Posts Tagged "perimenopause"

Menopause: the symptom? Or, the disease?

Posted by Liz on Sep 23, 2011 in emotions, estrogen, menopause, women's health | 4 comments

A few years ago, I ran across the following story on the BBC:

“Woman’s Death Blamed on Menopause.”

“A woman who refused to take hormone replacement therapy died while suffering a menopausal episode, an inquest had heard. Margaret Drew…was killed when she walked out of her family home on to a nearby railway line and was hit by a train…There is no trigger to this at all, except hormones making her do things that she normally wouldn’t do, Dr. Carlyon [Cornwall Coroner) concluded…”

Menopause. The silent killer. Oh really?  Drew’s husband claims that his wife was “delightful, lovely and friendly” 99% of the time; the other 1% she’d become “totally irrational.” Yet, she refused to try HRT, he says. On the day of her suicide, he said that his wife was “clearly angry about something.”

Something.

Obviously, the conclusion is that that the “something” is hormones. This reminds me of vintage advertising copy that conveys the simple message that a pill a day can cure all that ails, wipe away the tears, mood swings and instability so that women can “transition without tears” (or better yet, without killing themselves).

Notably, a search in the National Library of Medicine’s PubMed database turned up only one recent study specifically dealing with suicide ideation across reproductive stages. In it, researchers compared data in 8,794 women, and found an increased risk of thinking about suicide among women during perimenopause, not before or after entering menopause. These findings remained after controlling for risk factors such as anxiety and mood disorders. HOWEVER, the researchers noted that the study design did not allow them to form any definitive conclusions about the specific reasons for thinking about suicide.

Another search yielded information that the risk for a major depression increases during perimenopause, primarily as the direct result of vasomotor symptoms. The same does not hold true for women before menopause begins or once they enter menopause. Note that while major depression is a risk factor for suicide, not everyone who is depressed will actually kill themselves.

So, are hormonal fluctuations the sole cause of such deep unhappiness that women want to kill themselves?

Interestingly, just a week after the menopause/train suicide story hit the interwebz, a rather controversial set of data also emerged: since 1972, women’s overall level of happiness has dropped. These findings held true regardless of child status, marital status and age. Researcher Marcus Buckingham, writing in the Huffington Post, said that women are not more unhappy than men because of gender stereotyping and related attitudes, due to working longer hours or because of the inequality of housework/responsibilities at home, but rather, the hormonal fluctuations of menopause may be to blame. What’s more, he leaves us hanging so we’ll tune in for part two of the piece to learn the true cause of our declining happiness or better yet, read his book (which evidently guides women through the process of finding the true role that they were meant to play in life).

Importantly, reactions to this study (and various pundits’ assessment of it) have been mixed. One of the most poignant comments I’ve read asks the question “how is happiness measured? What does it mean?”

I have no idea what caused Mrs. Drew to walk into a train and kill herself. Perhaps she was depressed. Clearly she was suicidal.

I have no idea why research shows that women are less happier than they were three decades ago.

However, is menopause the cause? Aren’t these conclusions an example of how the Menopause Industrial Complex perpetuates societal myths that menopause is a disease that requires treatment? That as women, our attitudes, belief systems and actions are hormonally-based and driven? That we are hysterical beings who need guidance on how to find our way and fulfill our dreams, realize our paths, but only if we calm down?

Feeling angry? Blame it on menopause. Unhappy? Blame it on menopause. Not realizing your dreams? Blame it on menopause. Overworked, overstressed, undervalued? Blame it on menopause.

Blame it on menopause.

I don’t know about you but I’m tired, tired of hearing that menopause is not the symptom but the disease. Isn’t it time we start fighting back?

2011 Resolution – End the “shhh” and embrace the conversation

Posted by Liz on Jan 7, 2011 in Inspiration, menopause | 10 comments

I am discovering a pattern: when women learn about Flashfree, they inevitably tell me that they wish that they had a sounding board, someone to talk to about the aging-symptom paradigm, more exchange, more discourse. When I started this blog two and a half years ago, I wanted to become a conduit for that conversation or at the very least, an inspiration. So my resolution for 2011 is conversation, more conversation amongst my readers, between readers and Flashfree and out in the world beyond the Interwebz. We need to talk more, listen more, explore more. We need each other.

The following was written during the early days of Flashfree and it’s as relevant now as it was then. So, in a bold move, I am reprising it, in hopes that it will begin that spark that I would like to see carry us through the first year of a new decade.

Looking through the window: depression and menopause

Posted by Liz on Dec 27, 2010 in depression | 2 comments

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.

Wednesday Bubble: Are you dazed and confused?

Posted by Liz on Dec 22, 2010 in women's health | 6 comments

Every now and then I like to reach into the Flashfree archives and repost a piece that either has lasting relevance or is a must-read for those of you who are new to the blog. This post originally ran in May of 2008 but continues to occupy the top ten list of importance in my mind. The topic? How do you discern information in a study and what do you need to look for. Plus, there’s an added bonus for all you Led Zeppelin fans.

Today’s Bubble – are you dazed and confused?

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A gal pal mentioned to me this morning that she often feels so confused about study findings proving or disproving the value of certain medications or herbs that she often just throws up her hands and does nothing. Many of us are as dazed and confused as she is so that I thought that a few key points about clinical studies might help.

