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Does Hormone Replacement Therapy cause cancer? The answer without question is no.  Does it increase the risk?  That answer is nuanced.  There is a lot of information and misinformation about the topic, and unfortunately, it’s possible that even your healthcare provider is not aware of what is what. It’s hard to know where to turn and who to get your information from. As a Women's Health Coach specializing in menopause and perimenopause, I have to stay diligent and vigilant about the latest data regarding Hormone Replacement Therapy (HRT), also known as Menopause Hormone Therapy (MHT).  But when my own healthcare provider is poorly informed and feeding me incorrect or outdated information, I admit that even I am susceptible to being gaslit.   For the past three years, I have been getting my annual mammogram and ultrasound (I have dense breasts, so I’ve always gotten an ultrasound in addition to my regular scan) at a local breast center in New Jersey.  I initially started going there because of ongoing breast pain that would later turn out to be muscular (pectoral) and not breast.  That is another story for another time, but I needed a specialist since other providers couldn’t tell me the root of the pain. The facility was a one-stop shop; all the equipment (including an MRI room) was on the premises. A doctor read your scans after the procedure, followed by a breast exam, and all results were given immediately. I liked the place. The administrative staff was personable, the technicians were friendly and competent, and it was incredibly convenient. What I didn’t like was constantly being on the defensive about my use of HRT. It started with my initial consultation where the doctor asked me why, instead of taking micronized progesterone at night, I didn’t “...just take a sedative?”  I had to explain that I had tried sedative-hypnotics like Ambien and Belsorma and benzodiazepines like Klonopin and Xanax, and not only were these highly addictive substances and not tenable for long-term use, but they didn’t work well for me. Micronized progesterone , on the other hand, had solved years worth of sleep issues in a matter of a few weeks, and it was extremely safe and non-habit forming.   Unfortunately, it didn’t end there.  Enter the Physician’s Assistant (PA) assigned to me for my manual breast exam.  We’ll call her Ruby.  Ruby was the person I spent the most time with since she would go through my chart, ask me medical questions, and make small talk as she did the exam.  Over the past three years, she has said several baseless things to me which (were I not who I am) I might have taken as gospel because she’s a medical professional; she knows everything, right? When we first met, she told me I couldn’t be on HRT for more than ten years and shamed me for being on it in the first place because it was a “natural” transition.  At that same appointment, she told me women shouldn’t be on the oral birth control pill for more than 15 years.  She said several other things I found offensive because of their inaccuracy, which I don't have time to list in this (already) lengthy blog post. Still, while I knew all these things to be untrue, I doubted my knowledge. At that point, I had only been coaching for about a year, and Circling the Drain Podcast was only a few months old.   This was also before menopause started having a moment —before Naomi Watts and Stripes before Stacy London became the community’s mouthpiece, and before Heather Corinna’s seminal book on the matter, What Fresh Hell is This ? Another year went by, and with my new appointment, I would gird my loins and mentally and emotionally prepare for whatever wild sh*t might come out of this woman’s mouth.  On more than one occasion, I considered taking my breast care elsewhere, but I’m a sucker for convenience and efficiency, and this place had that in spades.  Plus, it was just once a year, right?  So I kept the appointment, ignored Ruby’s words, and continued with my life. It wasn’t until my annual mammogram this past May that I had finally had enough.  I had now been coaching on perimenopause and menopause for three years; we had several renowned specialists on the CTD podcast, and data on the safety and efficacy of HRT was emerging in real-time daily. Most recently, the internet was a flutter with the earth-shattering news that not only did estrogen therapy (alone) not increase the risk of breast cancer, but it DECREASED the risk. This was such a win! I was more experienced, intelligent, and confident. Still, I again prepared myself mentally for my visit.  I completed my mammogram and ultrasound, and everything was clear.  Then came my breast exam with Ruby, and to my surprise, other than asking me some basic medical questions, making small talk, and making sure I was taking vitamin D (Why? Of all the things?), she didn’t mention anything about my HRT use.   What a relief! But.  I spoke too soon. As I left the examination room and walked down the hallway past her office, she called out a name (not mine). I looked back, confused, and she said, “Oh’, I mean Julia.”  I walked back to her office, paused in her doorway, and found her sitting at her desk. “You’re still on HRT, right?”   “Yup,”  I said. “Oh’ well, then you also need an MRI.” “I just had one two years ago, and we resolved the breast pain issue, so I’m fine,”  I said. “If you’re on HRT, you need to get an MRI every other year.  Also, you can’t be on it for more than five years.” HUH.  So. Two years ago, it was ten years, and now it’s five? I looked at her, perplexed, and said, “I don’t think that’s true, so I’m not going to do that, but thank you.” I was polite and firm and walked away, but I was annoyed, fed up, and deeply concerned about what she might be telling her other patients!  She called me no sooner than I sat in my car seat and started the engine.  I did not pick up.  She left a message saying (to paraphrase), “...I know we were discussing in the hallway about the estrogen…but I’ll send you an article, and please call me back to discuss.” When I got home and started to work on some Pilates class planning, I saw her email:   Hey Julia, I know we spoke in the hall before you leaving about HRT. Sorry probably should have discussed it in the room, my apologies.   I just wanted to clarify that the new research is regarding estrogen alone.  Not estrogen and progesterone.   Newer research is suggesting estrogen alone may be beneficial, not estrogen and progesterone.  I have not been able to find any new research saying estrogen and progesterone does not increase the risk for breast cancer.  The only research we have says there is increased risk when taken for more than 5 years.  Feel free to call me to discuss.  I included information from the FORCE website which I thought was good. I was livid.  Firstly, we should establish that if you have a uterus, you must take progesterone as it protects your womb from cancer (a progesterone IUD also works). The only folks who can take estrogen-only therapy are those who have had a hysterectomy. While FORCE is a reputable organization whose mission is to “...improve the lives of the millions of individuals and families facing hereditary breast, ovarian, pancreatic, prostate, colorectal and endometrial cancers”, it is not the first place that I would go for the latest research and guidelines on HRT use.  For that, I would go to The North American Menopause Society (NAMS). Here is where I want to convey the importance of seeing a menopause specialist, ideally one certified by NAMS, for your perimenopause and menopause care.   While the FORCE article was correct in a general sense, proper interpretation of the data matters, and Ruby completely missed those details because she is not trained in perimenopause and menopause care or the use of Hormone Replacement Therapy. It took me over a week to respond to that email because I needed to get past my anger and verify information with reputable resources like my Menopause Specialist at The Center for Midlife Health & Menopause at NY Langone.   