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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.

The alternative alternative: physician-prescribed alternative medicine

Posted by Liz on May 13, 2011 in Meditation/mindfulness therapy | 8 comments

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.

Ain’t no “woo woo” going on. Mind, body, relaxation and health

Posted by Liz on Jan 24, 2011 in health, general, Meditation/mindfulness therapy | 6 comments

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.

Is Flashfree for me?

Posted by Liz on Nov 19, 2010 in Inspiration, women's health | 0 comments

There’s a misconception going around that only women who are entering or have entered menopause should read this blog. And it’s not true. So, I thought that I’d use this opportunity to highlight some of the common themes and issues that run through an adult woman’s life, no matter her age:

• Health. Women’s health is so important. And so misunderstood. While some of that misunderstanding can be attributed to an early failure to evaluate drugs in important studies, for example, heart disease, the broader issue is that women are intricately wired beings whose systems are truly integrated and connected. Our physical health is so often influenced by our emotions and environment that it can be difficult to discern cause and effect,  and by default, treat appropriately and effectively. However, there are important steps that can be taken to stave off some of the unwanted effects of aging or even some diseases. Just think…exercise and heart health, bone health, mind health; a healthy diet and maintaining a healthy weight and helping prevent heart disease and diabetes; or, stress reduction, yoga, focused breathing to maintain balance and energy and promote immune health.

• Friendships and Networks. No matter our age, situation, relationship status, creed, religion, or color we rely on our relationships and networks to raise us up and bring us out of the darkness into the light, to fully blossom, thrive and grow, to create, express and love. Just think…strengthening friendships and support networks to maintain emotional and physical health or boosting self esteem to help with career and achievement

My point is that if you are in your late 30s or 40s and premenopausal, there are many things you can do now that will benefit you later. And many of these tips are addressed within the archives of this blog.

So,is Flashfree just for menopausal set?

Nope. Flashfree is for you. And although many posts focus on menopause, there is often a subtext of lessons that can be learned from and followed early rather than later.

Join me on the journey…won’t you?

Feeling anxious? It may be those hot flashes!

Posted by Liz on Sep 13, 2010 in anxiety, hot flash | 15 comments

Researchers say that there may be a link between hot flashes and certain types of anxiety. In fact, hot flash symptoms — increased heart rate and feeling flushed — have been shown to mimic feelings associated with somatic anxiety, i.e. butterflies in the stomach and tension (as opposed to affective anxiety, which people feel panicked or afraid or nervous).

Importantly, data have shown that as much as 8 months before premenopausal women start experiencing or reporting hot flashes, their scores on an anxiety index are off the charts, which means that constant butterflies or tension may be predictive of the move into menopause. The reason this is important is that they may be steps you can take now to address symptoms as they start to emerge, yoga and deep breathing for example, which not surprisingly, are often recommended to address anxiety symptoms.

The latest bit of information to hit research circles involves a study of 80, healthy, well-functioning menopausal women who were asked to keep a daily diary on hot flashes or night sweats (defined as a feeling of warmth or heat accompanied by sweating, pressure or rapid heartbeat occurring while awake or during sleep). In the diary, participants were asked to record how often hot flashes occurred over a one-week period as well as their severity. They were also asked to rate any symptoms of anxiety based on how often they occurred.

The results?

Higher scores of anxiety related to tension and butterfly-like feelings but not to panic or nervousness were significantly associated with more severe and frequent hot flashes or night sweats, even when factors such as sleep quality, age and education levels, all which might affect anxiety levels, were factored in. Age in particular is important because hot flashes tend to wean through the menopause as women grown older.

The reason this preliminary research is important is that it is possible that anxiety that women experience during menopause is actually related to hot flashes, rather than a specific mood disorder. By shifting the viewpoint to the true culprit, healthcare practitioners and women alike, might be able to better diagnose and more appropriately address anxiety symptoms, rather than leaning towards prescription mood treatments that are uncalled for.

At the same time, more research is needed. This was a small group of healthy, white women who were asked to self-report hot flashes/night sweats and anxiety symptoms. Although most of the research on hot flashes does rely on self-report, objectivity can be lost. What’s more, because these women were psychologically healthy, it’s hard to apply any conclusions to older women who might be seeking assistance specifically for anxiety.

So, are you feeling anxious? Depending on your age and menopausal status, it might be a harbinger of the flash or due to the flash. Either way, it’s worth considering.