Well, well, well…
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
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!
Wednesday Bubble: Reproductive cancers and estrogen
I’ve written previously about HRT and its definitive link to increased breast cancer risk. But how much of a role does natural estrogen play? Moreover, is exposure time important?
I ran across an interesting study in the the journal Cancer Epidemiology, Biomarkers and Prevention that suggests that the amount of time a woman spends in the transition to menopause may influence risk for reproductive cancers. The reason: overall exposure to total levels of natural estrogen and unopposed estrogen (i.e. estrogen with little or no progesterone as the result of aging).
In this study, researchers collected daily urine samples from 108 women (ages 25 to 58 years) for 6 months annually over a total of 5 years and tested them for total estrogen levels. Using models that evaluated variations in the length of the participants’ menstrual cycles, they also estimated where study participants were in the menopausal transition.
The findings
The results showed that mean levels of total estrogen increased with age in the pre- and peri-transition stages and decreased in the late transition stages. What’s more, the number of days of exposure to unopposed estrogen was higher during the transition to menopause compared with the pre-transition period; it also did not decline until after the menopause.
What these results mean
In general, the study results indicate that women are spending more time exposed to both total levels of estrogen and unopposed estrogen than previously thought. However, because the time spent in perimenopause varies from women to women, exposure to natural estrogen also varies.
The bottom line? Because studies have linked reproductive cancers to lifetime exposure to estrogen, determining the length of time that a women spends in perimenopause may help researchers determine cancer risk.
Stay tuned – these findings could ultimately impact how we go through the menopause and what we can do to conquer our risk of developing certain cancers afterwards!
She’s got moxi
Have you heard of or experienced moxibustion? Moxibustion is a technique used during acupuncture in which mugwort (or artemsia vulgaris) is burned to warm certain regions or acupuncture points. It can be direct (in which the moxa is placed directly on the acupuncture point) and indirect (in which the moxa is palced approximately 1 to 2 cm above the acupuncture point). The purpose of moxibustion is to encourage better blood and energy flow through the area to promote healing.
A study in the March 13 advanced online edition of Menopause suggests that moxibustion plus acupuncture can reduce both the frequency and severity of hot flashes.
In this study, researchers randomly assigned 51 women, ages 45 to 60 years who experienced at least 5 moderate to severe hot flashes daily to:
- 14 sessions of indirect moxibustion plus acupuncture at points consistent with evidence from clinical practice experience
- 14 sessions of indirect moxibustion plus acupuncture at points consistent with evidence from published literature
- no treatment
To ensure that researchers were able to distinguish between general improvements and improvements resulting from treatment, all study participants had to go through a 1-week period during which time they used not treatments at all.
Study findings showed that compared with no treatment at all, women in both moxibustion groups experienced significantly reductions in hot flash frequency (roughly 60% in both groups), and continuous reductions in hot flash severity through the fourth week of the study (by as much as 50%). 10 participants experienced side effects due to the moxi smoke (e.g. fatigue, stomach upset, flare-up and headaches ) and 5 reported burns to their skin).
Notably, women receiving moxibustion along points directed by published literature also experienced more improvements in quality of life scores, particularly as they related to symptoms and psychosocial issues.
This study appears to indicatethat moxibustion may help to enhance acupuncture’s effect on hot flashes during the menopause. Clearly, more studies with larger samples are needed.
Bad to da bone, part 2
Is there any way to prevent bone loss after menopause? It is possible that eating the proper balance of dietary fats (i.e. omega-3 fatty acids and omega-6 fatty acids) may help.
In a study published a few years ago in the Journal of Nutritional Biochemistry, researchers assessed bone mineral content and bone density in female rats. These measures are used to determine how much bone loss you have in a particular area and the risk for developing osteoporosis. The National Osteoporosis Foundation provides an excellent summary.
In the study, half the rats had their ovaries removed (leading to a rapid decline in estrogen and subsequent bone loss) and half remained intact. They were then fed diets with different ratios of omega-3s and omega-6s. After 12 weeks, data showed that rats with the lowest ratio of omega-6 to omega-3 fatty acids in their diets had significantly less bone loss and a higher bone mineral density, even in the absence of estrogen. This translated to significantly lower bone loss.