I confirmed that even with a distant family history of breast cancer (two great aunts on my mother’s side), I was still considered low-risk.  Furthermore, my mother and I were both tested for genetic markers and cleared. Ruby knew this.   My specialist also thought that a breast MRI based on the sole reason for HRT use was outrageous.  She then confirmed that micronized progesterone does not increase the risk of breast cancer.  It’s progestins (more specifically, medroxyprogesterone acetate), a synthetic form of progesterone sometimes used in HRT, but often found in the oral birth control pill and contraceptive injections like Dep-Provera. As a side note, the birth control pill has a nuclear bomb size amount of hormones so big that it tricks your body into thinking it’s pregnant, halting ovulation.  Despite that, the BC pill is not treated with the fear-mongering that HRT has attracted over the years.  In fact, according to Medical News Today , the oral BC pill increases breast cancer by as much as 29%. I don't tell you this to scare you away from the BC pill, as I think it's incredibly beneficial for a lot of women. I'm telling you this to give you context . Prescription HRT is not administered at the high level of the BC pill. Not only that, the HRT you're prescribed will never be as high as the natural level you had during your most fertile years. The dose is low. Regarding the length of time on HRT, researchers have found that timing (within ten years of menopause), dose, and type of HRT matter. According to the Menopause Journal   (North American Menopause Society), age or length of time on HRT use should not be a reason to discontinue HRT.  My mother has been on it for more than 20 years. While menopause is natural, it isn’t smooth sailing for all women and can have negative life-altering consequences.  I've had a few post-menopausal women say something like, "I don't get it. My menopause was fine; I didn't have any problems. I rubbed some tea tree oil on my wrists if I got hot. It's natural; just let it happen!" To which I always say, "Good for you!" I mean that in a sincere, non-condescending way. Sort of. But seriously, any woman who goes through this transition with little to no symptoms is lucky because the statistics tell us that this is rare. 74% of women said at least one symptom of menopause, primarily hot flashes and night sweats, was disruptive to their lives, and according to a survey conducted by the National Association of Female Executives, almost half of the women (45%) noted that menopause symptoms were worse than they expected. AND - know what else is natural?  Erectile dysfunction, but you don’t see men being told that it’s natural and they should "tough it out."  The "natural, tough it out" take on menopause is highly patriarchal in its reasoning, and I think it's wild that some women don't see that. I have the same opinion on IUD insertion , but don't get me started!! Having options and choices for treatment is what matters. You can read Dr. Mary Claire Haver's better-articulated take on all this here , in response to this tone-deaf garbage article published in the Lancet. Read both. It’s worth it. Hormone Replacement Therapy does not cause cancer, and increased risk depends on patient history, type of HRT, and the window in which it is prescribed.  Like any medication, it comes with risk.  As I wrote at the close of my response to Ruby:  A risk/benefit analysis should be done with the patient and a menopause specialist—preferably someone certified by NAMS.  While I believe you have the best intentions, you are not a specialist.  If you are having difficulty managing perimenopausal symptoms, you can do something about it. Don't let fear prevent you from seeking treatment. You deserve to feel better! For the best explanation I have ever seen on how breast cancer actually works, check out this post by Dr. Amy Killen here .   If you’d like to calculate your risk of breast cancer, you can do so at the National Cancer Institute here .  If you’re interested in HRT and other treatments for symptoms of perimenopause and menopause, you can find a certified menopause specialist near you on the NAMS website here . If you’re unsure where to begin, schedule your free intro Zoom session with me here ! This blog offers general information about health and related topics. The information and other content provided in this blog, website, or any linked materials are not a substitute for medical advice, diagnosis, or treatment. If you have a medical concern, please consult your healthcare provider or seek professional medical treatment immediately.

Almost one year to the date, I had ACL reconstruction surgery on my left knee.  It has been one of my life's most challenging and harrowing experiences. I started skiing and snowboarding at 36 and have struggled with confidence from the beginning. I didn’t have the blessing of learning this daring and somewhat dangerous hobby at a young age - when you have no fear of bodily harm and can absorb new skills like a dry sponge.  Still, I’d been working at it, and at the age of 47, I felt like I was finally learning to control my fear and felt more self-assured about this sport that I had grown to love. On the day of my injury (our first day on the mountain), I felt GREAT!  My husband and I were on our fourth or fifth run of the day; the weather was decent and improving by the minute.  Tahoe had unprecedented snow that season, so the conditions were perfect.  I was skiing with speed and confidence and TRUSTED in myself and my skills. Up to this point, I had spent a lot of time feeling embarrassed that I wasn’t good enough or fast enough.  This had a lot to do with the fact that I was always skiing in groups of people who had been doing this since they were teenagers.  While this was a story I was telling myself and certainly not how my friends felt about my abilities, these self-destructive untruths can really f*ck  with your head, which is why this day was so significant.  I was finally feeling like I was good enough! Yet, sh*t happens (usually at the best of times), and that’s precisely what happened to me! I was approaching the last stretch at the bottom of the mountain, not far from the ski lift, when I hit a thick patch of snow.  One ski went left, one ski went right, and neither popped off, but I did hear a popping sound in my left knee, followed by a tremendous amount of pain.  I sat in the snow and took a moment. As a Pilates instructor, I'm trained to assess bodies and work with all sorts of injuries and physical challenges. In turn, when I hurt myself, the first thing that my brain does is assess. I thought I might be fine for a split second since the pain had subsided completely, but as soon as I tried to stand and couldn’t stabilize my knee, I knew I was in trouble. It was like standing on a wet noodle.  That was when I understood the gravity of the situation and that it would likely lead to surgery, rehab, and probably a year+ of recovery. I also saw every plan and goal I had set (including leaving my job) flash before my eyes, followed by the devastation of knowing that it would ALL have to be put on hold or (at the very least) delayed. A trip to the emergency room would confirm my suspicions, and while I do love being right, I took no pleasure in being correct about this!  Once I got back to New Jersey, confirmed my ACL rupture, and scheduled my reconstruction surgery, things went as expected in that I began “prehab” (prehab addresses physical fitness, nutrition, lifestyle, as well as psychological barriers to healing after surgery). What I didn’t expect and, therefore, didn’t prepare for was the shame and existential struggle that would follow. I recently started reading Dare to Lead by Brené Brown as part of a book club run by Erin’s Faces (if you are not familiar with her clean beauty products, check them out here).  