Posts Tagged "perimenopause"

Well, well, well…

Posted by Liz on Mar 30, 2009 in emotions, general | 3 comments

wellbeing, that is. Is it elusive during the menopause?

Earlier studies have suggested that the way that a woman experiences menopause is dominated by several factors, including changes in the structure of their lives (e.g. social roles, personal relationships). When these changes do not occur as expected, for example, menopause starts early or late, they can cause greater distress than when they occur on time sot to speak. The same holds for menopausal symptoms; those that are perceived as normal are not necessarily unpleasant, while unusually heavy bleeding, emotional outbursts or frequent hot flashes can be disruptive.

I was intrigued when I ran across a study published in 2007  in the journal Contemporary Nursing which explored these very themes. Researchers recruited 18 women who were post-menopausal and self-described as having experienced ‘wellness’ during menopause. Interviews were conducted with all study participants, during which they were asked to describe in greater depth their experiences.

The study findings showed that the menopause experience was dominated by three themes:

The continuity of the experience

How women experience menopause is inevitably individualized and not easily generalizable. Indeed, data demonstrated that the nature of menopause and how women go through ultimately determine sits impact and how disruptive it is. More specifically, abrupt changes in menstrual patterns can be more jarring than incremental slowing and gradual cessation of menstruation.

How embedded menopause becomes in the rest of one’s life

In the course of the interviews, the researchers found that a woman’s ability to incorporate menopause into her life and routines versus allowing it to change the routines was key to maintaining an equilibrium. Hence, bothersome symptoms became only “only one experience among many and not the most outstanding.” Even hot flashes, which can truly disrupt a moment, became no more valuable to an overall experience than other daily events, mainly because these women did not allow them to disrupt familiar patterns and daily activities.

Containment of menopause

Participants who experienced a sense of wellbeing during menopause were able to compartmentalize their symptoms and for the most part, did not allow them to encroach upon the emotional or psychological domains. These women rarely if ever, experienced irritability, nervousness, anxiety or moodiness.

So, what does it mean?

Overall, the researchers found that a key to a sense of wellbeing during the menopause is focus, i.e. women are not focused on physical symptoms but instead, consider them part of the the overall experience of being a woman and are able to place them in the background. In other words, “the body [is] experienced in a “taken for granted way” so that menopause is not disruptive to an overall continuity of living.

The women who were studied were fortunate in that fluctuating hormones did not appear to alter or disrupt their moods or emotions. Hence, they were quite well-equipped to challenge the natural changes that were occurring and keep them away from the foreground. That aside, continuity and continuing to live one’s life without allowing physical changes to get in the way appeared to define the experience of menopause in more positive terms.

This brings to mind the word “natural” and challenges the notion of menopause as a disease. If we can find ways to stay on an even keel and take actions that minimize daily eruptions as nuisances rather than allowing them to disrupt, then we are indeed, on the right track. Wellbeing during menopause isn’t elusive; it simply requires careful planning and a different mindset.

What do you think?

St John’s Wort, Quality of Life & Hot Flashes

Posted by Liz on Mar 27, 2009 in herbal medicine, hot flash | 0 comments

Can St. John’s Wort improve quality of life during perimenopause?

While the benefit  of St. John’s wort for treatment depression and other mood disorders remains inconclusive, there is new evidence that it might be useful for symptoms of perimenopause that affect quality of life, namely hot flashes.

In a small study published in the February 3 Advanced Edition of Menopause, researchers randomly assigned 47 perimenopausal women experiencing 3 to 5 hot flashes daily to 900 mg St. John’s Wort extract three times daily or placebo. All study participants were asked to keep daily diaries noting the frequency and intensity of their hot flashes. Quality of life and hot flashes scores were also calculated.

At three months, women who had been taking St. John’s Wort reported significant improvements in menopause-specific quality of life and significantly fewer sleep problems. They also experienced improvements in daily hot flash frequency and hot flash scores.

Although the researchers caution that this is small study and that larger trials are needed,they say that St. John’s Wort may improve quality of life in ways that are important to perimenopausal women.

About St. John’s Wort

In addition to controversy over its effectiveness in treating depression, experts recommend against taking St. John’s Wort at the same time as alcohol, narcotics, amphetamines, tyrosine supplements, flu medicines and foods containing tyramine (e.g. yeast, aged cheese, eggplant, soy sauce). St. John’s Wort can also interact with prescription antidepressants, oral contraceptives and certain medications that thin the blood. More information about St. John’s Wort, its side effects and risks can be found here.

As with any herbal preparation, it’s critical to speak to a healthcare practitioner before embarking on therapy. Acupuncturist and Chinese Medicine Specialist Elaine Stern has a few tips with regards to what you should look for.

In the interim, keep an eye out for more news about St. John’s Wort. These results are encouraging news for hot flashers!

What’s your sleep number?

