So one of the ways that the hormonal changes can affect our brain chemistry, it could result in anxiety, I mentioned that briefly as part of the mood changes.   But anxiety in particular might need a little bit more attention in that it can be mild, just feeling, waking up in the morning and just feeling a little “off”, a little anxious, or lying in bed at night and worrying a little bit more.  Being a little bit more anxious about going to the party or going to another social event.  But it can also become much more significant and even severe.  There are women that never had an anxiety syndrome, never had panic attacks, and now all of a sudden are in the emergency room with chest pain, heart palpitations, shortness of breath, and there is nothing wrong with their heart.  It’s a bona fide panic, anxiety attack.  And that is a part of this whole hormonal influence on our brain chemistry is worrying more, anticipatory anxiety, stressing about upcoming events.  Any way, shape or form, just feeling more anxious.  Being more sensitive too to what someone says.  You know your husband says something “did he really mean this? did he mean that?” being anxious that he’s… even paranoid.  Maybe more jealousy coming up around this anxiety syndrome can happen all mediated by these hormonal changes.

Often women ask me the question is “how long is this going to last, Dr. Hudson?” and “when is this going to end Dr. Hudson?” and I wish I could answer that question “it’s only going to last this time”, but the truth is it’s…I can not.  It’s unpredictable.  It’s different for all of us.  The severity is different for each of us, the duration is different for each of us, which symptoms we have on this long list of potential symptoms is different for each of us.  But, on an average, according to the research, menopause symptoms for seventy five to ninety percent of women last four to seven years.  Now, there’s the ten to twenty five percent of women for whom that’s different.  And we don’t know if at year three, at year four or at year seven if you are going to be on your way out of these symptoms or are you going to be one of these ten to twenty five percent that is going to last longer.  There is no way to really know that.  We are trying to get some understanding.  If you’ve had severe PMS, it seems to have some prediction on menopause being more severe.  That’s one thing we seem to see a correlation with now.  But unfortunately, we can’t really predict what your menopause is going to be like, let alone, can we predict how long it’s going to last.  But we can work with the law of averages and try to give some reassurance. And most symptoms are temporary in most women.  The problem is there’s the women that are not “most women” and the problem is that there are a few symptoms that tend to be progressive, like vaginal dryness, vaginal thinning, urinary incontinence, that set of symptoms tends to get worse with time because that tissue gets more consequences as it is deprived of estrogen for a  longer period of time.  But most other things, symptoms, not bone loss, not some of those things, but symptoms.  Most of those are temporary in most women.

Foggybrain: “I lost my keys.”

Muddlehead: …”Hey those are my keys, no wait those are not my keys, whose are these?”

Foggybrain: “Dunno. Now I can’t find my wallet.”

Muddlehead: “I saw it outside in the backyard.”

Foggybrain: “What’s it doing out  there?”

Muddlehead: “Dunno but I misplaced my “to-do” list for today and for the life of me, I can’t remember where it is I’m about to go.”

Foggybrain:”Yea, but where are my keys?”

Muddlehead: “Dunno.”

Foggybrain: “I can’t find my coat. I think I left it at Bill’s.”

Muddlehead: “I’m late for work…why are you wearing my shoes??”

…Stay tuned for more conversations with Foggybrain and Muddlehead…

Why does it often take a life crisis or even interruption to get us to absorb what we do have?

This last two weeks I have faced such an event. In my mind’s eye, viewing the potential disaster of my future, I was confronted with the reality of the condition of my heart.

I had grown terminally discontent. The small things mainly. My husband leaving his used bath towel on the bathroom floor would send me into internal grumbling and complaining.

The light fixture that didn’t work forced me to condemn the whole house adding adage’s of “why can’t I have bigger, better, more?”

So subtle is the negative spirit that robs us from viewing the abundance of the present. Sometimes the threat of losing enlightens our spirit to embrace the gifts we routinely overlook day after day.

I switched paths and today my gratitude runs deep. The mantle on my fireplace, the specially designed tiles on my kitchen floor, the well being of my children and even the used bath towel my husband left once again on the floor. It all appears new and I feel clean.

And as I exercise this gratitude I am offered a strength that overshadows of any threat of the future, fear of disaster and a provides a profoundly joyous heart replacing the one that just wouldn’t see.

