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Menopause Information

WHAT IS MENOPAUSE
Menopause, is the first anniversary since a woman last had a menstrual period (2;6). Menopause can be natural (4) or surgical (hysterectomy) (1). Onset of natural menopause varies widely (late thirties to late fifties), with the average onset between 48 and 55 (6). Menopause, is the culmination of a prolonged stage of hormone related changes heralding the end of a woman’s reproductive years (3). All women go through it (2). Some see it as a positive event, others as a negative one (2;3).
There are three stages to “the menopause”, the pre (before), the peri (during), and the post (after). Pre-menopausal: women still experience somewhat regular menstrual bleeding, and have had a period in the last three months (3). Peri-menopausal: women experience varied or less regular menstrual bleeding, or have had a period within the last 12 months, but not within the last 3 months (2;3). Post-menopausal: women who have not experienced menstrual bleeding for 12 or more months (3). Symptoms vary widely from woman to woman, some have none, others some, still others many (2). Peri-menopause usually lasts 4 years and vasomotor symptoms (hot flashes, etc.) usually develop between 1 and 2 years before the last period (5). In dealing with symptoms, there are many options available, from lifestyle changes to supplements, to medication, be they traditional or naturopathic.
Some, but not all, women experience the following conditions during pre, peri and post menopause faze: psychological problems (anxiety, body image issues, and depression), weight gain, vasomotor symptoms (hot flashes and night sweats), urogenital (sexual and urinary tract) problems, osteoporosis and osteoarthritis, and dental problems.

References:

  1. Cappelletti, M., & Wallen, K. (2015). Increasing women’s sexual desire: The comparative effectiveness of estrogens and androgens. Hormones and Behavior. (2015), Doi: 10.1016/j-yhbeh.2015.11.003
  2. Fagulha, T., Goncalves, B., & Ferreira, A. (2011). A population-based assesment of midlife portuguese women’s experience of primenopuase and menopause. Health Care for Women        International, 32, 559-580.
  3. Mishra, G., & Kuh, D. (2006). Percieved change in quality of life during the menopuause. Social Science & Medicine, 62, 93-102.
  4. Morris, D.H., Jones, M.e., Schoemaker, M.J., McFadden, E., Ashworth, A., & Swerdlow, A.J. (2012). Body mass index, exercise, and other lifestyle factors in relation to age at natural menopause:Analyses from the breakthrough generations study. American Journal of Epidemiology, 157, (10), 998-1005.
  5. WebMD website. Webpage:Thyroid may cause sexual problems. retrieved from: www.webmd.com/women/news/20020321/thyroid-may-cause-sexual-problems
  6. Wylie-Rossett, J. (2005). Menopause, micronutrients, and hormone therapy. The American Journal of Clinical Nutrition, 8, (suppl), 1223s-1231s.

