Menopause is a natural part of aging in women. It affects each woman differently, and the symptoms associated with menopause can be difficult for some.
Learn from Wen Shen, M.D., director of the Menopause Consultation Clinic, about menopause symptoms and the latest treatment options. Knowing what to expect can help you stay as healthy as possible during this phase of your life.
Thursday, April 20, 2017
7–8 p.m. EST
Menopause has gotten a bad rap. Women in their 40s and 50s who have any symptoms – from moodiness to insomnia and headaches – may believe that it’s a normal part of aging and there’s not much they can do about it.
Fluctuating hormones caused by the normal decline of ovarian function can trigger the typical symptoms associated with menopause. One approach is to give the body a drug that mimics ovarian function, such as estrogen or hormone replacement therapy. This was a common treatment, until multiple studies showed increased risk of urinary incontinence, stroke, dementia and breast cancer from using menopausal hormone therapy.
Fortunately, there is another approach to improving the body’s ability to adjust to hormone fluctuations that doesn’t increase the risk of breast cancer and dementia. This approach looks at the other organ systems that are involved in addition to the ovaries. For instance, hot flashes will be greatly exaggerated in a woman who has blood-sugar problems – even if those don’t show up on a standard blood test.
Some women use bioidentical hormones instead. While they appear to have fewer immediate side effects, there is no evidence that they have fewer long-term risks.
At a recent functional medicine conference I attended, there were several discussions on how to address hormone “saturation” – the experience many women have after being on bioidentical hormones for several years and then having a return of their previous symptoms. We’re learning that underlying imbalances in gut function, adrenal hormones and blood sugar can have a major effect on a woman’s experience of her perimenopausal years.
IT’S NOT JUST THE OVARIES
Technically, menopause occurs when a woman hasn’t had a period for 12 consecutive months. The symptoms that can occur for years before that are due to the ovaries becoming less predictable in their hormone production. This means that estrogen levels can spike and fall like a roller coaster.
Unfortunately, once a woman knows that her hormones are fluctuating, she is likely to explain away all her symptoms as perimenopausal. But ovaries are not the only glands affected by hormone changes. The pancreas, thyroid and adrenal glands play key roles in determining how easy or difficult the perimenopausal years will be.
The most common, end-stage effect of pancreas dysfunction is diabetes. But long before the body reaches a disease state, there are more subtle effects. For instance, a woman with low blood sugar or insulin resistance will experience more severe hot flashes than a woman with normal blood-sugar regulation.
Following are common symptoms associated with perimenopause and factors that can determine the severity of those symptoms.
• Heavy or frequent periods. These can be worsened by blood-sugar and thyroid imbalances that don’t show up on routine blood work. Checking free and total levels of T3 and T4 as well as thyroid antibodies can be helpful.
• Hot flashes or low libido. Underlying adrenal stress can result in cortisol levels that are too high or too low, or reduced DHEA (precursor to several hormones). Cortisol levels are best tested with multiple saliva samples over a 24-hour period.
• Insomnia. With or without hot flashes, insomnia is often due to chronic stress, which causes the adrenals to produce excess cortisol.
• Mood changes and brain fog. Moods can be affected by the stress hormone cortisol as well as imbalanced neurotransmitters. Neurotransmitters such as serotonin are made primarily in the gut and can be evaluated with a urine test. Low levels of serotonin can also increase overall pain levels.
• Hair loss and weight gain. There may be underlying thyroid stress that doesn’t show up on routine blood work but requires a more detailed look at free and total levels of T3 and T4 and thyroid antibodies.
Once these underlying issues are identified, they can be addressed through food choices, lifestyle factors and specific supplements.
Marina Rose, D.C., is a functional medicine practitioner, certified clinical nutritionist and chiropractor with an office at 4546 El Camino Real in Los Altos. For more information, visit DrMarinaRose.com.
