Category — Physical Menopause Symptoms

As a nurse, I belong to a continuing education / latest research site called Medscape. It’s nothing short of wonderful. When I think of the sheer poundage of my professional magazines that I subscribed to in the past, it boggles the mind. (And stimulates my guilt reflex when pondering how many trees gave their lives so that I might give better nursing care.)

Now with a couple of keystrokes, I can stuff my few remaining brain cells with the latest nursing and medical knowledge. Amazing. I love love love the internet. But I digress – which happens to me a lot since The Big M.

I’d like to share a few of the latest research findings regarding menopausal women.

Hot Flashes Sufferers Live Longer?
I received a tweet the other day that stated “research shows women that have a large number of hot flashes live longer.” I went to the actual study and found that in truth, it was women that reported night sweats in addition to their hot flashes. They had a 30% lower mortality rate from heart disease than women who didn’t suffer from nocturnal overheating, irrespective of risk factors or HRT (hormone replacement therapy) usage.

Wow. I believe that I will likely live to 210 years of age if this is true. Thank God for wicking sleepwear. (Stay tuned for the debut of our Menopause Marketplace to find great wicking sleepwear vendors.)

Does Depression Affect Menopausal Symptoms?
This study found that women suffering depression reported more menopause symptoms. Conversely, the authors were surprised to find that menopause also seemed to lead to more depression. The first thing I have to say about these results is “Well , DUH!”

The second is that this sounds a little like “Which came first, the chicken or the egg?” Which we could debate forever, but why would we want to?

Most important were the conclusions of the study – that identification and treatment of depression might help with symptoms of menopause as well.

True enough, but at what cost? We are already seeing a number of articles promoting antidepressants to treat menopause, which really is like trying to shoot a fly with an elephant gun. While I am the first to say that menopause symptoms suck, I also believe in the remedy with the least side effects that helps.

I strongly believe in antidepressant drugs when necessary. When depression causes significant disruption of daily life activities or relationships or suicidal thoughts, then pharmaceutical treatment along with professional therapy can be life saving.

But we need to assess a matter of degree with depression. Some mild depression, e.g. feeling sad and blue, weepy, not motivated during menopause affected all of the Goddesses to some degree. When we shared it with one another, it lessened greatly. It was wonderful to find out that it was normal and it was likely temporary.

Two of our goddesses have suffered from depression pre-menopause and have taken antidepressant therapy successfully. The rest of us just felt crappy for awhile.

Risk for Major Depression Increases During and After Menopause

Basically this study found that the risk of major depression doubles during perimenopause and menopause when compared with premenopause. That sounds about right. To put that in perspective, if two of your twenty friends suffered a major depressive episode before any of you went into menopause, then it might be likely that 4 of your friends would suffer a major depressive episode. Leaving 16 feeling blue and “normally” depressed.

I couldn’t find out how the researchers defined major depressive episode. One of the researchers did make this statement, which was billed in the Medscape article as the take-home message for clinicians. “When women come in and are thinking that they have some extra difficulties with life and feel down and blue…take it seriously. It is not just a passing thing.”

Okay, that worries me. Because it describes nearly every menopausal woman I’ve known at some point in her journey. I personally felt down and blue, and was dragging my weary arse through the days during the worst of the Big M. I was also hot, cranky, and sleep deprived which likely made it worse. But it WAS just a passing thing. It was normal. The best treatment I experienced (besides sleep and cooling measures) was support and commiseration from my Menopause Goddess sisters.

While I’m delighted that we are doing some research on The Big M, I have to wonder why we aren’t looking into bioidentical hormones, herbal therapies, and the effects of support groups. Could it be because there is no funding for these types of research?

So ladies, remember the one Latin legal phrase I learned in nursing school “caveat emptor”. Let the buyer beware. You are the buyer of your own health care. Pick and choose. Ask questions – lots of them. Ask about side effects and risk-benefit analysis. And not to be a conspiracy theorist, but ask yourself who might have funded a given research study? Who stood to gain?

Lastly, make sure that you are followed by a physician or nurse practitioner, not led. Most health care professionals I know actually appreciate a patient who is actively involved in her own care. And if they don’t? I’d shop around for a new health care professional/partner.

