Peri-Menopause Aching-the study that’s never been done

“When I have to go to the bathroom in the middle of the night, I walk like an 80 year old woman. Dr. Nieder, I am only 48. There is something seriously wrong!” Lately, this complaint comes one or two times a week from peri-menopausal women. (Peri=around so peri-menopause is defined as around the time of menopause). Similar to my recent Hot Flash post, I started thinking about their complaints from my own experience. It hit me–I don’t ache like I used to. Yes, I exercise more now than in my mid-40’s but not as much as three years ago yet I don’t ache as badly as then. Why?  Research reveals the likely cause of the aches is estrogen deprivation but I cannot find studies that have been done on younger women. And most of the studies are more anecdotal comments about the “anti-estrogen” effect of medications given to women with breast cancer. Many of those patients are unable to tolerate the therapy because their joints hurt too badly[1]. In addition, all the studies on joint pain and estrogen loss have been done on post-menopausal women.[2]

What dawned on me is that the reduction in pain occurred about the same time I started sleeping again and the hot flashes were reduced. An “AH HA” moment indeed. But I’m an “N of one” which means my experience is unique to me and not statistically significant. I am only surmising that my patients will also improve based on my experience and the fact that my older patients are not complaining as much as my peri-menopausal patients are. Let’s hope these studies get done so I can give my patients facts instead of just life experience.

In the meantime, keep walking and staying optimistic. It will get better.

 

1. Qamar J. Khan, Anne P. O’Dea, and Priyanka Sharma, “Musculoskeletal Adverse Events Associated with Adjuvant Aromatase Inhibitors,” Journal of Oncology, vol. 2010, Article ID 654348, 8 pages, 2010. doi:10.1155/2010/654348

2.Estrogen alone and joint symptoms in the Women’s Health Initiative randomized trial. Chlebowski RT, et al. Menopause. 2013 Jun;20(6):600-8. doi: 10.1097/GME.0b013e31828392c4.

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HOT Flash

This short post is mainly directed at my menopausal patients. It came to me last night about 3 am. As it happened that was the second time I’d awakened for no obvious reason until a few moments later it seemed the room temperature had risen 10 degrees. No wait, MY temperature had done that. FlameV1Having nothing better to do until my temperature normalized (besides kicking off all my covers much to my husband’s dismay) it occurred to me, “this’ll make a great blog post!”

For those women struggling through the peri-menopausal period, better known as the meno-fuzzies, I have good news and bad news. Your cognition issues are real[1]. That’s the bad news. The good news is that this too shall pass and most of your brain function will return. You will also have fewer hot flashes and there will come a time when you will once again sleep through the night. Now that I’ve made it to the other side I can state with assurance that walking into rooms in my house only to discover that I have NO idea why I’m there are fewer now. No longer do I fear bursting into flame in the middle of my office. The bad news? Even though I’m in my late 50’s I still awaken in a sweat two or three times a week. And I have 80 year-old patients that assure me that they too still occasionally flash.

Are your fears about your memory well-grounded? Yes, but it will come back.
Is your insomnia as bad as you think it is? Yes, but you will sleep again.
Are you as irritable as your family says you are? Maybe, but exercise helps.[2]
Are you gaining weight because of the menopause? No, that’s more of the aging process.
Should you take hormones? That’s a very individual question and best discussed with your doctor in the office. Every woman needs to make that choice with her own needs and risk factors in mind.

