Posts Tagged "perimenopause"

Navigating the Maze, Part 1

Posted by Liz on Jun 3, 2008 in herbal medicine | 1 comment

I always enter mazes with great anticipation. The thrill of navigating the corners and moving forward without interruption, the intellectual aspect of the “game,” and the forced retracing of steps when I hit a wall.

Maybe we should think about perimenopause like that? Anticipate, analyze, and step back each time we hit a wall.

I spoke with New York City-based acupuncturist and Chinese Herbal Medicine specialist Elaine Stern last week. We talked about common perimenopause complaints, what’s actually going on in our bodies, and with the proper guidance, steps that might be taken.

I learned a few things and hope that you will also. Please note that it is neither mine nor Elaine’s intention to provide medical advice or replace personal consultation with a private practitioner. Rather, we hope that our conversation will help you understand some of the the changes you may be going through.

p.s. Because our conversation was so lengthy, I’ve broken it into two parts.

What are the primary perimenopausal complaints that you see consistently in your practice?

There are a core group of complaints that are very common. Beginning in perimenopause, women start to have a lot more PMS, and more mood swings that worsen just before the period and sometimes don’t get better right away after, as they did previously. Sleep disturbances may occur, especially in the second half of the cycle. Note that these peripheral problems are influenced by hormonal changes.

What exactly do you mean when you say the problems are “influenced by” hormonal changes?

From the time women reach age 36 or 37, they begin to ovulate less often, i.e. instead of 11 or 12 times a year, maybe they’re ovulating nine or 10 times. By the time they get to age 45, they might be ovulating every two or three months. Women’s hormones, that is, estrogen and progesterone, have an important relationship with one another and keep one another in check. A decline in ovulation means a decline in progesterone production, leaving, for all intents purposes, an imbalance.

What happens as a result of this imbalance?

Women in perimenopause may have a low progesterone level, which leaves the estrogen in relative excess in comparison. If the estrogen is in excess in relation to progesterone, the body tends to retain water, metabolism slows, and the liver becomes more sluggish and this affects the digestive system. They may gain weight because they are not burning food as efficiently. Estrogen stimulates breast cells, meaning that breasts may feel more tender than usual. Additionally, it stimulates endometrial growth, so periods may be heavier. And because estrogen stimulates the nervous system, it can also cause anxiety.

What types of treatment do you recommend for women experiencing these types of symptoms?

I believe it’s important to consider three modalities: acupuncture, herbal medicine, and nutrition.

So, let’s talk about acupuncture. Why is it helpful and what are the drawbacks, if any?

Acupuncture is helpful for women in perimenopause because it has a very good effect on the regulatory system; it smooths things out so to speak. It can help lessen anxiety, promote the immune system and can even out digestive problems. It helps rebalance areas that are out of balance. But what it can’t do is reverse the process of moving towards menopause. And you have to go quite regularly to keep the effects going.

Meaning what? Do you have to continue treatments throughout the entire menopause?

Well, this is why I find it helpful to combine herbs and acupuncture. Because herbs stay in the system all the time, they can keep a woman at an optimal level or balance in between acupuncture sessions.

Speaking of herbs, the whole issue can be very confusing for lots of women. One study may say that they are effective,and another, that they’re not. And, there’s often a lot of product selection. Can you clear up the mystery?

It’s important to separate the idea of Chinese herbs and Western herbs. Simply speaking, Chinese herbs are based on a system of Chinese medicine diagnosis. So, they are prescibed in combinations that treat these diagnostic categories. In other words, there is no one-to-one correspondence between a single herb and a single symptom. Because they are almost always combined, you can’t simply pick something off the shelf.

Western herbs, on the other hand, tend to be targeted towards specific problems. And there are good ones available for menopause.

Can you touch upon some of those?

Well, for example, black cohosh is a terrific herb. It’s not as strong as hormones but its track record is very good. While there are some studies that show it’s not very effective and others that show it is quite effective, I think that that has to do with how the studies were done. The other issue is quality of product and the lack of regulation.

Then, how do you choose when you go to the drugstore or health store?

