Wednesday, January 10, 2007
Menopause
This morning, we profiled a delightful 60-year-old woman named Pat Dodson. By all accounts, she has a charmed life. She lives in a beautiful old San Francisco speakeasy and throws lavish parties. But 14 years ago, things were much different. To look at her, you may have thought she was ill. She suddenly couldn't sleep well, she was angry almost all the time and was undergoing a significant personality change.

If she were my patient, I probably would've started searching for a medical problem to explain all her symptoms. As she came to find out, it was actually all pretty natural. She was heading toward menopause.

Now, surprising to most people, menopause, strictly defined, lasts just one day! It is the one day that is 12 months after a woman's last menstrual period. Ha! That is the longest day of a lot of women's lives. Seriously, though, perimenopause can last a long time and be difficult to treat.

And, the way an individual woman might act can vary wildly. It is not just about hot flashes anymore. A woman's oxytocin levels may go down. Oxytocin is sometimes referred to as the "cuddle hormone." A woman may somewhat suddenly appear less affectionate and less likely to want to care for her family. Truth is, I learned a lot reporting this story and better understand some of the women in my life. I am curious, though, as to what other symptoms you've experienced or seen during perimenopause.
So much is spoken about the effects of menopause such as "hot flashes and night sweats" but to me as a young newly wed 51 year old woman, please talk about vaginal dryness and loss of libido. This is a huge problem for me - it affects my sex life considerably and is impacting on my relationship with my husband who is normally a loving, supportive man. Intimacy is painful and frankly my doctors have not given me much hope. I use a patch, I look after myself and take vitamins and also acidopholus which I have found helps. I went through complete surgical menopause 4 years ago.
I'm 48 (8/1/58) and still don't know what a hot flash is, though I have observed my same-age friends go through their own personal summers periodically. In my late 30's, I started to incorporate soy products into my diet and at age 44, added fresh ground flaxseed too. I now do a 1/4 cup of flax seed a day and eat soy a couple of times a week. My periods are regular and I'm not dangerous (though some of my husband's friends are afraid of me - go figure). I say that because by this age, my mother was dangerous. My father used to explain to me (starting when I was 8 and she was 43) that she was going through the change of life and some women went crazy at this point in their lives. Ten years later, when she was still terrorizing us and he was still making the same excuse for her, I decided to start researching menopause & maybe figure out how to sidestep some of this "insanity", without the use of drugs. so far, so good.
I'm 45 and have been perimenopausal for over 10 years. For the first few years I was able to laugh about the "power surges" (hot flashes) and having to change my nightware (and bedsheets) several times a week. The eratic menstrual cycles has always bugged me. The last few years though, I've had weight gain and periodic bouts of anger and depression. I'm scheduled for endometrial ablation in two days, which will hopefully take care of the eratic cycles (often two during a month). The rest...I guess I'll just try to smile and "deal with."
Thank you so much for writing this article! I am just starting down this perimenopause road and was shocked when I first starting having symptoms. I've always been a healthy person and didn't know what was happening to me. I don't remember older women ever speaking of their symptoms, or what they were experiencing, or any talk of that nature. If more women would speak to the younger ones and tell them what to expect, maybe it wouldn't be such a shock. This article helps get the word out. I have found relief by using natural and alternative methods like vitamins, herbs, and creams. I whole heartedly reccommend that other women do their own research on their symptoms and what is happening to them. Be educated on this time of life and seek out other information that you don't get at the doctor's office.
I appreciate your reporting, Dr. Gupta, and your interest in menopause. More research needs to be done in this area. As so many of the symptoms of menopause are also associated with aging - it is difficult to tease out which is which.

The focus on oxytocin in this blog and in the related article is peculiar. There is minimal evidence and there are few references in pubmed regarding a role for oxytocin in mental health. Who refers to oxytocin as the "cuddle hormone"? In my career I have not heard a neurosurgeon, endocrinologist, reprodutive endocrinologist, or OB/GYN refer to it as such.