Omega-6 fatty acids are most commonly found in foods such as vegetables oils, nuts, seeds and eggs while omega-3 fatty acids are more commonly found in fatty fish (salmon, mackerel), nuts (walnuts) and certain vegetable oils. Notably, eating both omega-3 and omega-6 fatty acids has been shown to lower the risk of heart and possibly other diseases. However, research continues to point to balance.
These particular findings may be due to the ability of omega-3 fatty acids to reduce the production of inflammatory compounds that associated with the breaking down or “resorption” of bones. Estrogen provides a similar protective effect but after its decline, the body becomes more vulnerable.
While researchers caution that the study results cannot be translated to humans, they certainly look promising.
It’s all about balance, right?!
Wednesday Bubble: professional drivers only
A friend of mine sent me a video the other day entitled “Menopausal Women in a Parking Lot.”
I got such a kick out of it that I decided to take a slight detour from our regular scheduled Wednesday program and share the joy.
Ladies, please! Do not try this at home. These are professional drivers actors.
Timing is everything
Headache, irritability and mood swings….they’re going to disappear someday. Promise.
Research findings show that certain symptoms commonly linked with menopause decline linearly, meaning that as you move through the transition, those bothersome symptoms will move with you and then gradually diminish. Phew!
A study that appeared in Obstetrics & Gynecology early last year showed a direct association between menopausal symptoms and reproductive hormones at any given time during the menopause. Researchers evaluated menstrual bleeding patterns, symptoms and levels of estradiol, follicle-stimulating hormone (FSH) and testosterone in women over a nine-year period. Stages of menopause were analyzed based on bleeding patterns. All women underwent structured interviews, completed symptoms questionnaires and were followed for bleeding dates and hormone measures.
The results showed that headache was significantly associated with stage of menopause, declining in the pre- to postmenopause transition. Mood swings and irritability were both associated with declining FSH levels. Additional analyses also revealed a link between PMS, perceived stress and all three of these symptoms (i.e. headache, irritability and mood swings).
So what about other symptoms like hot flashes and night sweats and depression? A small percentage of women may have to deal with them a bit longer. In fact, data suggest that they may persist well into the postmenopausal period although the reasons are not entirely clear.
What’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?
Wednesday Bubble: Risk
Do data justify routine assessments of breast cancer in older women? According to a study published in the March 10 online edition of the Journal of the National Cancer Institute, the answer is a resounding “yes!”
Researchers from the California Pacific Medical Center Research Institute in San Francisco systematically reviewed published literature and meta-analyses of various aspects of breast cancer risk and prevention, including risk assessment models, breast density measurements and lifestyle factors.
While the results showed that measures of breast density (which can be determined in mammograms) were very strong predictors of a woman’s risk for developing breast cancer, risk assessment models, which use medical history and demographics (e.g. race, age, income, socioeconomic status, etc) were only moderately accurate in predicting risk.
Yet, when combined, the risk of developing breast cancer could be determine more accurately in roughly a third of women.
Study Implications
The researchers note that “for women at high risk of developing breast cancer, the findings are very significant.” For example, women who learn that they are at high risk might want to consider more frequent mammograms or digital scans such as MRIs. They also say that treatments such as raloxifene and tamoxifen, when used for five years, confer roughly 15 years of protection. Conversely, women at low risk may be able to reduce the frequency of mammograms.
Importantly, lifestyle factors such as regular exerise, losing weight, a low-fat diet and reducing alcohol intake appeared to lower breast cancer risk in women of all ages. However, eating more fruits and vegetables did not seem to make any difference. This is not to say, however, that women should eliminate fruits and vegetables from their diet as studies do suggest that these foods are protective against other forms of cancer, such as colon cancer.
In a time when evidence is accruing against HRT and its health ramifications, it’s assuring to know that there are ways to determine if we’ve placed ourselves at greater risk of disease and strategies to counteract our missteps.
ACUFLASH
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?