The aim of the study was to evaluate the short and long–term effects of acupuncture on vasomotor symptoms (VMS) and quality of life–related measures. The authors found that a course of acupuncture treatments was associated with significant reduction in VMS, and several quality–of–life measures, compared with no acupuncture, and that clinical benefit persisted for at least 6 months beyond the end of treatment.
- A total of 209 perimenopausal and postmenopausal women aged 45 to 60 years, experiencing four or more VMS per day, were recruited from the community and randomized to receive up to 20 acupuncture treatments within the first 6 months (acupuncture group) or the second 6 months (waitlist control group) of the 12–month study period.
- The primary outcome was mean daily frequency of VMS.
- Secondary outcomes were VMS interference with daily life, sleep quality, depressive symptoms, somatic and other symptoms, anxiety, and quality of life.
- The VMS frequency declined by 36.7% at 6 months in the acupuncture group and increased by 6.0% in the control group (P < 0.001 for between–group comparison).
- At 12 months, the reduction from baseline in the acupuncture group was 29.4% (P < 0.001 for within–group comparison from baseline to 12 months), suggesting that the reduction was largely maintained after treatment.
- Statistically significant clinical improvement was observed after three acupuncture treatments, and maximal clinical effects occurred after a median of eight treatments.
- Persistent improvements were seen in many quality of life–related outcomes in the acupuncture group relative to the control group.
February is American Heart Month. Learn about heart disease in women and what you can do to keep a healthy heart.
Get Informed: Facts on Women and Heart Disease
- Heart disease is the leading cause of death for women in the United States.
- Although heart disease is sometimes thought of as a “man’s disease,” around the same number of women and men die each year of heart disease in the United States.
- Some conditions and lifestyle choices increase a person’s chance for heart disease, including diabetes, overweight and obesity, poor diet, physical inactivity, and excessive alcohol use.
- High blood pressure, high LDL (low-density lipoprotein) cholesterol, and smoking are key risk factors for heart disease. LDL is considered the “bad” cholesterol because having high levels can lead to buildup in your arteries and result in heart disease and stroke. Lowering your blood pressure and cholesterol and not smoking will reduce your chances for heart disease.
While some women have no symptoms of heart disease, others may experience heavy sharp chest pain or discomfort, pain in the neck/jaw/throat, or pain in the upper abdomen or back. Sometimes heart disease may be silent and not diagnosed until a woman has signs or symptoms including:
- Heart Attack: Chest pain or discomfort, upper back pain, indigestion, heartburn, nausea/vomiting, extreme fatigue, upper body discomfort, and shortness of breath.
- Arrhythmia: Fluttering feelings in the chest.
- Heart Failure: Shortness of breath, fatigue, swelling of the feet/ankles/legs/abdomen.
- Stroke: Sudden weakness, paralysis (inability to move) or numbness of the face/arms/legs, especially on one side of the body. Other symptoms may include confusion, trouble speaking or understanding speech, difficulty seeing in one or both eyes, shortness of breath, dizziness, loss of balance or coordination, loss of consciousness, or sudden and severe headache.
Heart disease is largely preventable.
Listen to CDC’s Dr. Bowman discuss ways to prevent heart problems.
What You Can Do for Heart Health
You can lower your chance of heart disease and a heart attack by taking simple steps.
- Eat a healthy diet with fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products. Choose foods low in saturated fats, cholesterol, salt (sodium), and added sugars.
- Exercise regularly. Adults needs 2 hours and 30 minutes (or 150 minutes total) of exercise each week. You can spread your activity out during the week, and can break it up into smaller chunks of time during the day.
- Be smokefree. If you are ready to quit, call 1-800-QUIT-NOW (1-800-784-8669) or 1-855-DÉJELO-YA (1-855-335-3569 for Spanish speakers) for free resources, including free quit coaching, a free quit plan, free educational materials, and referrals to other resources where you live.