Brené spends an entire section of the book dissecting the concepts of shame and embarrassment and its underlying causes. If you’ve read Brené Brown, you know she is a master at demonstrating her point through storytelling.  In this case, she delves into the time she recorded the audio for her book Braving the Wilderness, where she essentially knocks herself unconscious after walking into a pane of glass in the recording studio.  This leads to a series of discoveries around her resistance to accepting help from others and accepting her limitations, particularly when recovering from a severe injury.  All of which were (you guessed it) grounded in SHAME. I’m no Brené Brown, but given she is a highly successful and intelligent human who managed to knock herself the f*ck out, and this incident propelled her into unpacking her own embarrassment and shame, I realized I, too, had some work to do around my injury as well. Like Brené, I grew up in an Eastern European household where stoicism was celebrated, injury and illness were met with a “shake it off” attitude, and few excuses were acceptable for not meeting your obligations. While some of this can be attributed to my German/Polish heritage (let’s be honest), a lot of it has to do with being a latchkey GenX kid of the 1980s. Raise your hand if you relate. 🙋🏼‍♀️ It was a difficult pill to swallow when faced with the reality that I would not be able to walk for weeks. And even when I could walk with a brace, it would not be for any sustained amount of time for MONTHS.  It meant I would have to relinquish specific responsibilities to my husband and others. I felt these obligations were my JOB or at least jobs I shared with my husband, like grocery shopping, general house cleanup, cooking, and walking our dogs. Then, there was taking care of ME. I needed help in and out of the shower, cleaning my wound, and changing the dressing. I couldn’t do anything that required standing, like cooking or making the bed. Even though none of this was my fault, I was deeply ashamed of needing help. I was also embarrassed that I injured myself skiing, as I felt this was a reflection of me being a “bad” skier. To further complicate things, I had given notice at work in late 2022 and agreed to stay until we found my replacement.  This had been dragging on for MONTHS into 2023, and with Spring in the air, I decided I would give a firm exit date once I returned from my trip.  It took courage to arrive at this decision and confidence that my husband and I were financially stable enough to live on one income while I continued to build my business and finish the HUNDREDS of hours I still had left in my Pilates certification.  I was excited and hopeful about this change! However, with expensive surgery and rehab ahead of me, I now needed my fancy health insurance, salary, and flexibility to work from home. I’d have to put off leaving even longer.  That hopefulness and excitement were gone, and I was left feeling deflated, reclusive, and depressed. That’s when the intrusive thoughts started. “You idiot, you picked up skiing at 36, and over ten years later, you still don’t know what you’re doing.  You’re so f*cking stupid; why did you think you could do this at your age?  Now, look what you’ve done to yourself.  The whole world is against you, and your husband will resent you for the rest of his life.” Where did this all stem from? According to Brené Brown, it’s shame. She describes shame as “...the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love, belonging, and connection.” She was right. Having been in a generally destructive, unhealthy romantic relationship for about eight years (before I met my husband), I did not trust that my partner loved me enough to want to care for me. I had been conditioned to believe that every kindness from my person came with some sort of price—because I was undeserving of love. I believed any expression of need was seen as an inconvenience or weakness. While I had done a lot of work (and therapy) to reframe negative self-talk, it’s often at our lowest that maladaptive thoughts and behavior rear their ugly head.  I was no exception. There were several instances where I was moving too quickly in my recovery when my body wasn’t ready, like forcing myself to go back to the office in the city and reassuring everyone that I could take public transportation, limping my way between train connections and up and down stairs. I insisted that I walk the dogs when I could hardly walk myself, moving at a glacial pace, while worried that if one of my pups launched at a squirrel, I might hurt my knee or lose control of the leash, allowing my dog to run away, but I did it anyway. In fairness to my husband, he tried to talk me out of all of these things, but I wouldn’t listen. I think I’ve mentioned that I learn everything the hard way. It wasn’t until I flew home to Florida by myself for a funeral that I learned my lesson.  I was at JFK and did not realize that with my gate being number 1 and me eating my lunch by gate 52, I would have to walk the length of 52 gates.  Listen, I know this seems obvious, but JFK is traditionally a nightmare and has a layout that doesn't make much sense, and I rarely fly out of that airport for good reason. I had assumed there were shoot-offs with clusters of gates, but that was not the case. Not realizing this, I took my time walking to the gate, but as the airport hallway kept going and going (AND GOING) in a straight line, I began to realize it was going to take more time than expected and that my leg brace, suitcase and I were going to have to pick up the pace if I wanted to make my flight! After about 20 minutes of excruciating pain and hobbling, I made it as they started boarding.  Feeling unsure (and ashamed), I went to the gate attendant and asked if I was (gulp) allowed to board before anyone else - with the “people who need assistance” grouping.  She said of course!  Until that moment, I hadn’t considered myself disabled in any way or needing assistance, but duh – I was!  What was wrong with me?  Why didn’t I make better arrangements? When I got back from Florida, I made some changes. I dove into Pilates workshops and other continuing education for Health Coaching. As soon as I was mobile enough, I returned to the Pilates studio for my hours, reframing my shame and embarrassment around my accident as an opportunity to discuss Pilates for knee injuries. I even volunteered to be a client for other teachers looking to practice on someone with post-op knee surgery. I found ways to help around the house (for my own sake) while accepting the love and support I needed and deserved from my husband. I created some work boundaries at the office and shortened my hours; soon after, we found my replacement! Only now do I see how my destructive behavior was rooted in shame.  My shame around needing help and feeling undeserving of love and care. In her book, Brené ends her story by summarizing the year with, “...more hard things happened, more beautiful things happened…” Looking back, that’s exactly how the year unfolded for me.  I feel incredibly thankful for the privileges that I have had. Not everyone has access to health insurance that covers never-ending physical therapy or the ability and flexibility to work from home. I have learned to be more compassionate towards myself and have been lucky to receive endless love and support from countless friends, family, and even strangers while at my very lowest and, at times, (truly) behaving like an a**hole. If you are really in the sh*t right now, know you are not alone and deserve support and love. If I can believe that, so can you. ♥️ You are stronger than you think and full of surprises!