MENOPAUSE AND DRY SKIN
Dry skin Menopause brings about bodily changes that can result in an acceleration of the aging process, specifically a slowdown in hormone synthesis. As well as sex hormones, the body slows the production of growth hormone, melatonin, thyroid hormones and dehydroepiandrosterone (DHEA). The body slows its production of skin renewing properties collagen and elastin, needed to maintain firmness (1). Muscles and bones start to thin, changing the appearance of the face and body and the results of sun exposure, poor diet, lack of hydration and smoking may become more apparent. If you are experiencing hypothyroidism your skin may become dry and course (4).
Interventions for skin aging there are many interventions for age related appearance problems. Skin care is a must, this protects against dehydration and sun as well as microorganisms etc. that can harm the skin. Some creams can help improve production of collagen and elastic fibers. Retinoid (vitamin A) creams promote collagen production. Anti-oxidant rich creams are also good. Ideally these have a mixture of Vitamin’s C & E together with ferulic acid [found in coffee and fruit seeds] and copper, selenium and carotenoids as well as Soy isoflavones (1). Laser and light therapy can help improve the appearance of skin, as can injectable (Botox).
Eating right is imperative for healthy skin. Drinking lots of water and eat five servings of the following antioxidant rich foods as antioxidants protect against age spot and wrinkle causing free radicals (2).
Phyto-estrogen can be found in soy and high fibre foods. These foods can balance hormones: soy, vegetables, whole grains, fruits, flax seeds,
Batacarotene, helps skin develop and improves skin tone: pumpkin, sweet potato, spinach, carrots, papaya.
Zinc helps soften skin and repair damage: poultry, red meat, whole grains, seeds, nuts, fish, shellfish.
Vitamin C, heals blemishes and produces a glow: papaya, strawberries, kiwi, blueberries, broccoli, oranges, guava, and blackcurrants (2).
Selenium, protects against sun damage like sun spots and skin cancer: Brazil nuts, (4 a day, or fish), eggs, shellfish, tomatoes, wheat germ, & broccoli (2).
Vitamin E, helps skin grow and stops cell damage: almonds, hazelnuts, sunflower/corn oil, avocado, pine nuts (2).
Essential fatty acids which can’t be made by the body (omega 3 & 6) found in oily fish walnuts, and seed oil (linseed, flax, and rapeseed). These are anti-inflammatory (2).
You may wish to take supplements to fight the signs of aging. Essential fatty acids plump and moisturize skin. Vitamin E stops cell damage. Curcumin (active ingredient of Tumeric) is used to improve skin radiance (glow). It is also a good treatment for eczema, acne and psoriasis (3). Curcumin is a natural anti-inflammatory (cause of aging) and a natural anti-oxidant, it can be taken in supplement form, eaten as an ingredient in food, turmeric, or used topically in beauty products (3). DHEA substitution can increase muscle mass, improve the appearance of loose connective tissue (adipose fat or tissue) and help recover one’s physical condition and appearance (1). Keep in mind that research is ongoing on DHEA and more studies are needed.
References:
1. Ganceviciene, R., Liakou, A.L., Theodoridis, A., Makrantonaki, E., & Zouboulis, C.C. (2012). Skin anti- aging strategies. Dermato-Endocrinology, 4, (3), 308-319.

2. Lewin, J. Eat your way to fabulous skin. Published on BBC Good Food, accessed: www.bbcgoodfood.com/howto/guide/eat-your-way-faboulous-skin

3. Sangeeta, & Sharma, A., (2014). The amazing pharmacological properties of Haridra-A short review. Ayushdhara, an International Journal of Research in Ayush and Allied Systems, 1, 27-31.

4. WebMD website. Webpage:Thyroid may cause sexual problems. retrieved from: www.webmd.com/women/news/20020321/thyroid-may-cause-sexual-problems

5. Mayo clinic website. Webpage: Drugs and Supplements, DHEA. Retrieved on April 13, 2016. Retrieved from: Mayoclinic.org /drugs-supplements/dhea/evidence/hrb_20059173

DEPRESSION

Some women may be predisposed to depressive symptoms caused by erratic highs and lows of ovarian hormones (1; 2; 3). In the female brain estrogen is a neuromodulator, meaning it can alter the functioning of multiple neurotransmitter systems, including those involving mood.  In most women, until the onset of premenopause, the brain is able to deal with changes brought on by fluctuating hormones during the menstrual cycle.  At the onset of premenopause some women (with a history of depression, premenstrual depression or postpartum depression/baby blues or genetic vulnerability to depression) may be vulnerable to hormone related depression (1). By no means is this to be taken that all women will experience hormone related depression during this time.

Only 18% to 29% of women will experience this (1).  The “inability to rapidly establish a new baseline of neuronal function could lead to increased susceptibility to mood disorders and diminished brain-related functions” (1, p.5).  Stress and depression may also impact a woman’s ability to regulate ovarian hormones, leading to an early onset of menopause (1).