- Limit alcohol use, which can lead to long-term health problems, including heart disease and cancer. If you do choose to drink, do so in moderation, which is no more than one drink a day for women. Do not drink at all if you are pregnant.
- Know your family history. There may be factors that could increase your risk for heart disease and stroke.
- Manage any medical condition you might have. Learn the ABCS of heart health. Keep them in mind every day and especially when you talk to your health provider:
- Appropriate aspirin therapy for those who need it
- Blood pressure control
- Cholesterol management
- Smoking cessation
The purpose of this study is to investigate whether the study medication can help people with mild to moderate Alzheimer’s Disease improve their mental abilities such as understanding, reasoning, and judgment. The study medication will be given together with an FDA-approved Alzheimer’s medication: Aricept® (donepezil), Exelon® (rivastigmine) or Razadyne® (galantamine).
More about the study:
- The study drug (MK-7622) is administered in the form of one capsule a day in the morning.
- There will be 830 participants in this trial
If you are interested, please find the full study details and eligibility criteria listed here.
- be between 55 – 85 years old
- be diagnosed with mild to moderate Alzheimer’s Disease (12 – 24 MMSE)
- have a trial partner who is able to attend any study visits that require assessment
- be currently taking a stable daily dose of acetylcholinesterase inhibitor (AChEI) such as Aricept® (donepezil), Exelon® (rivastigmine patch oral), or Razadyne® (galantamine)
Participants must not:
- have a history of seizures or epilepsy within the last 5 years
- have a history of mental illness
- have been diagnosed or treated for cancer within the past 5 years (excluding basal cell, squamous cell skin cancer, in situ cervical cancer and localized prostate cancer)
Please complete the online questionnaire to check if you’re eligible for the trial.
If you’re not familiar with clinical trials, here are some FAQs:
What are clinical trials?
Clinical trials are research studies to determine whether investigational drugs or treatments are safe and effective for humans. All new investigational medications and devices must undergo several clinical trials, often involving thousands of people.
Why participate in a clinical trial?
You will have access to new investigational treatments that would be available to the general public only upon approval. You will also receive study-related medical care and attention from clinical trial staff at research facilities. Clinical trials offer hope for many people and an opportunity to help researchers find better treatments for others in the future.
Learn why I’m talking about this Clinical Trial
Not from Alice OR Power Surge but important information for women.
/ Friday, November 13, 2015
DEAR DR. ROACH: My question is about symptoms for women’s heart attacks. I have always heard that symptoms for women can be much different from men’s. Instead of the chest-clutching, sharp pain that men can have, I have read that women’s symptoms can be any of these: heartburn or indigestion; pain in the jaw, neck, shoulders, back, one or both arms; fatigue and troubled sleep; dizziness and nausea; or extreme anxiety. Are you KIDDING me? I am a healthy, active 63-year-old woman. I have had all of these symptoms at one time or another. If I acted every time I had one of these symptoms, I would be at the doctor’s office every day. How is one to know which symptoms to take seriously and act on immediately, and which to wait a few days to see if it is temporary?
Thank you for addressing this confusing issue. — J.
ANSWER: I have seen many letters similar to yours. The confusing problem is that it’s true: In women, heart attack symptoms and the symptoms of angina before a heart attack can include all of those vague symptoms. The same is true of men as well, although it’s more likely for women than for men to have symptoms other than the classic left-sided chest discomfort (people are much more likely to describe angina as “discomfort” or “pressure” than “pain”).
So your question is entirely valid: How do you know when to take common symptoms seriously? The first thing I would say is that the greater your risk for heart disease, the more seriously you should take any symptom. Age, family history of heart disease, high blood pressure and cholesterol, lack of regular physical exercise and diabetes are among the most important risk factors.
The second thing I would say is to take new symptoms seriously. If you never get heartburn, for example, then heartburn at age 63 should prompt concern.
