a greater stress on the body, on top of other things, it can actually lead to injury, burnout, overtraining, or maintaining a higher than necessary cortisol level. And cortisol being that stress hormone, we want to be careful to balance that. 

What I’m really looking for when I’m working with women is, if it’s someone who’s looking to start a routine: where can they start, what can they do, and what’s realistic? I have one client who in her situation right now, with COVID, is really confined to her apartment—and so limited resources in a small space—so we’ve talked about doing more workouts inside her apartment. She’s also in a hot and humid area of the country, so getting outside, even for walking, is a challenge. What I did with her is provided three different online workout options based off of what she told me she’s liked in the past. She’s enjoyed more Pilates, yoga-style. So I gave her three options that she could explore. And the first step for her was just to initiate the free trials that were offered to experiment to see what would work best for her. In addition to that, she has also wanted to improve her exercise capacity in terms of her fitness capacity, and noticed that when she takes the stairs in her apartment building, this was challenging. It was a measurable way to do something inside—doesn’t have to be dedicated 45 minutes—but cumulatively over time taking the stairs instead of the elevator each week gave her some way to also measure her progress. When she knew she would feel better doing the stairs more often, she could see that progress over time. So a combination of things for her. But starting off with exploring workouts that she would enjoy, out of three that I provided, and the stairs, and then we’ll progress to what works for how many days per week can she implement this—implement the workouts into her schedule. 

Barb: Outside of the pandemic which has, obviously, limited a lot of what has been previously available to individuals, what do you hear from women as barriers to being active? It always hits me in the office when a patient just blankly says, “I just don’t like to exercise. I just have never enjoyed it.” And it hurts my heart to think that’s the case because it’s hard for me—how to know how to encourage that individual to do something that really they’re just not likely to enjoy. And it’s hard for me personally to relate to that because, typically speaking, I do enjoy exercise, and I recognize the benefits. So I’m just wondering how you help women over that hurdle who might make that statement?

Stasi: A lot of times I will ask the question of “Is there any time that you’ve moved your body that you’ve enjoyed? Is there any type of movement that feels good for your body.” And this, sometimes, can be a surprising question because I think a lot of people separate exercise and movement and we do have exercise—this vision—of more is better, push yourself harder. Certainly there’s certain exercise programs out there that capitalize more on this bootcamp mentality. And some people thrive in that environment, but as you identified, other people it’s either not pleasant, or it’s painful and not something that they’re going to be able to do long term. So with those individuals, often they—when they think about it, they say, “Well, I don’t mind walking my dog. But does that count as exercise?” Or “I enjoy dancing.” I have one client that she does enjoy walking, but that’s been a process. And her walking is really focused on her stress management—we are supporting her stress management, not necessarily for exercise even though, again, she is getting those benefits—but on our call the other day, she said, “You know what I need to do? I need to find a way to dance. I just want to dance. I love putting on music and dancing.” 

When have you moved your body that you've enjoyed?

I think that’s a great one too where most people enjoy music of some sort and music itself inherently can support movement. So, I think that’s another way. Another client who loves ballet, so it was figuring out how she can incorporate that artistic side that she has and figure out where she can participate in ballet and be able to find the classes for that. So a little bit of digging deeper into what movement looks like for them, and then finding things that they can do more consistently around that. I have had other clients who enjoy exploring—exploring new areas—so going to a new area and finding a way that you can explore on foot, so you are distracted. You’re looking for, if you are in nature or if you are in a new town, you are distracted by the newness and not necessarily realizing that you’re doing a lot of moving. 

Barb: So maybe a lot of it is really the word “chosen” and avoiding the term “exercise” per se, and making it more, as you say, about movement or just generally activity. That’s a good key to maybe engage women a little bit more to explore what their options might be.

My experience has also been that it’s the social support of doing things together that has been a huge motivator for women to stay in a group or get up and do it because somebody’s depending on them, whether it’s walking or a gym. Obviously, that’s become much more limited to us through COVID. I’m just curious, it sounds like you offer clients many online opportunities to exercise. Are some of those with a shared social setting where they are doing it with others then as well?

A client is doing mor fitness classes on Zoom because it's easier...