Blessings to all!

Was it a heart attack? I certainly had all the symptoms: chest pains, extreme dizziness and nausea, couldn’t take a deep breath, heavy fatigue.

It had come on so fast that morning. First it was the dizziness. The room was spinning as if I were on a Merry go Round. I stumbled over and had such tightness in my chest. The fatigue set in and I felt like I couldn’t breathe.

I have read many times to beware of “The Silent Killer” as heart disease is the number one killer of women. I will be 56 this month and having heart disease in my family caused even more concern.

I wanted to tough it out, ignore it. “It’s nothing”, I thought, “Maybe too much caffeine”. But the symptoms wouldn’t let up and I made the call.

A couple hours later, I walked out of the hospital feeling pretty much the same. It was not a heart attack or stroke. I was embarrassed and vowed never to do that again. And then I remembered hearing, that’s what many women do and they die.

Here are the warning signs of a heart attack in women and then I’ll share what the doctor told me.
Neck, shoulder, upper back or abdominal discomfort
Shortness of breath
Nausea or vomiting
Sweating
Lightheadedness or dizziness
Unusual fatigue
www.americanheart.org

I also read:
“Worldwide, 8.6 million women die from heart disease each year, accounting for a third of all deaths in women. Three million women die from stroke each year. Stroke accounts for more deaths among women than men (11% vs 8.4%) with additional risk for CHD unique to women related to oral contraceptive use in combination with smoking.

8 million women in the US are currently living with heart disease; 35,000 are under age of 65. Four million suffer from angina.

267,000 women die each year from heart attacks, which kill six times as many women as breast cancer. Another 31, 837 women die each year of congestive heart failure, representing 62.6% of all heart failure deaths.” www.womensheart.org

Ladies, the doctor shared that if we experience any of these symptoms in a manner that is new or different for us, go get checked. Do not wait.

So what happened to me? What was it that caused these symptoms? I had the flu. A very strange type of flu that I have not experienced before. I am a bit embarrassed over the fuss, but I can only imagine what would have happened had I not gone in and it was the real thing.

The doctor said I was right to come in. So with that, I hope my ER story had given you some useful information for yourself and women you know.

So amongst all these symptoms, the woman and the practitioner has to decide which is best for her.  The way I approach this is, in taking the history and doing the physical exam,  maybe there are some tests that are ordered.  Basically determine what…are her symptoms mild, moderate, or severe.  So, symptom category is one issue.  Then are the risks for certain major diseases, mild, moderate, or severe.  Risk for osteoporosis, risk for heart disease, risk for diabetes.  So we have to determine these to the best of our ability, subjectively and objectively.  So after I’ve kind of made some kind of determination there, then I look at my whole list of “okay, what are we going to do about the symptom relief”.  Is there anything in diet, exercise and lifestyle category that could improve some of these symptoms?  Is there anything in the nutritional supplement category that could improve some of these symptoms?  Herbal medicines.  And then we have all different kinds of hormones, whether we call them…there are bioidentical hormones that are derived from a natural substance and then made into a hormone that is biochemically identical to our hormones, those are bioidentical. Those can be compounded at a special pharmacy to come up with very customized formulations and combinations and dosings that pharmaceutical companies don’t make.  But pharmaceutical companies also have a small selection of bioidentical hormones in a patch or a pill or a vaginal device.   And then there is synthetic or semi-synthetic hormones.  So, we have all kinds of hormonal options to choose from.  And not all practitioners know about all, or are skilled, or are educated about all those hormonal options.   Your typical conventional minded practitioner is going to mostly use the hormones the pharmaceutical companies make.  And it’s usually the alternative minded practitioner, whether it is a naturopathic physician or a medical doctor that’s going to be using the customized, compounded hormone combinations.