You are well respected. I charge you to choose your words carefully and found them in science.
i am 45 and since this last summer have been experiencing what i thought was depression. lethargic, loss of interest, lack of ability to concentrate, mood swings and when i say mood swings, i am talking i can become a raving maniac over very little. either that or i will just start feeling sad about a thought that pops into my head and tears will fall. this isn't everyday, but it happens and i can tell i am over-reacting but reason doesn't help! course the night sweats have been around for several years. the exhaustion is constant and i can sleep sitting up as my coworkers will attest to. went to see my doctor this week, in fact, as i also noticed that when i wear turtlenecks my throat feels constricted. thought possibly i was having a thyroid problem. the doctor checked that and my levels and such are normal and then asked me what else i have noticed. well, when i thought about it, my skin is overly dry suddenly, even if i use lotion after every shower. i am colder this winter than i have ever been and am finding myself sitting with blankets on and turning up the furnace. i can't even stand to be in the basement - too cold. and the most attractive thing is my hair is thinning at a rapid pace. yikes! doctor feels it is menopause. i was floored. thought 45 was too young for that! said that all of my symptoms can be caused by menopause. i eat soy and walk on a treadmill at least 60 minutes, 6 days a week. i am normal weight for my height and my blood pressure was 110 over 70 at my last doctor's visit so i am in good physical shape. and i do eat soy and i am still experiencing these symptoms. i hate the thought of taking an antidepressant, but the doctor said that i could think about that and try them if my symptoms persist or get worse. i don't like taking medications but i also don't like feeling this way so it is being given serious consideration!
My Highschool Girlfriend may be goin through quarter life crisis. alot of people my age including myself seem to be very depressed with life in general, maybe we dont feel like we are meeting our own expectation in life.Dr Gupta can you add a blog regarding this subject or post somewhere we can learn more of this subject. Why are soo many 20 years old having such a realization of their own faults and disappointments.


One

I was born in july 1986
Thank you for addressing one of the most stressful and life changing (no pun intended) experiences a woman will ever have to face.

Being post menopausal, I can tell you that for some of us the overwhelming roller coaster of emotions that we suffer both during pre and post should be addressed. If only more people cared and pharmaceutical companies would research, perhaps many of us would still be married and not have aliented most of our family and friends before we knew what was wrong with us.

Thank you, thank you thank you Dr. Gupta for covering this important issue that affects many lives.
I am 48 and got to the point where my symptoms drove me to seek help. My mood swings were overwelming, and I was tearing up and crying all the time. Having worked for women in this condition, I know I couldn't put my employees, let alone my very understanding husband, through any more. Doc perscribed Zoloft at 50mg and what a change. I can function normally and feel in control of myself again. I have been on it for just 6 weeks, but what a difference. My only problem is now an inability to orgasm. I plan on asking for a 25mg dose at my next apointment in a week to see if that helps with that problem. My libido is so low that I don't really hare about the trade-off, but it isn't doing my relationship much good.
Over a two year period, I worked for a woman who was going through this and in complete denial. A formerly very even-keeled boss, she became manic--one day everything was fine and lovey-dovey, the next she was a crying maniac accusing me of everything from betrayal to trying to get her fired. I finally couldn't take it anymore and sought out a new job. We lost a dear friendship, but my own mental health required me to seek a more level-headed approach to daily living.
Thanks for this report, Sanjay. After hearing your report this morning I actually felt physically better. I'm 50. I had my first mild hot flash 7 or 8 years ago. Last month I had one that was so bad I was nauseated and couldn't walk. My last period was in May 2006.

I've been sleeping poorly for many months. My insomnia has left me feeling extremely fatigued.I frequently ache all over. My concentration has been so bad that I've had trouble doing many things that I enjoy such as reading or even watching movies or TV. I forget appointments and social engagements often. (I was intending to talk about these symptoms with my doctor at my annual check-up, but I forgot my appointment - I was a "no-show"). It's January 10 and I still haven't finished my Christmas shopping. My mood? When I'm not mad as hell, I'm depressed.

Until your report this morning I thought menopause was just one more stressor that I wasn't coping with very well. I was beating myself up for being weak and unable to manage the ordinary activities of my life. After your report I thought how maybe it was my ordinary life stressors were making my menopause symptoms worse! And just that thought made me feel better! I guess it's that I know it will be over someday and that there are things that can be done to help my symptoms now.

Pat looks 10 years younger than I do and she is about 10 years older! I will be glad when things start turning around for me.