My friend, M (you’ll remember her as the Menopausal Squirrel), felt pretty good about her health care practitioners. She liked and trusted her gynecologist right up until she began her menopause journey with a plethora of symptoms including hot flashes, mood swings, and insomnia. That’s when things got ugly.

On an office visit, she asked  about remedies and symptom relief. Her gynecologist recommended HRT. M. wasn’t too keen on that idea given the press since the WHI study. “What else can  I do? ” she asked. “Antidepressants” was the answer.  “No other options?” she queried. “There’s nothing else we can do,” she was told.

She walked out of the office and never went back.

Now I’ll be the first to admit that it can’t be pleasant to have a hot, bitchy woman demanding relief and answers in your office when you don’t really know what will help. And I truly understand as a health care practitioner how much you want to offer a definitive answer to such questions. Especially when your local drug rep has just offered you a sheaf of paperwork detailing why this might be a great new use for an old favorite drug.

Still, I gotta think that “I don’t know” might be a better start than “How about an antidepressant?” A fabulous followup might be “I’ll try to find out what other options might be helpful.”

A simple medical professional review session is in order here for all healthcare professionals involved in the care of menopausal women. And all menopausal goddesses are invited to read along to learn how to frame some of their questions in discussions about symptom relief or management.
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Review Statement # 1:   There is no silver bullet.
This is a phrase often used in health care circles to mean that there is no single drug, therapy, or regimen that will eradicate, alleviate, or cure any given syndrome or set of symptoms.

(It is well known that health professionals speak their own language – not sure where the silver bullet metaphor came from unless it was referring to the single thing that can kill a werewolf. While we may feel like we change as much as these lupine creatures during menopause, there really is no silver bullet for us.)

Review Statement # 2    All treatments have adverse or side effects.
Duh! And antidepressants have some whoppers!

Review Statement # 3    All Patients Are Individual
You wouldn’t think that this would even need saying. I heard it over and over again in nursing school. Still…………..

Review Statement # 4    Choose the least interventional option first for any symptom or disease state.
Okay, fans, moisture wicking clothing, natural progesterone cream, and go up from there. Need I say more?  To suggest that HRT or antidepressants are the first or second or only answers goes contrary to this very basic rule. Never try to shoot a fly with an elephant gun.  At least not until it goes rogue.

Review Statement # 5    Conduct a Risk-Benefit Analysis before prescribing treatment.
Take into account severity of symptoms, prognosis, and medical history versus possible benefits minus adverse effects or danger of future medical problems. In other words, examine the risks and potential benefits for each individual patient together with that patient. The operative word being Together.

Are antidepressants bad?  Or wrong? Heck, no. If one is suffering from depression that interferes significantly with daily living, these drugs can literally be lifesavers. This type of clinical depression is an indication that the benefits might outweigh the not inconsiderable risks. Should they be a first line for hot flash relief? Absolutely and unequivocally NO. The risk-benefit teeter totter will be weighted the other way.

Review Statement # 6    Involve the Patient In His/Her Own Healthcare
Duh again. Yes, it’s inconvenient. Yes, it will likely take longer. And the outcome will likely be far more satisfying for all concerned.

To be fair, I can’t tell you how many physicians over the years have told me that their patients don’t want to be that involved in care decisions; they just want to be told what to do. It’s possible we consumers have been at fault by not communicating our desire for involvement or by being too compliant or passive.

We need to prove them wrong and take an active role in symptom relief and control. Empower yourself, ask questions, seek information and move ahead as a full fledged participant in your own Menopause journey.

What did M do when she left her MD’s office? She shopped around., albeit hot flashing, grumbling, and sleep deprived.

She found an integrative wellness clinic that offered wellness counseling including dietary solutions and bioidentical hormones. Options were offered only after extensive testing for her hormone status, including thyroid as well as cortisol, estrogen and progesterone levels. She’s feeling 100% better. Especially since she is now in partnership with her healthcare provider/s.

Want to learn more about your own options? Check out Women In Balance, a non-profit organization dedicated to educating women about their health and wellness options.

