Could It Be Perimenopause?

Posted by on Jan 23, 2017

Sometimes I catch patients off guard by mentioning perimenopause as a potential underlying cause of their symptoms. In some cases, this is because the woman didn’t realize the menopause transition could cause more than hot flashes and night sweats. At other times, it’s because the person doesn’t realize that perimenopause can occur at their age. Normal menopause occurs between 45 and 55 (51 on average in the United States), and perimenopause can precede this by up to 7 years (as young as late 30s). We cannot predict when a woman will stop menstruating or how long she will have symptoms related to menopause, but talking to female relatives about their menopause transition and reflecting on personal experience going through puberty can be helpful. Below are some of the lesser known symptoms of perimenopause. You may experience any number of these symptoms or none of them. Provided the underlying hormonal issue is identified, these complaints are all treatable with interventions ranging from lifestyle to nutrient and herbal supplements to pharmaceutical medications. Menstrual Irregularities Counterintuitively, perimenopause often starts with heavier and more frequent periods. The reason being that progesterone declines before estrogen in the menopause transition, and progesterone is the hormone that helps extend our cycles and keep them lighter. There are lots of interventions available to help slow bleeding; consult your naturopathic doctor. Women can also skip periods, sometimes for months at a time. This is usually monitored but not treated if laboratory tests indicate there’s no hidden cause. It’s generally not harmful to skip periods, but it’s possible that the period following will be heavier than normal. Menopause (rather than perimenopause) is when you’ve had no spontaneous periods for 12 consecutive months, and until reaching that threshold, there’s always the possibility for more periods. Prepare accordingly. Mood Changes Irritability, anxiety, and insomnia are all common mood changes in perimenopause. Progesterone binds GABA receptors in the brain, which provides a calming effect; as progesterone drops, anxiety and insomnia can crop up or worsen due to decreased GABA stimulation. Irritability and sleep disruptions can be a result of the hormone fluctuations that occur during perimenopause. Energy & Weight Decline in estrogen can also trigger fatigue and brain fog due to the complex interplay between hormones and whole body functioning. The thought is that it takes time for the mind and body to adjust and adapt to the new hormonal milieu, although in some women these symptoms can persist. Perimenopausal weight gain is a nice illustration of the complex interplay happening in the body when hormone levels shift. Estrogen helps the body be sensitive to insulin. As estrogen declines, women tend to become more insulin resistant. This can lead to an increase...

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Preventing Varicose Veins

Posted by on Oct 13, 2016

Varicose veins are a common concern for women as they age. They range from being an unsightly nuisance to being painful and debilitating. Surgical treatment is becoming increasingly sophisticated, but there are many lifestyle and nutritional steps that can be taken to help prevent them in the first place. Why do varicose veins happen? Veins are low pressure, bringing blood back toward the heart with the help of muscle contractions and valves to prevent backflow. In the case of varicose veins, the veins dilate abnormally and prevent the valves from closing well. As a result, blood can flow backwards into the legs with gravity. Risk factors for varicose veins include obesity and multiple pregnancies (which put pressure on the abdomen, making it harder for blood to flow through), standing for long periods (forcing the valves to work harder against gravity), and family history. Varicose veins themselves are not concerning, but in some cases they can cause pain, swelling, and skin ulceration. Movement The first and simplest step to prevent varicose veins is to get moving. Walk around for a few minutes every hour. The muscle contractions in your legs will help support moving blood back toward the heart. Set reminders on your phone or FitBit so you don’t forget during a busy day. Exercise is also an excellent way to support and maintain weight loss, which will lower your risk for varicose veins and many other conditions. Drainage Dry skin brushing is a nice daily ritual that helps move extra fluid away from the limbs and toward the core where it can be processed. This is helpful for reducing swelling in the limbs and supporting the body’s own detoxification via the lymphatic system. Using a natural bristle brush, gently stroke from the hands and feet toward the heart. Here is a YouTube video showing you how to do it. Compression Recently, a vascular specialist told me she advises women as young as 30 to regularly wear compression stockings if they are at risk for varicose veins. You may be skeptical, envisioning the thick beige compression stockings of yore. Nowadays, there are many fashionable options in light (8-15 mmHg) and medium (20-30 mmHg) support, both of which are appropriate for prevention. Compression socks help promote venous return to the heart and prevent swelling caused by leakage from stagnant veins. They should be worn for most of the day (especially if there’s going to be lots of standing) and removed at bedtime. If you already have varicose veins, compression stockings can be used to reduce swelling2 and prevent skin ulcerations3. Diet A diet rich in flavonoids helps support the structural integrity of the veins. Eat at least 5 servings of brightly...

