Part One: What is going on?
With Dr. Sara Hart, ND, MSOM, LAc of Stillwater Healing Arts Clinic, Lyons
One moment you’re sitting in a meeting having a conversation with a colleague and you’re able to present yourself as a professional, intelligent person. Before you can blink, your mind turns to Jell-O, you can’t remember the last word you said nor the poignant message you were trying to convey, your body temperature seems to be going through the roof, and you’re sweating profusely.
As if this weren’t enough, ankle pain from an injury 20 years ago has come back with a vengeance, you’re waking six times a night, gaining weight, and feeling completely unhinged.
This experience in many variations is increasingly common today, as women move through the menopausal transition with a laundry list of complaints. “What is happening to me?” is the phrase repeated again and again in Doctorss offices by the 50 something female crowd (or much younger with surgical menopause). Menopause is traditionally known simply as the cessation of the menstrual cycle. Yet for the majority of women, the transition can be extremely uncomfortable and result in a myriad of symptoms.
When a female is born, she has as many eggs in her ovaries that she will ever have. By the time she reaches puberty, less than half of the eggs remain. Menopause is the experience of the ovaries releasing their last eggs and the hormone cascade that is associated with this process. The most dramatic hormonal change is the decline in estrogen and treatment is often directed here. This is just one aspect of menopause and while it seems to “cause” the symptoms, the root goes much deeper.
While western science has drawn the association to estrogen decline, there still is not a concrete explanation in biochemistry as to why the symptoms result as they do. A close look into immunology illustrates one relationship that impacts multiple systems, recognizing inflammation as the root of the imbalance.
Estrogen has a unique relationship with the immune system. Interleuken 8 (IL-8) is a chemical messenger in the body that interacts with white blood cells and is an important mediator for the body’s expression of inflammation. Estrogen potentiates IL-8 and these two aspects of the human body act as a blockade to the expression of the inflammatory cascade. It’s as if a dam were in place to prevent inflammation from being experienced. When estrogen begins to decline in peri-menopause, the dynamics of IL-8 on the immune system changes. Essentially, the dam breaks and the backlog of inflammation that the body has been living with is now experienced.
Chinese medicine has another take on menopause. Physiology is a continuous balancing act of yin and yang energies and while this is a theme for the whole of the system, we can also look at each part of the system and see the balance portrayed separately as well. Chinese medicine recognizes a myriad of different patterns possible during menopause, each accounting in detail for the symptoms that manifest.
A common pattern of imbalance during menopause is known as yin deficiency. The yin energy acts as the container and is restored through sleep, meditation, and peaceful living. This container needs to be strong enough in order to contain the active yang energy. When we live high stress lifestyles, compromised sleep and self-care, yin deficiency is a common result. Menopause is a particularly delicate time because we come to exhaust the reproductive energy, which serves as a sort of storehouse of energy for the body’s activity. If a woman goes into this phase with a degree of yin deficiency, she is likely to experience the full gamut of symptoms.
The menopause transition presents a new challenge to the body with the limitation of tolerance to inflammation that was otherwise easily ignored as well as the disruption in equilibrium of yin and yang. It is a time when the body demands to be better cared for and the results of improper lifestyle are more dramatically present. The path of greatest ease through this time often requires very conscious consideration of what a person truly needs and a close examination of how energy is expended.
Shift gears gently through menopause with natural medicine support. While hormone therapies can provide symptomatic relief, they are not solving the underlying problems that are causing the symptoms and long-term use can be detrimental. Stay tuned for specific information on the collection of symptoms common during menopause with three more upcoming articles, every other week. (Part 2: hot flashes and night sweats, Part 3: mental clarity and fatigue, Part 4: aches, pains, and weight gain)
For individual support, please visit Dr. Hart at Stillwater Clinic in Lyons.
Part Two: What is going on?
By Dr. Sara Hart, ND, MSOM, LAc of Stillwater Healing Arts Clinic, Lyons
It’s fine to feel the pores open and the moisture build up on the skin surface. When pounding the pavement for that last 100 yards of a day’s run, or pushing yourself biking uphill on the way back from Boulder (or any other hilly ride). Hot flashes are completely different, and feel like a completely inappropriate bodily response. Like when you’re in the grocery store and the person scanning your groceries notices you’re dripping onto your food as you transport them from the cart to the conveyor belt. Coupled with the panic of needing to get out of that place, it’s pretty much a disaster.
Hot flashes exist as a conglomerate of symptoms with various degrees of intensity. Their most common presentation is a sudden feeling of uprising heat and sweating. They can be accompanied by headaches, weakness, dizziness, shakiness, nausea, irritability, and can even be as extreme to include fainting or a feeling of suffocation.