Treatment for depression: Exercise has been linked to improved mood and a lessening of somatic complaints in pre and perimenopausal women (4; 5).  Perimenopausal depression and premenstrual symptoms also respond to hormone replacement therapy (HT/HRT) (1). And, many women opt for estrogen replacement therapy (ERT) (9; 4) which has been shown to increase a sense of well-being (6). For some postmenopausal women, HRT combined with selective serotonin reuptake inhibitors (SSRIs) may work better than SSRIs alone (1).   Others may opt for natural remedies.

Nutritionally eating well and adding vitamins (B6, B9 and B12), and supplements (SAM-e, that is S-adenosylmethionine and tryptophan) to your diet can help deal with depression (7;8). The following have shown to improve mood somewhat in people suffering from depression:  Omega-3 fatty acids, music therapy, and relaxation training (10).  Exercise is important to psychological well-being as it is thought to increase the production of neurotransmitters (Dopamine, Norepinephrine and Serotonin) that are necessary to feel happy (11).  Yoga has been shown to increase levels of a neurotransmitter called GABA, which is important in improving mood and lessening anxiety (6). Yoga can also improve the ability to regulate or control one’s emotions including depression, anger, and anxiety (12).

Menopausal women who exercise have been shown to assess their symptoms as being less important and so cope better with them (13).

Other pre and perimenopause related medical problems that cause depressive symptoms are thyroid problems (14) and anemia (or iron deficiency) due to excessive bleeding (15).

References:

1 Deecher, D., Andree, T.H., Sloan, D., & Schechter, L.E., (2008). From menarche to menopause: Exploring the underlying biology of depression in women experiencing hormonal changes. Pschoneuroendocrinology, 33, 3-17.

2 Epperson, C.N., Amin, Z., Ruparel, Kl, Gur, R., & Loughead, J. (2012). Interactive effects of estrogen     and serotonin on brain activation during working memory and affective processing in  menopausal women.   Psychoneuroendocrinology 37, 372-382.

3 Pearlstein, T.B. (1995).  Hormones and depression: What are the facts about premenstrual     syndrome, menopause, and hormone replacement therapy? American Journal of Obstetric  Gynecology, 173, (92) 646-653.

4 Fagulha, T., Goncalves, B., & Ferreira, A. (2011). A population-based assesment of midlife   portuguese women’s experience of primenopuase and menopause.  Health Care for Women  International, 32, 559-580.

5 Santin, A.P., & Ferlanetto, T.W. (2011). Role of estrogen in thyroid function and growth regulation.  Jornal of Thyroid Research, 2011, article ID 875125, 7 pages.  Doi: 10.461/2011/87525

6 Streeter, C.C., Whitfield, H., Owen, L., Rein, T., Karri, S.K., Yakhkind, A., Perlmutter, R., Prescot, A.,      Renshaw, P.F., Ciraulo, D.A., & Jensen, J.E. (2010).  Effects of yoga versus walking on mood,  anxiety, and brain GABA levels:  A randomized contgrolled MRS study.  Journal of Altrnative and  Complentary Medicine, 16, (11), 1145-1152.

7 Volker, D., & Jade, N.G. (2006). Depression: Does nutrition have an adjunctive treatment role?  Nutrition & Dietetics, 63, 213-226.

8 WebMD website. Webpage: Vitamins and Supplements Lifestyle Guide, SAM-e (S- adonosylmethionine, SAMe).  Retrieved from, www.webmd.com/vitamins-and-         supplements/lfiestyle-guide-11/suppliment-guide-sam-e

9 Han, K.K., Soares, J.H., Haidar, M.A., deLima, G.R., & Baracat, E.C. (2002). Benefits of soy isoflavone   therapeutic regiment on menopausal sysmtoms. Obstetrics & Gynocology, 99, (3)389-394.

10 National Institutes of Health, National Center for Compementary and Integrative Health web site.    Web page:  NCCIH Clinical Digest for health professionals. What science says, Octover 2015.  Retrieved from http://nccih.nih.gov/health/providers/digest/depression-science#heading1

11 Kita, I. (2014). Physical exercise can induce brain plasticity and regulate mental function. Advances in  Exercise and Sports Physiology, 20, (1), 1-7.

