Are You At Risk of Starting Menopause Early?

Are you in your 30’s and experiencing changes in temperature? Do you wake up in the night between 3-4am? Has the rhythm of your period changed? Is your bladder less reliable than it used to be?

 That got your attention, didn’t it?

All of these symptoms in a woman below 45 most often indicate that you are running yourself too hard! They are likely signs of what Chinese Medicine calls “yin deficiency”.  It can also be understood as “stress,” but it is more nuanced than that.

When we are young women we need to be careful not to burn out all of our yin essence, even though we may feel like we are capable of anything and everything. Women are excellent at stepping into the fast pace of life, competing in the job market, creating a career path and setting sights on motherhood. But we need to be attentive to our bodies, our hormones, and our yin through every phase of life so that we set ourselves up for a smooth next chapter.

Many women in my practice have spent their 20’s burning the candle at both ends, waiting until they are in their late 30’s to try for pregnancy, and then having a hard time. For those who do get pregnant in their 30’s, and then embark on the busy path of working and raising children, they end up in my office with insomnia, night sweats, and anxiety. When this stage of life is not well tended to, they reach menopause and the night sweats are worse! The anxiety is worse! The incontinence gets really bad. And forget any desires for intimacy or restorative connection with their partners: they are fried.

This can all be prevented.

It is music to my ears when a woman in her 20’s comes in and tells me “I am not ready for kids, but I want them one day and I want to make sure it happens easily when I am ready. How can we be sure my body is healthy and balanced now so that in 5-10 years I can slip right into an easy conception, pregnancy, and motherhood?”

Or, when a woman comes in and tells me she’s about to have her first child and she wants to know how to help her pelvis and vulva heal after the birth, to make sure her bladder and uterus return to where they should be.  She wants to insure that her pelvic bowl regains it’s strength and balance as well as to prevent any future imbalances in hormones or tissue integrity. She is thinking ahead, recognizing that care needs to be taken for the health of her future.

When we do start the peri-menopausal process, usually in our early to mid-40’s,  some of us start to notice little signs that perhaps we didn’t tend to our bodies as closely as we should have. When the hormones begin to shift, our connective tissue and smooth muscles can behave differently. This can show itself in reduced flexibility and reduced elasticity, and can also show up as bladder incontinence. The ways in which we did not take care of ourselves will begin to reveal themselves as we begin to undergo this change.

One of the key pieces of advice I have for women is to anticipate what is down the road and do not take for granted just how thin you can spread yourself in your youth. We are not built to lead the pace of life that we do. We all must rebel against it with fierce self-care. Take the time and devote the energy to nourishing your yin.

How do I nourish my yin, you ask? Oh, you will like these suggestions:

 ·      Slow down! Cut one or two errands out of your schedule everyday. Allow yourself to stop running around.

·      Your device – I need not say more!

·      Turn down the lights around 7pm and keep the house quieter and darker.

·      Hang out next to the water, amongst the trees, and in the garden.

·      Sit and stare at the sky.

·      Lie on the earth.

·      Practice BE-ing instead of DO-ing.

·      Eat good quality protein and minimize raw foods, especially as the weather cools down.

·      Rest your mind: no planning, no list making, no device, no reading. Just notice where you are, what you hear, the feeling of the air on your skin.

·      Take a bath (and add soothing smells and bath salts).

·      Play an instrument (even if you are no good!).

·      Weave, paint, craft.

·      Get acupuncture, cranio-sacral work, or an abdominal massage.

·      What else can you think of?

 The gist of this article is to say that as women, we go through 3 major phases of life: the Maiden, the Mother and the Crone. If we do not care well enough for ourselves in one stage, the next stage will likely be more difficult. Listen to your body. Think ahead. Do not assume the gifts of youth will be there for you to ease the transition into the next phase. Nurture yourself now as an investment in your life to come.

The Birth Control Pill: The Dark Side of "Easy" Contraception

The birth control pill is being misused by modern medicine. Did you know this? As women in our sexual partnerships, we are typically saddled with the conundrum of how to prevent pregnancy. In our modern world there is still not a viable contraception option that will take some of the responsibility (and physiologic burden) off of the woman… yet. When women come into my office and are on the birth control pill (or “OCP”, the oral contraceptive pill) I simultaneously sigh in exasperation and also feel my heart going out to this woman: I know your struggle. We have no easy options!

With that said, I still feel very strongly about women not choosing OCP’s as their form of contraception, but even more so that women do not start the Pill as a tool for managing other symptoms. Here is where we start to see it being applied ignorantly and inappropriately. When an MD puts a woman on the Pill to address symptoms of heavy bleeding, acne, mood swings, etc. it really gets my goat! I feel strongly that if women knew all of the reasons I land on this side of the debate, they, too, would shift their thinking. So, I am here to share with you my passionate case for why NOT to take OCP’s.