“Hot flashes affect about three fourths of women and usually begin before periods stop. Most women have hot flashes for more than one year, and up to one half of women have them for more than five years. What causes hot flashes is unknown. They may be related to fluctuations in hormone levels and may be triggered by cigarette smoking, hot beverages, certain foods, alcohol, and possibly caffeine. During a hot flash, blood vessels near the skin surface widen (dilate). As a result, blood flow increases, causing the skin, especially on the head and neck, to become red and warm (flushed). Women feel warm or hot, and perspiration may be profuse. Hot flashes are sometimes called hot flushes because of this warming effect. A hot flash lasts from 30 seconds to 5 minutes and may be followed by chills. Night sweats are hot flashes that occur at night.” From the Merck Manual.
While there is no way to retain the hormonal balance of your younger self, there are things that can be done to assist the ease of the transition. Hormone Replacement Therapy (HRT) has been the gold standard for treating the discomforts of menopause for many years. However, long term studies observing the use of estrogen and progesterone therapies, either alone or in combination, offer significant concern over the increased risk of cancers, cardiovascular diseases, strokes, and cognitive impairment. While some women are at higher risk of these diseases already, the use of exogenous hormones only makes the statistics worse. Like all pharmaceutical medications, HRT (even bio-identical) is best used for as short a time as possible to ameliorate the most difficult time while getting the system cooled off and balanced to no longer need it.
The first step involves recognizing the individual triggers to help mitigate the frequency and the intensity of hot flashes. Some of the most common triggers are: alcohol, caffeine, some medications, spicy foods, cigarettes, heat, stress, food sensitivities, and tight clothing.
While not all of these may cause hot flashes for every woman, they are important aspects to explore, as they may significantly be causing more harm than good for your body. Alcohol, caffeine, cigarettes ,and stress will be beneficial to avoid for long-term health and significantly increase the body’s inflammatory load.
Improving the body’s physiology assists the gradual adjustment in hormones to a new normal. The organs most likely to contribute to hot flashes during menopause include the liver, spleen, heart, and adrenals.
The Liver: Supporting detoxification is imperative in our modern world. Daily consumption of leafy green vegetables, turmeric, and beets are all beneficial, particularly to phase two detoxification, which is the process of eliminating toxins from the body. When stressed, the liver easily becomes stagnant and will manifest uprising symptoms and agitation.
The Spleen: Responsible for building the blood, the spleen correlates to the quality of our nutrition. When nutrient density is adequate, the body has all the building blocks necessary to undergo the day’s work and provides a firm foundation. When deficient, the body is easily affected by changes, and has difficulty returning to a state of balance. Allowing adequate time for digestion, assisting the digestive process when weak with enzymes or bitters, and choosing the highest quality food that is appropriate for your body will all benefit the richness of the blood.
The Heart: Connection to life’s passion and existing with compassion are keys to a healthy heart. When the heart is vital there is a rooted-ness in the body that allows for grace through transitions as a whole.
“At seven times seven a woman’s heavenly dew wanes; the pulse of her Conception channel decreases. The Qi that dwelt in the baby’s palace moves upward into her heart, and her wisdom is deepened,” The Yellow Emperor’s Classic of Internal Medicine, a 2,000 year old Chinese text.
If the heart qi is deficient upon entering peri-menopause, there may be significant struggle to realign one’s self with the values that ultimately strengthen the heart. Nutrient wise, omega-3 fatty acids are important to reduce inflammation throughout the body and especially the heart. High quality, toxin free oils are essential and can be dosed from 2-4 grams per day.
The Adrenals: The “battery” that powers our daily activity is affected significantly by the level of stress we consider normal. When we push ourselves to do too much, we exhaust this system in our bodies. Symptomatically, heat expressed inappropriately from the body, especially at night, in addition to fatigue may occur. Adrenal insufficiency can be an intensely debilitating disease requiring years of restoration and learning to live a calmer life. The best support for the adrenal system is routine. Having ample rest (including naps), daily relaxation and moderate activity maintains and restores the adrenal gland health.
For individual support through menopause or other life challenges, as well as custom herbal formulas to strengthen the organ systems, please visit me at Stillwater Healing.
Part 3: Mental Clarity & Fatigue
By Dr. Sara Hart, ND, MSOM, LAc, owner of Stillwater Healing Arts Clinic, Lyons
There is the unfortunate association with growing old and losing one’s mind. The notion that Grandpa can’t be trusted with the car keys anymore or that we don’t expect our elders to keep the grandkids names straight is accepted as the norm. When women approach menopause, the fear of mental sluggishness or losing words mid-conversation becomes a reality. While far too young to lose one’s mind, women in their 50’s or sometimes earlier with surgical menopause are commonly experiencing these challenges.