But the last category I want to mention is non-hormonal options.  So if you have insomnia.  This is why a doctor might prescribe Trazodone or Ambien, or those kinds of medications.  Pharmaceuticals for depression or anxiety.  There are even non-hormonal pharmaceuticals for hot flashes.  Some of the blood pressure drugs are actually used for that. Some of the anti-depressants are even used for that.  So we have all these categories.  In the herbal category maybe Black Cohosh. Maybe a Maca Extract.  Maybe a combination herbal formula that can… either one of those three choices can address kind of a nice array of menopause symptoms.  But perhaps you specifically have insomnia.  So we’ll use Black Cohosh and Valerian for example. But there are lots of specific nutrients and specific herbs for specific menopause symptoms.  And then the hormones are nice because they target a broad array of symptoms.  You can have kind of almost any menopause symptoms and a good menopause practitioner can determine what’s the best hormonal approach for this particular situation.

But then, weight gain in and of itself is something that happens to menopausal women. There is a normal weight gain related to age, due to our metabolism slowing down, we are losing our muscle mass the fact we also have a drop in estrogen and our insulin levels essentially do up and our cells become more insulin resistant. Maybe the most important thing to say about that, while complex is that we just don’t handle starchy foods and sugars as well anymore. Or, what are called high glycemic foods like bananas and cookies and bagels. They cause our blood sugar to rise quickly, or pancreas says “oh, okay, insulin”, to bring down the blood sugar a bit, but our cells and other parts of our body see that insulin so well anymore insulin then becomes a fat storage hormone. So less estrogen, more insulin, more insulin resistance, more weight gain. This is why peri and post-menopausal women say “my diet is the same as it’s always been” (and they say it’s good,) and “my exercise is the same as it’s always been”, (and let’s say it’s good for the purpose of this conversation.) But now, good may not be good enough, are insulin resistant and these same foods are causing weight gain. Now, in our 40’s, 50’s and 60’s we need to lower and starches and sugars that we’ve always eaten.  We have to eat less whole wheat bread. Even if it’s brown rice, we have to eat less brown rice. Let alone, if we still think bagels and pasta are a health food, we definitely have to lower those. Potatoes are terrible in terms of increasing our blood sugar and causing this fat storage dynamic, bananas, same thing. I encourage people to check out the low-glycemic index diet and the South Beach diet, this is actually a very good diet for menopausal women because it’s talking about insulin resistance and lowering the sugar and starch foods. Women in menopause start getting this abdominal weight gain much like men have already experienced abdominal weight gain. And these are both hormonally influenced phenomenon related to changes in our hormonal balance, if you will. And, the acquisition of this insulin resistance phenomenon.

Fatigue is another new symptom that women often talk about in this peri-menopause/early pose menopausal transition. Sometimes that is also one that is kind of hard to nail down and it’s hard for partners and family members to understand. Well, there is nothing really “wrong” with you, you don’t have a “disease”, you don’t have an infection, “why are you fatigued? Get with the program!” But there really are, again, changes in the sleep cycle, that’s the first place I look. Maybe she’s not having night sweats that are keeping her up, and she thinks “it’s not that”, and she thinks she is sleeping, but actually, maybe she doesn’t get into the deep sleep anymore. Again, brain chemistry. This lack of deep sleep affects our energy. Also, as our estrogen levels are low, our testosterone levels are also low. Our DHEA levels, another hormone we haven’t talked about, mostly from our adrenal glands are also low and that combination also affects our vitality. So, yes, fatigue is a fairly common menopause symptom, but we want to make sure it’s not something else first. Is it hypo-thyroid, is it anemia, is it depression, is it another health problem? If the doctor does their “due diligence”, and we don’t find a good explanation, we might easily come back to “oh, it’s how these hormones are affecting brain chemistry and vitality”.

One beautiful Saturday morning about 10 years ago I am reading the paper and sipping on a Starbucks soaking in the stillness and solitude of our home, when I hear her footsteps descending the stairs. Jan rounds the corner and I notice that she looks like she just plowed 40 acres of land last night with a broken down mule. Being the observant male that I am with all the sensitivity that I could muster, I said, ” What’s wrong honey, you look horrible.” She looked at me with a hollowed out expression and said ” I don’t feel like me anymore. I don’t understand what is happening to my mind and body with this menopause stuff.” I woke up feeling depressed and dreading the day.”

So understanding that I should say something that will bring comfort and caring, I said. “Gee honey, there seems to be something wrong with you everyday.” As she cocked her head to the side and squinted with one eye half shut, looking like the Hunchback of Norte Dame, she coldly stated, “Oh gee, thanks for your overwhelming understanding, and further more you don’t have the slightest clue about what I’m going through! If only you could feel for one day what I feel!!”  So my solution was to get out and go play golf.