12 Shapiro, D., Cook, I.A., Davydov, D.M., Ottaviani, C., Leuchter, A.F., & Abrams, M. (2007). Yoga as a                 complementary treatment of depression: Effect of traits and moods on treatment outcome.  Evidence Based Complement Alternative Medicine, 4, (4), 493-502.

13 Sakson-Obada, O.l, Wycisk, J. (2015). The body self and frequency, intensity and acceptance of  menopausal symptoms.  Menopause Review, 14, (2), 82-89

14 WebMD website. Webpage: Thyroid symptoms and solutions. Retrieved from,                 www.webmd.com/depresson/guide/depression-the-thyroid-and-hormones

15 New York Times website. Webpage: The New York Times Health Guide, Anemia.  Retrieved from:                 www.nytimes.com/health/guides/disease/anemia/symptoms.html

THYROID PROBLEMS & MENOPAUSE

A large number of women with menopausal-like symptoms may be suffering from (undiagnosed) thyroid problems. Approximately 30% to 40% of women develop thyroid problems at some point (2), and the likelihood of developing it increases with age (3). Hormonal changes brought on by entering into perimenopause may be partially responsible for this. During pre or peri-menopause the ovaries decrease production of progesterone leading to “estrogen dominance” or too much estrogen. This proliferation of estrogen engenders an over production of thyroid-binding globulin (TBG) by the liver. This substance in turn attaches the thyroid hormones (T3/T4) preventing absorption by the cells (4). This situation may trigger Hashimoto’s disease (5).

The same symptoms associated with menopause are also indicative of hypothyroidism. These are: weight gain, mood swings, sleep disruptions, depression and fatigue (both). The thyroid gland (part of the endocrine system) regulates the body’s metabolism and influences the reproductive system, appetite, muscle strength, brain, heart, and kidneys.

If you believe you are suffering from hypothyroidism as well as menopause symptoms talk with your doctor about having your TSH (thyroid secretion hormone) checked. This can be done with a simple blood test. Thyroid replacement therapy may be in order (2).

How to diagnose thyroid problems: A simple blood test, called a TSH (Thyroid Secretion Hormone) test will indicate whether or not there is a problem. If the TSH test shows your levels to be either in the top quarter of normal or higher than normal your doctor can order a T4 test to find out if your actual thyroid is not performing properly. If a thyroid problem is occurring then the T4 should be in the low normal/lower than normal range. If the TSH is going up and the T4 is going down, but they are still in the normal range ask to be retested in six months. (2). If a woman has borderline thyroid functioning or low iodine intake (another potential cause of thyroid problems) soy foods may increase the risk of hypothyroidism as the phytoestrogen in soy may disrupt the body’s ability to absorb synthetic thyroid hormones (1).

The usual prescription medication for hypothyroidism is Thyroxine (levothyroxine).   If a woman is taking this medication and then starts taking HRT she should have her thyroid tested after starting hormone replacement therapy as she may need to increase her thyroid meds (1). Also, if a woman is taking thyroid medication she should not take any calcium supplements within four hours of taking the mediation as it may decrease the absorption of it by up to a third (1). Hypothyroidism in menopausal women has been associated with a heightened risk of bone fractures. This is as thyroid hormones are key in maintaining healthy bones (1).

If you do not need to don’t take thyroid hormones as these can cause heart problems and decrease bone density (2).

You can undertake lifestyle changes to lessen the production of excess estrogen, or lower the likelihood of coming into contact with estrogen like substances including Phytoestrogens from plant sources and Xenoestrogens from synthetic products (6). Manage your weight as Xenoestrogens may accumulate in fat cells, which can make estrogen. Reduce stress, which increases the hormone cortisol in part by turning progesterone into cortisol. Avoid birth control pills and hormone replacement therapy if possible as they can contribute to estrogen dominance. Try to avoid foods with pesticides as well as those high in sugar, including simple carbohydrates. Grains especially can be problematic as they may contain estrogen compounds meant to increase the grain’s growth rate. Cattle and milk farmers use estrogen to increase livestock weight and milk production respectively. This may also be true of chickens (6). Avoid drinking or using drugs excessively as these disrupt liver functioning. The liver breaks down estrogen and removes it. Try not to cook with plastics as these have estrogen mimicking compounds that may leach into your food. Other sources of estrogen mimickers are: lawn and plant fertilizers, cosmetics and nail care products, paint, glue, and cleaning products (6).

