Saturday, January 30, 2010

Perimenopausal Depression

Are you suffering from hopelessness, apprehension, and deep sadness for prolonged periods?

If so, you may be suffering from depression. During my menopause transition I felt blue for no reason at all. I could not snap out of it, and my friends and family were mystified.

Most perimenopausal women do not experience major depression, but many have symptoms of feeling depressed, stressed, and anxious.

If you are experiencing menopausal symptoms such as severe hot flashes and lack of sleep from night sweats, it may be causing you to feel depressed. Are you in a depressed mood and feeling sad, or are you suffering from clinical depression resulting from a chemical imbalance in the brain?

I recently teamed up with leading menopause expert and co-author of The Menopause Makeover, Dr. Wendy Klein, to get the latest scientific information on perimenopausal depression.

Perimenopause Depression Interview

Staness: What are the most common signs of depression?

Dr. Klein: The most common signs of depression are feeling sad, feeling worthless and losing interest in the things that normally engage you. Having no “get up and go,” you would rather sit on the couch doing nothing than get up and do something that would normally engage you. Other symptoms include the loss of libido, changes in appetite – too much or too little – feeling very sleepy and tired and fatigued, or having insomnia, not being able to sleep. A common sign of depression is a change in your normal habits.

A more serious symptom of depression is sustained loss of interest in things that you just can’t seem to break out of, which is called dysthymia. Things seem really bleak and you just can’t quite punch your way out of this paper bag of darkness and it lingers. If it lingers or if you have thoughts that are scary, such as wanting to give up or wanting to hurt yourself or even suicidal thoughts, you must talk to your clinician because there are things that can be done to help you.

Staness: What can cause these feelings of depression during menopause?

Dr. Klein: Depression is multi-factorial. There are many factors that can cause an increased risk for depression. If you have depression in your family, a prior history of depression, and even some medications can cause an increased risk of depression. Certain endocrine disorders, such as hypothyroidism, or other illnesses, such as chronic fatigue syndrome, are also associated with depression.

Depression is an illness that can be triggered by the chemicals in your brain. Serotonin regulates your moods. It is the “feel good” hormone. When serotonin levels drop you can experience extreme episodes of depression.

You also want to look at lifestyle stressors – a change in relationship, finances, loss of a loved one, caring for parents – and consider the many modalities of treatment that are available to help you.

You approach depression in menopause the same way that you would approach depression at any other time: you first want to rule out other medical causes, or other medications that might be contributing.

Staness: Many women live with daily stress and then throw in menopause and a few medications, and it is no surprise menopausal women may suffer from depression. What depression treatment options are available?

Dr. Klein: A number of options are available, including psychotherapy, and antidepressants and can assist you if you are suffering from depression.

There are degrees of depression. Mild depression, feeling blue or sad, can be dealt with cognitive therapy, psychotherapy, meditation, yoga, eating healthfully, and exercise. We know that exercise does boost your endorphins and can lift your mood. Also, engaging in new activities may help, such as making yourself take classes, making yourself get out and do things, and enlisting the support of your family and friends.

If you have lingering or worsening symptoms, you may need medication, because we know that depression can be a malfunction of your neurotransmitters, particularly serotonin, which is the feel good neurotransmitter. Medicines can be enormously helpful, although you will want to incorporate lifestyle changes as well.

In short, if someone is experiencing the signs or symptoms of depression, there are number of things you can do. Eating healthfully, exercising regularly, and seeking support from family and friends may help.

Also, you can engage in any activity that gives you a sense of achievement. It may be taking a class, taking up something new such as yoga, or trying the drawing class that you always wanted to take, or volunteering and getting outside yourself. All of these things are very useful.

If you are still feeling very stuck and sad, talk to your clinician so you can get a referral to a good psychotherapist. If you need medication, in the broader context of menopausal symptoms, there is some evidence that hormone therapy can augment treatment and help people who are on anti-depressants feel even better. That is a decision for you and your clinician.
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If you suffer from depression or someone you love is depressed, get support, visit your health care provider and discuss your options for treating depression.

