Aileen blew into my office like a Summer storm.  “Help me, I’m a poster child for Hormones from Hell!”  After catching my breath, I assured her that there were many ways of dealing with the ravages of hot flashes, dry skin, mood changes and forgetfulness.  I started by reinforcing that menopause is not a disease. Inaccurately and unfortunately there is a pervasive sense that menopause is the “ultimate and inevitable bad experience” for aging women.  I jokingly explained that women were not designed to self-destruct at fifty!   
     Menopause is a normal, natural transition, and it is vital for women to view it with a positive perspective.  That simple understanding is the cornerstone
in building a plan to thwart the symptoms of “the change.”  But it is equally important to realize that not everyone has a problem with menopause.
      As a physician, my experience treating menopausal women is that there are some universal similarities in women’s experiences, but because of every person’s unique physiology and life journey, this time in a woman’s life is very individualized.
      I am a “recovering traditionalist”.  I was trained in the old school approach to menopause (which means drugs, and if that didn’t work, more drugs). In almost twenty years of practice I have found that many women are not satisfied with their options and many discover that their “treatments” are worse than their symptoms.  Especially in this age of “estrogen panic” where the media (and many physicians) has touted misleading and confusing advice on hormones, many women are looking towards alternative treatments for their symptoms. One woman put it well.  She said, “Physicians have a duty to give a woman the best care they can provide, especially their options.  However each person is ultimately responsible for his or her own health.  We, the patients, need help, guidance, and a listening ear.” Those were powerful and challenging words.
   The general dissatisfaction among women is amplified by the observation that only 17% of eligible women in the US are taking some type of hormone replacement and up to 80% of women who start on hormones stop them after two years!  The needs of women are not being met!  This problem with compliance is due to poor communication and fear.  After all, treatment of symptoms is not limited to simply taking a drug.  Successfully navigating the potentially turbulent waters of menopause requires a more comprehensive approach.
Herbs, complimentary teachings, diet, and exercise all should be discussed along with hormones.  The main caveat surrounding these modalities is that they must be held to the same standard and scrutiny that safeguards traditional hormone replacement.
The major problem in meshing the traditional and complimentary approaches to health is a mistaken perception of mutual exclusivity.  These treatments can coexist and be complimentary.
  I am saying that choice and personal responsibility are keys to unlock a joyous menopause.
      This is an opportunity to live with passion and fulfill your life mission. This is a time to take stock of the past and choose your path for the future. The choice is yours. It is a choice that is difficult if not impossible to make wisely without sound information and guidance.
THE 4 “A”s
    Many of the lifestyle choices you make, such as diet and exercise, can dramatically affect your menopausal experience. It is not a time to be complacent or anxious.  It is a time- a season- to rejoice and celebrate the joy of living. 
Following the four “A”s,   Attitude, Action, Aptitude and Apothecary, can be the prescription for menopausal merriment.     Attitude- what we believe is our reality, what we know is our truth.  Belief plays a major role in the symptoms of menopause.  Our thoughts become our actions, our actions become our deeds, our deeds become our habits, our habits become our character, and our character becomes our legacy.  In many instances, if you anticipate a horrible experience, you will be right!
Action- this involves two levels.  First, acting on your knowing.  The key to any successful person, whether it’s in business, raising a family, or celebrating menopause is taking action. There is nothing more sad than a good idea that dies from loneliness or lack of attention.  Whether that’s using hormones, herbs, massage therapy or exercise, you have to take action to achieve results.
       The second part of action is exercise.  It is the fountain of youth and can help in reducing both weight and hot flashes! 
Aptitude- educate yourself, learn your options.  Ask questions, talk to others, and take responsibility. Through knowledge about menopause, you eliminate fear and create opportunities.  M.D. does not mean menopause director!  Learn so you can be a partner in your health care.
Apothecary- We have a plethora of medicines and natural substances to treat the symptoms of menopause.  These are merely tools; however, they cannot stand alone. 
Explore your options and live joyously and healthy.
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     Have you ever wondered why your wife doesn’t appreciate your love affair with the remote control?  Are men really from Pluto and women from Jupiter?

     We may not come from different planets, but scientists tell us that many of the differences between men and women may actually stem from differences in brain structure. This variance leads to gender- specific behavioral traits.  In addition, female hormones (estrogen, progesterone, and testosterone) can cause microscopic changes in cells which may influence perceptions and thought
patterns.brains

     Brain researchers report that the two primary reasons for gender differences are brain structure and hormones.  These differences can lead to behaviors that can either help or hinder relationships.  God designed the sexes to be different so as to complement each other, yet these gender-specific attributes may also lead to conflict and confusion for many couples.  The good news is that we can also discover ways to live in harmony with our mates.

     For decades scientists have known that the right and left hemispheres of the brain have different functions.   It is well established that the left hemisphere predominantly controls analytical, concrete, goal-oriented behavior, whereas the right side manages more spontaneous, emotional, and artistic actions.  Most individuals, independent of their sex, have a dominant lobe that influences their personality.