Thanks for a wonderful report. Jackie
you talk about women who have there monthy, you never talked about a woman who has had a partial hestorectamony and still has there overies what their symptons of menopause is.
I'm 57 and still haven't experienced but a handfull of hotflashes. I eat very little red meat. Recently, at a Christmas party, I had steak, vegetables, and chocolate mousse for dinner. During that night I had hot flashes. Could it be they are putting too many hormones in our animals? especially estrogen to fatten the animals quickly? Is it possible I had hot flashes due to the steak?
The hardest part about menopause has been the inability to sleep. I teach first grade and need a good night's sleep so I can be patient with the students. I'm up several times a night using the bathroom and have difficulty falling back to sleep. I sure do miss the days when I slept without waking during the whole night.
Dear Dr. Gupta,

I agree with Dr. Melissa Wellons, MD, and find your report peculiar. You mention in your blog that you learned a lot about menopause while reporting this story, but I would challenge you to go for more thorough reporting. Instead of suggesting anti depressants as a treatment for menopause, I would like to see more money spent on relevant research. Also, nowhere in your reporting did you include the use of bio identical hormone treatment, which has been in use for many years, and is a more natural alternative to anti depressants and synthetic hormone treatment. Perhaps you could have included in your reporting some interviews from doctors who for many years have been successfully treating patients with bio identical hormones, diet and exercise � doctors Erika Schwartz M.D. and Eugene Shippen M.D. would have been a good choice for this. Perhaps you can do some follow-on reporting that will include them.
I am 57. I have been going through perimenopause for 13, yes 13, years. The first four years were hell. I thought I was crazy and my doctors though I was a hypochondriac. My blood tests kept coming back "perfect." It wasn't until my regular MD discovered a cyst on my ovary that he sent me to a specialist who ran a simple FSH test and diagnosed the obvious: estrogen dropoff.

Part of my curse was looking younger than my years. Doctors just didn't make the connection between my symptoms of debilitating fatigue, night sweats and irritability and my youthful appearance. They forgot to check one key number on my chart: my date of birth. I went on HRT and got relief, but, am now faced with the necessity of getting off of it. I've been weaning myself down gradually. My last period was two months ago. Please just let me have 10 more months.
I began perimenopause in my mid-40s, as did my mother. By 50, I was done. The biggest problem was nightsweats (very few hot flashes during the day) and interrupted sleep. I'd been told taking soy could help; indeed, the nightsweats did lessen. A low dose of antidepressents helped with the worst of the mood swings. Going back on the pill also helped control the hormone fluctuations. I fel it's vital for women to seek remedies, because such aids can smooth out the worst of the bumps and let her be her unique self again.
What Dr. Gupta has written is exactly what I'm experiencing today. In addition to hot flashes which are truly uncomfortable and embarrassing, I am extremely irritable, and have no desire for intimate contact with my husband. Further, I'm only 42 y/o and feeling a severe sense of loss/grief as this essential body function which is so much a part of being a woman ceases. I cry a lot each day. The herbal remedies don't work for me personally but I still take them hopeful that they will take affect.
After 37 years of excellent health, I spent the next ten years struggling with various ailments and the anxiety they caused. Muscle and joint pain, blood pressure flucuations, depression, shingle like breakouts, headaches, allergies, etc. The 4 or 5 doctors I went to in the first few years tried to medicate me for various illnesses even though I tried to tell them it was connected to my monthly cycle. I gave up and asked the Lord for help. I called my old doctor who had been retired for years and asked his advice. He directed me to throw away all the prescription medicine I was taking; take high potency vitamins and reduce my stress level. At age 48, when my menstrual periods stopped, I began to revive. I have continued to improve steadily and now at age 55, I am feeling better than I did at age 30. I am enjoying life more also. I now go to an osteopathic doctor (since 1990, 3 or 4 times a year as needed) who has never prescibed the first pill for me. He gives me osteopathic manipulative treatments. I am well thanks to the Lord, my old physicain, and my new DO.
I will turn 59 on my next birthday. To date, I have not experienced any symptons associated with menopause. I have taken no hormone drugs. I have taken Vit E for many many years as I heard many years ago that Vit E may reduce symptons of menopause. Is is too much to hope for, at my age, that I have escaped menopause?
I am a cervical cancer survivor who was thrust into menopause at 42. Through the miracle of hormone replacement therapy (HRT) I overcame loss of libido, hot flashes, etc and returned to my "old self". I now have a great gynecologist who specializes in menopause. Thank goodness for HRT!
I am fast approaching 70 and just want to relate that sometimes menopause is a wonderful thing. I experienced terrific mood swings when I had my period (temper tantrums, crying, etc.) After menopause, I became much calmer and it is wonderful. After about 5 years of menopause my doctor decided I should take hormones for preventing osteoporosis. When I took them, I was shocked to find the mood swings returned. When I stopped taking them the mood swings disappeared. Now I feel very well (no hot flashes, vaginal dryness, etc.) and look about 60 or younger. Just want to let women know that for some menopause is great.
Curious about other strange perimenopause symptoms huh? Well, I craved strange food and my carvings would always hit my in the middle of the night. I'd wake up craving Shreaded Wheat and sometimes tuna salad or Dutch chocolate ice cream. It was always one specific food. I'd lay awake foor hours but once I fell asleep and awakened the next morning I had no desire whatsoever for any of those foods any more. So wierd.