References:

1 British Thyroid Foundation website, webpage: Thyroid and Menopause. Retrieved from: www.btf-thyroid.org/information/articles/107-thyroid-and-menopause

2 Cemcor website, the center for menstrual cycle and ovulation research. Perimenopause and Thyroid Problems, common and confusing, retrieved from www.cemcor.ubc.ca/ask/perimenopause-and-thyroid-problems-common-and-confusing#sthash.3KueNbeQ.dpuf

3  website Medicinenet.com website, webpage: DOCTOR’S VIEW ARCHIVE

Thyroid Disease & Menopause, Medical Author: Ruchi Mathur, M.D. Medical Editor: William C. Shiel, Jr., MD, FACP, And FACR retrieved from: http://www.medicinenet.com/script/main/art.asp?articlekey=16424&page=2).

4 theperimenopauseblog.com website, webpage:35 symptoms of Perimenopause-Hypothyroidism. Retrieved from: www.theperimenopauseblog.com/35-symptoms-of-perimenopause-hypothyroidism/

5 thyroidpharmacist.com website, webpage: Estrogen Dominance as a Hashimoto’s Trigger. Retrieved from: www.thyropharmacist.com/articles/estrogen-dominance-as-a-hashimotos-trigger

6 Outsmart disease website, webpage: How estrogen dominance can ruin your thyroid health, posted January 8, 2013. Retrieved from: www.outspartdisease.com/how-estrogen-dominance-can-ruin-your-thyroid-hyealth/

 Heavy flow can lead to B vitamin deficiency

B Vitamins (B 12 as well as other B vitamins) are necessary for both physical (including cognitive) and emotional  health.  When women experience heavier than normal periods they may find that  a deficiency results. The vitamin B group  includes folic acid, B12, thiamine, and niacin.

B vitamins, especially B 1, 3, and 12 are needed to make myelin which coats nerve cells and makes them, and the nervous system, work properly (2).  Serotonin (a neurotransmitter implicit in emotional wellness and sound sleep) is produced in part from vitamins B 6 and 12. And, B vitamins help relieve stress.
Bone health, which becomes more of a concern as women enter into menopause, is impacted by a lack of B vitamins.  This is as B vitamins are necessary in helping the adrenal glands produce sex hormones, which keep bones strong and dense. Vitamin B 5, pantothenic acid, is especially important for bone health(2).
Even the liver needs B vitamins to help it break down and eliminate excess sex hormones, if these are deficient the liver may not work optimally and a hormone imbalance may result (2).  Too much of the sex hormone estrogen can impact thyroid functioning negatively, leading to hypothyroidism.

Vitamin B deficiency is indicative by: poor concentration, anxiety and irritability, feelings of tension and an inability to manage stress well (2).

Symptoms of vitamin B 12 deficiency specifically are: vertigo, dizziness (3), hair loss, tingling in the extremities, poor appetite, heart palpitations, mouth sores and memory problems (1). Other causes of vitamin B12 deficiency are: vegan diet or vegetarianism, gastric surgery, and over use of ant-acids (1).