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Probiotics: Enhancing the Impact of Lifestyle Changes in Metabolic Syndrome

Posted by on Jul 23, 2016

Metabolic syndrome occurs when certain health metrics (waist circumference, blood pressure, blood sugar, cholesterol) trend away from the healthy normal. The condition is common; it affects a quarter of adults in the United States and climbs to nearly half of all adults over 50. While the parameters might seem trivially different from normal (fasting blood sugar more than 100, blood pressure 130/85 or greater), these slight elevations put together have significant impact on long term health and wellness. For naturopathic physicians, the diagnosis of metabolic syndrome represents a pivotal point in a patient’s health trajectory. Left unchecked, each of these metrics will require one or more pharmaceutical medications to manage over time. Polypharmacy (the use of 4 or more medications at once) can reduce quality of life via accumulation of side effects, and it increases the risk for harmful drug-drug interactions. Alternatively, if metabolic syndrome is identified and addressed with lifestyle changes and sometimes select botanical/nutraceutical supplements, medications may be entirely avoided. A recent paper investigated probiotics as a way to enhance the impact of lifestyle changes on metabolic syndrome. In this small study, patients with metabolic syndrome were given lifestyle counseling and either probiotics (Lactobacillus casei, Lactobacillus rhamnosus, Streptococcus thermophilus, Bifidobacterium breve, Lactobacillus acidophilus, Bifidobacterium longum, and Lactobacillus bulgaricus, 200 million CFU twice daily after meals) or placebo. Health metrics were gathered at the start of the study, 6 weeks in, and at the end of the 3 month trial. Both groups improved significantly with lifestyle changes at 6 and 12 weeks. However, the probiotics group saw greater improvements than those taking placebo, especially in the latter half of the study. It’s important to note that the investigators are not suggesting probiotics replace diet and exercise in the treatment of metabolic syndrome. Lifestyle changes are essential, and they work. At the same time, probiotics may provide a way to get more bang for your buck. If you find yourself confused about probiotics and whether they help, you are not alone. There are many mixed messages in the media, often because study results are over-simplified to “probiotics work” or “probiotics don’t work.” The challenge is that the word “probiotics” encompasses a diverse range of products, varying in quality, composition, and amount.  Researchers are trying to figure out which species and strains of probiotics work for which conditions at which dose. It’s a lot to tease out. If you are wondering whether probiotics may help improve your health, I recommend a consultation with a naturopathic physician.  At A Woman’s Time, we are knowledgeable in the latest probiotics research as well as the supplement brands with the best quality control...

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Melatonin: More Than Just A Sleep Aid

