Search results for stress and hot flashes

Needles and symptoms and a pathway, revealed…more on acupuncture

Posted by Liz on Oct 17, 2011 in hot flash, menopause | 0 comments

Click on acupuncture in the tag cloud and you’ll know that I’ve spent a number of years examining and sharing information about important studies on this blog. In some, acupuncture has been shown to alleviate vasomotor symptoms like hot flashes and night sweats, and in others, acupuncture appears to be no better than placebo or sham needles that are placed on accurate points but not actually inserted into the skin. However, I’ve also long argued that by slightly changing the way that we conduct scientific studies in the West and allowing for individualization, observed benefits might be different. Indeed, that’s exactly what researchers have seen with ACUFLASH and you can read more about that trial here.

Less clear that whether or not acupuncture can help symptoms (for the record, I am biased and I believe that over time it can), is HOW it works. The centuries old Chinese medicine paradigm is never so apparent than with acupuncture and although I am not sure why we need to know the ‘how,’ I am fairly certain that until it is revealed, there will be a lot of researchers and health practitioners questioning its validity or utility.

So, this brings me to a wonderful pilot study in the online version of Menopause, exploring that very question: how does acupuncture work on vasomotor symptoms?

In this small trial, 33 perimenopausal and postmenopausal received traditional acupuncture, sham acupuncture or nothing over a period of 12 weeks. The active groups received three treatments per week and all the women reported having at least 7 hot flashes a day. But there’s the rub: the researchers also looked at how traditional acupuncture affected the hypothalamic-pituitary axis (HPA), the part of the body that comprises the hypothalamus and pituitary and adrenal glands, controls digestion, our immune system, mood and emotions, sexuality, and how energy is used and stored. Moreover, this part of the body reacts quite negatively to stress by releasing a hormone known as cortisol. Not surprisingly, women who have very severe vasomotor symptoms tend to produce high levels of cortisol.

What did they learn?

• Most of the benefits, (e.g. reductions in hot flashes) occurred by week five and; hot flash severity and frequency declined by 86% and 78%, respectively in both the real acupuncture and sham acupuncture groups. But while the sham acupuncture group didn’t continue to improve, the real acupuncture group did.
• Likewise, anxiety and depression improved in both of these groups, as did sleep scores.

And the “how?”

It appears, at least from this small study, that acupuncture positively affected levels of cortisol and DHEA, the major steroid secreted by the adrenal glands that affects none other than the body’s production of estrogen. Consequently, if acupuncture helps to control the HPA, and HPA affects vasomotor symptoms, then perhaps scientists have the first clue as to why acupuncture may help certain menopausal symptoms. It also opens up an entirely new avenue for novel strategies to control them.

The bottom line is that there is hope and a new direction that researchers will ideally follow. Ultimately, acupuncture may prove to be even more effective than pharmaceutical strategies for menopausal symptoms and definitely, much safer.

The jury’s still out but it seems a helluva closer to a verdict.

Meditation in motion: Tai Chi and the ‘pause

Posted by Liz on Jul 11, 2011 in aging, heart disease, mind-body therapy | 0 comments

I’ve written about yoga and meditation/mindfulness training and how both may help with menopausal symptoms in terms of alleviating stress and improving overall wellbeing. However, what about Tai Chi?

Tai Chi is an ancient Chinese martial arts practice that uses a self-paced system of soft flowing movements to improve respiration and deep relaxation. It has also been shown to boost muscle strength, coordination and physical condition, improve balance and like yoga and mindfulness training, benefit overall wellbeing. On the health side, it’s been linked with better sleep quality and duration, enhanced circulation and in fact, is considered a weight-bearing exercise akin to aerobic exercise of moderate intensity. As such, it may even help prevent osteoporosis. Yet, unlike regular strength training Tai Chi appears to offer an important means by which risk of metabolic heart disease during menopause may be reduced.

For women specifically, hormonal changes – namely a steeply progressive increase in testosterone — can contribute to a risk of developing metabolic syndrome (i.e. the cluster of risk factors — abdominal fat, high blood pressure and cholesterol levels and insulin resistance –that increases the likelihood of developing heart disease and diabetes). Moreover, as women age, the ability to effectively metabolize blood fats and maintain ample antioxidant defenses in their bodies requires higher maximal aerobic capacities (which inherently decline with age). Conversely, being sedentary deteriorates the efficiency by which fats are burned or utilized by the body and also negatively affects antioxidant defense lines and their ability to adapt to sudden or chronic exposure to oxidative imbalances in our bodies that can wreak havoc on cells and lead to build up of plaques and heart disease.

Where does Tai Chi fit in?