Long-term mental health is what we all hope for. For those of you who have frequented nursing homes and spent time with individuals who have lost their cognitive function, you have experienced the challenge that this poses to individuals, families and the community. For people early in this process, it is incredibly frustrating and can lead to serious depression. While menopausal brain fog is not typically as extreme, it is disconcerting, as it exists on the spectrum of cognitive decline.
Mental acuity is rooted in proper nutrition and circulation. The brain has complex organization of nerve function via neurons for systematic communication and glial cells for supportive functioning. Glial cells play a variety of roles for the nervous system and are influenced greatly by the immune system.
During menopause, the decline in estrogen affects every tissue in the body. Estrogen influences the immune system by moderating the impact of inflammation on the body via a component known as immune gobulin 8 or IL-8. Glial cells are particularly influenced by IL-8 and thereby especially vulnerable to changes in estrogen. When estrogen begins to decline, IL-8 is down-regulated significantly, meaning there is no longer the inflammatory moderator to protect the body. As I mentioned in Part 1 of this series, this is akin to a dam being broken that releases the pent up inflammation from a lifetime of challenges.
Once the inflammatory cycle is triggered in glial cells, it is very difficult to shut it down. Without the protection of IL-8 from estrogens decline, the inflammation in the brain is an obstacle to normal cognitive function. Unfortunately, it does not work to replace estrogen exogenously with a pill, cream or suppository. While this can affect some tissues in the body, it does not impact the inflammation of the glial cells. In fact, it has been demonstrated by the Women’s Health Initiative that some women taking Hormone Replacement Therapy have an increased risk of developing cognitive decline and Alzheimers disease.
Inflammation is a whole body issue. While we can identify how the inflammatory cycle begins in the brain, we are less able from a western medical perspective to identify how it ends. This is of course the most interesting component of this topic! From this system, we do however know what contributing factors will make cognitive function worse.
Blood sugar dysregulation – Variability in blood sugar damages end organ tissues. This is especially important for the brain. If you’ve skipped a meal recently you may have felt the irritability, panic, frustration or fogginess of low blood sugar. What you’re not going to feel right away is the more detrimental high blood sugar. This damages tissues slowly over time. Eating adequate protein with each meal (up to 1/3 including and especially breakfast) as well as eating at routine meal times and avoiding snacking are important elements to ensure the stability of blood sugar in healthy individuals.
Circulatory compromise – While the feet may feel cold from poor circulation, you’re brain is actually more difficult to reach from the heart because of the force of gravity. Normal oxygenation of the nervous system as well as detoxification of the tissues through continuous movement of body fluids supports healthy brain function. Daily exercise, proper hydration (at least 1/2 your body weight in fluid ounces) and deep breathing are essentials to protect our circulation.
Toxicity – The blood is not sterile as it was once thought to be and a blood sample from any number of people today will demonstrate an astonishing array of environmental toxins circulating through our bodies in this moment. Chemical compounds that the body doesn’t know how to process end up stored in the tissues, particularly in the fat. The brain is a very fatty tissue. Choosing non-toxic products for daily life, avoiding extraneous chemical substances, consuming organic foods and minimizing automobile, cigarette and plastic use will only benefit our planet and our brains.
Naturopathic medicine employs two main tools for supporting menopausal cognitive decline. Omega 3 fatty acid DHA is the one agent known to reduce inflammation of the glial cells. In addition, consuming adequate omega 3 fatty acids in general has demonstrated reduction in brain shrinkage with age and has implications to protect against dementia and Alzheimer’s disease. How much is enough? The therapeutic dose of Omega 3’s is between 1,000 mg/day and 4,000 mg/day. However, caution must be exercised if there is any risk of poor gallbladder function or other fat metabolism issues. DHA for supporting the nervous system has a therapeutic dose between 100mg/day and 300mg/day for average adults.
The other equally important tool for the whole body is the collection of tools we know as detoxification therapies. These are tools to improve cognitive decline from toxic accumulation, circulatory issues and can assist in the reduction of total body inflammation by improving metabolic function. Adequate hydration, routine cleanse programs, vegetable juicing and sauna use are all gentle and effective tools to utilize regularly for detoxification support.
For more information or questions, please contact Dr. Sara Hart, Naturopathic Doctor and Licensed Acupuncturist at Stillwater Healing Arts Clinic. Join us every Wednesday through September at 9 a.m., for FREE fresh vegetable juices as a demonstration of ways to support your health!
Part 4: Aches, Pains & Weight Gain
Remember that injury from your young adulthood when you thought you were still invincible? While you’d probably prefer to forget it, the tendency with peri-menopause is for old injuries to return with a vengeance. If not something specific that you recall with a dramatic story of adventure, the aches from daily, repetitive irritation to your body begin to announce themselves with age.
