Posts Tagged "symptoms"

Matted

Posted by Liz on Jul 14, 2008 in hot flash, Meditation/mindfulness therapy, nightsweats, stress | 3 comments

Ladies – get your mats ready!

Research suggests that yoga is actually superior to physical exercise for relieving vasomotor symptoms (e.g.  hot flashes and sleep disturbances) perceived stress and neuroticism in perimenopausal women.

The new study, published in the journal Menopause, compared the effects of 8 weeks of simple, trainer-supervised physical exercise to integrated yoga (sun salutation with 12 postures, breathing practices and cyclic meditation) in 120 perimenopausal women.

Positive, significant benefits were seen in all measures among women who were part of the yoga versus the physical exercise group.

Yoga appears to be a wonderful way to relieve some of the more troublesome menopausal symptoms without medication. I wouldn’t give up any physical exercise that you engage in but adding a yoga component to your routine may be provide some additional benefits.

Yoga classes are offered throughout the country in local gyms, specialized centers and often through the local YMCA or YWCA. If you’ve never participated in a class, you can learn more about the practice of yoga at  the following sites:

• The American Yoga Association offers a great introduction to yoga
• The Iyengar Yoga National Association of the United States also has some well-written content on their website, and oversees instructor certification. They may be a good resource for finding an instructor
• Yogajournal.com is a great resource for videos, teachers, community, blogs, etc. and a wonderful place to get started

Finally, I just want to mention that that is not me in the photo. If I were ever able to get into that position, it might take me months to get out of it!

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.

Partly cloudy

Posted by Liz on May 25, 2008 in emotions | 0 comments

[Credit: ‘Depression.’ Bronze. 2000. Created by Susan Paloschi. http://www.susanpaloschi.com/]

[Special thanks to Susan Paloschi for permission to use this image. Please visit her website to see the rest of her works.]

Last week I posted information about a small study that shows that depression during the perimenopausal years can be alleviated by exercise. I believe that this topic is truly worthy of further exploration.

Seems that women entering the perimenopause have a two-fold higher risk of developing significant symptoms of depression than women who are not undergoing this transition. This is especially true of women already experiencing hot flashes. What’s more, this risk tends to occur in women who had never previously experienced any depressive symptoms. While fluctuating hormone levels may not be the only culprits, research suggests that they have a direct involvement.

So in addition to exercise, what can you do to counteract occasional or persistent feelings of depression? Firstly, take comfort in knowing that these feelings, like your declining hormones, are transient and may eventually dissipate. If symptoms are severe enough, a low-dose antidepressant can definitely help as well. In fact, I know quite a few women who have gone on antidepressants to help stabilize their moods during the perimenopausal period. A thorough evaluation by a gynecologist, followed by a session by a psychiatrist, can determine if a short-term of antidepressants may help.

If you prefer to go the herbal route, St. John’s wort might be of help.  St. John’s wort has been used for centuries for mood disorders, and while data suggest that it might not be effective for major depression,  there is solid evidence from clinical trials to support its use in milder cases. Be aware that you may not exeperience relief immediately since like many herbal therapies, it takes awhile to kick in. Again, it’s best to see a specialist in herbal medicine who can guide you with regards to dosage and regimen and also advise  on possible contraindications, if any.

I’m a true believer that the sun can shine through on partly cloudy days. When the blues hit, well, there is definitely some steps you can take. It’s all about finding an approach that works for you.

A woman’s hell

Posted by Liz on May 19, 2008 in women's health | 0 comments

Seems like menopause was viewed as a “woman’s hell” back in the 18th and 19th centuries. A time when the uterus was thrust into “tumultous state of utmost irritation and disorder.” Contributing to this were bad habits such as premature arousal of sexual desire, reading bad novels, and overly spicy and rich foods. Apparently, it was even exacerbated by lounging around all day and breathing the bad air in salons.

This throws my evening plans right out the window!

A woman’s hell? Medical perceptions of menopause in preindustrial Europe

Historical summary of views of menopause. First paper on this written in 1774, word “menopause” coined in 1812, and first popular women’s guidebooks on the subject in the early 1800s “sold out in a few months”. Early view was that with age the uterus became too weak to expel the vile humors of the menstrual fluid, which backed up to turn to fat, breast and uterine tumors, and many other diseases, creating a “woman’s hell”. Later view was that the menopause was more of a natural process (although a women should be at that point asexual), but that the problem was the perimenopause, when the uterus, felt connected to the nervous system, went through a “tumultuous state of utmost irritation and disorder” which was then transferred to the rest of the body. “She became more sensitive, agitated, and easily afflicted by disagreeable incidents; pleasure was indifferent to her; she became sad and easily grew upset against her children, her husband, those around her, sometimes yielding to violent outbursts.” It was also remarked that simple country women suffered few or no complaints compared to upper-class urban women, who “constantly exposed body and mind to all kinds of disturbances and irritations. The demands of social life, the premature arousal of sexual desire, masturbation and loose sexual mores, the reading of bad novels, the unnatural state of excitation caused by concerts and theater, dances and gambling, and overly rich and spicy food, the abuse of coffee, tea, tobacco, wine and spirits–all this created an unrelenting state of over-stimulation. It was made even worse by a life of idleness spent reclining on cushions and chaise lounges instead of attending to domestic duties, by an unwillingness to breast-feed, and by the bad air in overcrowded salons.”

1999 Bull Hist Med 73;3:404-28

Stolberg, M.

Counting Sheep

Posted by Liz on May 12, 2008 in hot flash | 0 comments

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.