 

1. Cognition and mood in perimenopause: A systematic review and meta-analysis. Weber MT, Maki PM, McDermott MPJ Steroid Biochem Mol Biol. 2013 Jun 14. pii: S0960-0760(13)00111-8. http://www-ncbi-nlm-nih-gov.nihpublic-proxy.stanford.edu/pubmed/23770320

2. Physical Activity, Menopause, and Quality of Life: The Role of Affect and Self-Worth across Time. Steriani Elavsky, Ph.D. Menopause. 2009; 16(2): 265–271. http://www-ncbi-nlm-nih-gov.nihpublic-proxy.stanford.edu/pmc/articles/PMC2728615/?report=classic

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Menofuzzies in Perimenopause

Occasionally, the attempt to empathize with someone during a visit falls flat. She knows it, I know it, and the therapeutic encounter is anything but. Since I am around the same age as many of my female patients, when a woman comes in with perimenopausal symptoms I am quick to understand. It’s common for women to complain of sleep disorder, mood swings, weight gain, fatigue, irritability, muscle aches and memory issues on top of the daytime hot flashes and night sweats. A couple of years ago, at my husband’s 35th high school reunion, one of his former classmates was almost frantic because she thought she had early onset Alzheimer’s disease. As she spoke of her word-finding difficulty, walking into rooms and forgetting what she went there for and awakening every 45 minutes, all the women surrounding her were sagely nodding their heads. Nope, we told her, you aren’t crazy or paranoid, you are experiencing the “Menofuzzies”.

In order of magnitude what women most hate is:

  1. Weight gain.
  2. Mood swings.
  3. Weight gain.
  4. Insomnia
  5. Weight gain.
  6. Memory issues.
  7. Yep–Weight gain. It’s a big issue.
  8. Hot flashes and night sweats.

Even though I struggle with the fifteen pounds I have gained over the last 17 years, I am 5’10’ so the weight distributes well and I don’t look like I’m at the top of the acceptable BMI (Body Mass Index). Having never had any issues at all losing weight until I hit 40, I understand how frustrating it is to walk over fifteen miles a week (often more than that), eat far less than at any other period of my life and still have difficulty with the zipper. The mood swings I can deal with, the insomnia gets better with the exercise, the memory issues fluctuate but my older colleagues and friends (female) tell me that it will improve and the light at the end of the tunnel no longer appears to be a train. Except for the weight. Some of my patients have gained 20 to 50 pounds or more during this time of life and they are frustrated and angry. And they do not need me to empathize with them. Or tell them that other women are having the same problem. What they care about is THEIR weight gain and how to deal with it.

Unfortunately there are no easy answers to mid-life weight gain. It’s still a calories in/calories used kind of equation. I recommend Weight Watchers and these already time-stressed patients are frequently not interested in finding yet another meeting to attend. I suggest using the on-line and app versions of Weight Watchers and they promise to look into it. I encourage exercise and talk about the fact that it is the closest thing yet to a Magic Pill but they are already exhausted and look at me in disbelief when I tell them that one has to invest energy to make energy. I recommend apps like LoseIt to use self monitoring as a technique for weight loss. I advise them that there are no good pharmacologic solutions and rarely recommend lap-band surgeries or other similar procedures except in extreme cases.

I try to steer them away from hormones except when their insomnia from night sweats and persistent awakenings is intolerable. Generally patients don’t find much relief with over-the-counter preparations (OTC) but they seem generally safe to try. Many patients come in requesting anti-depressants but these often worsen their weight issues. Again, that Magic Pill of exercise can make a difference if an individual will stick with it. There’s no down side to exercise (unless you run in front of a truck) and a safe thing to try for many of the issues arriving in peri-menopause and beyond.

The bottom line is, like many health issues, there are no easy answers and certainly no ONE pill is going to make this transition and its difficult aspects all go away. Staying physically fit, maintaining or developing good dietary habits, having a fulfilling home life and a satisfying life outside of one’s home seems to be the best medicine for navigating this time of life. But not everyone has the supports in place to make the kind of lifestyle changes necessary to achieve these goals–their jobs exhaust them, their kids are in trouble, their husbands are unsupportive or absent, there is no flexibility in their schedules, their is no flexibility in their thinking and any number of other difficult circumstances. And when they are frustrated with little or no time to develop these kinds of lifestyle changes, they may find my advice lacking.

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