G. Hawks
Jakson, Tn.
At 37, after a tubal ligation and my last baby had weaned from the breast, my hormones were in a tailspin. My periods returned, twice monthly, excessive sweating, extreme irritability, sleeplessness, and worst of all, anger at my family and intolerance for the least of annoyances. My OB-Gyn said that I must have post-partum depression...a YEAR after my daughter was born! He wanted to prescribe anti-depressants and seemed irritated with me when I refused. When I asked if it could be hormonal, he dismissed me abruptly. (That was mighty brave of him, considering my short fuse those days!) Thank God for another caring physician who recognized the problem as hormonal imbalance and prescribed a short course of hormone therapy. Relief was almost immediate! A few years later, at 41, the sweating and swearing are under control, but alas, my libido and my marriage ain't what it used to be.
I appreciate the article on menopause. I am in my forties and for the most part have taken supplements to help my body "go with the flow" as I transition to a new phase in my life. I think the addition of natural phytoestrogens, calcium magnesium, B-complex, sometimes evening primrose prior to my periods, and an occasional night time supplement (I have a very busy brain)has been extraordinarily helpful for me. Add to it that I work out and dance; and I think I am doing fairly well as I go into this next phase of life with grace and spunk. My only sour note is recurring fibroids, I had them surgically removed 11 years ago and they are back, with a vengeance I might add. Now that's a bummer. :(
Thank you again Dr. Gupta.
I do not have hot flashes, nor am I plaqued with moodyness. Night sweats and sleeplessness is not a problem. I do not have difficutly concentrating and I do not have eratic periods. I am not lacking in desire and do not worry about being to dry. My periods are regular as they have been for forty four years. My problem? I am 56 years old and menopause is something that seems to happen to everyone but ME!
I began perimenopause in my late 20s. By 39 I was menopausal. At 63 years of age my life revolves around managing hot flashes; food cravings; mood swings; joint pain; weight gain; memory impairment; vaginal dryness and pain; dry skin; loss of libido; pain in my lower ribs; irregular heart beat; fluctuations in blood pressure; poor circulation; chronic fatigue; insomnia and hypersomnia; panic attacks; cranky digestion; and thinning hair.

I have found that I can control most of these symptoms with vitamin supplements (especially vitamins C and D), Lexapro (an anti-depressant), and limiting my intake of meat, dairy, poultry, alcohol, and caffeine. My daily menu seems to consist of parsley and pills.

Physically and emotionally the past 24 years have left a lot to be desired. On the plus side I have metastatic breast cancer and my new medication, Arimidex, seems to minimize many of my menopause-related symptoms. Now I can eat the occasional piece of pizza with my parsley and pills.

I would have preferred to learn this without the cancer but "beggars can't be choosers." After almost a quarter century of menopausal misery I'm just happy to be relieved of some of my worst symptoms.

To be menopausally fair some of my symptoms were intensified by other health problems related to my deranged thyroid gland. Unfortunately, treatment for my thyroid deficiency didn't eliminate or significantly reduce any of my menopausal symptoms.

In hindsight I realize that I should have consulted an endocrinologist when my menopausal symptoms started affecting my quality of life. More expert thyroid treatment might have significantly reduced my symptoms and prevented the various occurances of breast cancer.
I am now 66 and the symptoms of my perimenopause were very mild and did not cause any hardship. They used to say, a woman should not be president, because of PMS and/perimenopause. I got news for you, while women exhibit some of these symptoms some of the time (more agressive, for instance), most men are like that all of the time. So there you have it.
I went symptomless through menopause with no symptoms and was diagnosed as post-menopausal (confirmed by blood tests) at the age of 40. It happened 4 months after 9/11.

