Anxiety and Depression in Perimenopause and Menopause

Do you feel like there’s been a shift in your mental health? Are you worrying more than usual or having a harder time managing stress and anxiety? Are you feeling more sad or empty lately? Are you noticing an increase in irritability? 

Perimenopause and menopause are both associated with an increased risk of depression and anxiety. There have been a number of studies on this subject that reveal this correlation.

Perimenopause refers to the transition towards menopause which can last several years before periods stop. It often starts in the 40s but it can begin in the 30s for some women. Once the period has stopped for a year, you’re considered in menopause. This usually happens when women are in their 50s. 

Why is there an increased risk? 

The physical changes that happen to women during perimenopause and menopause can be alarming and stressful. Hot flashes, night sweats and insomnia can really strain mental health. A drop in libido is a common symptom that can lead to feelings of emptiness or depression. Difficulty losing weight and changes in physical appearance during this period can be a source of anxiety for many. Brain fog and fatigue can lead to a background feeling of stress all the time. 

Then there are the hormonal shifts that impact mental health. The drop in estrogen that happens during this time is believed to cause negative changes in mood for some women. Other hormones like progesterone and testosterone drop too but the impact of these changes on mental health is not well studied (unfortunately). The hormonal shifts may in turn impact neurotransmitter activity. Serotonin is a neurotransmitter that plays a role in mood and it may be impacted by the hormone shifts that happen during perimenopause and menopause. Past history of anxiety and depression increases your risk of symptoms getting worse during perimenopause. 

Some big life changes happen from 40 years old and on. Young kids and teens could be hitting some challenging milestones. Empty nest syndrome could kick in as adult children move out. Caregiver burden often goes up as parents age. Career burnout or dissatisfaction can start to weigh on you. All of these changes combined with the physical changes mentioned above could contribute to the increased vulnerability to anxiety and depression among perimenopausal and menopausal women. 

What to do about it

We can't stop menopause from ever happening but there is a lot that can be done to smooth the transition and reduce anxiety, depression and physical symptoms. This can be done with the help of natural remedies, diet changes and lifestyle changes. If you want to learn more about how I help women through perimenopause and menopause, don’t hesitate to reach out. 

What Causes a Skipped or Late Period (Besides Pregnancy)

It can be alarming when a period is missed - especially if you’re used to your period coming like “clockwork”. For some people, irregular periods are the norm. For others, it happens once in a while. Pregnancy needs to be ruled out whenever a period is late but this is not the only cause of a late or skipped period. Below are some other possible causes of a delayed period.

Stress

Stress can interfere with the natural hormonal fluctuations in the body which can in turn interfere with ovulation and the health of the uterus. Ovulation is the process of an egg being released from the ovary and it plays an important role in signaling changes in the uterus and, eventually, a period. Stress is a common cause of a missed period. Keep in mind that sometimes, even when we feel like we are not stressed and are handling our stress well, our bodies can still be impacted by stress. We’re not always the best judges of our stress levels. The body may tell us that we’re stressed before the minds does. 

Anovulatory Cycle 

Some months, ovulation may be skipped entirely. This is known as an anovulatory cycle. Ovulation is an important step that plays a role in maintaining the lining of the uterus and the subsequent shedding of the uterus lining (i.e. a period). Sometimes, ovulation happens later than normal which can push the period back. When ovulation doesn’t happen at all, a period will eventually come due to other hormonal changes but it will often be quite late. It’s normal to have a small amount of cycles without ovulation. Sometimes, a patient will tell me that that they’re period is NEVER late and they’re wondering why they are overdue for their period. In these cases, an anovulatory cycle may be the culprit. If ovulation is skipped regularly, there may be more going on and we’ll need to investigate further. Signs of ovulation include an increase in cervical mucous and body temperature about a week after the period ends (assuming a 7 day period).   

Thyroid Imbalance

High or low thyroid levels can lead to irregular menstrual cycles. The thyroid plays a major role in the health of the reproductive system.