I’ve started collecting Menopause Moments; real-life vignettes of all the wild and weird sequelae of the Big M. Why?  Because when these RIDICULOUS things happen, we mistakenly believe we are the only ones who have ever been afflicted so bizarrely. And that’s just not true. Thankfully!  Weirdness loves company – especially of the girlfriend persuasion.

Here’s a stranger than fiction Menopause Moment starring my friend M. She just recently began the menopause transition but it already has twisted up her life in unimaginable ways. One normal/abnormal day, she suffered one of those mind-altering, body immolating hot flashes.  You know the ones – where you are boiling from the inside out.

She rushed into the bathroom where they have a pedestal type sink and turned on the cold water. Just splashing it on her face would have been like spitting on a forest fire, though, and she knew it.  So she took off her shoes, climbed up on the sink and plunged both hands and both feet into the sinkful of water.

As her volcanic level temperature was drifting down from eruption to ooze, her mate opened the door to see her all hunched up on the edge of the sink. “Wow!” he said. “You look like a menopausal squirrel.”  She looked down at herself, looked back up at him, and they both burst into  peals of laughter.

I’m telling you; we can’t make this stuff up!  It’s just too outside the normal realm of human experience. Yep, the Big M. It ain’t for sissies and it sure does make us squirrely. The good news?  Squirrels have a sense of humor. So share your menopausal moment – we could use the laugh! It’s the only thing getting us through.  That and chocolate. Let’s hear it for menopausal squirrels!

When I was dragging my weary bod around like a lead weight during perimenopause, I figured it was just part of the Change.  But when my hair began thinning, my hands and feet were cold even though I was so hot generally I felt like a living furnace, and my weight was going up, my nurse mind went “Aha!”.  I need my thyroid tested.  Although these symptoms are nonspecific and indeed can be from low estrogen and progesterone, I knew they could also herald hypothyroidism.

So off to my MD I went.  She ordered T3 and T4 levels as well as the more specific blood test TSH which stands for thyroid stimulating hormone.  Basically, this is the hormone that tells your thyroid gland – hey, more thyroid hormone is needed, kick it into gear and produce some.  So if you are low on thyroid hormones this TSH level should be high.

Mine wasn’t.  It was normal. My blood tests were all normal.  I didn’t think much more about it, although the symptoms continued.  My previous MD left her practice and I found a holistic practitioner who is an MD, homeopath, herbalist and runs a complementary medicine clinic.

Complementary medicine is just what is sounds like.   All the tools of Western medicine are used and complemented by other disciplines such as nutritional healing, homeopathy, herbs, massage, acupuncture, and more.  (Also called integrative medicine or holistic medicine.)

This new practitioner performed a complete physical exam and pronounced me hypothyroid as I had every clinical symptom and sign.  The blood tests?  Just not sensitive enough.

Many physicians now believe that hypothyroidism should be diagnosed on the basis of symptoms rather than blood work.  If still unsure that low thyroid hormone is the culprit, they simply place the patient on a very low dose of supplemental thyroid hormone.  If there is improvement, the diagnosis is clear.

I started my Naturethroid and within two days was sleeping through the night, my hands and feet warmed up, I had energy again, and I was calm.  It took longer for the weight gain and hair loss to stabilize, but they did.

And as time has gone on, my dosage of thyroid hormone has been decreased gradually until I take very little.  My own hormone factory has kicked in again.  I have energy and am at my ideal weight.

I’m not sure why, but with the onset of Menopause, it seems that many of us also lose thyroid hormone.  Maybe all our hormones are more intricately linked to one another than we know; maybe it is part of the overall Change.  Whatever the reason, it’s worth checking out.  We may not have to feel so tired, heavy, low energy, and mentally foggy.

To find a practitioner near you, I suggest you check out the American Holistic Medical Association.  Their website is http://www.holisticmedicine.org/ You may also Googling complementary and integrative medicine in your area.

When I was a young girl, vaginas were not a topic for polite conversation. Or any kind of conversation, save in the odd sex education class.

Times have changed. And with the advent of Menopause, so have we. The Big M is not polite, and we need to confront one of its more disturbing manifestations head-on. Namely, vaginal dryness.