For more information: MenopauseMakeover.com

Monday, January 18, 2010

Understanding Menopause Symptoms

Understanding menopause symptoms is the first step to treating them. Symptoms can be caused by fluctuating hormones. Your body is giving you clues that will help you find balance again. Your symptoms will guide you throughout your menopausal journey and will continue to change until you reach post menopause.

Document your symptoms and discuss them with your practitioner.

Irregular Periods: At the onset of perimenopause, irregular periods can be the first symptom you notice. Your natural cycle is changing, some months you may ovulate and some months you may not. As a result, irregular periods may occur. Some months your period may be longer or shorter. Discuss your menstrual patterns with your health care provider.

Weight gain: Another early symptom, which is often the hardest to live with, is weight gain. I wish I could say all weight gain could be blamed on menopause; that would just make the experience a little easier to life with. Only some weight can be blamed on our ever-changing hormones. Many of us over the years had less time to exercise and eat properly, and when we enter menopause the effects are unforgiving. Getting back in shape and losing weight may feel like an uphill battle. A commitment to healthy lifestyle changes regarding food intake and exercise is now a necessary step to feeling better. This weight gain is a wake up call. As you gather information and make eating and exercise choices for your plan, you will start seeing and feeling results.

Breast Tenderness: Changing hormones may cause fluid retention in your breasts. Once your hormones are in sync again, you will notice this uncomfortable symptom alleviated. Cut back on caffeine and salt consumption.

Mood Swings: When you are experiencing life changes, whether emotional or physical, getting moody is perfectly understandable. Throw in hot flashes, weight gain, and vaginal dryness, and you wonder why you are moody? During menopause there are also biological reasons you may get moody and irritable. When your ovaries start making less estradoil (the active form of estrogen made in your ovaries) it starts affecting other bodily functions including the estradiol in the brain and that causes a decrease in your endorphin levels (the body’s natural feel-good regulator). When your endorphin levels drop, your brain sends out adrenaline that can increase your heart rate and dilate your blood vessels causing hot flashes and anxiety. This cycle can make the best of us cranky and moody. Then throw in life’s general ups and downs, you are now on a moody roller coaster. Declining estradoil that is fluctuating daily can ensure moods swings in many of us making it difficult to cope with daily challenges. If you are experiencing mood swings, this is a good time to start making time to relax, mediate, get a massage, take yoga, enjoy herbal teas and pamper yourself. Some women with severe mood swings that lead to depression consider taking Serotonin-reuptake inhibitors (SSRIs) a drug that can balance your brain chemicals. Exercise and a healthy diet can also help with moodiness.

Heart Palpitations: If you suspect heart disease or it runs in your family, it is best to have these heart palpitations checked out by your doctor. No one knows for sure why some women suffer from heart palpitations during menopause. It is usually attributed to fluctuating hormones. Discuss this symptom with your practitioner.

Migraine Headaches: If migraine headaches are new to you, or only happened during the first few days of your period or during ovulation, it indicates that you are responding to changing estrogen levels. During perimenopause these fluctuating hormone levels may trigger more migraines than you experienced during a normal cycle. For some women balancing their hormones alleviates migraines. For others, hormone therapy makes it worse. The good news is those migraines that appeared during menopause will probably disappear during post menopause. The medical community is still trying to figure out the connection of female hormones and migraines. Practice relaxation techniques, keep a migraine journal and track your migraine triggers (caffeine, medications, dieting, stress). Discuss treatment options with your doctor.

Memory Lapses: Often short-term memory loss can be experienced during menopause. There are many factors that may affect your memory: stress, age, medications, lack of sleep, and overall health. Ask for support from your loved-ones, so they may nurture you through forgetful moments. Keep your mind stimulated. Use a planner and practice a healthy lifestyle.