Weight Loss and Very Intense Exercise 

Maintaining a healthy weight is important for hormonal health. Extreme weight loss can disrupt this delicate balance. The same goes for extreme exercise. These two things can put a pause on ovulation which can delay or stop the period. Usually this leads to longer term loss of periods rather than one late cycle. 

Perimenopause

As the body moves towards menopause, a number of changes occur including a drop in estrogen levels. This can lead to shorter or longer gaps between periods. Perimenopause can happen in the 40s but some women start to show signs of it in their 30s. 

Polycystic Ovarian Syndrome

PCOS tends to cause irregular cycles in general rather than the occasional missed period. In cases of PCOS, a number of factors such as elevated androgens and insulin resistance make it difficult for ovulation to happen. This in turn leads to irregular cycles. 

These are just a few of the many reasons why a period could be late or missed. If you would like to start working with a naturopathic doctor to get to the bottom of your period concerns, book a free 15 minute meet and greet and I’d be happy to give you more information about how my services can help.

Is This Early Menopause or Anxiety?

Heart palpitations, hot flashes, feeling more irritable and frazzled, period getting irregular - these symptoms can all be part of the menopause transition. But they can also be anxiety symptoms as well. It’s often difficult to tell the difference and the two can occur simultaneously. 

Typically, once the period has stopped for a year, menopause is diagnosed. That window of time when the period becomes irregular and menopause symptoms like hot flashes start is called “perimenopause”. This is because “peri” means “around” or “near”. If you’re taking contraceptive or hormone therapy this can sometimes make diagnosis more complicated. 

Sometimes, depending on your age and health history, your naturopathic or family doctor can do blood testing to help determine if you’re near or in menopause. The age you enter into menopause can also be impacted by genetics. Knowing the age that your mother and sisters went into menopause can give you some clues. 

Both menopause and anxiety can be a challenge to face alone. Make sure you’re getting the right medical care and support to help you figure out not only what is going on, but how to manage it. 

Acupuncture for Hot Flashes and Other Menopause Complaints

There are two types of menopause transitions that I typically see. For some women, it’s relatively smooth sailing. For others, it’s a frenzy of heat, sweating, irritability, insomnia, mood swings and feeling completely fed up. For some, these symptoms only last a year or two. Others feel like they’ve been dealing with these symptoms for years after their period stopped.

I like using acupuncture as a tool to help women with these symptoms. Several studies have shown that acupuncture makes hot flashes less intense and less frequent. Some studies show that even after you stop acupuncture, the benefits continue.  

You may be wondering, if acupuncture helps women, why isn’t every perimenopausal and menopausal woman doing it? It seems like some women benefit a lot from acupuncture, and some don’t benefit as much.

One study found that one group of women noticed an 85% reduction of hot flashes. A larger group of women (about half) notice a 50% reduction of hot flashes. And then there was a group of women who only noticed a 10% reduction of hot flashes initially but this later went up to 23%.

This same study tried to figure out why there was such a wide variety of responses to the acupuncture. It concluded that women who benefited from acupuncture for hot flashes had sessions more often. They had roughly 8-9 sessions within the first 8 weeks. The study also found that women with more severe hot flashes tended to respond better to acupuncture.

So, more sessions increases your chance of success. Also, I like to increase the odds of success by adding certain herbal remedies, nutritional supplements, diet and lifestyle changes to the treatment plan.

Acupuncture also does a good job of improving other symptoms beyond hot flashes that go hand in hand with perimenopause and menopause like depression, anxiety, irritability, insomnia and pain. As a naturopathic doctor who focuses on mental health, that’s always exciting to see!

You don’t have to suffer through your menopause. You have far better things to do than worrying about your next hot flash or bout of anxiety. Get the support you need to thrive during this transition.

Ladies, Do You Have Symptoms of Low Testosterone?

