Looking through the window: depression and menopause
There’s a new term that’s being kicked around in medical circles: ‘windows of vulnerability.’
It appears that a growing body of evidence supports the fact that during times of hormonal flux or reproductive cycle “events,” women become increasingly vulnerable to mood swings, anxiety and depression. And while this is certainly not news for many women, it still requires some attention because among the many windows that women may go through, the menopausal transition is evidently one of the most complex. The reason? This is a time when hormones interact with aging, sexuality, life stressors, self-esteem and general health issues.
The subject of depression and menopause is not new to this blog, nor are statistics suggesting that as many as 20% to 40% of women are believed to suffer major depression or at the very least, depressive symptoms during the peri/postmenopausal years. Moreover, women may have as much as a two- to four-times increased risk of developing depression as they transition from pre- to perimenopausal status. Among the multiple factors at play, estrogen is one of the most important; estrogen has been shown to promote the amount of the mood neurotransmitter serotonin available to the body, thereby providing an important antidepressant effect. However, a recent review suggests that the role that hormones like estrogen play in depression is directly related to their wide fluctuations rather than the fact that they are becoming deficient.
So, why is this important? For one, it highlights that hormone replacement is not the only answer for depression during menopause but rather, that it’s critical to pay attention to timing, i.e. when preventive strategies, including exercise, behavioral therapy and antidepressants might yield the greatest long-term benefits. Yet, it also suggests that estrogen-based therapies may indeed have a role in depression during menopause. And, since estrogen alone therapy has been shown to up the risk for ovarian cancer except for in women who’ve had hysterectomies, it also helps supports the need to explore the role plant-based estrogens in treating menopausal depression; fortunately, S-equol has already shown promise in this regard.
Feeling the window of vulnerability? There’s no time like the present to insure that you aren’t simply looking through the window but actually seeing that there’s hope and help on the other side. There are a lot of resources and strategies available to address depression during this time of life. While depression may be a “menopause-associated risk,” like others, it can be successfully ameliorated.
Thank you to Dr. Claudio Soares from McMaster University for an excellent review of depression in menopause and the inspiring, succinct “windows of vulnerability” terminology.
Read MoreMenopausal symptoms? Treat them with Ease…
Or not.
I just wind of a new product called EaseFemin™, a supplement with a proprietery formulation that the manufacturers are calling IsoFactor™. These specific isoflavones and flavare derived from a unique Brazilian red propolis, which is a resin collected by honeybees. Evidently, propolis has been used in folk medicine since around 300 BC and clinical data show that it is non-toxic.
Theoretically, Ease-Femin™ taken once-daily, addresses irritability, hot flashes and night sweats. Moreover, an antioxidant has been added to fight cellular damage caused by free radicals circulating in the bloodstream.
Does this sound a bit too good to be true?
I would say, yes.
My first concern is that I did a search on propolis. And as an isoflavone compound, it’s not been studied extensively in menopause or any other condition. The second concern I have lies with isoflavones themselves. As I’ve written of late, it seems that only specific isoflavone compounds, namely S-Equol and daidzein, appear to have any sort of demonstrable effect on hormonal symptoms. So I am not entirely convinced about whether or not this is an exciting new avenue or the promise of spending money ($36.99 a month) for a product that won’t do much of anything.
This is another case of buyer beware. The research simply isn’t there to back the use of the product. At least not yet.
Read MoreWednesday Bubble: Is S-equol the next big thing?
Last year I wrote a few posts about the potential of the isoflavone S-equol for addressing menopausal symptoms, including hot flashes and mood swings.
If you are unfamiliar with S-equol, it is actually a metabolite of a one of the three soy isoflavone compounds (i.e. daidzein), and is produced by bacteria that live in the intestines. One of the most interesting things about S-equol is that is one of the principal types of isoflavones that are found in soybeans and most soy foods. However, up to 80% of the U.S. population and about half of the Japanese population (who consume inordinate amounts of soy) cannot manufacture S-equol on their own and need to obtain it in supplement form.
This month’s Journal of Nutrition has devoted an entire supplement to S-equol research, and I’ve been fortunate to take a more detailed look at the evidence supporting the role of S-equol for menopausal symptoms. Notably, some of the researchers actually say that “to conduct menopausal medical care appropriately [which, in their opinion, should be geared towards a better quality of life on an individual basis), it is necessary to provide evidence-based alternative medicines as much as possible.” It is wonderfully refreshing to find such esteemed colleagues backing my view of how menopause should be approached.
Hence, without further ado, following is what you need to know about the recap of study findings, and what still needs to be explored before we all start taking S-Equol.
In three randomized studies conducted in pre-, peri- and menopausal Japanese women who were or were not able to produce S-equol naturally, researchers found specific benefits in three areas:
- Mood improvement: 134 women who produced S-equol naturally and took a 10 mg daily S-equol supplement had significant reductions in anxiety; those who took 10 mg three times a day had significant declines in tension-anxiety and fatigue, and an increase in overall energy. Note that these women also limited their daily intake of soy products to no more than 20 mg/day.
- Hot flashes and other symptoms: In 320 women taking 10 mg S-equol daily or placebo for 12 weeks, S-equol supplements reduced the frequency of hot flashes by as much as 58%. Decreases in muscle and neck stiffness were also reported.
