Is Your Anxiety Worse With Menopause?

There are many common symptoms associated with both peri-menopause (the start of the hormonal changes) and actual menopause including hot flashes, night sweats, vaginal dryness, weight gain, increased joint pain, irregular cycles, heavier periods, hair loss, and insomnia.  In discussions with their friends, female family members and health care provider, most women have a general understanding of ‘what’s to come’ when it relates to the big hormonal transition however symptoms such as increased, worsening or new anxiety might be a surprise.  Many women have experienced at least some form of anxiety in their lifetime and find it concerning when those nervous, overwhelm, worry or fretting feelings really ramp up in their forties and fifties. 

Research (and anecdotally in my practice) shows that women who are prone to anxiety before menopause are much more likely to have higher levels as they go through it.  In fact, it is reported that 51% of women between 40-55 years old experience mood swings or anxious type feelings more regularly than when they were in their twenties and thirties.  While there is little research on the subject of “why,” and the reasons are conflicting, there are a few consistent theories that may apply.

As women approach menopause, the need to become pregnant becomes less therefore ovulation becomes less frequent.  Without ovulation a woman does not make (much) progesterone and progesterone is the more calming, soothing, anti-PMS hormone for women.  This leaves estrogen to become more dominant which can cause increased symptoms of PMS, irritation, anger and overwhelm.

This hormonal transition of menopause is often occurring at the same time that life is stressful – Murphy’s law?  Women are juggling family, work, financial, relationship, and world responsibilities while trying to eat healthy, exercise, stay sane and navigate menopause.  This causes a lot of internal stress on the body, particularly the adrenal glands, which leads to feelings of anxiety, irritability, overwhelm and panic. 

Women going through peri-menopause and menopause often experience long periods of insomnia or waking up regularly between 2am-5am.  This leads to more fatigue and less patience causing those low-level feelings of anxiety to worsen.  Everybody feels better after a good night’s sleep as it is restorative to the body.

So, what can be done?  First, recognize that it is a normal (but not fun or fair) part of going through menopause.  Talk to your female family members about their experience and then consult with your health care provider about options (even if temporary) to help you get on the other side of all the transition.  Find coping skills to first recognize what is going on and then how to act/react with yourself and those around you.  Put yourself in time out and take 5-10 minutes for yourself (or more) and just breathe deeply, go for a walk, sit in the sun, read, exercise or close your eyes.  Focus on setting boundaries and saying “no” to things that create more stress and chaos in your life and remember that it is okay to do so.  Lastly, hope that your menopause is short and sweet!

 

References:

1.       Bromberger, J., Kravitz, H., Chang, Y., Randolph, J., Avis, N., Gold, E., and Matthews, K.  Does Risk for Anxiety Increase During the Menopausal Transition?  Study of Women’s Health Across the Nation.  Web.  2 June, 2013.

http://www.medscape.com/viewarticle/803506

2.       The Merck Manual.  Menopause.  Web.  2 June, 2013.

http://www.merckmanuals.com/home/womens_health_issues/menopause/menopause.html?qt=progesterone&alt=sh

3.       Kumari, v., Konstantinou, J., Papadopolous, A., Aasen, I., Poon, L., Halari, R., and Cleare, A.  Evidence for a Role of Progesterone in Menstrual Cycle-Related Variability in Prepulse Inhibition in Healthy Young Women.  Web.  2 June, 2013.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3055354/

What Causes Osteoarthritis?

Many women experience joint pain whether it’s in their knees, hips, fingers or shoulders.  The pain might come and go, be worse in the morning, or feel aching and stiff most of the day.  The diagnosis is typically done with symptoms and possibly an x-ray that shows joint changes.  Arthritis can start as early as the late teenage years/early twenties however more than 50% of people over 65 years old exhibit symptoms of arthritis.  What causes the joints to begin to deteriorate and create arthritis?

1.       Joint injury – Research shows that those who sustained a joint early at a young age are more apt to develop arthritis in that joint at a later age.  As an example, 51% of women developed knee arthritis 12 years after tearing their anterior cruciate ligament (ACL) in soccer.  Many can point back to a car accident, sports injury, broken bone or other trauma when discussing their problem area(s). 

2.       Obesity – Extra weight on the body coupled with daily activities and gravity means more load on the hips, knees, ankles and feet causing those joints to become more strained and inflamed over time plus it increases the wear and tear on the cartilage that leads to osteoarthritis. 

3.       Age – Sorry ladies, aging does take its toll on the joints considering more than 50% of people over 65 have arthritis symptoms (as stated above).  Many women will say “I didn’t have these problems in my 20’s or 30’s!” but over time joint injuries happen, diet/lifestyle choices take effect, genetics kick in, hormones change, weight fluctuates…and suddenly one day women find themselves waking up more stiff and aching.  Those of you who can still go from sitting cross-legged on the floor to a standing position without (much) assistance count yourselves lucky. It will probably change.

4.       Congenital abnormalities – If someone were born with joint problems or cartilage issues, then over time the stress on the joints will cause arthritic changes.  For example, scoliosis in the spine, or one leg shorter than the other will shift the way the body carries itself causing joint problems. 

5.       Endocrine disorders – Diabetics and those with low thyroid hormone are at risk for more joint and cartilage problems that can lead to arthritis.  Women heading into menopause often complain of more joint pain because their estrogen levels are gradually (or suddenly) decreasing. 

