St John’s Wort, Quality of Life & Hot Flashes
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!
Read MoreWhat’s your sleep number?
[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:
- nonexistent, I never sleep
- occasional, I sleep one or two nights a week
- obstructed, I sleep but I wake up regularly throughout the night
- pretty good, I rarely wake up
- 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?
Read MoreMore great news about needles
Tis the Season for needles…pine and otherwise!
Norwegian researchers are reporting that acupuncture plus self-care can reduce the frequency of hot flashes substantially in postmenopausal women! Now that’s a gift I can get my arms around!
In this study, published in the December 4 advanced, online edition of Menopause, 267 postmenopausal women who experienced at least 7 hot flashes every 24 hours for at least 7 consecutive days received:
1) 10 acupuncture treatments plus an informational brochure on self-care for menopause symptoms, or
2) An informational brochure on self-care for menopause symptoms only
The results showed that hot flash frequency decreased by 50% over 24 hours in women receiving acupuncture compared to those who only received self-care instructions. The researchers aso noted significant improvements in vasomotor (e.g. night sweats) , sleep and emotional/psychological symptoms among women receiving acupuncture.
I’ve written about the value of acupuncture for hot flashes and improved sleep quality previously. I’m glad to see that more evidence is accruing supporting this wonderful, safe modality to improve menopausal symptoms.
The American Association of Acupuncture and Oriental Medicine is also an excellent source for more information and help finding a qualified practitioner.
Read MoreAwake again…naturally
[Pablo Picasso, Sleeping Woman]
When was the last time you slept through the night? Depending who you are, the stage of menopause you’re in and well, your symptoms, the answer to that question can vary. Add stress to the mix and it adds up to a lot of lost zzzs for some of us.
Experts continue to be challenged by the “s” word when it comes to the transition, with numerous recommendations ranging from yoga to hormone therapy to black cohosh to exercise to deep breathing. But again, whether or not these steps work depends on you.
I decided to delve a bit deeper into this issue and what I’m finding are many studies that don’t necessarily jive with each other. One of the latest bits of research comes from Brazil and is published in the November issue of Maturitas.
In this 6-month study, researchers examined two postmenopausal women with insomnia. Each woman participated in indivdiual therapy programs involving 1.5 hours/biweekly sessions comprising stretching, strengthening, massage and relaxation.
One woman experienced significant increases in REM and total time spent asleep, while the other had a reduction in the time it took to fall asleep and enter the initial stages of sleep (non-REM).
Both woman reported overall improvements in their insomnia.
Now mind you, I know a few women who have suffered insomnia most of their adult lives. So, I’m not certain whether or not exercise and/or relaxation truly improves overall sleep patterns when hormones and symptoms are wreaking havoc. At the same time, however, I continue to see studies extolling the benefits of exercise and relaxation on sleep patterns, with very few reporting negative findings.
I’d love to hear your thoughts and what works or doesn’t work for you.
Read MoreCounting Sheep
Seems like bills, the primaries, the environment, family, kids and work aren’t the only things that we’re losing sleep over. News from one of my favorite wire services suggests that severe sleep disruption, and not night sweats or irritability is one of most commonly-reported complaint among middle-aged women entering menopause. This is quite important as most of the evidence points to vasomotor symptoms like the sweats and flashes, as largely responsible for poor sleep.
I’ve heard from several of my gal pals that they are having difficulty sleeping. Equally troubling, however, is that if your go-to medical expert is a family doctor, well, he or she might not be completely clear on what to do about sleep distubances, especially when it comes to alternative therapies.
So, what works and what doesn’t when it comes to sleep issues?
In addition to the more obvious solutions, such as cutting back on caffeine and alcohol, beefing up intake of phytoestrogens (which are found in soy, flaxseed and tofu) or engaging in relaxation exercise and meditation right at bedtime, herbal extracts like valerian and passionflower might help.
Now mind you, there’s a lot of controversy over claims that valerian helps to decrease insomnia and reviews of the literature say that there’s not enough evidence to support its value. Personally, the valerian/passionflower combo has worked well for me, although I sometimes awaken with a “hangover” type feeling. There’s a relatively new black cohosh/valerian tablet on the market as well with some studies to support use in sleep disturbance. Note that while I’ve been advised to use black cohosh before bed, I personally prefer the product without the valerian component.
Another option is a supplement called 5-HTP. 5-HTP is an amino acid and natural precursor to the neurotransmitter serotonin. Serotonin is a major target for today’s antidepressants, and in addition to being involved in mood regulation, it also plays a role in modulating appetite and body temperature. An important note of caution when using 5-HTP is that if you are also using an SSRI or MAOI antidepressant, you need to speak to your doctor first before trying; too much serotonin in your system can be toxic or even fatal. 5-HTP can also interact with other agents so self-medicating without consulting a health professional is a big no-no.
Even with a little help, insomnia can persist through the perimenopause to menopause transition, especially right before your menstrual period. I believe that your practitioner can be great resource for steps that you can take to counter the sleep issues.
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