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/

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

5 Tips to Stay Healthy This Holiday Season

Thanksgiving is over, the leftovers devoured and shopping has begun.  Many are beginning to decorate their houses for the holidays and plan for the parties at schools, neighborhoods, work, and with friends.  It is the time of year when delicious food becomes a focus as everything revolves around sugar and butter.  This often means that well intentioned plans of ‘staying healthy’ fall by the wayside until January 2^nd.  Do not get down on yourself; use these 5 tips to help keep you balanced through the rest of the year.

First, be good when you can.  Specifically, pay attention to what you eat for breakfast, lunch, and dinner if you are going to snack on treats during the day and enjoy parties at night.  Focus on high protein and vegetables such as a smoothie or eggs and spinach in the morning.  Eat vegetable chicken soup and salad for lunch; then again choose lean protein, vegetables, soups and salads at night.  When you find yourself reaching for cookies or fudge during the day, grab carrots or celery and start crunching.  The sound of the crunch is satisfying and may take your mind off the sugar cravings.

Second, do not ignore your exercise routine and consider taking it up a notch.  Burn off the extra drinks, the coffee cake, the chocolate pretzels, and the sugar cookies.  If you normally exercise three days per week, increase it to four.  If you have a typical routine, shake it up with a new class.  Search options online so that you can work out from home instead of heading to the gym due to time constraints.

Third, plan ahead.  All that sugar, fat and alcohol can make one feel bloated, heavy, sluggish, and puffy.  Consider taking digestive enzymes when you eat to help your body digest all those heavy foods better.  Probiotics can help with intestinal health, the immune system and may improve bloating.  All the rich foods may make one prone to gout.  Research shows that eating cherries or drinking cherry extract can prevent gout.

Fourth, fall back on common tricks used during the season.  Eat before a party to feel full.  Drink water and remain hydrated or opt for sparkling water instead of alcohol.  Walk away from the table full of food or the trays of snacks brought to work.  Give away baked goods as gifts instead of keeping them around the house or limit the amount of sugar allowed in your house during the season.  Choose your snacking wisely – only go for things you really want or only get once a year instead of something you could eat anytime.

Fifth, manage your stress.  ‘Tis the season for meltdowns and family drama.  Between the baking, cooking, planning, travelling, packing, organizing, shopping, wrapping and managing…remember to take some time for you.  Get a good solid 8 hours of sleep so that you wake up refreshed in the morning.  Say ‘no’ to things that really aren’t that important and choose not to volunteer for everything.  Divide out the responsibility amongst your family or friends when it comes to parties or gifts and remember to make your list and check it twice to stay organized.

Learn more at the women's health website, Empowher!

Research:

1.      Cherries May Prevent Gout Flares.  Web.  25 November, 2012.http://www.medscape.com/viewarticle/772073

2.      Use of Probiotics in Gastrointestinal Disorders.  Web. 25 November, 2012.

http://www.medscape.com/viewarticle/736305

Viagra and Other Ways to Lower Stress

Pfizer, inc. (the big pharmaceutical company) is unrolling a program on Thursday to help those without insurance the ability to continue certain medications for free for up to a year. On that list includes Viagra. I turned to my friend and asked, “Viagra?” To which he responded, “Unemployed people need a stress release now more than ever! Don’t take that away from them.” Ha! Point taken.

In this economy that is recovering one day and reversing the next, the stress response is something I learn about from all of my patients. More important than how much stress you are under is how, exactly, are you handling it?

If it’s chronically interfering with your sleep, your relationships, your energy, your waistline, your temper…it’s a problem. While there is no Pfizer pill for getting your job back or making more money, there are ways to help improve your situation.

Many supplements help with stress and your adrenals. At the very core are a multi-vitamin (a good quality one, not a cheap brand comprised of a hard tablet that doesn’t dissolve), Vitamin C and B-vitamins.

Herbs for sleep might include valerian, passionflower, oats and chamomile. Herbs for energy include rhodiola, ashwagandha, maca, and licorice (not to be taken if you have high blood pressure).

Exercise everyday (or most everyday) for at least 30 minutes. This can be a huge stress reliever and is great for your overall health. Go for a walk, jump rope, do jumping jacks, push-ups, sit-ups, stretches, and get online to follow programs on youtube.com for free.

Watch your caffeine intake! How much coffee and soda are you drinking in a day ‘just to keep going?’ Caffeine stimulates your cortisol and adrenaline output which can eventually lead to a burn-out sensation. Cut back and switch to water.

Take a moment to catch your breath. If you don’t meditate, then sit quietly and focus on the way that you breathe. Do you take nice deep breaths that expand your ribcage or do you shallow breathe so that only your collar bone moves a little? Slow, rhythmic, deep breathing can reduce your stress response, lower your blood pressure and improve your mood!