Mike Clarke from the School of Nursing and Midwifery at Trinity College in Dublin wrote a great article last year about the need to standardize results of studies for a specific disease ( in this case, rheumatoid arthritis). He defined the problem as follows:

“Every year, millions of journal articles are added to the tens of millions that already exist in the health literature, and tens of millions of web pages are added to the hundreds of millions currently available. Within these, there are many tens of thousands of research studies which might provide the evidence needed to make well-informed decisions about healthcare. The task of working through all this material is overwhelming enough without then finding the studies of relevance to the decision you wish to make…”

So what do you do? A few key points:

• Consider that every study has the potential for bias. Perhaps researchers are using 7 instruments to measure depression and only highlight findings from 3 of these in order to preserve the most positive or significant results. Clearly, the reader is being led towards certain outcomes and away from others.
• Study designs, types of patients studied, age of patients studied, gender, you name, can differ so it’s difficult, if not impossible to draw definitive conclusions when comparing results of one to another.
• Another issue of great interest to practitioner of Western medicine is whether or not a study is controlled. This means that two groups are compared that are identical in every way except one group is given an experimental treatment and the other, a placebo or standardized treatment. Note that often, real world conditions are often recreated rather than conducted in a real world setting and many studies are not controlled, meaning that the science behind the findings is questionable.
• Alternative and complementary medicines are still incompletely understood among many practitioners of Western medicine. What’s more, products are not regulated as carefully as medicinal agents and manufacturing practices vary. Consequently, studies of these agents or modalities are often inconclusive. And of course, often underfunded and under-appreciated.

No wonder we all feel so dazed and confused!

I’ve written several times about the importance of consulting a practitioner or medical expert before embarking on any regimen for perimenopausal symptoms. Even if you only see someone once, at least that dialogue may be useful for defining a regimen that may work best for you and what you’re going through. And if you live off the beaten track without access toa good practitioner, well then excellent resources like Medline or the American Botanical Council may be be of help in discerning what’s what.

The short answer is that there are no short answers. But with careful guidance and a bit of prudence, you may just be able see the light and smooth out the bumps on this rollercoaster ride we’re all on.

Is your sleep elusive?

Posted by Liz on Nov 5, 2010 in sleep disturbance | 6 comments

Ever since I discovered Zeo, I’ve become pretty interested in sleep and in discovering the reasons why my sleep (and so many other women’s that I know) is lousy. What I’ve learned is that it’s while it’s easy to define the problem, it’s not so easy to assign an overriding factor. In fact, it appears that the more researchers delve into this elusive but necessary component of our lives, the less they truly understand.

Sleep issues tend to plague both men and women as they age. Indeed, deep sleep (or at least its electrical representation, also known as “electroencephalographic wave amplitudes”) has been shown to dwindle was we grow older, resulting in lighter and frequently interrupted sleep. Add factors such as hormones, health, life strain/midlife issues and psychological stress and you may end up exacerbating an already existing sleep deficiency or creating an entirely new problem. Moreover, researchers have shown that distinct sleep patterns might be associated with different influencing factors. For example:

• Difficulty falling asleep may be associated with menopausal symptoms in general, stress, and lower stress hormone levels.
• Awakening during the night might be associated with age, being late in the menopausal transition (before moving into full-blown menopause), having had early menopause, hot flashes, depressed mood, joint pain and stress.
• Early morning awakening may be associated with age, hot flashes, depressed mood, anxiety, joint pain, stress, and lower estrogen/higher fallopian stimulating hormone (FSH)  levels.

Let’s add to the confusion, shall we?

In a study appearing in the upcoming November/December Menopause journal, researchers evaluated health, menopausal status and sleep difficulties in 962 women who were assessed annually from birth through the ages of 48 to 54. The findings?

• The percentage of women experiencing moderate (trouble sleeping a little) or severe (trouble sleeping a lot) sleeping difficulties increased by more than 10% between the ages of 48 and 54.
• Menopause status (i.e. perimenopausal, postmenopausal, perimenopausal, early menopause due to hysterectomy or initiation of hormone therapy) appeared to be related to the presence/severity of sleeping difficulties. In fact, women who had had a hysterectomy, were postmenopausal or had started hormone therapy in the previous year had 2 to 3.5 times greater odds of severe sleep difficulty compared to premenopausal women. Of note, some of these women had not experienced poorer physical or psychological stress than their peers.
• However, with regard to moderate sleep difficulties it becomes more difficult to pin down: once the researchers accounted for certain factors that might skew the results, such as psychological stress, vasomotor symptoms/hot flashes and depression, only women who had had a hysterectomy remained at risk. Although the reasons for this are not entirely clear, the researchers say that sleep difficulties among these women in particular may be related to underlying health before they entered menopause.

The key take-away of this study is that for some women, menopause transitions (i.e. hormonal shifts as they go from pre to perimenopause, and then from peri to postmenopause) influence the severity of sleep disturbances regardless of age or other life or emotional factors. This finding is in line with findings from other studies, which have linked specific hormone-related symptoms such as night sweats to sleep disturbance/fragmented sleep.

However, having had a hysterectomy appears to lead to moderate interruptions in sleep, possibly as a result of prior health issues. So, severe sleep issues = menopause, and moderate sleep issues = ???

The downside of this research truly lies with semantics: how do you define moderate sleep disturbances and in turn, treat them? Do you look for  and address the cause or influencing factors? As noted in an accompanying editorial, multiple factors in various combinations in certain women may very well contribute to overall sleep quality.

In other words, when it comes to sleep, treat the individual, not the masses. Aging, life, hormones all come into play in certain individuals at certain times.

When it comes to sleep, one size does not fit all.