As the days wore on and the nights became colder we both sensed a profound disconnect in our relationship. As Jan’s mood and symptoms escalated from her hormone imbalance, I too was becoming moody and depressed and just didn’t want to be around her. I would fantasize about taking off for a long motorcycle trip.

We both knew that changes were going on but we didn’t know how to get back to where we were before all this menopause stuff hit. The primary thought that I felt during this time was, that it was all about me. I’m in adequate, unlovable, whatever…

What I have learned through this DVD menopause project, is that Jan didn’t have any more control over her menopause symptoms, than I have over the course of world affairs. When I finally recognized that this isn’t about me and I began to show her a little empathy and compassion, she was able to give me the same in return.

For me, the menopause experience has been a journey of self-discovery about who I am as man and husband. The realization that menopause is treatable and it is not all about me, has taken our relationship to a much deeper level, even before menopause.

Look men, we have a choice, we can shrivel up into our self centered little world and try and pretend that this problem is not real, have a beer or play golf, tune out etc., or we can take matters into our own hands and try and fix this situation, like you would a leaky faucet. Any of these remedies will most likely lead to disaster.

Listening, empathy and compassion will go a long way no matter what life challenges come your way. So ask yourself, “What if this was cancer or another dread disease, would she not deserve the same dignity, love and respect?”

So the solution? Show a ” Whole lotta Love”!

Rock on!!

In women, estrogen and testosterone in particular can often improve these hormone related memory changes. There are also some natural substances that improve blood flow and that improve some of the neurological inputs. There is a little substance called NADH that can improve memory quite a bit. Gingko maybe doesn’t so much improve memory day to day but can help slow the decline of memory loss. There are actually numerous other plants that can improve memory. Gota Kola, an herb that people haven’t necessarily heard of, and one of my favorites Rodiola. It’s sort of a more eastern European plant with a considerable amount of research. Men in particular might be interested in that Rodiola has been studied to not only improve memory and concentration, but athletic performance. Recovering much more quickly from your workout example. So, for both men and women, that is kind of a good little tidbit to know. But, it’s actually a significant plant in memory loss.

Loss of libido can be a frequently reported symptom that women talk about. A better concept is “changes in sexual function”. Sexual function includes desire, which we call libido, arousal (the ability to get “worked up” so to speak), and then it includes the orgasmic response. So, those three areas are the key areas of sexual function. The hormonal changes can affect all three of those areas. With the drop in desire, intellectually the woman might still want to have sex, and likely does, if things re going well in life and the relationship. So intellectually she does, but she just doesn’t have the feeling, the juice, the joie de vie. She just doesn’t think of it. That’s very much a hormonally mediated symptom. She also often experiences a lower ability to get aroused. It takes longer or it’s less intense, the same with sensations to touch. The sensation to touch lessens. ?? to a decrease in blood flow to the area, there is less ability to feel and so the orgasmic responses are often slower and less intense. Now, men also have these changes with drop in testosterone, or at least, men often do. For women, our sexual function is also partly determined by testosterone, but for women it’s mostly estrogen and partially testosterone.

The women who use a topical testosterone cream applied to the genital area right before sex can actually have enhanced orgasmic response. The best approach to improving libido and arousal is using estrogen and testosterone together in a prescription form.

Vaginal dryness is also a part of a woman’s sexual function, because if sex is uncomfortable, then she doesn’t feel like having sex. So that’s one of the first things I do in an interview, in a woman who says “I just don’t feel like having sex”, I ask her about, “well when you do have sex, is it uncomfortable? And if it is, where?” There is dryness in the vaginal wall, but there is also… a drop in estrogen that affects the opening to the vagina. It’s called the introitis, and that ring contracts and narrows estrogen. So, not only is the vagina now thinner and drier, with less lubrication and less circulation, the opening is narrower, and so it’s painful. This change in vaginal comfort is part of libido and arousal and orgasmic response. Vaginal estrogen medication is a miraculous treatment for vaginal dryness and discomfort with sex because it not only takes care of the dryness it then makes the tissue more elastic so now this narrowed opening can get more elastic again. Vaginal estrogen with some topical testosterone to the genital area right before sex, and perhaps some systemic estrogen and testosterone when some of the herbal formulas don’t work for libido, she’s hopefully restored a satisfactory sexual function…more to come…are we having fun yet??