Third, context matters. Symptoms such as nausea or jaw pain that occur with exercise — even carrying a bag of groceries or walking up stairs — is definitely a reason to talk to your doctor.
Most women don’t know that heart disease remains their No. 1 killer, far outstripping breast cancer (or any cancer). Both women and men need to take even vague symptoms seriously, especially if the symptoms are new, exertional or if the person has several risk factors. As a primary-care doctor, I’d rather see my patient for her concerns that symptoms may be heart disease than see her in the ICU with a heart attack.
Despite the bold and assertive name by which the hot flash is known, her origins remain elusive. Of course, doctors and scientists understand many of the mechanisms of menopause such as the reduction in estrogen and the important relationship between the ovaries and the pituitary gland, but the central cause of hot flashes – the heating of a woman’s core – is a secret Mother Menopause has yet to reveal.
“I’ve written editorials that we’ve sent men to the moon and we’ve broken the genetic code, but we cannot really explain the physiology of a hot flash,” said Cynthia Stuenkel, M.D., clinical professor of medicine, endocrinology and metabolism at the University of California, San Diego, School of Medicine in La Jolla, Cal.
What is known then? The hot flash seems to be an equal-opportunity phenomenon, plaguing as many as 75 percent of women, regardless of race or reproductive history. Whether you had children, and how many, and at what age, or remained childless, doesn’t seem to have any correlation with hot flashes, their severity or frequency. Nor does breastfeeding history or the age at which a woman began or stopped menstruating.
Smoking is believed to bring on menopause about one to two years early and some inherited tendencies can mean that women in the same family may see their eggs becoming less responsive around the same time of life. Obesity is believed to cause more hot flashes in some medical circles. But other doctors disagree.
What they do agree upon is that the thermoregulatory center of the brain which regulates temperature somehow loses its typical functioning capacity as estrogen decreases. Follicle-stimulating hormone (FSH) is produced by the pituitary gland in the brain. Its job is to stimulate the dominant follicle on one of a woman’s ovaries each month to release an egg.
But as the number of eggs decline throughout a woman’s childbearing years, the ovaries makes less estrogen and communicate this situation to the pituitary by “talking back” to it with a hormone called inhibin. The pituitary responds to the decline in estrogen by sending out more FSH, a hormone that is often measured when trying to gauge a woman’s fertility.
What isn’t more intimately understood is how the declining estrogen levels affect thermoregulation in the brain and specifically a center called the hypothalamus. Internal and external symptoms do not mirror the subtleties going on in the brain.
During a typical hot flash, which lasts from two to five minutes, a woman experiences a feeling of heat, usually in the upper torso, as blood vessels dilate. “In some women that are fair you’ll see some redness,” said James Liu, M.D., chair of the department of obstetrics and gynecology at University Hospitals/MacDonald Women’s Hospital at Case Western Reserve University School of Medicine in Cleveland, Oh.
Liu said the internal core temperature actually drops a little despite the feeling of heat, while fingertip temperature goes up. Epinephrine, also known as adrenaline, courses through the bloodstream, sometimes causing an increased heart rate.
That can be disconcerting to women who have been taught of late not to ignore what can be the more subtle symptoms of heart attack in women. Liu offers simple advice for determining the difference between a hot-flash-induced pounding heart and a heart attack. “A heart attack is unrelenting,” he explains. “A heart attack episode is constant.”
The pounding heart that comes with the hot flash ends with the heat. Unfortunately, that drop in core temperature often sends women on a rollercoaster ride in the other direction, now feeling cold, and, of course, often very wet from copious sweating.
“We don’t know what triggers the temperature instability. That’s something we’re trying to figure out,” Liu said, echoing Stuenkel, and explaining that normally humans maintain a very stable temperature even under warm conditions.
Cynthia Stuenkel, M.D. via phone interview July 3, 2015 James Liu, M.D., via phone interview July 6, 2015
via The Science Behind What Happens In a Woman’s Body During ….