In 2016, I decided I would return to night school to pursue my MS in Nutrition and dietetics. Considering I had a BFA in Theatre for my undergraduate degree, this was a big ask because I was missing much of the prerequisites needed to qualify for a Masters’s program for that kind of degree. Still, I had just turned 40 and wanted something different for my career. So, I registered for Economics 101 at Hunter College and began my journey. After passing with a B, I registered for Statistics (Why oh why didn't I take that in undergrad instead of Computer Science?!), and about halfway through the semester, I got engaged and had a significant death in my family. At that time, I was full steam ahead, not knowing what was up and down, but LIFE forced me to stop and evaluate where I was going and what it would cost me (literally and existentially) to get there. My husband likes to remind me that I have to do everything the "hard way." I'm not offended by that comment because it's true. It has gotten me very comfortable with failure, making mistakes, and learning from them. I have no problem quitting something that isn't working. Getting comfortable with that is a practice—as in, you must cultivate comfortability with letting things go. That is a true growth mindset. But (and this is a BIG but), you must also recognize the difference between wanting to quit something because it's hard and quitting something because it no longer serves you or you’ve outgrown it. This is true of jobs, hobbies, and even relationships. The realization that pursuing my Master's would put me in tons of debt and take me FOREVER and that (when I ruminated on this) it just didn't make sense felt like such a relief! Instead of forcing myself to continue, I gave myself permission to walk away. I knew there was another path and needed a minute to decipher what that would be. I went about work as usual, supported my family during an unimaginable loss, mourned that loss, planned my wedding, got married, and COVID hit just a few years later. The pandemic was devastating, but it gave me a moment to pause and reflect. That's when I decided to get my Health Coaching certification and finish my Pilates apparatus training. It was hard, and I often felt like I would never get through it, but (to quote Glennon Doyle) we can do hard things! Quitting something that no longer aligns with your goals doesn't make you a "quitter." It shows that you won't settle for anything less than the best version of yourself.

So give them to yourself! Accomplishments in midlife differ from those in our twenties or even thirties. In the past year, I've found myself hitting some major milestones, starting with leaving my job, finishing a Harvard wellness certification program and finishing my Pilates equipment certification, a 2.5-year journey with over 300 hours of teaching and practice and many obstacles along the way. In two weeks, I will sit for and (fingers crossed) will pass the National Board of Health and Wellness Coaches board exam. These things are a big deal, right? So, why doesn't it feel like I should celebrate? Because I did it for myself and no one else, that's why. I know this isn't true for everyone; still, we tend to spend our early years doing what we think others think we should do, whether it's cultural norms or simply parents pressuring a kid to be a doctor and sending them to medical school when they want to study Art History. However, midlife can and should bring choices and the mental clarity to make good ones. As I've aged, I've found more agency to ask myself, "What do you really want, and how do you want to spend the rest of your life?" Then, when you achieve these major milestones, it can feel more like a natural progression of your goals vs. a major life event like when you graduated college and partied with your friends until the sun came up...because who has time for that kind of behavior now? Plus, I don't stay up past 10 pm, but I digress... Still, we deserve to feel accomplished, and we should celebrate, but celebration may look different than it did when we were younger. When I found out that I had passed my three-hour written Pilates exam, I was elated but still felt a little MEH, so I decided to take a moment and plan for how to celebrate anyway. I wanted to do something that I would truly enjoy, but that would also be easy. So, my husband and I went out to one of our favorite restaurants for dinner at 6 pm. (Don't judge me - there's nothing wrong with eating early and saving money!) I ordered the Prime Rib early bird special along with a glass of Mezcal on the rocks For me, this was perfect, and it was exactly what I wanted. My husband didn't suggest it or do it for me; I asked for what I wanted, and he was happy to oblige and he certainly made a toast to my success, BUT, I gave myself those flowers --- the flowers I wanted, and the flowers I wanted were meat and liquor. It got me thinking about that idea, though. The idea that yes, it's great to have others celebrate us and even with us, but what is more important, is making time to celebrate ourselves. So. What does that look like? If you've got the bandwidth and motivation to throw yourself a party, I say f*ck yeah! Good for you! In my case, it was dinner. Maybe in your case it is literal flowers - huzzah for that, but it could also be smaller things because God knows, we're all short on time and long on responsibilities. It could be taking 15 minutes to unsubscribe from annoying emails you've been meaning to get to but haven't found the time. Maybe it's unfollowing or blocking social media accounts that make you feel like your life is hot garbage. Perhaps it's playing hooky from work or asking your partner to get out of the house with the kid(s) all day so you can engage in some serious bed rotting and binge your favorite YA TV show on Netflix. Not that I know anything about bed rotting; that is a Gen Z thing, but I'm interested in trying it! THE POINT IS -whatever you've accomplished at this age, big or small, I hope you find a way to give yourself flowers - whether it's actual flowers, Mezcal and meat, bed rotting or mental floss, it's important to make it a priority. Midlife means celebrating yourself. You deserve it!