First, let’s just get an understanding of what a menstrual cycle is about. As my colleague, Dr. Julia Christensen, ND said “the menstrual cycle, also known as the moon cycle, exists as the result of an orchestrated symphony involving many hormone pathways from the brain to the ovaries.” Beautifully stated. Women’s bodies are quite complex. The pituitary gland (in the brain) communicates with the ovaries constantly, but the waves of hormones vary, depending on where you are in your cycle. From the day you bleed (day 1) until the day you ovulate (roughly day 14), your body is in an estrogen dominant state. This estrogen dominant state stimulates a lovely thickening of the uterine wall to provide a nice home for a fertilized egg to implant should fertilization occur.

When you ovulate, your ovaries are stimulated to release an egg by the hormone luteinizing hormone (LH), which is released from the pituitary gland and triggers the shift in the ovary to send that egg on down the fallopian tube. As that egg makes it’s way, your ovaries shift gears and release progesterone. Now, from day 14 to day 28 (or so) your body will be in a progesterone dominant state. This is the hormone that will be supportive of early pregnancy, so the first few weeks after an egg has been fertilized. If no fertilization occurs, the egg will not implant (which causes a whole new cascade of hormones) and the body will peak at a high level of progesterone on day 21 of your cycle, and then it will begin to fall. The reason you bleed around day 28 is because that rich thickening of tissue that developed during the estrogenic portion of your cycle, and was nourished by the presence of progesterone during the second half, is suddenly deprived of hormonal stimulation when the progesterone levels fall. The bleed is due to progesterone withdrawal.

Got all of that? Good. Now, for The Pill:

To start, if you are on OCP’s to “regulate” your cycle, be not fooled! They are not actually regulating your cycle. The Pill does not regulate your menstrual cycle.

The Pill is inducing a state much like pregnancy, which means that you are not ovulating. This means that this whole “symphony” of hormonal conversation between your brain and your glands is not happening. This means, therefore, that you are not actually cycling. Your body is not in its normal, natural state.

So what about if you are on the OCP to help with acne, mood swings, PMS, endometriosis, PCOS, or any other symptom? The Pill is not addressing the cause of any of these issues. In fact, the Pill is masking the underlying cause of these issues, and disturbingly, might be making all of these worse.  Each of these symptoms indicates that some other aspect of your physiology is off. The possibilities range from adrenal dysregulation, liver congestion, gastro-intestinal imbalances, nutrient malabsorption, stress responses, and more.

Here are more interesting facts about OCP’s:

·      They disrupt the healthy balance of gut bacteria and can contribute to intestinal permeability and inflammation. We need healthy gut bacteria to have a healthy immune system, to break down food and properly absorb nutrients, to metabolize hormones (Estrogen & testosterone, as well as thyroid hormones), and to maintain a healthy metabolism. [1]

·      The combination of the Pill inducing an estrogen dominant state and the disruption of the gut bacteria (which leads to an ineffective clearance of excess estrogens) leads to an overall estrogen dominant state of being for a prolonged period of time, which can lead to symptoms such as ovarian cysts, fibrocystic breasts, heavy bleeding (especially once the Pill is discontinued), mood swings, and weight gain.

·      Thyroid hormone binding globulin is increased on the Pill, which means that your body experiences a hypothyroid state. This can lead to weight gain, moodiness, lack of energy, hair loss, dry skin, and several other symptoms. [2],[3]

·      Sex hormone binding globulin is also increased, which binds up sex hormones and makes the body unable to use them. This includes testosterone, which is essential for your sense of drive in the world, for mood and interest in life, healthy muscle mass, and for libido.

·      From a nutrient standpoint, OCP’s interfere with many of the essential ingredients for a healthy body. Levels of B6 (required for healthy neurotransmitters and a balanced mood), magnesium, zinc, phosphorus, calcium, and selenium. [4] It can also increase iron and copper, which can cause agitation and anxiety-like symptoms.

So, at the end of the day, now you can see the mess that I see when a patient sits down and tells me she has been on the Pill. As I noted, I understand how difficult it can be to choose a method of contraception. However, when the Pill is used to treat any other symptom the body is presenting, it is just sloppy medicine, in my opinion. Not only does it fail to address what is really being communicated by the body, it is very likely exacerbating the root of the issue and many, many more physiologic functions beyond that.

For help in getting off the Pill and repairing your gut, hormone balance, metabolism, thyroid function, fertility, and anything else that may have gotten out of whack, find a licensed Naturopathic Doctor, licensed acupuncturist/ Chinese herbalist, or functional medicine doctor. And remember to ask any prescribing doctor whether the medication they are giving you is helping your body to heal, or if it is just a band-aid to cover up symptoms. Ultimately, it is your choice as to whether or not symptom management is your end-goal, but I encourage people to really understand what they are putting into their bodies and why. As a doctor my job is to educate you about what your symptom picture means and help you to understand what your options are for returning to a balanced state. If I have not done that, then I have not done my job.

[1] https://www.ncbi.nlm.nih.gov/pubmed/26658991

[2] https://www.ncbi.nlm.nih.gov/pubmed/1219185

[3] https://www.ncbi.nlm.nih.gov/pubmed/12521654

[4] https://www.ncbi.nlm.nih.gov/pubmed/22224344