Most peri-menopausal women will begin to notice an increase in aches and pains. Simultaneously, many women experience a gradual increase in weight, which provides an added burden to the joints. Arthritis surfaces at this time, and what may have been an easy-to-ignore irritation, now shows up day after day. The accumulation of injury and assault to the body over time no longer can be compensated for, or suppressed in the same way that the body was able to manage it before.
Put into simplified terms, the symptoms of menopause are a result of inflammation. While it is a theme that inflammation is a main culprit for many illnesses, the musculoskeletal system is a region where it is easy to see the relationships. Why it persists, is the mystery to examine.
Acute inflammation is the process of the body’s attempt to heal itself after a trauma. This is functional and serves the body well. For example, an ankle twisted while hiking will immediately swell, blood flow increases to the area to both infiltrate it with white blood cells and oxygen, as well as to deposit materials to assist in stabilizing and healing the injured tissue. Acute inflammation clears out in a few days, having done its job so the tissue can return to normal.
Chronic inflammation is another story, and results in long-term health problems. This sort of inflammation results from persistent irritation to body tissues for a variety of reasons. An injury that is not given proper time to heal, such as an ankle sprain put right back to use or tennis elbow where stress is experienced in the same region again and again, will both result in chronic inflammation. Chronic inflammation acts similarly to acute, except that the ongoing infiltration of the tissue destroys the tissue rather than heals. The prolonged infiltration creates fibrosis and impedes the blood flow to the area, limiting the healing process.
In addition to proper rest, an injury requires numerous components to heal.
Oxygen – oxygen fuels our metabolic exchange and is critical for tissue healing. Tissue oxygenation can be improved with the following:
Improve cardiovascular function – have your Doctor evaluate your heart function routinely, especially if you have a family history of heart disease, stroke, or heart attacks.
Remove obstacles – exercise daily to increase circulation and respiration, at least 30 minutes walking, biking, or all the many ways to enjoy the world. Exercising outdoors is important!
Breathe clear air – most homes have more toxic indoor air pollution than some of our dirtiest cities in the US. Carpets, paints, building materials, etc. all have persistent off-gassing chemicals released into the spaces they create. Using an air filter and choosing non-toxic items is important for the health of our families.
Reduce tissue acidity – when our bodies have a reduction in oxygen, we can create a vicious cycle of inflammation due to the acidity that results. Other factors that contribute to tissue acidity include stress, cigarettes, coffee, alcohol, red meat, and poor rest.
Circulation – waste elimination in addition to the components required for healing is an essential piece. One of the main reasons that tendons and ligaments are so slow to heal is because they are not tissues that have much circulatory exchange.
Enhancing circulation is the main goal of hydrotherapy treatments, which will increase healing times.
When it comes to chronic inflammation, applying either heat or cold packs alone can result in increased stagnation, which limits long-term improvement.
A simple therapy for improving circulation is to alternate heat and cold to the region of pain, or to the whole body. The basic recipe is three minutes hot, thirty seconds cold. Enhance the experience with the infrared sauna for a combined benefit of the infrared rays on pain management and the hydrotherapy effect of improved circulation.
Proper Nutrients – muscle relaxation depends upon magnesium to facilitate the release of contraction. Persistent spasm or aching is a common experience of magnesium deficiency. Additionally, this is one of our most deficient nutrients in most Americans’ diets. Selenium is a basic nutrient essential for cellular regeneration, which is what the muscle cells are doing each day with tissue repair. Manganese is essential for the formation of healthy cartilage. All together, we need to have adequate nutritional intake and digestive function to support our musculoskeletal system.
Getting the proper pieces in place can assist in the body’s healing once and for all. While a low-grade inflammatory process can exist for decades unnoticed, the harm is still happening. The menopausal changes to the body’s inflammatory process allows women to have the direct experience of when they may be doing too much or needing to shift routine to support better health.
Weight gain during menopause is related to the decline of what we know in Chinese medicine to be the kidney yang energy, or reproductive force. This aspect of our vitality not only provides the energy for creating new life and sexual function, it also provides our daily vim and vigor. Living a high energy, stressful life routine can deplete this energy early in life. Once again, the dramatic changes that occur with menopause allow the body to experience the result of the processes that have actually been going on for a very long time. Restoration of the kidney yang is possible, not to the point of reproduction but to restore the daily energy and metabolic function.
All of the components for restoring musculoskeletal health also pertain to weight loss. However, with this energy decline, exercise is often the worst thing we can do. Not a leisurely stroll or bike ride around town, but the pushing of oneself to accomplish a 10k when not having run in years. Restoration of this energy predominantly occurs with rest. Establishing a new set of parameters for how energy is utilized and shifting nutritional patterns are essential components.
For more information on assisting the hormonal transition and all the experiences that come along with it, please contact Dr. Sara Hart at Stillwater Clinic in Lyons.