- Bone health: In 54 women who had undergone menopause within 5 years of the study, those who were able to produce S-equol naturally and took 75 mg isoflavones daily supplement (mostly consisting of daidzein) lost a significantly lower percentage of bone in their hip area than women who were not able to produce S-equol naturally but also took the daily supplement. Researchers believe that S-equol actually mimics the action of estrogen in the body in terms of its ability to maintain bone mass and the balance between the build up of bone (bone formation) and the loss of bone (bone resorption). However, studies looking at how it acts in the body have only been conducted in mice and at relatively high doses. Information reported in the Journal supplement does show that at higher dosages, S-equol can negatively affect the tissues lining the uterus.
A few key take-away points to think about when we think about S-equol:
Researchers believe that the research in S-equol helps to show that soy isoflavones work best in individuals whose bodies are able to produce S-equol naturally. However, you’ve read the stats – the majority of people who live in the US do not produce S-equol naturally. Dosing and the exact type of S-equol may also influence outcomes. Likewise, They still aren’t sure how bacteria in the intestines influence S-equol’s effects and wonder if somehow, some other mechanism is at play. Further research is also needed to see if the beneficial effects of S-equol on menopausal symptoms can be extended to women who do not produce it naturally.
It’s too early to boost this bubble and I’m excited by this evidence-based alternative. Naysayers love to point out that alternative therapies are sham and snake oil. While this may be true of some preparations, it’s clear that researchers are taking natural substances to a higher level to see if they offer efficacy without the risks of hormone replacement.
Read MoreWednesday Bubble: HRT – Ask the Hard Questions
Your doctor has just recommended that you try hormone replacement therapy, better known as HRT. You’ve heard the horror stories about increased risk for breast cancer, lung cancer, ovarian cancer, heart disease…yikes! And yet, you are flashing like nobody’s business, sweating like you’ve just run a marathon and moody as all hell. What should you do?
Ask the hard questions.
Anyone who reads this blogs knows that I am not a huge fan of hormone replacement therapy. There are numerous reason for my personal biases, ranging from the inherent health risks to the belief that menopause has been treated as a disease for far too long and that the paradigm needs to change. These reasons represent the initial driving force behind this blog, which is to explore viable and evidence-based alternatives to HRT and discover strategies for dealing with the emotional and physical aspects of midlife and the transition in more positive and empowering ways.
However, I also support any woman’s decision to use HRT. Your life is your life and only you can control the decisions that feel right for you.
Nevertheless, it’s critical to ask the hard questions.
So, what do I mean by that?
Medications are meant to heal, sometimes even cure what ails. But medications can be dangerous if they are misused, overused, or inappropriately prescribed. It can be confusing, because who can you trust to deliver the truth? And where should you turn when the media can’t agree on the story, when doctors are misinformed or too busy to take the time to thoroughly vet a patient or when one internet source states one thing and the other, another? What’s more, what’s at stake?
So, I’d like to put forth some initial questions for your consideration.
For your doctor
- Why is your doctor recommending HRT? What does he/she believe it is going to help? What are your personal risks, based on your current health status, family history, genetics and disease profile? Are you a smoker, drinker? have heart disease, lung disease, diabetes, etc?
- Does your doctor have any personal investment in HRT, i.e., has he/she done research on HRT on behalf of companies who manufacture it?
- What is the risk/benefit ratio for you? Are the risks higher than the benefits or visa versa?
- How long does the doctor expect that you will need to take HRT? How does this affect your risk/benefit ratio?
- Has the doctor had any patients who have had bad experiences with HRT? Would he/she be willing to discuss those experiences generally?
About your information source
- What is the source of information about HRT? Is it/he/she reputable? Have you taken the time to follow the trail and looked into its/her/his personal interest in HRT?
- Is he/she/his/her company or association sponsored by manufacturers who have a financial interest in HRT?
- How accurate is the news report? Do you thoroughly understand the news report? Does the news report seem like it has a bias? Has it throughly explained the study that it is basing its information on? (Gary Schwitzer’s HealthNewsReview provides excellent guidance on reading health news and what you should be looking for.)
- Who sponsors the website you are getting my information from? Is it industry sponsored? What is the background of the people who are writing the information that is highlighted on that website?
I am sure I’ve missed some important considerations or questions but these represent great starting points.I’d love to hear your thought. Or if you feel that I’ve missed the boat entirely.
Always…if you want the truth, you’ve got to ask the hard questions.
Read MoreChamo chamo chamomile-on
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Is chamomile the ultimate chameleon, good for both anxiety in depression?
Back in February, I posted information about a small study that showed that a daily chamomile tablets (containing 220 mg of pharmaceutical grade extract) significant reduced anxiety and improved well-being among postmenopausal women. Thanks to a fellow reporter and Twitter colleague Miriam Tucker, I learned that the researchers of this study presented findings at a recent Anxiety Disorders of American meeting that might be of equal interest, i.e. that benefits of chamomile might extend to depression as well.
In a second part of this study, the researchers looked at the effect of chamomile on the same women who currently suffered from anxiety and depression, who had a past history of depression or who had never had depressive symptoms. Although the results were not as striking as in the first study, they did see what they characterized as meaningful reductions in depression ratings among women who had both anxiety and depression. Across all the groups, the researchers observed significant declines in depressed mood, guilt and thoughts of suicide).
Women entering perimenopause have twice the risk for developing depressive symptoms than during other phases of their lives. Researchers have also shown that attitude towards menopause can also increase the risk. While various interventions including antidepressants, exercise and maybe even moderate intake of red wine may help, it’s wonderful to know that scientists are seriously looking into the role of chamomile and studying it under controlled conditions to prove or disprove its power over our moods.
Is chamomile the ultimate panacea when it comes to mood swings and the blues? Perhaps not. But it may provide a wonderful option to women and men alike, who are seeking solutions out of the medicine cabinet.
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