"20 minutes? Twice a day? I can’t even sit still for 20 seconds!" you might say. Artist, teacher, and coach Mark Price talks to us about finding stillness! About 20 years ago, I was at the peak of my career as a performer, having done 10 Broadway shows within 10 years, but I was also a hot mess. I burned myself out and was walking around with a mild case of PTSD after surviving two losses, which left me with a nasty habit of rehearsing disaster. Therapy helped, healers helped, and support groups helped, but I was dependent on all of them. There was a part of me that felt robbed of agency as a result of the swat team of healers I sought out. Fortunately, I had the privilege of great support, but I wanted more self-sufficient tools to help forge a path back to myself. Around that time, I had a friend who recommended a Vedic meditation course. Vedic meditation was designed for the “householder,” people with busy minds and active lives; you didn’t have to meditate for hours to experience the benefits. It’s a deceptively simple practice; as you effortlessly think a primordial sound or mantra, the body begins to rest, sometimes significantly deeper than regular sleep. As the body experiences that deep rest, it begins to neutralize the old legacy of stress recorded in cellular memory, which is the thing that allows us to perform better, cultivate present-moment awareness, and access more significant states of well-being. It also allows us to pull back the lens on our demands and decide which ones are worthy of our time and attention, our two most valuable assets. In this respect, meditation gives us back time by helping us prioritize our time and attention. When I learned that the benefits of practice were so prominent for me (less negative self-talk, greater capacity, lowered anxiety), I ultimately became a teacher. I also became a trauma-informed somatic facilitator, helping people address the body holistically. In retrospect, the thing that allowed me to sit for 20 minutes twice a day early on was the effortless nature of the practice, the non-directed focus style, and the change I noticed. But as I began working somatically, I began to see how working with the body helps clients build capacity for practices of stillness. Top-down processes like meditation, pranayama, or talk therapy can help to create capacity, perspective, and clarity. In contrast, bottom-up approaches (somatic facilitation) can help metabolize the effects of chronic stress and trauma. Working somatically helps expand the capacity to sit for meditation by building out that internal sense of safety. By utilizing both top-down and bottom-up approaches, we are giving the body and mind an equal place in an integrative and holistic process of healing. Nothing in our modern world tells us to slow down, to check in with the body, or to practice stillness, but there is excellent knowledge and wisdom when we do. This is why I tell students that meditation and somatic awareness are tools of disruption-helping us identify and interrupt themes and patterns that keep us overworked, distracted, and sick. When we meditate and notice what the body is experiencing, we are strengthening resiliency and empathy. We begin to see that our freedoms and liberation are directly tied to those around us, which enables us to interact with demands and situations versus react to them. If anything resonated with you from above, feel free to reach out and say hello. My interests and strengths lie at the intersection of meditation, somatics and social change to help others alchemize stress into expansion, wellness, and, ultimately, collective care. Mark discovered Vedic meditation after suffering from the effects of PTSD and performance anxiety. He found the effects to be so transformative that he embarked on a 2 year teacher training process which led to continued studies in trauma informed facilitation, somatic stress release, and social change work. He founded Alchemy Collective to help support others with their own healing journeys and to deepen the ways in which they can show up for each other. With his 13 years of experience as a teacher and performance coach, he developed programs such as Base Camp and The Wellness Project for creatives. He's taught across the country and led various corporate programs internationally. For more information visit: www.alchemycollective.org.

Celebrity trainer and group fitness instructor Cheri Paige Fogleman tells us how to stay motivated! "Motivation for exercise" is that elusive magic potion that sexy-fit-Instagrammers seem to all have, and mere mortals wish they had the recipe for. Now YOU do. Instead of “motivation,” I prefer the term “commitment.” Motivation is just so fleeting. The goal is to understand how to develop an ongoing relationship with exercise. So, commit. Commit to walking yourself, as you commit to walking the dog (or watering the plant, or calling your mom, or reading to your kid each day, etc.). Now, what are you committing to, exactly? Commit to providing yourself, daily, with some instant gratification. Wait. Wha?!? Instant gratification? For a long-term relationship with exercise? Yes. Flip your thinking— from long-term results to instant gratification. Take a moment and brainstorm all the immediate results you feel from working out. I’ve created a list, and yours might be a bit different. But here are some of my ideas: Feeling more awake Feeling more alert Feeling more empowered Better range of motion Feeling more hopeful/mood boost Feeling warmer Better feeling joints Stress relief Better balance We live in such an instant gratification world that it's nearly impossible to stay motivated when only focusing on long-term results (like weight loss or stronger bones). When I’m sitting on the edge of not wanting to exercise, I remind myself of just how much I’m gaining from only 20-30 minutes of mindful movement. A short workout still has a LOT of return on investment when looking at the instant results. Try focusing on the quick results and know that we don’t only get just one of these immediate results when we work out— we get ALL of them each and EVERY TIME we exercise. What kind of mindful movement, exactly? Think of a gentle jog, bike ride, cardio kickboxing YouTube video, yoga class, Pilates class, or a strength training session (with greater results from longer bouts of movement). The more you focus on the immediate results of exercise, the more likely you are to come back tomorrow for more because to achieve long-term results, consistency is KEY. The more regular you are with exercise, the more likely you are to see those longer-term goals, like: Increased strength/bigger muscles Stronger bones Healthier skin Better sleep (for some folks, this can be a more immediate result) Weight loss Better endurance Stronger immune system Improved cardiovascular health Something to note here: These instant results of exercise are more about how things feel in your mind, body, and soul, while the longer-term results are more about how things look and the physical and biological measurements of things. Stay committed to your workouts not by looking in the mirror or weighing yourself but instead by stopping and taking note of how things feel before and after a workout. Key Takeaways: Commit to yourself instead of looking for motivation Focus on the immediate results of exercise Let the instant results call you back for more of the same tomorrow and the day after because consistency is key to longer-term change Cheri Paige Fogleman is a celebrity trainer and group fitness instructor whose career has spanned over two decades. She breathes life into cardio-sculpt, flexibility, and core classes. Cheri’s specialty is helping fitness newbies (and those returning!) live longer, stronger, and more fulfilling lives. Among other certifications, she’s pre/postnatal certified and a certified run coach through RRCA. She was one of the first trainers in the world to teach live workouts online through Daily Burn 365, and her audio running podcasts are also available on Daily Burn. https://www.bodybycheri.com/