Stasi: Some can be. Typically because different people are in different time zones, what I will encourage individuals if they are looking for more of that social connection—and that accountability is such a great point because that is a key piece—to reach out to any local fitness centers to see if they are offering Zoom classes. I do have a client in California who belonged to a gym, and they converted all of their classes via Zoom. And she’s actually doing more of them because it’s easier, and she’s home. So now she can do more of them, and she schedules them in her day, and she’s also done classes that she wouldn’t typically do in person because she feels more comfortable turning off her screen and doing the moves without knowing someone is watching her. 

Barb: Sure. Which really leads into the next question I was going to ask. Is there any unexpected good news coming out of this opportunity to stay active in the terms of pandemic, but I think maybe you just touched on it that it’s maybe forcing women to explore options that they previously had not and for some women, there’s new found time. 

Stasi: Yep. Exactly. Yeah, I think the time piece and exploring new ways of moving and doing things a little more differently. 

Barb: Let’s talk a little bit about diet and the opportunities or services you offer women in your coaching around nutrition and diet. With your background my guess is that you see a significant connection between how the body is fueled and how the body performs. I’m wondering how you speak to women about the importance of that and encourage them?

What do you want to optimize? How do you want to feel?

Stasi: Yeah, that’s a great question, and certainly a big connection. I do use my sports nutrition lens from an area of how can nutrients and food fuel the body to perform optimally. From a sport standpoint, that has been on the field or on a track or on a court, but when we are looking at women in perimenopause and postmenopause, they are still looking to optimize their function. So it’s getting a sense from that woman. What do they want to optimize? How do they want to feel? Or, where are they not feeling their greatest? I would say it comes down to looking at symptoms. Oftentimes symptoms such as hot flashes, helping women identify when they are happening and if there are some food triggers. So refined carbohydrates, alcohol, caffeine, hot beverages—they are all things that can trigger hot flashes in women. Some women, too, notice specific foods. There are some that find dairy and even wheat products—whether it’s gluten or the wheats, we may not necessarily know—but on the days that I eat these foods, either I don’t feel as well, or there’s more frequent and intense hot flashes. Sometimes it comes down to individuality as well as their symptoms, and figuring out how to best manage those with what they’ve noticed. 

Other women, it’s noticing certainly weight is a concern and identifying where their nutrition habits can be optimized to support either weight loss or weight management. And too, there’s big discussion around helping them understand the changes that are happening hormonally, why we do see the weight change during this time of life, and what is realistic from a realistic weight-management goal for them. And also bringing in body acceptance and understanding why do they want to lose weight? Where is that coming from? And what are other things that they can also do to support their health regardless of if the number changes on the scale? So being transparent on that process too during this time of life.

Barb: And I think one of the challenges I hear during those discussions with patients is, you know everybody’s wondering about the next short-term fix in which women grab on to do the quick few, and I keep bringing it back to more long-term commitments to habits and changing habits. Again, I’m wondering if you’re finding this population resonating with acceptance of a really long-term solution here, rather than signing up for the latest short-term thing that they’ve read about in a Facebook group or something. If just really feel like the barrage of diets made available gives people the sense that that’s going to be what’s really going to bring them success. And I think that really is, obviously, short-sighted and not likely to bring them the long-term success they are looking at. I’m curious whether you find women willing to accept and engage in a really true commitment to changes of habits.

Stasi: Yeah, that’s such a great question, and we can probably do three other podcasts on this topic. The one thing I do point out and disclaim—I should have put this disclaimer at the front—I am, at 36 I am premenopausal. And so women who are working with me, I have to put that out there to let them know that I cannot directly relate to—personally relate to—what they are experiencing. But I understand that a change in anybody that feels like it happened overnight and out of your control is hard. Compounded with that is the continual messaging that we, as women  (or individuals who identify as women) in this society consistently hear is this ideal body size and shape. That messaging over time—and this then combined with the diet culture and the diet industry that has showed us that, yes, you can do this on a quick fix; just pay for this, just follow this, it’s easy—does a disservice, especially when we do look at the science around weight loss. It’s not that easy, and we are learning that it’s way more complex, and there is a gap in terms of we know that women during menopause, we do see weight gain during this time. We do see change in body composition, but we don’t have the exact formula—and I don’t know that we ever will—around that. And so a lot of times it’s a discussion with women around what does weight loss represent to them. A lot of time it’s this desire to be who they were before because there was predictability, there was a structure, and now things are out of control and feel out of control. So it’s helping women. That acceptance piece tends to be a longer conversation and individualized to where women want to be now in their life and how can they reimagine and envision their health without limitations. And helping them understand that. The women who are working through this over time, there’s less of an emphasis on the scale and more of an emphasis on habits and how they feel. Not to say that there aren’t days where it’s hard for women to be in their bodies, whether it’s hormonally, whether it’s socially, and that’s okay. We can have those hard days. We want the majority of our energy being put towards that acceptance piece, but recognizing that it is going to ebb and flow, and that’s normal—normal for being a human and normal for being a woman. 