Posted by on May 18, 2016

Melatonin is well-known for being a sleep aid, but this humble hormone isn’t only useful for insomnia. Emerging research suggests melatonin’s antioxidant action is helpful for acid reflux, tinnitus, and pelvic pain caused by endometriosis. Gastroesophageal reflux disease (GERD) typically presents with symptoms of heartburn and stomach pain, especially at night and after eating. There are many issues at play, most significantly a loosening of the sphincter that separates the stomach and esophagus after eating, which then allows stomach acid to reflux into the esophagus. The esophagus is not built to withstand acid, and repeated exposure to stomach acid can cause inflammation and damage. There are several lifestyle changes that can do wonders in the treatment of GERD. They include: Avoiding triggers (chocolate, mint, spicy foods, large meals). Eating modestly portioned meals in a relaxed setting (dinner no later than 3 hours before bed). Maintaining a healthy weight, which reduces pressure on the stomach that causes reflux. If lifestyle changes alone don’t alleviate symptoms, supplements and/or medications are indicated to prevent damage to the esophagus over time. In 2010, Kandil et al compared the effects of melatonin alone, omeprazole alone, and combined melatonin/omeprazole therapy on acid reflux. At a modest dose of 3 mg nightly, melatonin was found to improve reflux symptoms alone and in combination with omeprazole. The benefits were attributed to antioxidant effects that protected the esophagus from damage and tightening of the sphincter that separates the stomach and esophagus1. Given the safety, affordability, and accessibility of melatonin, it’s worth a therapeutic trial. Tinnitus is ringing in the ears, and when severe, it can disrupt sleep and hearing. In a randomized, double-blind, placebo-controlled crossover study, researchers gave patients melatonin 3 mg nightly (or placebo) for 1 month and assessed tinnitus severity with audiometric testing and self-rating of symptoms. Melatonin was found to reduce severity of tinnitus over placebo both via audiometric testing and patient’s self-rating of severity. Much like GERD, tinnitus is a multifactorial condition that may be influenced by damage to the inner ear, medication side effects, and female hormones. However, as mentioned above, the safety and affordability of melatonin make it a good candidate for a therapeutic trial to see if it helps. The antioxidant effects of melatonin also appear to alleviate the chronic pelvic pain of endometriosis. In this condition, endometrial tissue (normally only found inside the uterus) implants at various sites inside the body and causes inflammation. The pelvic pain experienced with endometriosis can be severe, and surgical removal of the abnormally placed tissue can lead to problems of its own (such as adhesions that affect digestion and fertility). In a randomized double-blind placebo-controlled trial, Schwertner et al found that melatonin (at a...

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Balancing Brain & Gut: Acupuncture for IBS

Posted by on Mar 15, 2016

Irritable bowel syndrome (IBS) is a condition characterized by irregular bowel habits (constipation and/or diarrhea), abdominal discomfort, and excessive gas. Though it presents through the digestive system, IBS illustrates the complex interplay between the mind and physical body. Accordingly, the aim of treatment should be to balance the gut and the brain. Traditional Chinese medicine (TCM) developed with the understanding that the mind and physical body cannot be separated; therefore, acupuncture can address both aspects of IBS elegantly. The gut/brain connection is tricky to untangle. On the one hand, neurotransmitters have been found to work in both the brain and digestive system. For example, if serotonin is dysfunctional, it can cause both depression and IBS because it has effects in both areas. This would suggest that the brain is the root of IBS. However, research is emerging that the bacteria that live in our digestive system can secrete substances that affect not only digestion but also mental functioning; an imbalance in gut flora could therefore be implicated in both digestive disturbances and emotional changes. So while we don’t know whether the chicken or the egg came first, it’s apparent that both the brain and gut need to be addressed to effectively treat IBS. There are many approaches to IBS, from lifestyles changes to herbs and nutrients to pharmaceutical medications. In keeping with the naturopathic principles of removing obstacles to cure and supporting the body’s ability to heal itself, I start with lifestyle recommendations: Make sure you’re drinking enough water; aim for about half your body weight in fluid ounces (75 oz. for a 150 lb. person). Eat a diet rich in fiber and consider fiber supplementation to reach a goal of 25 grams per day. Manage your stress with exercise, meditation, diaphragmatic breathing, etc. Not only are these changes likely to improve your IBS symptoms, they’ll improve your overall health. For some individuals, lifestyle changes alone are not enough. Acupuncture is a great next step. From a TCM perspective, IBS is an imbalance between the Liver (the organ of stress) and the Spleen (the organ of digestion). For some, the excess of the Liver predominates (stress/anger leading to constipation), while for others the deficiency of the Spleen is at the forefront (worry/overthinking leading to loose stools). In both cases, the Liver and Spleen need to be harmonized. Recent research confirms what many practitioners already know: acupuncture treats IBS well. In addition, Zhenzhong et al found that the method used by the acupuncturist matters. In their study, electroacupuncture worked best for IBS with constipation, while moxibustion helped IBS with diarrhea2. To an acupuncturist, the reasoning for this is easy to understand: electroacupuncture calms an excessive Liver, while moxibustion bolsters a...

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