Hot Flashes and Night Sweats: The number one symptom that most people associate with menopause is hot flashes. Feeling flush, overcome with perspiration, and dizzy, is no fun. Being disturbed from a good nights sleep with a hot flash (aka night sweats) that sends you to the bathroom to splash cool water on your face and change into a dry nightgown, is no fun either. When your estrogen levels suddenly plunge it can create a hot flash. Being overweight, diabetic, suffering from an under or over-active thyroid, and certain medications can also cause hot flashes. Wear layered clothing and bring a fresh blouse when you leave the house. In the summer, wear a cotton sundress and keep a stylish fan handy in your purse for instant hot flash relief. Discuss this symptom with your practitioner. Often low-dose hormone therapy can bring relief. Practice relaxation techniques, get regular exercise and maintain a healthy weight.

Sleep Problems: If you are experiencing night sweats due to changing hormones, it is no surprise you are not sleeping at night. A sleepless night may bring a day of irritability and mood swings. Non-menopausal sleep problems, such as consuming caffeine or alcohol before bedtime, may also cause sleepless nights. If these sleep problems are caused by menopause symptoms, discuss hormone therapy with your practitioner. Avoid caffeine and alcohol before bedtime. Prescription sleep aids can also bring relief. Practice relaxation techniques and eat a healthy diet.

Vaginal Dryness: Intercourse can be painful if you are experiencing vaginal dryness. When your estrogen levels drop, vaginal dryness can occur, your vagina can tear more easily from friction, and the vagina tissues can loose their elasticity and become smaller. Estrogen plumps up the cells in the vaginal wall so they produce more lubrication. Hormone therapy may bring relief. A bioadhesive lubricant, such as AstroGlide that can be purchased over- the- counter, may also bring relief. If vaginal dryness is your only menopause symptom, you may consider using an estrogen cream applied vaginally.

Loss of Libido: If you are experiencing vaginal dryness and sleepless nights it is no wonder you lack interest in sex. Besides the effects of menopause, it is also normal for your libido to decline with age. Between the ages of 55 and 65 sexual activity slows for men and women. Don’t let a decrease in hormone levels blow the flame of desire out of your love life, visit your doctor, take the appropriate tests and discuss hormone treatment options. Certain medications may also contribute to a declining libido: blood pressure, depression, heart disease, or diabetes medications. If you need to treat your relationship, visit a counselor. A healthy sex life is possible during and after menopause.

Skin Changes: There is no escaping the aging process, but during menopause you really start seeing the effects of less estrogen. Your skin is supported by collagen and elastin fibers, which are supported by estrogen. That is why your skin looked so soft and contoured to your face before menopause. For those of you who loved getting a summer suntan, the affects of sun on your skin are damaging, with or without estrogen. Gravity plays a big role here too. After 40 plus years of being on this planet, gravity takes a toll on everyone. What most of us notice during menopause is that the elasticity and firmness of our skin decreases rapidly due to less estrogen production. Wear sunscreen (SPF 15+), exfoliate regularly, practice good skin care, and moisturize daily.

Bladder changes: Just as lower levels of estrogen can affect your skin, it can also change the flexibility of the muscle fibers around the urethra (the tube that lets urine out of the bladder). Age, obesity, family history, and hysterectomy may also contribute to bladder changes. Kegel exercises are a great option to reduce these effects and help firm up your urethra muscle. Just squeeze your vagina muscles and hold them for 10 seconds, then relax and count to 5, then repeat. It is best to do 5 sets 3 times a day. You will see a difference within a month. Also, start wearing a light mini-pad; they are much easier to change than your panties or slacks. You may notice when you balance your hormones this symptom improves. If not, your doctor may suggest medications.

Hair Changes: Almost 50% of women complain of hair changes during menopause. Age, family history, high blood pressure, medications, depression, thyroid disease, stress and hormones can be factors contributing to hair loss or excessive hair growth. You can have thinning hair and you can sprout some hairy growth on your face. For a few rogue hairs or peach fuzz try tweezing, Jolen Hair Bleach (sold at most pharmacies), electrolysis, and waxing works well. If you are suffering from hair loss, Rogaine 2% may bring relief.

The more educated you are about your body’s changes going through menopause, the more you will be able to embrace this transition. Fluctuating hormones, age, genetics and lifestyle can all affect your menopause journey. Empower yourself to take action and manage menopause.

Wednesday, January 13, 2010

Are YOU going through menopause?

