Wednesday Bubble: PMS and the ‘pause

Posted by Liz on Apr 10, 2013 in Uncategorized | 0 comments

Hey all you perimenopausal women! Have you been taking a familiar walk of late? If you are anything like me, wondering how the walk down (Peri)Menopause Lane has turned out to be an PMS nightmare of epic proportions, take some comfort in knowing that you are not alone. In fact, while I remained convince most of my life that PMS would disappear as my menstrual cycle went awry, it’s been anything but. If possible, it’s worse than ever.

Turns out that a primary culprit may be exogenous (outside or external) progestogen, the type found in hormone replacement therapy (HRT) or oral contraceptives. PMS symptoms — depression, anxiety, mood swing, anger, lethargy, bloating, weight gain, headache or joint or breast tenderness — tend to flare during the luteal phase of the menstrual cycle, that is, before ovulation. And women who are subject to PMS during this time are believed to have a heightened sensitivity to the increase in progesterone levels (even if levels are lower in relation to estrogen during perimenopause) as well as malfunctioning neurotransmitters that cause the central nervous system to go a bit haywire. Add outside sources of progesterone and you’ve got a veritable pot of angst ready to boil over at a moment’s notice.

But what if you are not taking exogenous progesterone? Well, you still may have a heightened sensitivity to the increase in progesterone levels that occur post-ovulation. For perimenopausal women in particular, experts recommend stopping smoking and trying to maintain a healthy weight, especially if your practitioner recommends the addition of estrogen. In a related editorial, there is also a reference to a fruit extract known as Chasteberry (Vitex agnus castus) which was shown to control irritability and mood swings in a scientifically-sound, placebo-controlled trial.

If you prefer to go the pharmacology route and don’t want to take hormones, there has been some work done that shows that SSRI antidepressants (in much lower doses than those used for depression) can be useful in PMS (but of course, can subject women to certain side effets, such as tummy woes, insomnia, headache; these can be better avoided through cyclical use). The last resort? Hysterectomy, at least according to experts (rather extreme, don’t you think?). Mostly though, consider other options – exercise or vitamin B6 also have some clinical evidence to back their use. Finally? Before you take that walk down Menopause Lane, take a breath. Chances are that the worst of it will be behind you before you know it.

Household work..the key to better sleep?

Posted by Liz on Apr 8, 2013 in exercise, hot flash, nightsweats, sleep disturbance | 1 comment

Have I got your attention yet?!

It’s no surprise that hot flashes and night sweats rank among the most important factors when it comes to poor sleep. However. less clear are the factors that may provide a buffer against the flashes. And aside from the usual suspects e.g., crankiness and moodiness or the inability to focus, poor sleep has been linked to heart disease and obesity, among other less desirable health conditions.

So, what can you do?

I’ve written about the benefits of physical activity and amelioration of menopausal symptoms many times on Flashfree. And, I imagine I will continue to do so. But what about sleep? There is evidence that physical activity can help bolster both sleep quality and sleep quantity. Yet, few people have examined the domino effect, i.e. fewer hot flashes  ← physical activity → better sleep. Moreover, even fewer have considered the benefits of non-leisure physical activity, like housework.

Now, before you accuse me of setting women back 60 or 70 years, let’s consider exactly what I am suggesting.

According to research, women participate in less leisure time physical activity but greater levels of household physical activity than their male peers. This is apparently truer among ethnicities other than Caucasian (especially African American), who also tend to have greater levels of obesity and poorer sleep characteristics. So, it would follow that by increasing both, women might fare better in the sleep department, right?

In fact, when researchers took a small group of women participating in the larger SWAN study and evaluated their self-reported and scientifically measured sleep patterns for four nights, that is exactly what they found. The group, which was comprised of both White and African-American women, reported having flashes or sweats, were between the ages of 54 and 63, had an intact uterus and were not on medications that could affect hormone levels or symptoms. And while the number of women was quite small (only 52), they fit into the full spectrum of BMI targets (from normal to obese to overweight). In addition to sleep patterns, they also shared details of their most common daily physical activity (how often, how long and how intense) and household/caregiving responsibilities (time spent caregiving, preparing/cleaning up after meals, and routine chores as well the intensity of these activities).

