The alternative alternative: physician-prescribed alternative medicine
In addition to exploring mid-life emotional, physical and social issues, Flashfree is about effective alternatives to hormone replacement therapy for menopausal symptoms. A huge challenge in this arena is that alternatives are often automatically dismissed as “woo woo” medicine, with naysayers claiming that there is little scientific evidence to support their use. Nevertheless, I have long believed that with the proper considerations and adjustments to the way that medical studies are conducted, findings might prove to be very different than they are. That’s why I’m heartened to read that mind-body medicine, which includes yoga, tai chi, qi gong, meditation, guided imagery, progressive muscle relaxation and deep breathing, comprises a large portion of the types of practices that are being incorporated into everyday life (and medicine).
Is the tide turning?
It may be, at least when it comes to mind-body strategies.
According to a study in this week’s Archives of Internal Medicine, over 41 million Americans report trying some sort mind-body strategy. More importantly? About 1/8th, or 6.36 million of these individuals are using these strategies on the recommendation of their healthcare providers, most of which involves deep breathing, meditation and yoga or a combination thereof. Moreover, complementary strategies are apparently suggested mostly in people who have chronic illness, such as pulmonary disease or anxiety. On a broader level, physicians are increasingly recommending mind-body therapy to individuals with neurological deficiencies including headaches, migraines, back pain with sciatica, strokes, dementia, seizures or memory loss. Meanwhile, in so far as menopausally-related symptoms, there is evidence that mind-body medicine may ease hot flashes and promote overall wellbeing (which in turn, eases symptom severity).
For something that is as easy and safe as mind-body medicine, one has to wonder why it’s taking so long to catch on. And yet, the question remains: are physicians starting to turn to alternative or complementary strategies because conventional medicine isn’t working or has been just about exhausted for a particular condition or patient? Is it possible that physician recommended alternative strategies lead to better outcomes or declines in use of the healthcare system? Only time will tell.
Stay tuned.
Read MoreAin’t no “woo woo” going on. Mind, body, relaxation and health
Relaxation.
It’s so elusive for many of us. And yet, so important to our overall health and wellbeing. In fact, researchers are finally discovering how relaxation actually counters changes that occur in our bodies that result from exposure to constant stressors.
For decades, Dr. Herbert Benson, founder of the Mind-Body Institute in Cambridge, MA and an associate professor at Harvard University, has been writing about the relaxation response, a “mind-body intervention that elicits deep changes in the physical and emotional response to stress.” Strategies that elicit the relaxation response include meditation, yoga, tai chi, Qi gong, deep breathing, controlled muscle relaxation and guided imagery. And although many would like to point to the “woo woo” factor at-play, an evolving and wide body of published literature is indicative of how interested the medical community is in the mid-body connection and the positive changes that these practices promote, including a slowing or heart rate, a reduction in blood pressure, improvements in blood sugar and fats, and even boosts in our immune system. However, what has long eluded researchers is what actually happens in the body to achieve these improvements.
In a novel study published in 2008 in PLoS ONE, Dr. Benson and his colleagues looked closely at 19 volunteers who had practiced relaxation response strategies (e.g. meditation, yoga, repetitive prayers) for as long as 20 years and compared them to 20 novices, individuals with no relaxation practice experience. These novices were provided with training sessions for 8 weeks that included information about how to reduce daily stress and the relaxation response and a 20 minute, individually-guided session comprising diaphragmatic breathing, a body scan and meditation.For 8 weeks thereafter, the novices then used a 20-minute relaxation CD at home and were asked to review the informational brochures. Blood samples and analysis of gene expression between experienced and novel relaxation practices, and pre- and post-training were then compared.
Importantly, while the researchers observed distinct changes in the genes in experienced relaxation practitioners compared to novices, when the novices started to incorporate relaxation practice into their lives, they also started to express similar positive alterations in their genes. Moreover, these changes are directly related to how cells respond to stress and create free radicals and inflammation that can lead to long-term damage. Additionally, type of relaxation strategy that was practiced was of no important; by achieving a relaxation state, individuals could make positive changes in their cellular structures thought to promote health.
Both inner and outer psychological states and environmental factors play a role in how women experience peri and post-menopause, their self-esteem, attitudes and severity of symptoms. If a daily practice of some sort of relaxation strategy can actually alter genes in a way that improves health and well-being, why can’t that daily practice also improve the menopausal/midlife experience?
While I’ve long embraced the idea, I’ve never actually made a concerted effort to incorporate some sort of relaxation strategy into my daily activities. I’m going to change that. Ain’t no woo woo but a woot woot so far as I can tell.
Read MoreWhat’s your sleep number?
