Archive for Signs
The Basics of Signs of Perimenopause – Forgetfulness and Trouble Concentrating
Posted by: | CommentsFor some women, perimenopausal forgetfulness or changes in their ability to concentrate are extremely troubling, especially when we don’t connect these changes to hormonal fluctuations. Sometimes these symptoms of impaired concentration come at the same time we are observing age-related changes in our elderly parents, and we can wonder if we are prematurely losing our edge or suddenly becoming less sharp. Many women have confided in me that they were worried they were developing Alzheimer’s disease.
When Janice found herself sometimes going over and over the numbers that she was responsible for crunching at her firm, losing track of where she was and having to start over again in preparing the complicated reports that she regularly produced as part of her job, she decided to try ginkgo biloba to improve her mental concentration. She also took black cohosh to help with perimenopausal hot flashes.
The leaves of this ancient decorative tree, ginkgo biloba, have a rich history of medicinal use. In China ginkgo leaves have been used for literally thousands of years to increase blood flow to the brain. Today ginkgo biloba leaf extracts are very commonly prescribed in Germany and France.
What we know about ginkgo’s workings in the body is largely based on animal research. Clinical trials with humans have examined ginkgo’s effects on a variety of symptoms and conditions, including memory loss, depression, macular degeneration (a cause of blindness in adults), certain hearing problems, and tinnitus (ringing of the ears), among others.
In animals, it has been shown that ginkgo biloba extract affects the lining of the blood vessels, and in humans, researchers believe it improves cerebral blood flow. In a very simplified summary, it could be said that by boosting the flow of blood and oxygen to the brain, ginkgo stimulates and improves certain brain functions, some of which are related to our ability to recall certain facts.
In his book The Healing Power of Herbs, naturopathic doctor Michael T. Murray states that clinical research indicates that ginkgo should be taken consistently for at least twelve weeks to be effective. After taking 120 mg of ginkgo daily (three 40 mg capsules), for eight weeks, Janice said she felt some improvement in her ability to concentrate: “Let’s just say I haven’t hit the wall at three o’clock recently. For a while, by late afternoon, I would be in my office with the door closed, taking twice as long as usual to do one small task and sometimes sitting there for a good two or three minutes trying to remember what I was supposed to do next.”
Janice acknowledged that along with taking ginkgo, she had also made a serious effort in the previous month to reorganize and reprioritize her workload, delegating certain responsibilities and asking her assistant to step up her share of the duties. “It’s been great for both of us,” she told me. “I’ve realized that I don’t have to do everything, and she seems to appreciate the trust I have in her.”
It’s not clear which helped Janice’s ability to concentrate more: ginkgo or reordering some of her work. She did point out, however, that reorganizing her workload and providing explicit instructions to her assistant “took a lot of clear thinking.” Looking at me over the top of her glasses, Janice said, “Maybe the ginkgo helped me think all that through. Once I had a picture in my mind of how I wanted things done, I had to be able to write some of it down and explain the rest articulately. Fm not sure I could have done that two or three months ago, I felt so muddled at times.”
If you try ginkgo, look for an extract that contains 24 percent ginkgo flavones glycosides. Few side effects are associated with ginkgo, and these occur only infrequently (gastric upset, headache, and dizziness). One of my patients did report headaches when she took ginkgo, but she switched to a different brand and took it without any side effect.
In relation to improving memory and concentration, I also want to talk briefly about DHEA (dehydroepiandrosterone). Like melatonin, DHEA is not an herb but a hormone, and it is widely available as an over-the-counter preparation. It is called a precursor or foundation hormone because in the body it “cascades” or turns into other hormones, including testosterone and estrogen. In adults, DHEA levels begin dropping at about age twenty. Some researchers believe that restoring DHEA to youthful levels can delay the effects of aging, notably memory loss and impaired concentration. Some scientific data also found that DHEA lowered the death rate from cardiovascular disease in men (results that have not yet been repeated in women).
DHEA is sometimes discussed as a preparation that can minimize several perimenopausal symptoms in addition to memory loss: bone loss, fatigue, vaginal dryness, sleeplessness, and dry skin. Using DHEA for perimenopausal symptoms is sometimes based on the theory that this precursor hormone will cascade into estrogen and thus alleviate symptoms produced by estrogen deficiency. It’s not that simple, however. First of all, not all scientists agree that taking DHEA as a supplement will produce the same cascade effects. Assuming that DHEA supplements will cascade into other hormones also assumes that all the other chemicals and enzymes needed are present in the body, and we can’t know this.