When women think of their hormones the first thing they think of is estrogen. But testosterone plays a huge role in the well-being of every woman. High testosterone has a lot more attention than low testosterone. This is because it’s commonly known that high testosterone is linked to PCOS, acne, scalp hair loss and facial hair growth. Not many women know how having low testosterone can impact them.

Another name for low testosterone in women is “female androgen deficiency syndrome”. The most well-known symptom of this condition is low libido. However, not every woman with low testosterone has low libido. There are many other symptoms like:

- Low motivation

- Fatigue

- Depression

- Feeling generally unwell

- Osteoporosis

- Increased body fat

Low testosterone is most common in post-menopausal women. It can happen in younger women as well. It also seems to be common in women who are burnt out or experiencing something called “adrenal fatigue”. This could be because some of your testosterone comes from the adrenal glands. These are the glands that produce adrenaline and take a big hit when we’ve been stressed or overworked for too long.

More research needs to be done on this important syndrome and more women need to be aware of it. I test for low testosterone through blood or saliva tests. There are many herbs, nutrients and lifestyle protocols that I recommend to raise testosterone levels in women.

The transformation that you feel when your hormones are brought into balance is incredible and so worth the effort. I encourage you to learn more about all your hormones - including testosterone.

Hormone Testing with a Naturopathic Doctor

Hormone testing can be helpful in guiding treatment plans in some cases. It can tell you which hormones are higher than ideal, which ones are lower than ideal and which ones are normal. This can tell me which herbs, nutrients, dietary and lifestyle changes to recommend. Sometimes it’s obvious what needs to be worked on and we can skip testing. Sometimes it’s not as clear and testing provides guidance.

Cases that I may use hormone testing for are:

- Periods that are irregular and difficult

- Menopause that isn’t responding well to my usual treatments

- Challenging PMS cases

- Difficulty losing weight when there is a suspicion that hormones are involved

- Major fatigue, brain fog and other symptoms when there is a suspicion that hormones are involved

There are different ways that I test hormones. One way is the usual blood test that most family doctors do as well. Another other option is to test saliva. There are pros and cons to both.

Blood Tests

Blood hormone tests have been accepted by the medical community for longer than saliva tests. There is a good amount of research supporting them.

Some MDs and NDs have raised concerns about only relying on blood tests for hormones. Sometimes blood test levels and saliva levels line up with each other. Other times I find that patients with normal blood test levels have saliva levels that are not ideal. These saliva levels often match with the symptoms the patient is experiencing.

Saliva Tests

In order for hormones to enter saliva, they may need to travel into cells/ tissue first. This may not be the case for hormones in the blood stream. Some think this means saliva better reflects the levels of hormones that are actually acting on your cells/ tissues. I won’t be able to explain all the biochemistry here. You should know that research on saliva testing is still ongoing. Opinions on it may change in the future.

Insurance Coverage

It used to be that tests run by naturopathic doctors were not covered by insurance companies. Lately, more insurance companies have been covering testing. The only way to know for sure is to contact your insurance company and ask.

If you need some help managing your hormones book an appointment or free 15-minute consult today.

Common Causes of Fatigue

Fatigue is one of the most common complaints I hear about. When I ask patients to rank their energy on a scale of 1 to 10 most people hover around 5 and would like to see their number go up. Fatigue could be a symptom of a huge range of causes from mild to serious. Today I’ll talk about some of the common causes that I see.

The Basics

Some causes of fatigue are simple to spot on a blood test. Examples are:

- low iron

- hyperthyroidism

- hypothyroidism

- low B12

Another basic cause of fatigue is poor sleep quality. This includes issues falling or staying asleep. This is an area that I like to work on with any fatigued patient.

Hormonal Health

Hormone fluctuations or imbalances can lead to fatigue. Some common examples are thyroid dysfunction, menopause and premenstrual syndrome. Other cases are more subtle. You may have completely irregular cycles or painful cramps but no specific diagnosis. Sometimes getting hormones back in balance can help with fatigue in these cases.