I think we need to learn to laugh when experiencing these uncomfortable menopause signs and symptoms and if you haven’t seen our music video  yet, get a giggle and watch the following video after the break:

Menopause Madness (click play to start)

[There is a video that cannot be displayed in this feed. Visit the blog entry to see the video.]

But there is something more serious some of us women suffer during this transitional time that I would like to briefly write about. Sometimes I wake in the morning feeling useless and believe the messages in my head that say, “You can’t do this, who do you think you are, you’re too old, you’re a loser, you are not needed anymore…” etcetera and etcetera.

Being a naturally vibrant and life-loving woman, this for me is disturbing. As I fight through the onslaught of slandering woes and push myself to do the necessary tasks for the day, I find my mind calms a bit. But some days the self doubt, anxiety, restlessness are too much and I close the laptop, go to a movie and buy a large extra butter popcorn. I know that it is only a day and tomorrow will be different, maybe no better or worse, but different.

There are 35 symptoms of menopause and the aforementioned are only a few. The physical ones, hot flashes, night sweats, etc are a sweaty walk in the park compared to those that affect our mood and mental well being.

Guys who live with menopausal women, it does subside. I know it is difficult. I feel sad for my husband sometimes when I am shut down, checked out and just trying to ride the nasty mood out.

I believe all of life’s transitions for both men and women are challenging. Passing through these stages allows us to see at our deepest level, the true nature of our character and our need for grace.

It also shows us what we are made of. And right now I gotta admit, feeling tired and edgy and with Halloween being tomorrow…I’m made of a whole bunch of freshly ingested Snickers bars and Butterfingers! Yea baby! (Not a recommended health care choice in Dr. Tori’s “Women’s Encyclopedia of Natural Medicine”!)

There’s kind of a short list of symptoms, and a long list.  And the short list, the most common thing really would be hot flashes.  That’s the thing that probably brings women most to the doctor’s. Whether they are day time or night time we call them hot flashes, although some people say night sweats.  If we are in the peri-menopause, of course there are changes in the menstrual cycle, but once one has stopped bleeding, then you don’t have a period anymore.

-Hot flashes

-Insomnia

-Mood swings, including: weepy, irritable, anxious, very snappy sometimes, not being able to tolerate the world so well

Those are probably amongst the most common.  And then we get to less common things:

Some of the less common symptoms would be in the transition time when hormones are going up and down: headaches, in particular.  Other than that time, once one has kind of settled in to menopause and their hormone levels are low, other less common things might be irritable bowel; gas, bloating, changes in bowel habits, dry skin, itchy skin, the voice getting kind of deeper, dry eyes, vaginal dryness, vaginal thinning, discomfort with sexual activity (we probably should move that up to one of the more common symptoms).  There are some rare and peculiar things like ringing in the ears, or shoulder, almost a frozen shoulder kind of issue, body aches are not on the super common, but frequent list.

Urinary frequency as well as involuntary loss of urine; a little dribbling, a little leakage, that is all related to changes in estrogen levels and the genital area.  Once that tissue gets thin, there is not only just dryness and itching, but there is also loss of tone and changes in angles of things, changes in how the sphincters work, and so then there is that involuntary loss of urine, or frequent urination.

So the reason why hot flashes, mood swings and sleep problems are the most common is not absolutely known.  But we do know that once the hormonal changes occur in the brain, then our brain chemistry is different.  So estrogen, progesterone, these things in particular affect serotonin, dopamine, norepinephrine; important brain chemistry that determines our feeling about life, our reactions to the world, our irritability.  So, changes in brain chemistry, how those brain chemicals work with hormones, is very well connected.  That also affects the sleep cycle.

The hot flashes are a little bit more complicated even.  In terms of vascular instability with hormonal changes, changes in the temperature setting point, changes in our blood flow to our skin, all these things are changing because of fluctuating hormone levels, but ultimately, low estrogen levels by and large.