I think it was stress related, brought on by the trauma of 9/11. I lost a number of friends in the attack on the Pentagon and I was recalled to active military service shortly after the attack. I know that probably doesn't meet with conventional wisdom but there is no history of early, symptomless menopause in my family.
I'm only 30, and when I hear these stories I start to panic already. How common is it to have a very difficult menopause? Don't get me wrong, forwarned is better, but how much should I be worrying?
I am 46 and have just started with symptoms I believe. My periods are either sooner or later. My biggest symptom is increased migraines. Although I had them since my 20's, definitely increased to two a month, usually coinciding with PMS and erratic ovulation. I also have noticed lack of libido and feeling "spacey" and up and down on emotions. I go from being really tired to not being able to sleep once I get there, or waking up a few times in the night where I used to sleep like a log.
I am very grateful for any information regarding menopause. I am unclear where I am exactly in the process, but I haven't had a period for 11 months. I have frequent hot flashes during the day, night sweats, some forgetfulness, mood swings and loss of libido. I also have MS and have been diagnosed for almost seven years although I experienced symptoms for 10 years before being diagnosed.

This is significant because I had so long since forgotten what my true self feels like that when I began perimenopause I accepted the irrgegularites as just additional symptons related to my chronic illness. I don't think that I am alone. I've managed to just keep praying and pressing on. I take prescription meds for the MS including an injectible. I take over-the-counter remedies and herbs for the menopausal symptoms. I actaully miss the affection that a spouse or lover could provide but I'm too tired for a social life after managing the symptoms of MS and working forty hour weeks. I know that a positive change is going to come and I'm so ready for it.
I am a bit confused! I'm not sure if I am going through the pre-menopuase state. My periods are very irregular lately. Sometimes I get my period once every 2 months. Is that what that means? Please shed some light for me. I am 47 yrs old.
Women who have earlier suffered any bout with depression, anxiety, insomnia need to be alert for reoccurence during menopause...& especially peri-menopause, before there are many overt physical changes.
All the physical changes seem to sometimes (often?) trigger severe new episodes, which, too frequently, are trivialized by physicians, particularly when all else is going well with the woman. (What do you have to be depressed about? your life is fine is heard all to often!)
Help from a psychiatrist or other mental-health professonal with experience in this area can help a great deal. It's not just about hot flashes!
I had a partial hysterectomy a year and a half ago, I'm 47 now they left the ovaries in but all else was taken out because I had a fibriod the size of a grapefruit. I find my moods are not very erratic since I've been on Effexor 150mg for the past ten years a treatment for Clinical Depression I do find that I bloat up alot and have gained weight, I still do my usual exercises to lose the weight gain but to no avail. My sex drive has not changed at all I still enjoy it and climax every time. I do get hot and cold flashes but not severe.
I seriously believe the anti-depressant is what's holding all emotions and all things that come with menopause at bay and tollerable for myself and others around me. But could please tell why we gain so much weight and exercise to lose it to no avail at all. Could you write an article which explains the difference between surgical menopause and natural menopause if there are any differences at all. I would greatly appreciate it.
A couple of years ago I found myself unemployed, fat, miserable and careening into menopause. Now, struggling with a new career, hot flashes and the insanity of middle aged dating, I�m a 50 year old woman who is just beginning to discover how joyful life can be. I found the best way to cope was to talk to everyone I met about it.... It was liberating and I learned a lot about myself along the way. Communication and shared stories are the key. Others have told me that they have found My Menopausal Musings to be helpful. There are a LOT of sections on hot flashes and crying.
In the almost 19 years since the onset of menopause I have never had hormone replacement therapy nor any hot flashes. Perhaps once every few months my face would feel like I stuck my face into the sun for a few seconds but never more than that.
In my childhood and adult life I was always athletically active until last year (backpacking, hiking, paddling, tennis, biking). Never smoked, drink perhaps 3 drinks a year, favorite drink is milk and juice. Delivered three full term healthy children.
Now I am displaying some symptoms not found in a cursory search of symptoms on Google or elsewhere.
Anyone else have total lack of hot flashes? Still alive? Should I worry?
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