Not surprisingly, women who had greater levels of leisure physical activity were 8 times more likely to report that their sleep quality was better than their less active peers. And, women who reported greater household, non-leisure physical activity awakened fewer times during the night, but only if their BMI levels were lower. Yet, the benefits were mostly seen more among White women. Even more troubling is that the researchers say that they could not determine the ‘why’ of these findings, even though they conducted several different types of analyses and comparisons.

The good news is that for some women, engaging in greater levels of household physical activity and leisure physical may reduce sleep disturbances, especially if they are not overweight. For others, especially my African-American sisters, the mystery remains. African-American women often report more severe hot flashes than their White peers. And while experts have pointed fingers towards rates of obesity or distinctions in estrogen levels or smoking history, the reasons remain unclear.

Meanwhile, while I am not necessarily suggesting that you increase your household responsibilities, I do believe that even with the limitations of this study, more physical activity may beget better sleep and possibly fewer or less severe hot flashes. Finally? Can we please find some effective and viable strategies for women of colour? Although the menopause experience may vary by ethnicity, as women, we need to find solutions that work for most of us, not some of us.

Wednesday Bubble: cultivate your inner lotus

Posted by Liz on Apr 3, 2013 in Meditation/mindfulness therapy, stress | 0 comments

[Photo credit: Priya Ramesh, Coorg India. 2013]

On Monday, I shared information about the benefits of mindful meditation and being present and how they positive affected stress and the hormone cortisol. I cannot stress the importance of incorporating stress busters into your life; not only is your mental health at stake but the risks to your overall health are numerous. If meditation is not your thing, there are other strategies to consider, including yoga, Tai Chi, acupuncture and deep breathing. There is also Qigong.

Qigong is a Chinese practice harkening back more than 4,000 years. In many ways, it incorporates the best of several strategies, including alignment of movement and breath, meditation and yoga (strength, flexibility). My friend and colleague, Jeri Hemerlein, teaches a female-specific form of Qigong at the Yoga Center in Columbia, MD. Known as Radiant Lotus Qigong, Jeri describes it as a flowing form combining ancient Chinese and Tibetan techniques to health issues unique to women. Radiant Lotus Qigong uses the lotus flower as a metaphor for female resilience and flexibility. The movements open the body’s energy, gently stretching and releasing tension from muscles, joints and spine while waking up the immune system. The form seeks to enhance the whole body health of women from menstruation to post menopause, while supporting the Divine Feminine nature and helping the woman return to an innate state of loving compassion, wisdom and inner strength during times of stress and intense emotions. The form was created by Advance Qigong practitioner Daisy Lee,  who developed it after studying with various Qigong teachers who were able to successfully address women-specific issues through original and individual forms.

If you visit Daisy’s website, you can learn more. Or, if you are local to the DC/MD area, you can attend a workshop that I am blessed to be giving with Jeri on April 23, 2013 at 6:30 pm in Annapolis. ‘Cultivate Your Inner Lotus: Menopause, Stress & Qigong” aims to help you gain a better understanding of stress during menopause and provide you with specific techniques to address it on your own. I hope that you’ll consider joining us.

Cultivating your inner lotus may be the best thing you can do for yourself.

The present of being present: cortisol and mindfulness meditation

Posted by Liz on Apr 1, 2013 in Meditation/mindfulness therapy, stress | 1 comment

It seems that I write about stress a lot on Flashfree. Perhaps that is because like many, my life — namely my work — can be very stressful from time to time. However, according to the American Psychological Association, I’m not alone; most Americans suffer from moderate to high stress and the problem does not appear to be going away. Moreover? Work issues are the primary stressors in 77% of people.