Posted by Liz on Mar 13, 2009 in hot flash, Meditation/mindfulness therapy, menopause, mind-body therapy, sleep disturbance | 2 comments

[Rembrandt van Rijn, Sleeping Woman, 1658]

On a scale of 1 to 5 would you say that your sleep number (the quality of your sleep) is:

1. nonexistent, I never sleep
2. occasional, I sleep one or two nights a week
3. obstructed, I sleep but I wake up regularly throughout the night
4. pretty good, I rarely wake up
5. great, I typically sleep through the night

If you are like most peri- post menopausal women, it’s likely that you rate the quality of your sleep about a “3. ” In fact, a review in the journal Current Neurology and Neuroscience Reports suggests that 28% to 64% of peri- or postmenopausal women have some form of sleep disturbances that may aggravated by sleep apnea, periodic limb movements syndrome (restless leg syndrome) and psychological distress (anxiety, major depression).

One of the primary causes of sleep disruption during menopause is declining estrogen levels, which increase peripheral and central temperature, dilate blood vessels and lead to hot flashes. Unfortunately data also suggest that  hot flashes double the time spent awake although ironically, they often follow rather than proceed awake times.

More good news: both sleep apnea and periodic limb movements syndrome increase with age. Menopausal women are espeically at risk due to declining progesteron levels and increased body mass index (and associated increases in neck circumference). Both sleep apnea (in which the airways become partially or totally obstructed) and periodic limb movements obviously interefere with sleep quality. In fact, sleep researchers have documented apnea, restless leg syndrome or both in up to 53% of women between the ages of 44 and 56.

The evidence is less certain for mood disturbances and sleep, although studies have shown clear links between reproductive hormonal changes and clinical depression in women going through menopause. What’s more, women in menopause who are clinically depressed have reported more frequent and longer times awake than those who do not have any mood disturbances.

Steps to take

I’ve written previously on this issue and there are a variety of non-pharmacologic steps that might improve sleep quality including standardized herbs and acupuncture.

Hypnosis, relaxation techniques that include breathing and/or biofeedback) may also assist. These strategies are part of a larger approach called cognitive-behavioral therapy for insomnia (CBT-I) which in a small study, was found to significantly improve anxiety, depression, partner relationships, sexuality and hot flashes in menopausal women.

Notably, the benefit of HRT for sleep/mood disturbances remains unclear and studies are inconclusive.

As with any issue associated with menopause, it’s critical to speak to a health practitioner about the issue so that the course of therapy can be safely individualized and personalized.

What about you? How’s your sleep? And what are you doing about it?

ACUFLASH

Posted by Liz on Mar 9, 2009 in hot flash | 0 comments

Researchers are studying whether or not Traditional Chinese Medicine acupuncture care plus self-care can effectively relieve hot flashes.

The ongoing study, known as the ACUFLASH trial, is examining acupuncture as a complete treatment package, a standardized (rather than haphazard) approach in which following diagnosis, the patient receives treatment in specific points. Each practitioner is also free to add individualized points to treat other symptoms related to the menopause, such as depression, anxiety and  insomnia. Treatment will comprise up to 10 sessions over 12 weeks, and may also include soy, dietary supplements and herbal medicine.

Study participants will receive either acupuncture treatment as described or self care alone (over the counter drugs, self-provided interventions such a soy and herbal supplements). Participants may also  use any additional care such as massage or prescribed medications but these interventions will be followed up, registered, and analyzed accordingly.

Traditional Chinese Medicine Acupuncture uses diagnostic methods according to principes of Traditional Chinese Medicine. Acpunture is believed to affect the autonomic and central nervous systems which directly influence hot flash activity.

Early data looking at patient experiences demonstrates that many women receiving acupuncture treatment have reported substantial impact in terms of a reduction in the frequency and severity of their hot flashes both during the day and at night. They also report better sleep, and improvements in mood.

Sounds very promising, doesn’t it? What’s your experience with acupuncture? Care to share?

Soy-ta interesting….

Posted by Liz on Jan 30, 2009 in herbal medicine | 1 comment

A new study suggests that a key component of an isoflavone found in soy, confers significant improvements in mood-related symptoms in perimenopausal and postmenopausal women who lack the ability to produce this component on their own. The component, which is called S-equol, is involved in the metabolism of an isoflavone known as daidzein.

In this study, which appears  in the online edition of the journal Menopause, researchers randomly and blindly assigned 134 women to daily placebo, 10 mg of equol daily or 10 mg equol three times a day. All study participants also completed questionnaires at the study’s start and after the completion of the study on menopausal symptoms and moods. Additionally, they underwent physical exams and urine testing.

The results showed that women taking equol experienced significant declines in all menopausal mood symptoms except depression (although compared to women who were assigned placebo, the decline in depression was significant).

Overall, women taking equol showed significant declines in tension-anxiety and fatigue, and improvements in vigor scores. No side effects were noted, except for a rash in one woman taking equol.

These data suggest that supplementation with S-equol may help to improve mood-related symptoms in peri- and post-menopausal women. What’s more, the team concluded that equol supplementation may offer a promising alternative to estrogen therapy.

Sorta interesting, right?!