Hormone replacement therapy in any form really helps to stabilize vessels, it helps to stabilize brain chemistry, it helps to re-estrogenize tissue that is being deprived of estrogen like vaginal tissue, the skin, the collagen.  Estrogen determines tone, collagen strength, pH of our bladder or our vagina. It determines the stability of our brain chemistry.  It is massively connected to all these things and men and their hormones have not so dramatic of connections, but also we have these hormone receptors virtually everywhere in our body.

Memory loss and confusion can be very difficult to determine what that is due to because there are normal age related changes in our memory, in our focus, and in our concentration…stay tuned for more in Part Two coming soon…

About Dr. Tori Hudson, Naturopathic Physician, graduated from the National College of Naturopathic Medicine in 1984 where she has since served in many capacities: Professor, Medical Director, Associate Academic Dean, and Interim Academic Dean. In 1990, she was awarded the American Association of Naturopathic Physician’s President’s Award for her research in the field of women’s health care and 1999, Naturopathic Physician of the Year.

Dr. Hudson is a national lecturer, contributor to many magazines, books, author, educator and researcher. She has over 24 years of experience and expertise in women’s health utilizing nutrition, nutraceutics, herbs, natural hormones and other therapies to treat all gynecological and primary care conditions. Dr. Hudson is the Program Director for the Institute of Women’s Health and Integrative Medicine and is the Director of research, development and education for Vitanica, an herbal/nutritional supplement company for women’s health care products.

Career Highlights

Educator

Professor of Gynecology and Clinical Faculty at the National College of Naturopathic Medicine, Portland, OR.

Clinical Professor, National College of Naturopathic Medicine; Bastyr University; Southwest College of Naturopathic Medicine?First Woman in the United States to become a full professor of Naturopathic Medicine

Guest lecturer, Oregon Health Sciences University, Alta Bates Medical Center, University of North Carolina, Kaiser Permanente, St. Charles Hospital and other medical schools and institutions.

Conducts symposiums and training for health care professionals

Nationwide lectures for both professionals and the general public. Dr. Hudson also appears on many local and network radio and TV programs including appearances on “Good Morning America”, PBS’s “Healthy Living Series”, and Lifetime’s “New Attitudes”

Author of scientific papers, textbooks, medical resource books, and consumer articles

Researcher

Awarded the American Association of Naturopathic Physician’s President Award, for her research conducted in the field of women’s health care -1990

Menopause and botanical treatments.

Natural treatment protocols for cervical dysplasia

Clinician

Clinical practice, 24 years

Private practice and director, A Woman’s Time Health Clinic, Portland, OR

Private practice at the Manzanita Natural Health Clinic, Manzanita, OR.

Consultant

Director of research, product development and education; Vitanica

Office for the Study of Alternative Medicine, within the National Institutes of Health.

Department of Health and Human Resources, Health Care Reform.

Natural products industry.

Natural products industry trade publications: Taste for Life, Nutrition Science News, Delicious Magazine

Published Books

Women’s Encyclopedia of Natural Medicine, Second Edition, McGraw Hill, 2007

Women’s Health Update, volume I, II, III, TK Publications *

Gynecology and Naturopathic Medicine, A Treatment Manual; 4th Edition, Beaverton, OR TK Publications 1995

Contributor: Text of Natural Medicine, Third Edition; Churchill Livingston, 2005

Published Research – Highlights

The Journal of Naturopathic Medicine “Osteoporosis: An Overview for Clinical Practice”

The Journal of Naturopathic Medicine “Consecutive case study research of carcinoma in situ of cervix”

The Journal of Naturopathic Medicine “Clinical Effects of a Menopausal Botanical Formula”

The Journal of Naturopathic Medicine “Escharotic Treatment for Cervical Dysplasia and Carcinoma”

Published Articles – Highlights

The Townsend Letter for Doctors and Patients her monthly column, “Women’s Health Update”

Journal of Alternative and Complementary Medicine

Natural health magazines; Taste for Life, Health, Good Housekeeping, Prevention, American Health, Vegetarian Times, Fitness, Healthy Living, and others

Rodale Press Books; numerous contributions

* For Women’s Health Update, Vols. I, II