With Fall approaching, I began to get an itch. An itch to tear my entire house apart, reorganize, and donate things that do not bring me joy. Given my last day at my corporate day job was approaching, it seemed like a bad idea as I needed to focus my energy on booking clients, but it was uncontrollable. As a human with ADHD, I find it difficult to focus and get work done when I don't have a clean workspace, and given I'm now working so much from home, my entire house has become my workspace. I had spent the last year or so (basically) working three jobs, and my home had officially devolved into a disorganized mess. I began to feel I couldn't do anything else until this was resolved. I was paralyzed. "Clutter isn’t just the stuff on the floor. It’s anything that gets between you and the life you want to be living” - Peter Walsh Officially moving into teaching and coaching full-time, I was finally doing what I wanted to do. Still, the idea of being unable to reach a pan under the counter because there was unnecessary sh*t in the way made me batty. It was like the final step in living my best life. It had to be done. But why was I feeling this way? When I tell you it was uncontrollable, I'm not being hyperbolic. As it turns out, there is a logical explanation and it has everything to do with our mental health. According to a study by Princeton University, researchers discovered that our environment can positively or negatively impact our ability to complete tasks and overall mental health. If the physical space around us feels scattered, our mental space will likely feel the same. A study by the University of Connecticut found that by removing or controlling clutter, we can directly reduce the stress that stems from the mess, which can help us to feel happier, less anxious, and more confident in ourselves. Decluttering can also lead to the following mental health benefits: Boost your mood and help improve your physical health. Completing physical activity while organizing can enhance creativity by allowing the mind to wander. Letting our mind go a little as we manage our clutter can help us relax mentally while our body stays active. Combining the two can boost our mood because we feel less stressed about what once was clutter, and we feel accomplished after seeing the progress! Sharpen your focus. Clutter is very messy and chaotic, so it is no wonder we can struggle to focus. When your space is de-cluttered, it is much easier to obtain a sharper focus because what you see is in a specific place. The sense of organization helps your mind to be on track to complete tasks. Energize you into productivity mode. When you are decluttering, you are problem-solving and getting things done. You gain energy from the visual accomplishments of decluttering. Your accumulated energy can also help tackle other items on your to-do list! Relieve anxiety. When things are not organized or clean, it can bring fear. You may feel constantly stressed, worried, or afraid of more clutter accumulating. To allow our minds to find peace, decluttering can lift that weight and help us think clearly and feel calmer. According to Psychology Today, It is estimated that 1 to 2 million people in North America are living with so much clutter that they can barely walk through their homes or find a place to sit or a surface to rest a plate. Although it is not classified as a separate disorder in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM IV), compulsive hoarding is a debilitating condition that can destroy relationships and tear families apart. In my case, it was the physical clutter of my home, but clutter can include everything from the mess in your kitchen cabinets to the digital clutter of unanswered emails and texts. Chaos can lead to a feeling of overwhelm and paralysis and, as I found out, is directly linked to past trauma. You can learn more here if you'd like to open that can of worms. I've nearly finished my decluttering journey, and I can tell you I have much less anxiety and MORE focus. The relationship between clutter and anxiety is something that many people struggle with. Could clutter be standing in your way or causing (what I like to call) background anxiety? If you're someone who finds yourself constantly battling clutter, it might be time to take a closer look at how it's affecting your mental health. By prioritizing organization and minimizing unnecessary belongings, you can create a space that promotes calm and clarity. You can try these steps laid out by The Queen Bee herself, Marie Kondo, here. Let me know what you discover!

This is a follow-up to my June 5, 2023, post about the relationship between ADHD and menopause. If you haven't already, you can read it here. This journey started when I asked myself, "Do I have ADHD, or is it perimenopause?" The answer is that it's a bit of both. In mid-June, I got an appointment with a highly recommended psychiatrist who takes insurance (I know -- a miracle!) and received an official diagnosis of ADHD. As I mentioned in my previous post, I was pretty confident I'd dealt with this since childhood. Still, it wasn't until I hit perimenopause that the symptoms were exacerbated, and I was forced to pay closer attention. With ADHD being underdiagnosed in young girls, this is the story of many adult women. Suddenly, so many strange behaviors over the years made sense, like my ability to have singular hyperfocus on a task yet procrastinate uncontrollably on others, speaking a million miles an hour, unable to let others get a word in, yet I can employ active listening in my coaching. My ability to have a rockstar-level executive function as an administrative assistant, but I experience time-blindness in my personal life. ADHD is contradictory. This much I have learned. It's such a relief to know there is a reason for the madness, but it's still a struggle. So, what steps have I taken to make it more manageable? Medication isn't for everyone, but I wanted to try it. This was particularly important to me because it's (believe it or not) the surest way to confirm the diagnosis. When you start an ADHD medication, it will either help with focus immediately or make you feel um...unhinged. In other words, if the meds work, you have ADHD; if you feel like you're going to have a panic attack, you don't have ADHD. Pretty simple. I started a low-dose prescription of Vyvanse, and fortunately, it was not the latter. It was a keeper. What do I like about it? Unlike Adderall, it's the timing of the time-release -- Vyvanse provides 10 to 12 hours of symptom control and takes up to one hour before it first takes effect. In comparison, Adderall can last for 10 hours, but the immediate-release formulation only lasts six hours, causing most patients to take an additional mid-afternoon dose. With that, on Vyvanse, you're less likely to crash, and (most importantly) it's less likely to f*ck with your sleep schedule because you're not double-dosing. I'm not thrilled with the idea of taking medication, but the good news is that I don't have to take it every day. For example, I didn't take it on vacation last month, and I don't take it on most weekends. This ability to skip doses also makes it more productive long-term - a genuine concern because as time passes, you can plateau with the dosage, forcing you to take more to get the same results. I want to avoid this. "How about lifestyle, Julia," you might be thinking to yourself. Yes, I changed my lifestyle in addition to taking meds. Firstly, I added additional morning workouts because I feel more focused and energized when I exercise in the morning; if you want to know more about the science of that, you can listen to CTD season three, episode 56, with Dr. Wendy Suzuki here. I started using the Task List feature in the Evernote app and incorporated deadlines with alarms to help me organize my scattered noggin. When having a particularly disordered brain day, I can go to my list and tell myself, "You have X things due by X day. Choose one of these three things on the list and START." I find that's the hardest thing. I often feel so overwhelmed by my to-do list that I don't know where to begin. Parsing my list out into sections by the due date helps with that feeling of being overwhelmed because I can see exactly where I need to start. Another thing I began using is the super, basic iPhone alarm. If I have a busy day, I program my entire schedule into my alarm app. I set each notice to go off at least 15 minutes before the actual task, meeting, or whatever! For example, I set an alarm for 30 minutes before leaving for Physical Therapy and 15 minutes before a podcast interview. This has done WONDERS for my time blindness. Lastly, and most importantly, I've given myself grace. I know it's corny, but I've spent countless minutes, hours, and even days beating myself up for missing an appointment or not remembering an evident and essential detail about something like my dad's birthday. I've been cruel and unforgiving of myself when I would never treat a person I cared about that way.I'm happy that I now better understand what's going on in my head. As I've said before, naming the thing is everything. If you are the slightest bit sus about having ADHD, it's crucial to get a diagnosis. We have SO much coming at us as mid-life women, and it can be empowering to know what the heck is what. Only then can you take the steps to manage it.