Yogic pranayma breathing has been linked to improvements in antioxidant capacity and in lower oxidative stress markers. Moreover, it may also improve cardiorespiratory function. Tai Chi combines postures with slow, deep breathing (i.e. 6 breaths per minute) and may also convey the same benefits. In a recent study published in the Journal of Aging Research, 8 premenopausal and 7 post menopausal sedentary women were asked to participate in an 8-week Tai Chi program that involved the following:

• 75 minute training sessions twice weekly consisting of  a 5 minute check in, 10 minutes of stretching/warm-up, and 60 minutes of a modified 18-posture Tai Chi and Tai Chi fan style. The Tai Chi routines coupled breathing to music, took a minute to a minute and a half per motion. The women learned five to 10 postures per week and the complete set was practiced for two weeks. Instructors were also sure to monitor and correct postures during each class.
• Twice-weekly, 60 minute at-home practice that also included completion of a log that detailed the practice (to insure compliance).
• Measures of body weight, diet, physical fitness, balance, flexibility, muscle strength, maximal aerobic capacity and blood samples.

Not only did 8 weeks of Tai Chi practice significantly improve balance, muscle strength and flexibility in both groups, but also produced as much as an 18% decline in a major marker for heart disease risk (i.e. plasma total homocysteine). Additionally, Tai Chi combined with measured, slow deep breathing improved the activities of antioxidant markers in the bloodstream that play a role in defending cells against damage from oxidative stress.

Although this study is quite small and bears repeating with significantly higher numbers of women, the findings do imply that Tai Chi and slow deep breathing have the potential to play an important role in improving functional/physical declines that occur during menopause and equally if not more importantly, improve antioxidant defenses against metabolic diseases, especially heart disease. Tai Chi is not only low impact, low-velocity and safe, but within the framework of menopause, it may prove to be a golden ring amongst alternatives to prevent disease. Meditation in motion, indeed.

Hot flashes and night sweats. Mind over matter?

Posted by Liz on Jun 20, 2011 in hot flash, nightsweats | 2 comments

[youtube=http://www.youtube.com/watch?v=LH8xbDGv7oY]

Hot flashes and night sweats, oh my! They hit like a ton of bricks when you’re least expecting them and then exit as quickly as they arrived. They affect up to 70% of women and tend to worsen in late perimenopause and in menopause. And while hormone replacement therapy may decrease how bothersome they are and good health diminish frequency and severity, it appears that how well women believe they are controlling their symptoms outplays all of these other factors, so much so that perceived control may actually beneficially affect emotional distress, prevalence and severity of symptoms and how often women engage in behaviors that benefit their health.

Findings of a  new study that’s just been published online in Maturitas run counter to many that came before it, studies that have shown that smoking and body mass index and alcohol consumption, as well as marital status, age, professional status, parity, educational status and income may significantly influence hot flash prevalence, frequency and severity. However, this time, researchers found that among 243 women between the ages of 42 and 60 years, the most important factor was control.

Participants were first asked to assess the intensity and intensity of hot flashes and night sweats on a five point scale (i.e. never to daily to almost every day and not intense to extremely intense). They were also asked to estimate perceived control over their symptoms using a validated rating scale. Finally, menopausal status, i.e. pre-, peri- and post- were assessed. Additionally, common sociodemographic and lifestyle factors shown to influence hot flashes and sweats were accounted for.

Importantly, women who used no medications or used soy and herbal products had higher perceived control over their symptoms than women who used hormone therapy. Moreover, this distinction had nothing to do with how severe their symptoms were as the researchers say that severity was similar among all three.  Additionally, women who drank greater amounts of coffee appeared to perceive their symptoms as less severe than those who drank less. While previous research has found the opposite, i.e. caffeine intake predicts the occurrence of hot flashes, it is possible that the stimulation associated with caffeine might have boosted coping mechanisms and strategies, thereby leading to fewer or less severe symptoms. Still, perceived control ruled the day, leading to a significant beneficial impact on severity of flashes and night sweats. The reason? It’s possible that feeling in control leads to other behavioral changes, such as dressing in many layers to allow for adjustments as the inner temperatures increase, avoiding spicy foods or effectively controlling stress. However, the results also imply that how much control we feel we have strongly influences how we ultimately feel.

Clearly, more research is needed. But when it comes to hot flashes and night sweats, mind over matter may play a strong role.

Puffing away the years: smoking and early menopause

Posted by Liz on Jun 3, 2011 in Early menopause | 1 comment

A few years ago, I wrote a post linking cigarette smoking to early menopause. And yet, questions remained about duration of smoking and the quantity of cigarettes in terms of their influence on timing. Hence, I thought that it might be worthwhile to take a closer look at the issue and see if there was more information.

A few facts:

It’s estimated that by the year 2030, there will be over 1 billion menopausal women in the world, with roughly 47 million women entering menopause annually. Yikes! That’s a whole lotta hot flashes, night sweats, mood swings and the like. And, what this means is that information is power (and empowering). Importantly, research has also shown that early menopause is associated with greater mortality, heart disease cases and osteoporosis. In fact, for every year that menopause is postponed, there is a 2% reduced chance of death due to heart disease. On the other end of the spectrum is late menopause, which is also associated with health issues, including an increased risk for breast, ovarian and uterine cancer.