The dictionary defines menopause as “the time in a woman’s life when menstruation diminishes and ceases, usually between the ages of 45 and 50.” It is identified as not having a period for one year. Perimenopause (peri is Latin for “around or near”) is the time prior to the cessation of menstruation when you experience hormonal changes and you are still having periods. Many doctors now refer to perimenopause as the menopausal transition. So I will also refer to it as the same. Postmenopause is the time after menopause when the symptoms of estrogen absence appear.

Going through the menopause transition is the reverse of puberty. Puberty was the transition in your life when your hormones were gearing up for your reproductive years to come. Remember your first period? Emotional outbursts, swollen breasts, restless nights, and feeling bloated? Now, at the menopausal transition you may experience many of the same symptoms, but for different reasons. Instead of “turning on” your hormones, your body is now “turning off” your hormones. Many women who had difficult puberties have challenging menopause. Women who got through adolescence easily often have the same experience with menopause. We are all different and menopause is no exception.

So how do you know you are going through menopause?

Let’s identify your symptoms. You may have one, some or all at different stages of menopause. Sixty to eighty percent of women experience mild to moderate symptoms, 10-20 percent suffer from severe symptoms, and 10-20 percent have no symptoms. Your symptoms can be a guide to what is happening in your body. These clues are the hard evidence you will need when deciding what course of action you may wish to exercise.

Do you experience any of these symptoms?

• Weight gain
• Mood swings
• Night sweats
• Heart palpitations
• Changes in your period
• Migraine headaches
• Bladder changes
• Vision changes
• Joint aches
• Nail and tooth problems
• Breast tenderness
• Memory loss
• Hot flashes
• Sleep problems
• Loss of libido
• Dry vagina
• Hair and Skin changes

These are all messages from your body.

If you are experiencing one or many of these “changes” you may be perimenopausal, menopausal, postmenopausal or having symptoms from surgical menopause (hysterectomy). You are not alone; 44 million women are going through similar transitions with 4,000 a day joining the club.

If you suspect that you are going through one of the stages of menopause, call you doctor and request a FSH (Follicle Stimulating Hormone) blood test. The results of this test will allow you and your doctor to determine how best to treat your symptoms.

While waiting for test results, start an exercise program. Regular exercise can improve the symptoms of menopause. It helps regulate weight, benefits your heart and bones, and contributes to a sense of overall well-being and improvement in mood.

Document your symptoms, develop a strong relationship with your health care provider, and discuss treatment options.

Thursday, January 7, 2010

Suffering From Hot Flashes?

Hot Flash 101

The most common and often the most irritating symptom associated with menopause is the hot flash. As many as 75 percent of women going through menopause in the United States experience hot flashes with 10% to 15% of women having severe or frequent hot flashes. I had miserable hot flashes that heated up at the most inconvenient times and sometimes flaring up every few hours. I tried every trick in the book to eliminate this miserable symptom – from herbs, to teas, to exercise, to diet, to praying hourly that they would disappear – but they persisted.

With confusing and conflicting information online and in best-selling books, I teamed up with leading menopause expert and co-author of The Menopause Makeover, Dr. Wendy Klein, to get the latest scientific information on alternative, complementary and medical options to relieve hot flashes.

Understanding available hot flash options will give you the opportunity to discuss menopause management with your clinician. This interview with Dr. Klein is the first in a series that addresses the various menopause symptoms.

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Hot Flash Interview

Staness: Dr. Klein, what exactly is a hot flash?

Dr. Klein: A hot flash is a sensation of extreme heat in the head and upper body generally associated with sweating.

We know from studying women that the internal core temperature does increase. You can a put a sensor on the skin and before a woman experiences a hot flash she will be able to tell you, “I am going to have a hot flash.” And sure enough, there will be an increase in internal core temperature followed by profuse sweating which is very uncomfortable. As you know, the purpose of sweating is to cool the body so there is often a reflex of sort of chill that follows the hot flash. It is a very uncomfortable and distracting sensation. It can occur at any time of the day. It can occur with tremendous variability, it can happen many times an hour or only just once or twice a day. Some women have one or two hot flashes a day, and get through menopause with no problems while other women have fifteen or twenty a day. We are all different.