     These two hemispheres are connected by a large network of nerves called the corpus callosum.  This superhighway permits the free transfer of complex information between the two lobes. When the corpus callosum is absent (as in some rare birth defects) or severed (by accidental trauma or as medical treatment for otherwise untreatable seizure disorders) the individual’s behavior and personality may become disjointed and unpredictable.

      A woman’s brain contains an average of 40% more of these interconnecting nerve fibers: a veritable superhighway for the two sides of the brain in comparison to a man’s two-lane road.

     How is this significant?  It means that a woman can literally use her whole brain in a task, whereas a man is much more likely to use just one hemisphere at a time. This results in a woman being able to process many tasks at once, whereas a man tends to focus on conquering one task at a time.

     Men and women also use their brains differently (when we use them).  Fascinating studies utilizing state-of-the-art technology show that during identical tasks, women tend to use the right and left sides of the brain equally whereas men use one hemisphere more intensively.  This female “whole brain” thinking, supported by the corpus callosum interconnections but not dependent on them, gives a physiological basis for the enigma of women’s intuition.  Being able to use the whole brain in processing information allows women to perceive things in a broader sense and make conclusions based on a vast array of input.  This sixth sense is founded on the “whole brain” thinking that takes input from a multitude of sources to produce uncanny and often unexplainable insights.

       A woman’s brain has more nerve cells than a man’s in an area called the hippocampus, the area of the brain that is intimately linked to processing and expressing emotions.  The hippocampus is also the switchboard for regulating the response to stress.  This area is also very sensitive to the effects of estrogen, which partly explains the emotional changes seen with fluctuations in female hormones, i.e., puberty, PMS and menopause.  Because women have more neurons in this switchboard, emotions are more closely linked to other behaviors, and stress is perceived differently

     Hormones are nature’s messengers.  They are chemicals that transfer information from one cell to another, in some cases even altering the structure and function of the target cell.  The development of female brain function and structure is especially dependent on estrogen.  As the female fetus develops, estrogen works its magic by altering brain structure and sensitizing receptors for the important neurohormone serotonin.  Serotonin is the critical “mood messenger” hormone that is responsible for the expression of various emotions, including depression. Any alteration in the workings of serotonin can present as a clinical depression or anxiety disorder.  Estrogen is closely tied to the function of serotonin and that is why women are twice as likely to develop clinical depression as men.  This connection with serotonin also partially explains why fluctuations in hormones (as in puberty, postpartum, and menopause) can cause changes in emotions.  For years, the male-dominated medical fraternity downplayed this episodic mood shift as largely due to external stresses: the “it’s all in your head” approach. We now know that it is all in your head, just in the literal sense, because of the interaction of estrogen with brain cells and serotonin.

     One of the most important steps a man can take in helping his wife who is suffering the emotional trials and tribulations of PMS or menopause is to understand that these changes are real and based on both physical and emotional factors in addition to the stresses of her life situation.  Fortunately, clarification of the roles played by hormone fluctuations and brain functions had also led to parallel discoveries of how diet, exercise, and nutritional supplements can correct imbalances to restore health and wholeness.

   
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    “Hey doc, my face looks like a war zone.  I wouldn’t mind having the complexion of a sixteen year old if I could have the body of one also, but this is ridiculous for a grown woman!”  Gladys was a victim of adult onset acne, and she was not pleased.  She is not alone.  Some experts estimate that up to 50 % of women over 30 suffer from some type of acne or acne like complexion disorders. 
     
     It is not known what triggers adult onset acne. The development of hormonal irregularities in the
menstrual cycle may be a factor, or ovarian cysts may cause hormonal abnormalities that increase androgen productivity, resulting in acne breakouts.  The classic situation is one in which a woman experiences irregular cycles, setting up an over production of estrogens and testosterone.  These hormones stimulate oil production in the skin glands which in turn become inflamed and irritated. Sometimes these sebaceous glands continue producing a higher amount of sebum well into adulthood and thus acne infection continues even at that age. Androgens have also been associated with acne flare-up in women before menstrual cycles or sometimes during pregnancy.   Whatever the cause, it is not wanted or welcomed.
     
     Most acne treatments require prolonged care, from months to years. These treatments include topical creams and gels and/or oral medicines.  Once improvement is achieved, a maintenance dose is usually necessary. Women who develop adult acne typically have the problem for years, frequently through menopause.  The suspected hormonal disruptions that trigger adult onset acne are often treated by attempting to regulate the hormonal imbalance. The modalities used most in hormonal acne treatment are oral contraceptives and antiandrogens. (medicines that counteract the effect of too much testosterone in a woman’s system).
     
     There are several simple things to do to minimize adult onset acne.  Washing with soap and water once or twice daily is a good way to keep debris and oils from the day accumulating on the skin surface. Salicylic acid and benzoyl peroxide are both common over-the-counter treatments for acne. Benzoyl peroxide exfoliates the skin and the anti-bacterial agents in it clear the excess debris from the skin to help prevent infections.      
     
     Retinoids are a class of molecules in the vitamin A family. The retinoids are potent against acne because they stabilize abnormal growth and death of cells in the sebaceous follicle. These abnormal growth cycles are believed to play a key role in the formation of blackheads, whiteheads, and other acne. The danger in retinoids is that they cannot be used by pregnant women or women who might be getting pregnant because of the high rate of serious birth defects in unborn children.
     