If you’re thinking about trying DHEA, I have two recommendations:
- Have your DHEA levels measured first in blood or saliva to determine how much of the hormone your body is currently producing. As is true with any hormone, you wouldn’t want to take more if your body is still producing a normal level.
- Work with a health care professional who is knowledgeable about DHEA supplementation so you can arrive at the dosage appropriate for you. Recommended DHEA dosages for women range from 5 to 50 mg daily.
The Basics of Signs of Perimenopause – Guilty of Depression
Posted by: | CommentsWhen Karen started to slide into depression in her midforties, she was afraid to tell anyone about it. “I have no reason to feel depressed,” she told me. “My marriage is good, my children are wonderful, and I live in a beautiful home. I have so much to be grateful for, and yet I can’t control how depressed I feel. I feel guilty, like I am being self-indulgent, and that I should just snap out of it. I also get very anxious about these feelings, like I’m brooding over inconsequential things. I start worrying that something bad will happen to me or someone in my family and that my nameless worries will become a reality. I can make myself almost crazy.”
Depression that hits us in midlife is rarely a matter of self-indulgence, and it’s not something we can will ourselves to snap out of. A host of factors can influence depression during perimenopause, and women who become depressed at the time of hormonal fluctuations may be experiencing combined effects. In our forties, physical hormone shifts often go hand in hand with major life events, they really are woven together.
Because she couldn’t identify anything going on in her life that could account for her depression, Karen hesitated to seek help. She was concerned that she would be viewed as histrionic, unstable, or a hypochondriac. It had been more than a year since she had a thorough physical exam, so I urged her to see her health care provider for a checkup. “Your emotional health is every bit as important as making sure your body is working properly,” I told her. I suggested that she and her provider might investigate the possibility that her depression could be related to hormonal changes. She needed to explore both physical and psychological reasons for her depression, I explained.
Meet Sharon, whose husband recently faced a very serious illness. Her depression and fatigue were very normal responses to an extremely stressful life event. She worried that if his health were to become much compromised; she wouldn’t be able to care for him and their children, the youngest of whom they had adopted from another country only a year and a half earlier.
Sharon confessed that in her low moments, she had begun to doubt the wisdom of adopting their youngest child. “We went through the long, complicated, and expensive process of adopting her because we thought we could provide a loving, stable environment for her,” she confided. “I think that we do, but there are days lately when I feel so distracted or depressed, I don’t think I do the best job of being her mother.”
Distracted, depressed, and overwhelmed in midlife by the demands of a toddler, it’s possible that Sharon would have had these feelings even if her situation were not compounded by her husband’s health scare. Considering the relationship between her hormonal patterns and what was going on in her world helped her to distinguish between her issues individually so that everything didn’t blend together and loom larger than life. Sharon and Karen had very different situations, one more turbulent and the other with an almost enviable stability. Yet both were battling feelings of depression. What’s important here is that hormonal variations may certainly be a factor in both cases, and that this component should be neither overlooked nor dismissed.
The Basics of Signs of Perimenopause – Depression and Loss of Libido
Posted by: | CommentsLack of interest in sex is commonly regarded as a sign of depression, but in perimenopausal women suppressed libido and depression are complex bedfellows. Depression and lack of libido may both be signs of a hormonal imbalance, but the hormonal component is often overlooked, under the mistaken assumption that women in their forties are too young for “the change.” Women who are prescribed an antidepressant may find their interest in sex more remote than ever. That was true of Caroline, who at 48 said she had little sexual desire and that when she did make love, she found the experience curiously unsatisfying.
Caroline’s feelings of depression might have been independent of hormonal changes, but I wanted to make sure we had the whole picture. At the end of our discussion, I suggested that she talk with her health care provider about three issues:
- Hormone measurement. Measuring the saliva or blood levels of Caroline’s estrogen, progesterone, and testosterone would give us more information about other possible influences on her lack of libido and depression.
- Alternative medication for her depression. Caroline was taking a selective serotonin reuptake inhibitor (SSRI). These medications can be very effective in managing depression, but some women report side effects of decreased libido or difficulty reaching orgasm. Switching to a different SSRI sometimes helps, but some women prefer to try the herb St. John’s wort. This herb also acts on serotonin levels but does not have side effects.
- Referral for counseling. Caroline said she “loved her husband dearly” but also had feelings of lingering disappointment about his erratic career and the financial burden that his spotty work record had placed on her. I could see this was a difficult subject for Caroline, and I thought it would help her to explore it more fully, initially in one-on-one counseling and perhaps later with her husband in joint counseling.