[Rembrandt van Rijn, Sleeping Woman, 1658]
On a scale of 1 to 5 would you say that your sleep number (the quality of your sleep) is:
- nonexistent, I never sleep
- occasional, I sleep one or two nights a week
- obstructed, I sleep but I wake up regularly throughout the night
- pretty good, I rarely wake up
- great, I typically sleep through the night
If you are like most peri- post menopausal women, it’s likely that you rate the quality of your sleep about a “3. ” In fact, a review in the journal Current Neurology and Neuroscience Reports suggests that 28% to 64% of peri- or postmenopausal women have some form of sleep disturbances that may aggravated by sleep apnea, periodic limb movements syndrome (restless leg syndrome) and psychological distress (anxiety, major depression).
One of the primary causes of sleep disruption during menopause is declining estrogen levels, which increase peripheral and central temperature, dilate blood vessels and lead to hot flashes. Unfortunately data also suggest that hot flashes double the time spent awake although ironically, they often follow rather than proceed awake times.
More good news: both sleep apnea and periodic limb movements syndrome increase with age. Menopausal women are espeically at risk due to declining progesteron levels and increased body mass index (and associated increases in neck circumference). Both sleep apnea (in which the airways become partially or totally obstructed) and periodic limb movements obviously interefere with sleep quality. In fact, sleep researchers have documented apnea, restless leg syndrome or both in up to 53% of women between the ages of 44 and 56.
The evidence is less certain for mood disturbances and sleep, although studies have shown clear links between reproductive hormonal changes and clinical depression in women going through menopause. What’s more, women in menopause who are clinically depressed have reported more frequent and longer times awake than those who do not have any mood disturbances.
Steps to take
I’ve written previously on this issue and there are a variety of non-pharmacologic steps that might improve sleep quality including standardized herbs and acupuncture.
Hypnosis, relaxation techniques that include breathing and/or biofeedback) may also assist. These strategies are part of a larger approach called cognitive-behavioral therapy for insomnia (CBT-I) which in a small study, was found to significantly improve anxiety, depression, partner relationships, sexuality and hot flashes in menopausal women.
Notably, the benefit of HRT for sleep/mood disturbances remains unclear and studies are inconclusive.
As with any issue associated with menopause, it’s critical to speak to a health practitioner about the issue so that the course of therapy can be safely individualized and personalized.
What about you? How’s your sleep? And what are you doing about it?
Read MoreHi ho, hi ho….
It’s off the work we go.
I’ve seen this joke a zillion times. And I’m not amused.
But seriously. A study reported in ‘Ahead of Print’ edition of the journal Menopause suggests that a majority of menopausal women report daily physical or emotional symptoms that significantly affect their daily personal, professional and social lives.
Researchers surveyed 961 members of the National Association of Female Executives about their knowledge and understanding of hormone replacement therapy. The participants were divided into subgroups based on whether or not they were pre-, peri-, menopausal or post-menopausal.
Among study participants, 88% reported personal experiences with menopause, 95% had physical symptoms and 79% had emotional symptoms. Some 40% said that these symptoms caused problems in at least one area of their lives. More than a third of women who used HRT to treat symptoms cited the health concerns as a reason for discontinuing.
Undoubtedly, individualized care is critical to improving quality of life for women in or around menopause. Indeed, the researchers cite this in their conclusion. But when it comes to our professional lives, how can we improve our daily experiences when hormones are wreaking additional havoc on daily stressors and challenges?
I would like to suggest that integrative therapies may offer a path to salvation. For example, pace respiration or meditative breathing can easily be done at your desk or even on a park bench during a lunch break. A 1995 article in Menopause found a decline in the number of hot flashes and average skin temperature among women who practiced breathing exercises.
Paced respiration involves deliberate inhalation and exhalation of air.
- Sit comfortably
- Inhale for 5 seconds through your diaphragm (the goal is to fill your diaphragm, not your upper lung area), pushing your diaphragm out
- Exhale for 5 seconds, pulling your diaphragm in and up
- Repeat several times
Another technique is known as “counting breath:”
- Sit in a comfortable position with your spine as straight as possible
- Count your inhalations and exhalations. When you inhale for the first time, think “one.” When you exhale, think “one.” Next, think “two,” and so on. Continue until you reach 10
- If you have time, start over again and do another set of 10
- The ultimate goal is to 5 sets
Meditation takes time and practice so try not to beat yourself up if your mind wanders while doing either of these exercises. The primary goal is to focus on your breathing and to calm your inner and outer fire.
Any other practices that work for you? I’d love to hear!
Read MoreMy Dream: West Meets East…Someday
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.
- 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.
- 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.
- 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?
Read MoreThe Early Bird Gets the Worm
[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.
Read MoreArchives
Tags
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.