So, what are the factors that appear to determine the timing of menopause? Well, things like obesity, alcohol consumption, mother’s age, social class, long menstrual cycles, multiple childbirths, oral contraceptive use and even exposure to pesticides have been linked to later menopause, while smoking has been shown in multiple studies to increase the likelihood for early menopause. This issue may be even more relevant for the late Boomer generation who came to age in the 70s, a time when cigarette and marijuana smoking were the norm and not the exception. That generation, by the way, is my generation.

Here’s what we know:

In a thorough review of 109 published studies, researchers have found the following:

• Current smokers appear to enter menopause anywhere from 2.5 months to 2.5 years earlier than non-smokers and have 1.3 to 1.7 times greater odds for early menopause
• Former smokers appear to start menopause as much as 2 years earlier than non-smokers, with the risk ranging from 30% to as high as 80%
• Although there is not a lot of information on the severity of smoking habit and menopause (i.e. number of cigarettes smoked daily), there is some indication that women who smoked more than 20 cigarettes daily were likely to start menopause as much as 2 years earlier than women who smoked 11 to 20 cigarettes daily
• The relationship between number of years having smoked and early menopause is unclear

There are numerous reasons why smoking may lead to earlier menopause, including interference with estradiol levels, an increased loss of eggs and an increase in the levels of androgen hormones, which counteract activity of estrogen in the body. And, despite the differences between the studies that the researchers examined, they say that a clear link was demonstrated between smoking and starting menopause at an earlier age. The impact of quantity and time (or years) smoking is less consistent and still not completely clear.

The overriding message is that if, like me, you are a former smoker, you might find yourself in a position of starting menopause a wee bit earlier than expected. Consequently, there’s no time like the present to start taking preventive measures, like increasing calcium intake, changing your dietary habits or improving your exercise regimen. Mind-body exercises like meditation or yoga can ameliorate stress and improve overall wellbeing. And black cohosh? Personally, I swear by it. In concert, these steps might shut down or at least keep the magic menopause dragon at bay.

Menopause: outlook and outcomes. Is it you? Or them?

Posted by Liz on May 6, 2011 in appearance, hot flash, menopause | 2 comments

When you start flashing and sweating, the whole world, especially the world under the age of 45, is watching and judging, right?

Not so fast. In fact, what I think you think, may not be what you think at all. In other words,  personal attitudes about menopause and its symptoms could be shaping how well or poorly it’s experienced. And this experience may be based in beliefs, moods and perceptions, not reality.

According to research, many women say that menopause makes them feel “stupid, embarrassed, incompetant, unattractive, etc.”

However, more importantly, these women believe that others have the same thoughts about them, which researchers say are likely to influence the types of strategies women use to manage their symptoms, strategies that range from “keeping up appearances” to avoiding social situations altogether.

When I read this, I started to wonder if menopausal women are actually stacking the deck against themselves and contributing to societal attitudes about aging and menopause. What’s more, do women misperceive how younger adults feel when they start flashing around them?

To answer these questions, researchers polled 290 young men and women between the ages of 25 and 45. Almost two thirds were female. The questionnaire was geared towards answer the following:

• How are hot flash symptoms, namely redness and sweating, perceived when they occur?
• What types of beliefs exist around menopause?
• Is there any relationship between age, gender and perception about menopause?

Importantly, over half of those polled attributed a red face to emotions, e.g., embarrassment, anger or stress. However, while younger women tended to attribute redness to an increase in body temperature, younger men tended to believe that redness was related to physical exertion. Similar responses were provided for sweating, with women attributing sweating to a health problem and men, to environmental temperature. Hormonal factors and menopause were reported by less than half (41%) of men and women polled.

Also important was the fact that overwhelmingly, both men and women indicated that they felt empathy or neutral about symptoms and not at all uncomfortable, and almost all (97%) would inquire if a woman was feeling well or ill.

These responses truly suggest that menopausal women tend to overestimate the extent to which others are able to judge their menopausal status. Moreover, young men and women tend to empathize and show concern and compassion, emotions that are inconsistent with expectations that others will react negatively to a public hot flash or associated redness. Even more important, age did not appear to influence general beliefs about menopause, which researchers suggest implies that “the experience of menopause, or seeking information about menopause in mid life, might lead to more neutral or positive beliefs.”

So, what does this all mean? Granted, the sample in this study was primarily female and self selecting, meaning that they chose to participate or not. Therefore, it is possible that these findings do not accurately reflect the views of a broader population, especially men. However, the researchers do point out that they attempted to find participants from a variety of occupations that were more specific to setting where women might report a higher degree of social embarassment.

Nevertheless, what these findings do suggest is that real life might actually contradict how women feel others feel about their menopause, and that reactions might actually be tempered or non-existant in social settings. This should encourage a broader population of menopausal women to overcome their fear of embarrassment or to no longer resign themselves to “coping” but rather, empower them to take charge.  On a larger level, they also show that there’s a need to step up and negate stimatizing or negative views of menopause, even amongst ourselves. This can be achieved through sharing of experiences, not only with similarly aged women but also, with younger women and men who can gain a lot of life experience at a considerably younger age.

The next time you start flashing in public and looking around to see who’s staring, just remember that it may be you, not them. And your ‘tude will truly rule the day (and those flashes), if you let it.