From a midlife perspective, stress and its related hormone, cortisol, can cause a lot of health-related problems. In fact, not only does cortisol promote a fat dump in the midsection, but experts say that overexposure to cortisol and other stress hormones has a cumulative affect, leading to heart disease, sleep issues, digestive issues, obesity, depression and worsening of skin conditions. It’s critical to counter stress’ negative effects before they take their toll and start to do permanent damage. One important strategy to achieve a better balance is meditation.
Fortunately, a team of researchers at UC Davis’ Center for Mind and Brain are devoting time to studying psychological and physiological processes in order to explain the benefits of meditation. The framework for this effort is the Shamatha Project, which is apparently the most comprehensive meditation study ever undertaken. Most importantly, this scientific twist on a centuries old practice may ultimately elevate meditation’s place in Western medicine.

To better understand the effects of meditation on stress, the research team recently took 60 people (between the ages of 22 and 69) who had some prior experience with meditation, measured cortisol and body mass index and their current degree of ‘mindfulness,*’ and then randomly assigned them to a three month meditation retreat or a waiting list. Those on the waiting list participated in the same, three-month retreat at a later date. (*Participants completed a mindfulness questionnaire that measured the degree that these people directed their cognitive resources to sensory experiences and how often they drifted, as well as their ability to let go of distressing thoughts.)

At the retreat, the group met two times a day for one hour, guided sessions and the rest of the time (around 6 hours) practiced solo meditation in 20 to 30 minute increments. Meditation practices were focused on mindful breathing and relaxation and promoted compassion and kindness toward others. Overall, the emphasis was on present awareness rather than meandering into the future of ‘what if’s.’ During the middle of the retreat, all were encouraged to enter into silence for a period of about four weeks. Aside from scheduled meals and group meditations, everyone was on their own to decide sole meditation, exercise and free time.

Did learning how to direct and focus attention away from uncontrolled, ruminating thoughts and worry and toward a chosen target reduce cortisol levels? The researchers say that they found a correlation between a high score for mindfulness and a low score in cortisol, both before and after the retreat. The results were greatest for participants who were able to achieve the greatest increases in mindfulness, that is, the more that they reported directing their thoughts to the present/immediate experience, the lower their resting cortisol levels were. Participants also experienced large improvements in overall wellbeing, daily mood and emotional functioning.

While the findings do not prove cause and effect, they do suggest that changing the mind paradigm to focus on the now rather than the future may ultimately help to reduce our tendency to think about the past or worry about the future and in turn, counter excessive cortisol release.

Tonya Jacobs, a postdoctoral researcher and the study’s lead author, explains that “the idea that we can train our minds in a way that fosters healthy mental habits and that these habits may be reflected in mind-body relations is not news; it’s been around for centuries. But, accumulating evidence might help the idea — that the present is the best present we can give ourselves — be better integrated into Western mentalities and health practices.

Mindful meditation may ultimately prove to be one of our strongest defenses against stress and its companion, cortisol!

Friday Folly – Preservative-free?

Posted by Liz on Mar 29, 2013 in aging, appearance | 0 comments

Wednesday Bubble: The Magic Menopause Ball

Posted by Liz on Mar 27, 2013 in menopause | 2 comments

Can you accurately pinpoint the timing of your final menstrual period? Lord, I finally hope so because if you are anything like me, 50+ and over this bleeding thing, the ability to read into the magic menopause ball sounds like heaven. However, more importantly, it may have significant benefits for women’s health overall. For example,  knowing when you will enter menopause provides you with the ability to address bone loss and other risks now (the rate of bone loss greatly accelerates to roughly 2.6% in the year prior through two years after menopause). And there’s no time like the present to start bolstering your defenses against the health-related ravages of aging.

This post comes with a warning: it’s a bit geeky science-y.  Some topics are harder than others to write about. However, I hope that you’ll bear with me and read on; it’s important.

This is not the first time that the future is being explored; you may recall another test that measures the antimullerian hormone, an ovarian marker that relates to the number of immature follicles a woman has (as the marker declines, so do the number of eggs a woman houses, and the closer to menopause she is). Another way to gauge the start of menopause is to monitor bleeding patterns. Not only is this onerous, but, data suggest that more than 60% of women in early perimenopause become postmenopausal with no apparent signs.