Staness: What causes a hot flash?

Dr. Klein: We are still trying to understand exactly what causes hot flashes. We know that they are related to the hypothalamus, which is in the center of the brain and acts like the thermostat for the body. What we don’t understand is why some women are so troubled by them and others are not.

Certain women seem to have triggers. An alcoholic beverage may bring on a hot flash, or a change in external temperature can cause a hot flash for some women. In general, the hormonal flux or variation in hormone levels seems to be related to this sensation in some women.

Staness: Are there other causes?

Dr. Klein: We know that smoking is associated with hot flashes. Women who smoke have a higher risk of troublesome hot flashes, so obviously you should not smoke.

Also certain medicines can cause hot flashes such as certain antidepressants SSRI, Selective Serotonin Reuptake Inhibitors, are common antidepressants that can actually cause an increase in hot flashes. Yet, for some women, a very low dose can actually alleviate hot flashes, making antidepressants an alternative to hormone therapy.

Illnesses and fever can cause hot flashes, as can malignancies, and tuberculosis – many illnesses can cause hot flashes.

Increased BMI, Body Mass Index, has been associated with hot flashes. We used to think that women who were heavy had excess estrogen, and therefore fewer hot flashes. Now from the major study that was done in the SWAN, Study of Women Across the Nation, we know that women who are heavy, who have abnormally high body mass index, are at increased risk for hot flashes.

Staness: What’s a menopausal gal to do if she suffers from hot flashes?

Dr. Klein: The real issue is how troubled are you. Some women find that they can manage their hot flashes with simple lifestyle changes, such as wearing layered clothing, lowering the thermostat, carrying a fan, drinking cool beverages, avoiding triggers like caffeine and alcohol.

Some women can have a few hot flashes a day and over time, seventy-five to eighty percent of cases the hot flashes will diminish and disappear. Then there is a subset of women for whom hot flashes are really troubling and don’t go away. Lots of women have recurring hot flashes waking them up over and over again and they can’t go back to sleep. They are not getting enough rest; they wake up grouchy, tired, and sweaty. If it is really a problem, there are hormonal therapies that will alleviate these symptoms. As you know hormone therapy can have side effects, so you must always weigh the benefit versus the risk. There are very low dose hormone therapies that are now available that can be extremely useful for alleviating hot flashes.

There are some other options to consider such as soy and black cohosh. The studies regarding soy are mixed, with some showing that soy can be helpful; while there are other studies that show soy may help with mild symptoms. Soy is benign and easily available and may be worth trying. Black cohosh is another herb and has been used in Europe widely, but you have to be careful because there have been reports of toxicity with high doses. Used in limited amounts in standardized doses black cohosh supplements may help some women with hot flashes. Again, there have been mixed studies, so whatever you do, and with anything you take, you should always discuss with your clinician.

You can also try lifestyle changes – wearing layered clothing, practice deep breathing, meditation and yoga, exercising – all of these things that can be really helpful in learning to live with the symptoms if they are moderate.

Another option to treat hot flashes is gabapentin. This is a drug that was originally developed as an antiseizure medicine. Gabapentin is widely used for pain relief, because it was discovered that with patients in whom it was used for seizures, it helped with pain. It was then found that it helped with hot flashes. Gabapentin is a reasonable alternative to discuss with your clinician if you do not want to or if you cannot take hormone therapy.

Staness: I was on birth control pills for years and had no idea I was perimenopausal until I stopped them, then the hot flashes started erupting. Are birth control pills a good option for hot flashes?

Dr. Klein: Birth control pills are a form of hormone therapy. They are a higher dose than standard menopausal therapy, but there is estrogen in most birth control pills and that keeps hot flashes away. If you are in the perimenopausal phase, birth control pills can also be useful for regulating your periods, plus they keep hot flashes away.
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Understanding the causes and solutions for hot flashes is the first step to managing your menopause. If you suffer from hot flashes, discuss your treatment options (alternative, complementary and medical) with your healthcare provider.