Hilary Russo talks to us about the power of Havening! Your amygdala loves to freak out. She does. Yes, it is a she. I’ve met her, and her name is “Amy.” In the Havening world, we call her that because she is many things. Amy is a warrior who wants to stand up for herself. But she is also a scared child that needs protection. And whatever the situation, when Amy feels threatened, she must be reminded of something important. All is well, and you are safe here, in your haven. Enter: Havening Techniques. This neuroscience-based approach uses touch and pleasant distraction to rapidly alter your thoughts, moods, behaviors, and habits (within minutes, really) and permanently. What happens next is like “CPR for the Amygdala®.” Your brain releases the happy chemicals, including oxytocin (love hormone), serotonin, dopamine, and GABA, and then enters a Delta Wave sleep state. Trying to find the calm in the chaos is like hitting a traffic light that’s red and putting the pedal to the metal as if it were green. You just can’t do both at the same time, and the outcome likely won’t work in your favor. You need to self-regulate and find that sweet spot where you’re in the parasympathetic nervous system. And that’s where Havening can be helpful for everyday upsets like stress, anxiety, lack of focus, and sleep to deep-rooted traumas (when working with a certified practitioner) like PTSD, panic attacks, addictions, grief, and fears. There really is no downside to how this beautiful modality can set you free and help you find your clarity, confidence, and calm. It’s also a wonderful (SEL) social and emotional learning tool for children at any stage. The best part of this approach is that you can self-apply to self-soothe for self-care with Self-Havening when it comes to life’s disturbances. And here’s how it’s done. The Havening Touch is three simple moves. This video demonstrates more about how it works. The movement is like you are washing your hands, giving yourself a hug (arms crossed and gently stroking from shoulder to elbow), or lightly caressing your face. When you close your eyes and pair the touch (any or all three) with a pleasant thought (it can be a person, place, experience, or even a song), you are letting Amy know, “I’ve got you,” and you’ll likely feel lighter, calmer and more at peace in minutes. If you feel like you need more support with traumas or deeper-rooted upsets that may be holding you back and weighing you down, it’s always best to work with a trusted and trauma-informed practitioner who can facilitate a session and work with you through the process. Havening has the power to turn your traumas into triumphs and help you heal from within. Give yourself the gift of active emotional well-being by putting the healing in your own hands. It’s the Healing, Understanding, and Gratitude that your mind and body need to be kind to the mind. Check out our CTD podcast interview with Hilary for a deeper dive here. Hilary Russo, is The HIListically Speaking® Health Coach. She is one of the first 150 Certified Havening Techniques Practitioners in the United States and 500 in the world of, only 800 worldwide. Hilary studied directly under the developing doctors of Havening, who have called her a “pioneer” in the field working with children, as well as purpose driven C-Suites execs to Metropolitan Opera singers and media professionals in the field of secondary traumatic stress. Trauma informed, her HUG it Out™ program is designed to mirror back what you don’t see in yourself with neuroscience based tools that help you heal from within. She’s also a Certified Integrative Nutrition Holistic Health Coach, certified Hypnotherapist and award-winning multimedia host/journalist and international speaker focusing on health and wellness. Hilary is also a college professor at St John’s University in NYC. Join Hilary’s HUG it Out Collective on Facebook. You can also find Hilary at the mic hosting the successful HIListically Speaking Podcast: empowering conversations of trauma to triumph through health healing and humor. If you’re interested in learning more about Havening, set up a complimentary HUG it Out session today to see if Havening is right for you! Connect with Hilary on all social media at @hilaryrusso.