It isn’t vaginal dryness that we notice right off the bat. It’s the first time we have sex and it HURTS. A normal, healthy sex life is something most of us have taken for granted for many years. Suddenly, physical intimacy becomes pain. Who saw that coming?

Loss of libido occurs and that is distressing enough. Yet, when desire returns and we find that sex is painful, it can be a devastating experience. I’ve received soooooooo many letters about this phenomenon. As one of the single goddesses wrote after a disastrous encounter, “It was one of the most humiliating experiences of my life.”

Because our normal lubrication has “dried up” with the hormonal changes of aging, we may need help. Thankfully, we have options these days.

Our best course of action is to supplement with a good lubricant. Use before intercourse and keep it handy in case you need a little more during. Emerita makes one of my favorites called “Natural Lubricant”, a water-based, non-greasy lubricant. It feels very similar to our own natural lubrication. Hence the name.

Emerita also makes a product called “OH! Warming Lubricant” which can help fuel the “fire down below” in a gentle, sensual way while providing “natural” lubrication. The Venuses like this one a lot. Available at health food stores, major drug store chains and direct from Emerita.com.

Another of my favorites is called “Wet Naturals” which also feels like our own lubricant. Wet Naturals has three varieties. Beautifully Bare is most like natural. Sensual Strawberry is lightly flavored and scented, not sticky. Silky Smooth is a silicone based lubricant that is great for massages and also works underwater. (Hey, whatever floats your boat.....) Available at major US drugstore chains and >Drugstore.com.

Another option is topical estrogen applied vaginally. This is a form of HRT (Hormone Replacement Therapy) and requires a prescription from a physician. Topical estrogen is more effective than either patch or pill for vaginal dryness.

The Mayo Clinic discusses several forms on their website The Mayo Clinic:

1. Vaginal estrogen cream (Estrace, Premarin, others). You insert this cream directly into your vagina with an applicator, usually at bedtime. Your doctor will let you know how much cream to use and how often to insert it, usually a daily regimen for the first few weeks and then two or three times a week thereafter.

Women In Balance, a non-profit organization, and leader in hormone balance education for women, announces one day health conferences at the Waterfront Marriott Hotel in Portland OR on Saturday August 1st, 2009 and in Orlando, FL on October 24, 2009.

The need for unbiased information on hormone balance and natural options has received great attention since Oprah Winfrey had a series of episodes discussing bio-identical hormone therapy. Women In Balance created a national series of all day conferences because of the groundswell of interest in hormone balancing and it’s impact on overall health.

"Our mission at Women in Balance is to empower women to take charge of their hormone health. Our informative conference is a wonderful way to begin the journey to optimal health", says Dr. Jane Murray MD, chair and founding member of Women in Balance, and Medical Director of Sastun Center of Integrative Health, in Overland Park, Kansas. The Conference package includes exciting national speakers, a workbook, goodie bag of product samples and a health conscious luncheon, for $50.

The event has limited seating to create an intimate space for participants to allow questions of the speakers, and networking opportunity with other women with similar issues. Topics include: Understanding Hormone Balance – How your body really works, Lifestyle approaches for Hormone Balance – Dealing with your new normal, and Options for Midlife Health – Empowering yourself to hormone balance.

To register for the conference please go online to: WomeninBalance

When I was in nursing school many moons ago, I learned next to nothing about the Menopause transition. Our 1100 page textbook on Women’s Health was called "Maternal Child Health" and devoted a single paragraph to the Big M – defining it as the cessation of menstrual periods. Thankfully, more is being taught in nursing school now (not too sure about medical school…….).

A male nursing student wrote a song about Menopause for his nursing school class – here it is, straight from You-Tube. Enjoy!

A couple days ago, I posted a too-funny Jack In The Box commercial about menopause. A male friend (thanks, Jed!) sent me the following Lay’s potato chip vignette from their site dedicated to the feminine viewpoint called Only In A Woman’s World. Enjoy!

Menopause goddess Theresa Venus turned me on to this hilarious Jack In The Box commercial. When consciousness about The Big M invades prime time, commercials, AND fast food? America is paying attention! Yep, we are finally going to be talking about it. And laughing, weeping, and bitching. Take a look.