A new approach to pinpoint the timing of menopause involves a calculation of changing levels of estradiol (the most important form of estrogen in the body) and follicle stimulating hormone (FSH – the hormone produced by the pituitary gland that stimulates the ovaries to produce eggs). The closer a woman is to menopause, the higher the FSH levels and the lower the estrogen levels. To determine if this test is valid, researchers developed a model based on data collected from 574 women in the ongoing Study of Women’s Health Across the Nation (SWAN). These women were all between the ages of 42 and 53, had an intact uterus and at least one ovary and were not taking hormones. They were ethnically diverse (Caucasian, African-American and Asian) and had given blood samples over a ten year period.

The findings? After adjusting for factors that might influence menopause, including age, smoking and weight, they found that measuring FSH and estradiol could accurately pinpoint three major timepoints: roughly two years and one year prior to the final menstrual period and the final menstrual period. Moreover, the ability of the test to predict the final period increased as women moved closer to the goal.

Now, scientists use variables to gauge how well a test can predict the number of people with a condition (sensitivity) as well as how well a test can identify those people without the condition (specificity). The new model was shown to be able to accurately identify 89% of women who reached their final menstrual period, which is excellent.

Scientific mumbo jumbo aside, the upshot is that it’s likely that we’ll be able to predict the date of our final menstrual with great accuracy in the near future. Better than an 8-ball. The answer is ‘Yes.’

[This study appears in the April 2013 issue of the Journal of Clinical Endocrinology and Metabolism.]

Iso what? Iso who? Hot flashes, isoflavones and clinical trials

Posted by Liz on Mar 25, 2013 in hot flash | 0 comments

I’ve long been intrigued by the replacement of hormone replacement therapy with soy isoflavones. Yet, studies looking at their effectiveness for alleviating hot flashes and other vasomotor symptoms have been mixed. The reasons for this are multiple, and point to such factors as dose and actual composition of the supplements used, severity of hot flashes and how often women are taking isoflavones over the course of the day. Researchers have also discovered that only 20% to 30% of Westerners produce equol, (there’s even a dispute over this stat) a component of the potent isoflavone dadzein that has an affinity for estrogen and appears to be slowly cleared from the body;(note that both of these factors contribute to its beneficial effect against flashes.

Despite these challenges, what would happen is you simply upped the dose and/or frequency? Would it change the’ iso what’ or ‘who’ to an actual ‘iso yes!?’

That’s exactly what researchers sought to learn when they recruited 130 peri- and post-menopausal women with severe hot flashes (i.e. five or more  a day). Women who produced equol and those who did not were separated and then randomly asked to take placebo, low dose (33 to 66 mg/day) or high dose (110-200 mg/day) equol or placebo capsule (s) and take them once daily or two to three times daily. They also kept daily hot flash diaries, assessing each hot flash by its intensity, daytime or nighttime occurrence and how bothersome they were. They met with the research team face to face twice — 9 weeks in, and 3 weeks after the study completed.

The findings made it quite clear that dose and frequency are almost as important as whether or not a person is able to produce equol. In fact, when women took higher doses of isoflavones more frequently, they had 2.4 per day fewer hot flashes than women taking the lower doses just once a day. And, the flashes were significantly less severe. What’s more, most of these benefits were realized during the night, when, as most of us know, flashes and sweats are especially disruptive. Moreover, there was not much of a difference between women who are able to produce equol and those who are not; while these women did experience greater declines (as much as 10%) in both how intense their flashes were and how frequently they occurred, the difference was apparently not statistically significant.

So, let’s cut through the scientific clutter:

• Higher doses of isoflavones tend to have a greater effect than lower doses
• More frequent dosing (two to three times a day) appears to be more beneficial than once a day dosing.
• Greater benefits are likely to be seen in women who naturally produce equol, especially when it comes to hot flash intensity
• Both perimenopausal and menopausal women may potentially benefit from higher, more frequent dosing.

This type of research is just beginning and the findings need to be teased out in larger numbers of women. It’s also unclear if spreading the lower dose out throughout the day would make a difference. Still, what these findings do bring to light is an evolution of thinking and that’s what makes me most excited. Rather than determining that isoflavones are useless, researchers are finally starting to treat them as though they were pharmaceutical agents, using them in randomized clinical trials, varying doses, frequency and patient populations and truly, thinking outside the box.