Managing Menopause Matters

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

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Menopause sometimes requires a survival guide

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.

BIOIDENTICAL HORMONES

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.

From http://www.losaltosonline.com/special-sections2/sections/your-health/53300-

Acupuncture in menopause (AIM) study

Menopause, 05/27/2016Avis NE, et al.

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.

Methods

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.
Results

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.
Read more at http://www.mdlinx.com/nurse-practitioner/medical-news-article/2016/05/27/menopause/6682615/?news_id=578&newsdt=052716&utm_source=DailyNL&utm_medium=newsletter&utm_content=General-Article&utm_campaign=article-section&category=latest&page_id=1

8 Energy Boosters to Beat Menopause Fatigue

tired-zombie
Menopause got you dragging? Here are a few simple ways to fight menopause energy drain and regain your oomph.

If you’re like many women, you’ll probably experience bothersome symptoms during menopause — one of which may be fatigue. Fatigue is a common menopause complaint, especially in the early stages of menopause, as your body adjusts to its new chemistry.

But low energy can be also caused by number of other medical conditions, including anemia, coronary artery disease, diabetes, heart failure, hypothyroidism, hyperthyroidism, and kidney or liver disease. If you are fatigued, “you should talk to your doctor just to be sure it’s a menopause symptom,” says Wendy Klein, MD, associate professor emeritus of internal medicine, obstetrics, and gynecology and chair of the Women’s Health Conference at the Virgina Commonwealth University School of Medicine.

“Most women don’t need treatment for their menopause symptoms,” Klein says. “The majority of women will have symptoms that are transient. They last two or three years and abate by themselves.” But there are lifestyle changes you can make to help relieve symptoms you may experience.

If you’re dealing with fatigue as you go through menopause, try these eight simple tricks to boost low energy:

1. Exercise daily. You should aim for at least 30 — and preferably 60 — minutes of exercise most days of the week. Exercising may be the last thing you want to do when you’re feeling weak or tired, but exercise actually boosts your energy, says Staness Jonekos, who co-authored The Menopause Makeover with Dr. Klein. “Exercise is your fountain of youth,” Jonekos says. “It produces those feel-good hormones and gives you the energy you’re looking for when you’re not feeling good.” Some people find it helps to exercise earlier in the day rather than close to bedtime.

2. Cap caffeine and alcohol consumption. Caffeine and alcohol can both affect energy levels and interfere with getting a good night’s sleep if you indulge in the evening. They may give you an immediate rush, but when they wear off, they can leave you feeling more drained than before. Nicotine can also have this effect, so if you smoke, quit. You’ll find you have more energy without artificial stimulants.

3. Limit food portions. Being overweight during menopause can cause you to feel sluggish. The best diet is one that is rich in fruits, vegetables, and whole grains and that includes lean sources of protein (poultry, lean meats, and fish) and low- or no-fat dairy products. Limit the amount of fats and sweets you eat. Eating smaller meals more frequently can provide energy throughout the day, Jonekos says. But if you eat more often, be sure you’re not overeating — watch your total calories.

4. Embrace relaxation. How do you unwind? Whether you like to read, take long walks, or meditate, take the time to indulge in your favorite activities. “You’re entitled to pamper yourself and take time for yourself,” Jonekos says. “As a result, you will be more energetic.” Stress and anxiety could be causing your fatigue, and relaxation techniques can be very helpful in learning to overcome them. A study published in Menopause: The Journal of the North American Menopause Society shows that stress-reduction therapy may also help with menopause symptoms, decreasing the degree to which women were bothered by hot flashes by 22 percent.

5. Get your Zzz’s. Another menopause symptom is hot flashes or night sweats, which can keep you up at night. Restful sleep is important during menopause so you’re not overly tired during the day. This may require keeping your bedroom cooler than you usually do. Use a ceiling fan and wear lighter bed clothes. Make sure the room is dark and set your body clock by going to bed and waking up around the same time every day — even on weekends.

6. Stay hydrated. “You need to nourish your body with healthy food and water,” Jonekos says. Thirst is your body’s way of telling you that you need more fluid. When you’re dehydrated, your body has to work harder to perform, which can lead to fatigue. Dehydration also can cause nausea and difficulty concentrating. Keep a water bottle handy so you can drink when you’re thirsty. Choose water or caffeine-free tea or coffee — not calorie-laden drinks, as weight gain can make you sluggish.

7. Don’t overbook. You may be fatigued because you’re trying to do too much. Learn to say no. Know your limits and what you can and can’t accomplish in a day. Also, if you set reasonable limits, you’ll be less stressed, Jonekos says.

8. Try herbal remedies. Two herbal remedies that may help reduce menopause symptoms that can cause fatigue and anxiety are black cohosh and valerian. Talk to your doctor before taking herbs as teas or supplements as they can interfere with some medications.

“No one recipe fits everyone,” Jonekos says. “But if you’re suffering from fatigue during menopause, you need to take control, and you can do that by adopting a healthy lifestyle.” Eat right, exercise, get adequate sleep, and learn to relax — you will find you have more energy to enjoy your life.