I know. As if we need one more symptom or issue to worry about at this stage of life. Am I right? The good news is that NO - there is no connection. Well, not exactly. But. According to CHADD.org (Children and Adults with Attention-Deficit/Hyperactivity Disorder), there is a severe gender gap that leaves girls and women under-treated, under-diagnosed, and often misdiagnosed: Girls frequently display inattentive symptoms, including forgetfulness, trouble paying attention, and problems with organization. Boys tend to display hyperactive/impulsive symptoms, like blurting out or being unable to sit still in class. These hyperactive/impulsive symptoms get noticed more easily by parents and teachers while inattentive symptoms sometimes get ignored. Girls are also less likely to be diagnosed earlier because they often display more symptoms of anxiety. Medical providers may only treat a female patient’s anxiety or depression without evaluating for ADHD. Hormones, which affect the symptoms of both ADHD and anxiety, can complicate things. ADHD was never something that EVER crossed my mind. Not until I was put on a low dose (150mg) of Wellbutrin to treat low libido. If you listen to Circling the Drain podcast, you know that Ellie and I have been on an experimental journey looking for low-libido solutions, and this was part of that experiment. While it didn't help with my libido, it did help with my focus. I was shocked. "Is this how I'm supposed to feel? Are most people this focused?" I thought. It turns out Wellbutrin is prescribed off-label for both low-libido and ADHD. Until then, I thought much of my behavior was perfectly normal. I have an A-type personality and consider myself a person who gets sh*t done; how could I possibly have ADHD? I've worked as a C-suite executive assistant for over 13 years in the high-stress, high-demand world of real estate development. If I didn't have my shit together, I'd fall on my face, right? Maybe. It wasn't until a friend recommended KC Davis' podcast Struggle Care, episode 31: Wait. Am I ADHD? with Dr. Sasha Hamdani, I realized I might be wrong about EVERYTHING. Do you ever listen to a podcast or read a book where you feel like someone is speaking directly to you? It turns out my ability to hyperfocus is probably what has kept me employed all of these years. All people experience hyperfocus in some way or another. You might call it being in the zone. However, when you have ADHD, it's either hyperfocus or NO focus. Women are VERY good at getting by and creating workarounds to cope with ADHD. Are we really surprised? We've been coping our whole lives. As I said, girls are often undiagnosed because their symptoms are not as apparent as with boys. For example, a boy might have outbursts of hyperactivity, but a girl might be hyper-talkative and easily distracted. Boys may openly fidget, while girls (taught to keep to themselves) may bite nails, pick cuticles or sometimes describe "internal hyperactivity." I think you can imagine what that is. Also, this trapped energy might manifest as a tic. More on all of that here. That was my story. I used to go through bouts of blinking uncontrollably. My mother's solution was to take me to the eye doctor, who (of course) said there was nothing wrong. I mean, it was the 80s. This habit went on for years, and I still want to do it occasionally (my husband has caught me), but as an adult, I have more control over my body, so I'm more aware. What does all of this have to do with peri/menopause? ADHD can be exacerbated by hormone fluctuations and everything else that comes with this time in life! More on that here. You might have gone your entire existence thus far without knowing you had ADHD, normalizing some minor, strange behaviors until something happens that forces you to pay attention. Like when I missed three different podcast recording appointments because of something called time blindness. I went from asking myself, "Is it me or is it perimenopause?" to "Is it me, perimenopause, or ADHD?" Indeed, many symptoms of peri/menopause are also symptoms of ADHD. For example, forgetfulness, depression, anxiety, and irritability, overlap, making it hard to tease out what is what. Some less common symptoms here: Being easily distracted Frequently failing to complete tasks, work, or chores Making careless mistakes Easily losing items Forgetting to do necessary tasks Having difficulty making plans Feeling easily overwhelmed by tasks or projects Inability to commit to a decision Difficulty with time management If any of that resonated with you, I'd suggest starting with the podcast episode I listed earlier. If it makes you feel seen, you might want to schedule an appointment with a therapist who can evaluate you and ultimately refer you to a psychotherapist for further help. I'm meeting with a specialist this week and will keep you all posted!

Certified EFT practitioner Sarah Louise Lilley tells us what it is and why it's great for regulating stress! Stress's profound, negative impact on our bodies has been extensively documented. 🥁Insert dramatic drum roll… Fortunately, there’s a powerful technique called Emotional Freedom Technique (also known as EFT or Tapping) that can help regulate stress. While EFT is commonly used for addressing PTSD, trauma, and phobias, it’s also a tool to alleviate everyday stress. Scientifically proven to lower cortisol (the stress hormone) and increase DHEA (the recovery hormone.) EFT is a simple and effective tool that only requires using your fingertips! 🖐️ Tap Away Stress: Whether you’ve just experienced a difficult interaction with a family member, are preparing for a challenging work meeting, or are winding down at the end of the day, I encourage you to tap. Tapping enables you to acknowledge and release the stress in your body, preventing its accumulation. A Moment to Pause: Tapping also allows you a valuable moment to pause. During times of stress, blood flow is diverted away from our brains, impairing clear thinking. EFT provides an opportunity to calm the nervous system, allowing cognitive function and creativity to resurface. Doing so allows us to consciously choose how to respond rather than reacting from a triggered or habitual place. Calm the Body, Calm the Mind: Unfortunately, we seldom indulge in positive fantasies. Imagine if we were obsessed with all the good things that might happen! However, particularly when stressed and anxious, it’s easy to fall into negative thought patterns, ruminating about potential future catastrophes. Tapping breaks this cycle, serving as a powerful pattern interrupt. As I frequently tell my clients, the stress isn’t in your head; it's in your body! When you calm the body, the mind follows. A Simple Practice to Calm the Nervous System: If you’re feeling triggered, anxious, or stressed, here’s a simple practice that can help you move from your mind to your body, process stress, and calm your nervous system. Tune into your body. Notice where in your body you feel that stress. Is it in your head, stomach, or solar plexus? You can even put your hand on that part of your body. Does the sensation have a color, texture, size, or shape? Maybe it feels like a lead ball or a swirl of gray fog. Then Tap on the EFT collarbone point, or move through the EFT points as you breathe into that physical sensation. Not forcing anything, but breathing into it as you allow it to shift. Embracing the Power of EFT you hold within your fingertips (literally🤣) the ability to tap away stress, pause, and break free from negative thought patterns. Happy Tapping! ❤️ Sarah Louise Lilley is a certified Emotional Freedom Technique or “Tapping” practitioner. She loves helping people overcome their fears, blocks, and phobias. Sarah is a mentor at EFT Universe, where she teaches and nurtures the next generation of EFT practitioners. A former actor and producer, she is also a mom and an avid equestrian - always counting down the days until she can get back on a horse! Based in NYC, Sarah works with clients worldwide via Zoom. To learn more, you can visit her website here. Listen to her interview dropping July 5th on Circling the Drain Podcast here.