Posts made in September, 2008

Hell Hath No Fury

Posted by Liz on Sep 6, 2008 in women's health | 1 comment

Hell appears to be amongst the number one search term on the Internet.

Do you think that folks are doing research on accommodations before their final visit? Exploring the esoteric fabric of our existence? Seeking a thrill by typing in their browsers a word that was once thought to be one of the worst of those four letter wonders?

I could probably spend hours pondering the why’s. But since Mother Nature is wreaking her hell on the East Coast this weekend with daughter Hanna, I’d rather revisit one of my most popular posts. This is a tribute of sorts and to remind us that there ain’t nothing more furious than Mama when she’s messed with. Double-entendre? You bet!

Enjoy!

Seems like menopause was viewed as a “woman’s hell” back in the 18th and 19th centuries. A time when the uterus was thrust into “tumultous state of utmost irritation and disorder.” Contributing to this were bad habits such as premature arousal of sexual desire, reading bad novels, and overly spicy and rich foods. Apparently, it was even exacerbated by lounging around all day and breathing the bad air in salons.

This throws my evening plans right out the window!

A woman’s hell? Medical perceptions of menopause in preindustrial Europe

Historical summary of views of menopause. First paper on this written in 1774, word “menopause” coined in 1812, and first popular women’s guidebooks on the subject in the early 1800s “sold out in a few months”. Early view was that with age the uterus became too weak to expel the vile humors of the menstrual fluid, which backed up to turn to fat, breast and uterine tumors, and many other diseases, creating a “woman’s hell”. Later view was that the menopause was more of a natural process (although a women should be at that point asexual), but that the problem was the perimenopause, when the uterus, felt connected to the nervous system, went through a “tumultuous state of utmost irritation and disorder” which was then transferred to the rest of the body. “She became more sensitive, agitated, and easily afflicted by disagreeable incidents; pleasure was indifferent to her; she became sad and easily grew upset against her children, her husband, those around her, sometimes yielding to violent outbursts.” It was also remarked that simple country women suffered few or no complaints compared to upper-class urban women, who “constantly exposed body and mind to all kinds of disturbances and irritations. The demands of social life, the premature arousal of sexual desire, masturbation and loose sexual mores, the reading of bad novels, the unnatural state of excitation caused by concerts and theater, dances and gambling, and overly rich and spicy food, the abuse of coffee, tea, tobacco, wine and spirits–all this created an unrelenting state of over-stimulation. It was made even worse by a life of idleness spent reclining on cushions and chaise lounges instead of attending to domestic duties, by an unwillingness to breast-feed, and by the bad air in overcrowded salons.”

Solberg M. 1999 Bull Hist Med 73;3:404-28.

My Dream: West Meets East…Someday

Posted by Liz on Sep 4, 2008 in herbal medicine, Meditation/mindfulness therapy, women's health | 3 comments

In 2005, a panel convened by the National Institutes of Health issued a statement emphasizing that menopause is not a disease. Yet, only yesterday, I ran across a newly-issued primer on menopause that is geared towards primary care physicians. In the introductory paragraph, I found the following statement:

“Managing menopausal health requires an ongoing effort to keep up with date with data on medical management of menopausal symptoms and treatments designed to prevent a number of disabling conditions associated with menopause and aging…”

Delving deeper,  I found only eight paragraphs devoted to alternative therapies (namely, phytogestrogens, black cohosh and bioidentical hormones). What jumps out on the one full page on which they are reviewed are statements such as:

“…controversy regarding long-term safety issues.” (black cohosh)

“…these same hormones are used in less expensive, FDA-approved estrogen products.” (bioidentical hormones)

“…evidence to date suggests that phytoestrogens do not ameliorate hot flushes or other menopausal symptoms. In addition there are not data to support the safety of long-term therapy with phytoestrogens and other herbal medications.” (phytoestrogens).

I’ve got a few bones to pick.

1. Historically, controlled studies with herbal preparations have been underfunded and undersupported by national institutions in this country, which is why the Western practitioner often claims “scant evidence.” Yet, if you do a search on alternative therapies on PubMed, there appears to be a growing interest in their utility and an increasing amount of time and resources devoted to studying them. Studies are published regularly in peer-reviewed journals such as Menopause. I’ve blogged about controlled evidence on a regular basis for months now. And, even the Nationa l Institutes of Health is in on the act; with trials currently underway evaluating the role of meditation, soy estrogens, herbal alternatives (e.g. black cohosh, red clover) for menopausal symptoms.
2. The controversy over long-term safety issues and black cohosh is being seriously addressed. I blogged about this only a week ago, noting that the National Institutes of Health Office of Dietary Supplements has publicly stated that millions of individuals have safely used black cohosh with no ill effects.
3. The North American Menopause Society-sponsored monograph highlights several advantages that bioidentical/compounded hormones might offer over conventional products, including greater dosing flexibility, lower doses for women who are especially sensitive and the avoidance of potential allergens.