From http://www.everydayhealth.com/hs/guide-to-managing-menopause/8-energy-boosters-for-menopause-fatigue/

Evaluation and Management of the Premenopausal Woman with Low BMD

Current Osteoporosis Reports, 10/31/2013  Review Article  Clinical Article

bone density machine

bone density machine (Photo credit: x1987x)

Cohen A et al. – Interpretation of bone mineral density (BMD) results in premenopausal women is particularly challenging, since the relationship between BMD and fracture risk is not the same as for postmenopausal women. Assessment of markers of bone turnover and follow–up bone density measurements can help to identify those with an ongoing process of bone loss that may indicate a higher risk for fracture, and possible need for pharmacologic intervention.

  • In most cases, Z scores rather than T scores should be used to define “low BMD” in premenopausal women.
  • The finding of low BMD in a premenopausal woman should prompt thorough evaluation for secondary causes of bone loss.
  • If a secondary cause is found, management should focus on treatment of this condition.
  • In a few cases where the secondary cause cannot be eliminated, treatment with a bone active agent to prevent bone loss should be considered.
  • In women with no fractures and no known secondary cause, low BMD is associated with microarchitectural defects similar to young women with fractures; however, no longitudinal data are available to allow use of BMD to predict fracture risk.
  • BMD is likely to be stable in these women with isolated low BMD, and pharmacologic therapy is rarely necessary.

From MDLinx

Menopausal Hormone Therapy

PS-main-logo

Menopausal Hormone Therapy and Health Outcomes During the Intervention and Extended Poststopping Phases of the Women’s Health Initiative Randomized Trials

JAMA, 10/02/2013  Evidence Based Medicine  Clinical Article

Manson JE et al. – Menopausal hormone therapy continues in clinical use but questions remain regarding its risks and benefits for chronic disease prevention. To report a comprehensive, integrated overview of findings from the 2 Women’s Health Initiative (WHI) hormone therapy trials with extended postintervention follow–up. Menopausal hormone therapy has a complex pattern of risks and benefits. Findings from the intervention and extended postintervention follow–up of the 2 WHI hormone therapy trials do not support use of this therapy for chronic disease prevention, although it is appropriate for symptom management in some women.

Methods

  • A total of 27 347 postmenopausal women aged 50 to 79 years were enrolled at 40 US centers.
  • Women with an intact uterus received conjugated equine estrogens (CEE; 0.625 mg/d) plus medroxyprogesterone acetate (MPA; 2.5 mg/d) (n = 8506) or placebo (n = 8102).
  • Women with prior hysterectomy received CEE alone (0.625 mg/d) (n = 5310) or placebo (n = 5429).
  • The intervention lasted a median of 5.6 years in CEE plus MPA trial and 7.2 years in CEE alone trial with 13 years of cumulative follow–up until September 30, 2010.
  • Primary efficacy and safety outcomes were coronary heart disease (CHD) and invasive breast cancer, respectively.
  • A global index also included stroke, pulmonary embolism, colorectal cancer, endometrial cancer, hip fracture, and death.

Results

  • During the CEE plus MPA intervention phase, the numbers of CHD cases were 196 for CEE plus MPA vs 159 for placebo (hazard ratio [HR], 1.18; 95% CI, 0.95–1.45) and 206 vs 155, respectively, for invasive breast cancer (HR, 1.24; 95% CI, 1.01–1.53).
  • Other risks included increased stroke, pulmonary embolism, dementia (in women aged >=65 years), gallbladder disease, and urinary incontinence; benefits included decreased hip fractures, diabetes, and vasomotor symptoms.
  • Most risks and benefits dissipated postintervention, although some elevation in breast cancer risk persisted during cumulative follow–up (434 cases for CEE plus MPA vs 323 for placebo; HR, 1.28 [95% CI, 1.11–1.48]).
  • The risks and benefits were more balanced during the CEE alone intervention with 204 CHD cases for CEE alone vs 222 cases for placebo (HR, 0.94; 95% CI, 0.78–1.14) and 104 vs 135, respectively, for invasive breast cancer (HR, 0.79; 95% CI, 0.61–1.02); cumulatively, there were 168 vs 216, respectively, cases of breast cancer diagnosed (HR, 0.79; 95% CI, 0.65–0.97).
  • Results for other outcomes were similar to CEE plus MPA.
  • Neither regimen affected all–cause mortality.
  • For CEE alone, younger women (aged 50–59 years) had more favorable results for all–cause mortality, myocardial infarction, and the global index (nominal P < .05 for trend by age).
  • Absolute risks of adverse events (measured by the global index) per 10 000 women annually taking CEE plus MPA ranged from 12 excess cases for ages of 50–59 years to 38 for ages of 70–79 years; for women taking CEE alone, from 19 fewer cases for ages of 50–59 years to 51 excess cases for ages of 70–79 years.
  • Quality–of–life outcomes had mixed results in both trials.

From http://www.mdlinx.com/internal-medicine/newsl-article.cfm/4870253/ZZ4747461521296427210947/?news_id=466&newsdt=100213&utm_source=Newsletter&utm_medium=DailyNL&utm_content=General-Article&utm_campaign=Article-Section