Vitamin B 6 is necessary to efficiently metabolize carbohydrates, proteins and fats and to support a healthy metabolism (3).  Symptoms of vitamin B 6 deficiency specifically are: weight gain, irritability, depression, brain fog, and memory problems (3).
Sources of B vitamins:
B1: liver, eggs, fresh and dried fruit, vegetables (peas)
B2: rice, eggs, fortified cereals and dairy products (milk)
B3: milk/diary, eggs, meat, fish, wholegrains
B5: whole grains, broccoli, potatoes, oats, eggs, chicken, beef (kidneys)
B6: avocados, bananas, potatoes, pulses and soya, wholegrains, chicken, turkey, eggs, fish, pork
B12: eggs, dairy products, meat and fish/shellfish (vegetarians can get B12 from sea vegetables and fortified foods)
Folic acid: green vegetables, avocados, asparagus, peas, chickpeas, brown rice, oatmeal, liver
If you wish to take a B complex supplement try to find one with 10 mg or more of B1 to B6, over 10 mcg of B12 and 200 mcg or more of folic acid (2).

References:
1 Health span website, webpage: Vitamin B12, iron and getting on top of menopausal hair loss. Accessed: www.healthspan.co.uk/menopause-advice/appearance/vitamin-b12-iron-and- getting-on-top-of-menopausal-hair-loss
2 Health span website, webpage: Soothing menopausal stress with vitamin B. Accessed: www.healthspan.co.uk/menopause-advice/depression/soothing-menopuasal-stress-with- vitamin-b
3 Health line website, webpage: B-well: why women in perimenopause need B-vitamins. Accessed: www.healthline.com/health-blogs/hold-that-pause/b-well-why-women-perimenopause-need-b- vitamins

Hot flashes, Sweating & Disturbed Sleep

Also, known as vasomotor symptoms are due to changes in female sex hormones.  When this happens, a woman may experience difficulty sleeping, insomnia or waking in the night, as well as sweating and hot flashes.

Insomnia may increase during perimenopause, due to hormonal fluctuations altering circadian rhythms (10) and sleep patterns.   While insomnia increases in both sexes with age, women are more likely to experience it, starting at the onset of pre-menopause.  Women may in fact experience sleep disruptions five to seven years before the actual onset of pre-menopause (87). Hot flashes (night sweats) are often at the root of insomnia, but other problems like poor health and sleep apnea (especially experienced when overweight) may be the underlying cause.  Anxiety and depression can also play a role in insomnia (80).

Regarding hormonal changes, both oestrogen and progesterone play a part in sleep.   Oestrogen helps regulate magnesium levels. Magnesium is important to sleep as it is associated with muscle relaxation (81).   As women lose the ability to produce oestrogen magnesium production may be compromised.  This in turn impacts the ability to relax and fall asleep.   Low oestrogen may be responsible for night sweats and has been associated with sleep apnoea (breathing problems) during sleep (81).  Progesterone is associated with deep sleep, without it women find it hard to get a restful sleep (81).

Sleep hygiene in imperative to mental and physical wellbeing.  Most adults need seven to nine hours of sleep per night.  A lack of sleep is associated with a lack of concentration, anxiety, (81) depression, and irritability (all associated with menopause).  It is also correlated with being overweight/obese and increased risk of heart disease, high blood pressure, diabetes and substance abuse (88).

How to improve sleep hygiene:  Establishing a sleep routine; change your diet to avoid fatty or sugary foods and caffeine, all of which are associated with being stimulating and underlying night sweats (81); calcium and magnesium may be helpful (81).  Magnesium, often lacking in processed foods.  Magnesium has been shown to increase the ability to get to sleep and stay asleep, and to awaken. Magnesium has been shown to increase melatonin production and decrease stress hormone cortisol production (83) and to reduce the symptoms of treatment resistant depression (82).   Calcium aids in making melatonin from tryptophan (an amino acid).  Melatonin helps regulate sleep/wake cycles and the body’s internal clock (89).  Potassium has been shown to improve the quality of sleep and lesson the likeliness of sleep disruption (90).

Hot flashes and night sweats may be due to rapid changes or fluctuations in ovarian hormones.  Hot flashes usually occur early in perimenopause, and come and go depending on the severity of hormonal fluctuations (10).  Some women continue experiencing hot flashes for years after menopause.