     Topical and oral antibiotics are used together with other agents. Topically, antibiotics neutralize the skin-based bacteria and, when used with other agents, help deplete the excess sebum or oil secreted by the sebaceous glands, allowing acne spots to heal without infection. 
     
     Oral contraceptives prescribed for women are based on their ability to regulate hormones.  A birth control pill stimulates the production of a protein that binds testosterone, thus reducing the androgen’s ability to affect oil glands.
     
     Occasionally, adult onset acne can be confused with a condition known as rosacea.  Although it is not exactly acne, its red-faced, acne like appearance can cause many physical, psychological and social problems if left untreated. In a recent survey by the National Rosacea Society, nearly 70% of rosacea patients said that this skin disorder lowered their self esteem, and 41% of patients said that they avoided social contact or functions because of their skin disease.
     
     The cause of rosacea in unknown and there is no cure, but with available medical help this skin disorder can be controlled and minimized. Its typical symptoms are redness on the cheeks, nose, chin or forehead, small visible blood vessels on the face, bumps or pimples on the face, and watery or irritated eyes.

    
     Whatever the cause, whatever the result, if adult onset acne is cramping your style, see your doctor because there is help.
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“I’m sick and tired of being sick and tired!” 
“I just have no energy.”
     One of the most common problems of the 21st century woman is fatigue.  I am not exaggerating by stating that well over 40% of women I see in my office complain at some
stage of their life of excessive tiredness.  Lack of energy is not a local phenomenon either (in spite of the claims of one woman who was sure that SRS had something to do with her low energy level.  Of course this was the same gal who had been nabbed by aliens and forced to watch reruns of “Geraldo”).  National statistics are equally as impressive.  One study even went as far to claim that 30.3 % of adolescents experienced excessive fatigue (PEDIATRICS Vol. 119 No. 3 March 2007, pp. e603-e609) 
   The classification of fatigue runs the gamut from a transient mild tiredness to a debilitating lack of energy.  One of the inherent problems in studying a condition such as this is the subjectivity of the diagnosis.  Those who suffer with chronic fatigue are often perceived as malingerers and patronizingly dismissed.  There is still reluctance on the part of many medical practitioners to legitimize chronic fatigue syndrome, the most extreme form of tiredness, as a genuine entity; however, this appears to be an area where the science is finally catching up with the clinical observation.  As with any medical problem that is poorly understood, the treatment of excessive fatigue is varied, sometimes unconventional, and often unsuccessful.  It is important to distinguish chronic fatigue syndrome from “garden variety” tiredness as they differ in numbers of symptoms and degree of disability.  For many sufferers it comes down to how much the lack of energy interferes with normal day to day activities.  The Center for Disease Control in Atlanta has set down certain criteria for physicians and researchers to use in making the diagnosis of chronic fatigue syndrome
.  A CFS diagnosis should be considered in patients who present with six months or more of unexplained fatigue accompanied by other characteristic symptoms. These symptoms include:
  • cognitive dysfunction, including impaired memory or concentration
  • exhaustion and increased symptoms for more than 24 hours following physical or mental exercise
  • unrefreshing sleep
  • joint pain (without redness or swelling)
  • persistent muscle pain
  • headaches of a new type or severity
  • tender lymph nodes
  • sore throat
  You can see from these symptoms that there is tremendous overlap with other common problems.  We all may experience some of these problems some of the time. The key is the persistence and intensity of the problem and, importantly, no other medical or emotional troubles that serve as a cause.
   There is hope!  Since becoming a more universally defined syndrome, additional research has been done on ways to thwart this bothersome illness.  Many of these treatments and suggestions also apply to the woman who has only mild symptoms.  So whether you are unable to get out of the bed or just collapse at the end of a busy day, these pointers may be worthwhile pursuing.
     First and foremost, get a good checkup by your doctor.  Many medical conditions such as hypothyroidism, menopause, Lupus, depression, anemia, and sleep apnea have fatigue as a primary symptom.  If you check out well with your doc, consider the following:
1.  Check your sleep habits.  We are a culture of sleep deprivation.  It makes logical sense that if we don’t sleep restfully we will be tired the next day.  I am amazed at the number of folks that forget this simple connection.  Improve your sleep and your energy will rebound.
2.  Force yourself to get off the couch.  Multiple studies show the positive effect of exercise on energy level.  You may be saying, “I would exercise if I wasn’t so darn tired!” It is tough, but forcing yourself to do something, even a good walk, will, over time, improve your energy level.
3.  Garbage in equals energy gone.  We are what we eat, and this applies to energy level.  In fact, energy derives from the body’s ability to metabolize food.  If we put molasses in our car’s gas tank, it won’t go far.  If we put junk in our gas tank, we won’t go far!
4. Reduce stress.  Stress magnifies everything!  The more stress, the more your lack of energy.  It’s as if the body tries to shut down to save itself from the stress. The more you can minimize stress, the more energy you will have.
  I realize this is a very superficial treatment of very complex solutions, but maybe it can stimulate you to investigate these approaches on your own. 
   
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