Adrenal Health

Naturopathic doctors talk a lot about a type of fatigue called adrenal fatigue. I like to call it burnout. The adrenal glands produce the "stress hormone" cortisol. The theory is that being stressed and busy all the time can push the adrenals to work too hard. Eventually they get overtired and you feel that as an energy crash. With adrenal fatigue, you feel tired but wide awake at bedtime. You feel irritable, frazzled or depressed. Your gut may be acting up and you may be experiencing cravings and weight gain. You also may find that you get sick all the time – or every time you’re on vacation.  There’s more to the theory but I’ll dig into it in a future article.

Gut Health

Poor gut health can contribute to fatigue. This includes diarrhea, constipation, bloating, heartburn or anything else that involves the gut.  A healthy gut means better nutrient absorption. It also means better elimination of toxins and waste products and improved vitality. Food sensitivities and poor diet have also been linked to fatigue.

Immune Health

Most autoimmune conditions are associated with fatigue. Some common examples are rheumatoid arthritis, Hashimoto's disease and Graves' disease. Hyperactive immune systems (think allergies and asthma) can also be associated with fatigue. Balancing the immune system is an important part of my treatment plan in these cases.

Mental Health

A less commonly discussed cause of fatigue is mental health conditions. Depression and even anxiety can significantly zap someone of their energy. It's important to address these causes of fatigue when needed. Treating these can improve fatigue more than any quick-fix energy boosting supplement could. 

Fatigue is frustrating and getting a handle on it can improve your quality of life in so many ways. If you need help with your fatigue book an appointment or free 15-minute consult today.

How Does Acupuncture Work?

What is Acupuncture?

Acupuncture involves inserting thin needles into specific points on the body. This achieves a wide range of results. As a naturopathic doctor, I'm licensed to perform acupuncture. It's a tool that helps many people. Acupuncture has been relied on in the east for over 3000 years. Modern scientific research is only beginning to understand this treatment. There is still much that isn’t understood.

In the east, acupuncture sessions are often done many times a week. Most of my patients opt for less frequent visits. Usually we do acupuncture one time a week for a couple sessions. Then we start spreading out the sessions. Once treatment stops, effects usually linger.

In this article, I will explain how acupuncture may work in three different ways.

Chemical Explanation

Studies propose that acupuncture may alter neurotransmitter production. Neurotransmitters are things like serotonin (the “happiness chemical”) and norepinephrine (similar to adrenaline). Acupuncture may also alter brain and nervous system function. For this reason, acupuncture may be helpful for:

- depression, anxiety and other mental health conditions

- digestive issues

- high blood pressure and menopause

- insomnia

- immune health

Acupuncture may also improve blood flow to certain regions of the body. By doing so it can help with period cramps, digestive issues, migraines, pain and more.

Modern science doesn't fully understand why specific acupuncture points have these impacts. MRI studies have linked needling points to altered activity in different parts of the brain. Also points often are over nerve pathways. There is still much to learn.

Mechanical Explanation

In cases of pain management, acupuncture needles are often place near painful areas. They can be placed in muscle knots to release tension. Placing them around nerves can block pain signals that travel along the nerve. The needles may stimulate the release of pain blocking chemicals. This includes opioids and endorphins. 

Traditional Explanation

Of course, before all these explanations there was a traditional explanation for acupuncture. The aim of acupuncture from this point of view was to ensure the healthy movement and amount of “qi”. Some think of “qi” as energy. If you have irregular periods the traditional explanation may be that you have blocked qi. If you get sick all the time it may be blamed on deficient qi.

Another goal is to balance yin and yang. Yang represents heat and energy while yin represents coolness, moisture and rest. Someone who is hypothyroid, cold all the time and exhausted may be diagnosed as deficient in yang. A constipated person with light or no periods may be considered low in yin.

The traditional explanation also involves improving the health of various organs.

This is an over-simplification but my aim is to just give you a very general understanding.

Would you like to try acupuncture for any of the conditions mention above? Are you wondering if something you’re suffering with could be treated with acupuncture? Book an appointment or free 15- minute consult to find out!