The primer to which I refer was developed specifically to help primary care physicians understand the challenges that their menopausal patients face so that they can provide better care. However, the monograph does a great disservice by its sole emphasis on Western medical approaches verses Eastern whole-body approaches.

Physicians- if you’re listening, hear this:

MENOPAUSE IS NOT A DISEASE AND SHOULDN’T BE TREATED OR APPROACHED AS ONE.

A few thoughts:

• Please review your data, read alternative peer-reviewed journals and educate yourselves about  alternatives for your patients who have been scared off by the negative findings surrounding HRT and antidepressants and other pharmaceuticals.
• Pay attention to the fact that well-respected journals such as Menopause and Climacteric and the Journal of the British Menopause Society actually devote pages to alternative therapies that have been evaluated in well-controlled studies.
• Embrace multidisciplinary collaboration and invite educated and credentialled alternative practitioners into your fold who might be able to offer you and your patients important solutions when Western ways fail.

Over 5,000 women enter menopause daily. Many of these women are going to call on your for help with managing this very natural transition that we call the menopause. Why not take a moment and meet the challenge without pigeonholing it?

Thoughts anyone?

The Early Bird Gets the Worm

Posted by Liz on Sep 3, 2008 in Meditation/mindfulness therapy, stress, women's health | 1 comment

[Credit: Sailingscuttlebutt.com]

A friend wrote to me recently and mentioned that a clinical psychologist had told her that she is seeing more and more patients who are entering early menopause. The cause? Apparently, stress has something to do with it.

Another myth to debunk? Or is there something to this?

I found two studies in the American Journal of Epidemiology whose findings appear to suggest a role for stress in predicting an earlier age at menopause. Yikes!

In the first study, published in 1997, researchers sought to identify factors that might determine age at which menopause would start. They studied the effects of demographics, reproduction history, number and length of stressful events (i.e. those occurring within the last 6 months and those lasting longer than 6 months) and other health factors. 185 women were studied for approximately 8 years.

The findings showed that earlier age at menopause was associated with women reporting irregular menstrual periods in their 40s, who smoked, were African Americans or on diets. More importantly, however, stress predicted earlier menopause in both women who were African American and in women who reported having irregular periods.

In the second study, published in 2007, French researchers examined the potential role of occupational factors in determining the age at which a woman started menopause.  Using several statistical models, the results showed that among the 1,594 women studied, earlier age of menopause was associated with having a high-strain job and difficult schedules. Additionally, earlier menopause was associated with smoking more than 10 cigarettes a day.

Taken together, these data, in more than 1,600 women, show that there are indeed, certain factors that play a role in prompting an earlier menopause. Stress clearly has a part to play.

I’ve written previously about stress and its role in menopausal symptoms, as well as steps that can be taken to lessen stressors in our daily lives.  They include yoga, acupunture, reiki, deep breathing exercises, and of course, meditation.

While we might not be able to alter the course of history, we might be able to insure that the path is a bit smoother going forward. In this particular situation, being an early bird is indeed, a good thing for years that follow.

Ch Ch Changes

Posted by Liz on Sep 1, 2008 in heart disease | 2 comments

Among the many changes that occur during menopause, one of the most potentially dangerous is actually being attributed to testosterone rather than estrogen.

Results of a 9-year study study published in the July 28th issue of the Archives of Internal Medicine show that the key hormonal change associated with developing the metabolic syndrome is the steep and progressive domination of testosterone. What’s more, this increase occurs independently of aging and other potential confounding factor (such as smoking, body mass index, ethnicity, marital status and education).

(Metabolic syndrome is a term used to describe the cluster of risk factors (e.g. abdominal fat, high blood pressure and cholesterol levels and insulin resistance) that increases the risk of developing heart disease and diabetes. It affects up to a third of women after age 55.)

Study participants included 949 women recruited from the ongoing  Study of Women’s Health Across the Nation, which is examining factors that affect health and quality of life in women during their middle years.  Women were either premenopausal or in early menopause, and had never used HRT.  Overall, women were shown to have a 1.45 times greater risk of developing the metabolic syndrome in perimenopause and a 1.25 greater risk after menopause.

So, let’s do the math.

1. Metabolic syndrome is closely associated with high blood pressure, obesity, and insulin resistance.
2. Menopausal women are at increased risk for abdominal redistribution and weight gain.
3. Regular exercise/physical activity and a diet that is rich in fruits and vegetables and whole grains, and low in saturated fats, are essential.

With regards to the predominance of testosterone, well, that’s just one more hurdle to overrcome. In the coming weeks, I’ll see if I can find a few evidence-driven tips to counteract this imbalance. In the meantime, we’ve got yet another reason to keep moving!