That’s one reason to see a practitioner. A good practitioner will have examined the studies and will understand a bit about the marketplace. In this way, she or he will be able to direct you to a good product.

But if you live in a rural setting and don’t necessarily have access to a good practitioner, what are your options?

Almost all the studies that have shown good results have been conducted using a particular blend. We refer to these herbs as “standardized” because they are created using a percentage of one or two specific ingredients that are essential to creating an effect.

Where can you learn more about which products have been used in studies?

I recommend looking at Medline or even searching for “standardized X extract” on the American Botanical Council websites. A simple rule of thumb is that the least expensive product is not always going to be the best. While it’s hard to generalize, if you can find the product that was used in studies, well, it’s a great start.

Tomorrow, I’ll post the rest of this interview, which includes more information on Western herbs, a brief discussion about nutrition, and some overall advice.

Is it real? Or is it…

Posted by Liz on Jun 2, 2008 in women's health | 0 comments

An interesting report from the American Herbal Products Association highlights the dangers of simply going into a drug store and buying an herb right off the shelf. A study in the Journal of Agriculture & Food Chemistry shows that 3 of 11 black cohosh supplements purchased did not contain black cohosh but rather, a less expensive Chinese herb called cimicifuga that do not have the same chemical compounds or uses as the North American variety (which contains cificifuga racemosa).

What this means is that when you go shopping for herbs, well, they’re not all the same. Indeed, the best rule of thumb is to try to find a product that has been tested in clinical studies, or is manufactured by a reputable company. I’ll have more to say about this later in the week. But in so far as black cohosh goes? Remifemin, which is manufactured by Enzymatic Therapy, Inc, has been studied in clinical trials and is standardized, meaning that it contains the chemical compounds proven effective in alleviating certain perimenopausal symptoms. It may be slightly more expensive than the generic brand, but at least you know what you’re buying.

Rollercoaster

Posted by Liz on May 31, 2008 in women's health | 1 comment

This is a picture of my favorite wooden rollercoaster. It’s in Coney Island, New York. I haven’t ridden it in awhile but I remember that the seat bar was always so loose that you had no real security during the ride. It was even worse in reverse. So it was always hard to know what to expect, when to expect it, and truly, what to do…other than hang on for dear life and hope for the best. But somewhere, in the recesses of your mind, you knew that the ride would end eventually and you’d be fine.

Just like perimenopause.

I’ve posted a few times about acupuncture, herbs, and most recently, about discerning information that comes out of studies. To help clear the confusion a bit, I spoke with acupuncturist and Chinese Medicine Specialist, Elaine Stern, L.Ac. I’ll be posting that interview over the next couple of days. Stay tuned! Oh, and have a hot dog on me!

Dazed and Confused

Posted by Liz on May 29, 2008 in women's health | 0 comments

[youtube=http://youtube.com/watch?v=Xajqf-PhO8s&feature=related]

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.

Cheers…literally!

Posted by Liz on May 27, 2008 in heart disease, women's health | 0 comments

Seems that moderate alcohol consumption helps overall well-being among perimenopausal women!

Recent study findings show that women undergoing the menopause ‘transition’ who consume alcohol at moderate levels (~ one drink daily), don’t smoke and exercise feel better than those who don’t drink. What;s more, another study suggests that older (i.e., 70 to 75 years of age) women who do not drink have a greater risk of death and poorer health-related quality of life than women who consumed one or two drinks a day.

Back in March of this year, I also reported that researchers had found a link between moderate alcohol intake in middle age and a decreased risk of heart disease, even among individuals who never drank before this time.

That’s part one of this story. Strangely enough, having risk factors for heart disease increases the likelihood for an earlier menopause. These data in particular, compiled from the landmark Framingham Heart Study and reported by the American Heart Association, actually go against common beliefs that a depletion in hormones causes an increased risk for heart disease in women after menopause.

Granted, one study does unequivocally prove something. But what is apparently clear from these three trials is that one or two drinks a day, especially red wine, may prove to help women decrease their risk for heart disease and also, provide a counterbalance for symptoms that cause moods to run amuk.

Sounds like good news to me. Cheers!