Barb: I think about a patient I saw yesterday who’s in early menopause, and she’s in her early to mid-40s, and weight gain has been her thing. But her body mass index is still under 25, again maybe not the best metric, but it’s really a change for her. And I’m trying to give her the message of change and acceptance. And, you know, she’s just not having it. [laughs] She is not happy with my message whatsoever. I don’t have a long-term relationship with this patient, and as she left, I thought, you know, I think I might not see her back. This wasn’t what she wanted to hear. 

As a provider I think that the more avenues and channels women have to get accurate information about what this really is about—or what it isn’t about and what we can and what we can’t do—is really helpful. I’m grateful for Gennev to make a bigger platform, a broader platform that makes this menopause/perimenopause more knowable. And I think one of the taglines for Gennev is to offer a modern approach to menopause. It’s an old story, but I think with new information and more opportunity to communicate we can empower women to do this better, hopefully. So, I’m grateful for what you’re offering women.

Menopause is a natural, normal, physiological transition for women...

Stasi: Thank you. And that really I think there is a lot to changing the conversation. And even if there are people who walk away—we have certainly, I think, had clients come through our platform and say, “This is not what I’m looking for.” I think people want someone to fix menopause and make it go away [laughs], and I don’t know that that’s in the foreseeable future. [laughs] But I think it’s that bigger changing conversation of what is a natural, normal, physiological transition for women, and always has been. And now we are talking about it, and that’s the bigger thing. So even what you mentioned, you started that conversation with that patient. Even if they don’t come back they’ve heard it, and let’s hope that we can all start changing that conversation so it is a difference. There is a difference here in the next—hopefully sooner rather than later—but we’ll say in the next decade we’re seeing some good progress.

Barb: Yes. And I would say I am always encouraged by this time of life where many women recognize the need for change and the maybe recentering some time and energy for self care and are ready to engage in that, so it feels like an exciting time to partner with women to kind of help them move forward to be more successful. I’m sure you are experiencing that now in what you are doing as well. But that’s been my experience in providing care for this population for the last 12-14 years. 

Stasi: Wow. And thank you for doing your part. Hopefully we all just start getting on board, and then every woman wants to join that movement. 

Barb: Exactly! As we conclude our time together today, Stasi, I like to ask guests where do you find fullness at this stage of your life?

I have a puppy that makes me appreciate the simplicity...

Stasi: Ah, such a great question [laughs]. Got to put it out there during a pandemic [laughs]—there’s different things for that. I would say right now, honestly, pandemic considered, I am finding fullness in the little things. There are times where right now—I mean I even think maybe this is the dietitian in me, but I look forward to each meal [laughs]. I look forward to my cup of coffee in the morning. I look forward to the meal preparation. Those again are things I enjoy, and something my partner and I do, looking forward to making dinner every night together [laughs]. I would say right now those are the little things. I have an almost-one-year-old puppy that really makes me appreciate the simplicity of having something that wakes up every morning and is so excited for the day, and so excited to eat breakfast that was the same breakfast as yesterday. It puts perspective in things. So right now for me it’s really appreciating the little things and practicing gratitude as well for those things that I have. 

Barb: Yeah. Thank you. And I think you’ve just articulated what most of us are, to some extent, experiencing as well: imposed, slowing down. Most of us would never take the time to what we’ve now been imposed, so I’m glad there’s an upside in a few of those things. Thank you for sharing. And especially thank you for your time today and again, the work you do with Gennev. I hope many women can successfully navigate this and find their best selves through the coaching you provide. 

Stasi: Yes. Well, thank you for the work that you do for your patient population, and through your website and your blog, and your podcasts. It’s been a pleasure talking with you today. 

Barb: Good. Bye bye.


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