What does all this mean?  It means, take good care of yourself!  This is your one body.  Eat healthy, stay hydrated, maintain a healthy body weight, limit sugars and processed foods, and stretch regularly.  Thankfully there are articles here for tips to reduce the symptoms of arthritis if your joints are causing you pain on a regular basis.  Lastly, talk with your health care provider about appropriate work-up and treatment suggestions. 

References:

1.       Sofat, N., Ejindu, V., Kiely, P.  What Makes Osteoarthritis Painful?  Rheumatology. 2011;50(12):2157-2165.

2.       Roos, E.  Joint Injury Causes Knee Osteoarthritis in Young Adults.  Curr Opin Rheumatol. 2005;17(2):195-200.

3.       Kramer, P.  Prevalence and Distribution of Spinal Osteoarthritis in Women.  Spine. 2006;31(24):2843-2848.

How Much Alcohol do you Drink?

Alcohol consumption is a large part of the American culture in that it is used in celebration, toasts, as a form of bonding, at sporting events, after bad days and during the holidays.  It is advised that men not drink more than 2 drinks per day, and women keep it to 1 drink per day however recent research in the February 2013 Journal of the Academy of Nutrition and Dietetics found that 18 percent of men and 11 percent of women are drinking above and beyond this recommendation. 

In a given week, how many alcoholic beverages do you drink?  Wine with dinner? Cocktails with the girls? A beer to relax?  While moderation is important and the occasional drink may be okay, remember that alcohol has other implications that may get in the way of your health.  First, alcohol increases the risk of certain cancers, particularly breast, liver, mouth, colorectal, and throat.   Second, alcohol requires a lot of processing by the liver which can interfere with the processing of other important substances such as medications, chemicals, and hormones.  Third, liver processing, especially at night, can lead to insomnia or 3am wake-ups.  Fourth, alcohol is not calorie free therefore it can cause weight gain and (depending what your drink of choice is) increases in blood sugar levels.  Fifth, ongoing alcohol consumption can further depress mood disorders, lead to a decreased memory and worsen psoriasis and other skin disorders.

Alcohol addiction is an important health concern to recognize in both yourself and the people you love.  Many choose alcohol as their coping mechanism when times are stressful or things are tough however other healthier options are available.  Even though the current recommendation for women is 7 drinks per week, remember that a drink is typically considered 5 ounces of wine, 1.5 ounces of hard liquor or 12 ounces of beer and 7 drinks may be too many for you and your health goals.  With that said, how many drinks do you really have? 

References:

1.       Grens, K.  Too Many Americans still Drink too Much: Study. Web.  25 February, 2013

http://www.nlm.nih.gov/medlineplus/news/fullstory_134308.html

2.       Bagnardi, V., Rota, M., Botteri, E., Tramacere, I., Islami, F., Fedirko, V.,   Scotti, L., M., Jenab, Turati, F., Pasquali, E.,  Pelucchi, C., Bellocco, R.,  Negri, E., Corrao, G., Rehm, J., Boffetta, P., and  La Vecchia, C. Light Alcohol Drinking and Cancer.  Web. 25 February, 2013.         http://www.medscape.com/viewarticle/778949

3.       Kazakevich, N., Moody, M., Landau, J., and Goldberg, L.  Alcohol and Skin Disorders.  Web.  25 February, 2013.

http://www.medscape.com/viewarticle/742538

5 Facts About the Hormone Testosterone for Women

When women think of the word testosterone they often think of MEN.  To sum it up, testosterone is what makes a man a man (so-to-speak) while estrogen and progesterone are often more associated with women.  However, testosterone is just as important to women but not in the same high level amounts.  These are five things about testosterone that may have you asking your health care provider for a test.

1)      Testosterone is made from cholesterol (its backbone) and another hormone known as DHEA.  DHEA is made in the adrenal glands and can help with stress, increased energy and low mood.  The more well known DHEA is DHEA-S, which is the one to test for.  Supplementing with DHEA should be done in the morning however; women should use lower doses than men.  The side effects can include increased anger, irritation, acne and inappropriate hair growth often on the face, nipples and chest.

2)      Testosterone helps significantly with energy, motivation, sense of well-being and sex drive in women.  When testing for this hormone, the total and free levels should be evaluated as the ‘free’ is active.  Testosterone has similar side effects to elevated DHEA and should be used with caution only under your health care provider’s direction.

3)      Keep in mind, testosterone is not a ‘magic pill’ for sex drive.  Many women have normal levels of testosterone and still find themselves lacking in desire.  A lot more goes into the libido for women than it does in men.  As women get older, their hormone levels overall change but so do their energy levels, sleep habits and stress which all interfere with their sex drive.

4)      Testosterone is made in both the ovaries and adrenal glands. Women who had their ovaries surgically removed may notice a significant decline in testosterone in the body.

5)      The birth control pill, if used correctly, protects against unwanted pregnancy but can also lower sex drive by lowering testosterone.  The pill increases a hormone known as sex hormone binding globulin that binds up excess free testosterone and gets rid of it from your body.  With less testosterone floating around, the desire for sex is less.

 

Just as a man might need testosterone replacement, so might a women but with significantly lower doses.  Consider asking your health care provider about testosterone and DHEA-S testing if hormone changes, fatigue, mood issues, and lower sex drive are occurring on a regular basis.  Your hormones may truly be out of balance.

References:

1.       Androgen Replacement Therapy in Women.  Web.  2 December, 2012.

http://www.medscape.com/viewarticle/773774_1

2.       Birth Control Pill Could Cause Long-Term Problems With Testosterone, New Research Indicates.  Web.  2 December, 2012.

http://www.medicalnewstoday.com/releases/35663.php