One of our Menopause Goddess readers (thanks, Dale) shared a useful article on bone health she found posted on womentowomen.com authored by Dr. Susan E. Brown. (link at bottom.) Of course, Women to Women pitches their own supplements and products, but their information is clear, detailed, and right on.

Advertising on blogsites and info disseminating websites tends to make me a little nervous. (That is no reflection on women to women or any other website, just a personal character trait. Some might call it a flaw.) But hey, good information is good information regardless of the source. And the more we educate ourselves, the more we are likely to make good choices for our health for the second half of our lives.

The Goddess’s Skinny on Bone Health
Menopausal women lose bone density – some more than others. It’s a good idea to get a bone scan to find out how your bones are doing. Even before you get a bone scan, there are some proactive things you can do to maintain strong, healthy bones.

Exercise
Walking, Pilates, Yoga, Tai Chi. All of these can help and should be done at least three times a week. Personally, I’ll put walking as the overall best exercise I know and it doesn’t require instructors or training, just a good pair of shoes.

Weight Training
Before you groan as I always did, we aren’t talking about strain and muscle bound body building here. Using light weights can build your bones as well or better than all that heavy lifting. Use 2 pound free weights and do a number of repetitions. If you want more of a workout, go slower. That’s right, the slower you go, it seems the better the weight training. And when you first start, think less is more. You likely will find the light weights easy and be tempted to do more. But the burn has a time lag and will be felt the next day or two rather than right away.

Supplements
Calcium alone is not sufficient for bone health. Vitamin D3 is also important. Since we all started using ginormous number SPF sunscreen, guess what has happened to most Americans as an unintended consequence? We are deficient in Vitamin D, an essential nutrient for making and keeping our bones. Yep, sunshine converts cholesterol in skin to Vitamin D. (Proves once and for all, moderation in all things is a good way to live.) Light skinned people may create enough Vitamin D with 30 minutes of sun exposure a day. Those with more melanin need longer. Or we need supplementation. How much supplementation? Depends. Have your Vitamin D level tested and work with your trusted health care practitioner/partner to determine what is best for you.

Diet
More fruits and vegetables, less meat in diet has been shown to aid bone health. Even more important might be weight loss. For some reason, weight loss is associated with a decrease in bone density. Yet some (read most) of us feel a need to diet thanks to the weight gain that accompanies the Big M. A good idea is to lose weight slowly and exercise as an integral part of any weight loss program you undertake.

Hormones
There is so much contradictory information about estrogen building bones, estrogen being unimportant in bone health, progesterone being the real bone health hormone, progesterone being unimportant and unnecessary. If they are indeed beneficial, there may be very real risks to HRT (Hormone Replacement Therapy). Studies are being done, but the jury is still out.

It seems to make intuitive sense that bioidentical hormones might be less risky and more usable by the body. (Actually, it seems like a freaking no-brainer to me, which is why I use a very low dose Estradiol patch and use natural progesterone cream.) That’s natural progesterone cream, not wild yam cream. Wild yam cream is not in a usable form for our bodies. Check out emerita.com for Pro-Gest cream or prodnature.com for Natural Woman cream.

This is where you can work with your trusted healthcare advisor to find the best solution for yourself. If you are considering hormone replacement, have your hormones tested first to determine your baseline. Saliva testing worked much better for me than blood testing – perhaps both will give a fuller picture.

Stress Reduction
Last, and certainly NOT least, stress level has been shown to adversely affect bone health. While it may seem that the Big M is nothing but stress sometimes (gee, could that be the main mechanism for osteoporosis?), take care of yourself. Curl up with a good book, take a bubble bath, sit quietly under a tree. Don’t wait until everything is done (because hello, it never is done. Ever.) Don’t put it off and don’t put anything ahead of your "me" time. One of our Venuses calls it "exercising my me muscle". And if anyone asks you what you are doing? Tell them you are boning up on health and wellness. Don’t wait until you get your bone scan to start exercise and relaxation. Do it now. Goddesses’ orders.

http://www.womentowomen.com/bonehealth/bones-menopause.aspx