Disruptions in the body’s ability to regulate temperature may in part be due to a disruption in the production of certain neurotransmitters (serotonin and noradrenaline).  These neurochemicals help to stabilize what is called the thermoneutral zone.  Sex hormones play a role in the production of neurotransmitters, so when estrogen etc. starts to fluctuate so does the production of serotonin and noradrenaline.  This in turn can disrupt the body’s ability to regulate heat and cold.  So, if you can increase the production of these neurotransmitters, by natural or artificial means, it may help. There are activities and foods or supplements you can take to increase them naturally.  Some anti-depressants/anti-anxiety medication can also help with this.  These are SSRIs (selective serotonin re uptake inhibitors) and SNRIs (Serotonin nor-epinephrine re-uptake inhibitors).  Keep in mind that this will help, but might not completely reverse the problem (294).

Natural ways to increase the production of serotonin include, but are not limited too, the following:

Light therapy (especially blue spectrum light) increases serotonin.  When possible walk out doors in bright sunlight for 15 minutes a day (134;135).  Otherwise, you can buy an inexpensive light box.  Keep in mind that blue light can harm your eyes, so don’t look directly at it.  Also, avoid blue light at night as it may affect the ability to go to sleep (including TV and tablet screens).   If you purchase a blue light box place it on a high enough surface to allow the light to hit the lower part of the eye, as this is where blue spectrum light naturally is absorbed (178).

Nutritional interventions to increase serotonin include the following: turmeric, dark chocolate, green tea, cold-water fatty fish, and fermented foods (yogurt, kefir, unpasteurized sauerkraut).  The last helps balance gut bacteria as too much of a bacterium called lipopolysaccharides can lower serotonin levels (264;267;268).   Eat tryptophan rich sweet or starchy (ideally complex) carbohydrates without protein (264; 273;274) as protein has nutrients that disrupt the uptake of tryptophan.  Eat   carbohydrates on an empty stomach (about three hours after a protein).  The food source (like gram crackers, pretzels etc.,) should have at least 25 to 35 grams of carbohydrates and no more than 4 grams of protein.  If you want a quick boost to your mood try a simple carbohydrate, but keep in mind that this will raise your blood sugar as well.  You should feel an effect 20 to 40 minutes after eating (274).  See appendix for books on the subject.

Reduce or eliminate caffeine as it may desensitize brain cells to serotonin (266), and avoid artificial sweeteners (aspartame) as it inhibits the uptake and conversion of tryptophan (264;265).

Exercise increases the production of neurotransmitters Dopamine, Norepinephrine and Serotonin (22).

Hot flashes may also be the result of blood vessels losing elasticity.  This is called endothelial dysfunction. Here blood vessels stop functioning properly, by not constricting (narrowing) or dilating (widening) properly to accommodate proper blood circulation (187).  Endothelial dysfunction may be the result of an inability to properly produce the neurotransmitter nitrogen monoxide.

Treatment for vasomotor problems like hot flashes or night sweats include the following.    Taking the amino acid arginine may help as it is made into nitrogen monoxide by the body (188).  If you choose to take arginine take amino acid lysine with it.  Lysine will help keep arginine circulating in the blood to be transformed into nitrogen monoxide (189; 190).

Soy has been shown to improve hot flashes (19; 24; 54), for instance adding approximately 100 mg of soy isoflavone per day, in the form of a supplement, may decrease vasomotor symptoms (19). Those with thyroid problems should avoid soy as it is a phytoestrogen and may lead to estrogen dominance, which negatively effects thyroid functioning.  Vitamin E (800-1200 IU), and Black Cohosh (dose of 40 mg/1 to 2 times a day) may also help (51;54).  Saint John’s Wort, (Hypericum peroratum L or HPL) may relieve hot flashes (26).  Keep in mind that Black Cohosh can cause rash, liver damage, and stomach upset (54).

Exercise should not be overlooked. Women hen exercising women report feeling more in control of their lives and bodies when they exercise.    Women also report more positive feelings towards their overall situation, and say they are less distressed by these symptoms, regardless of their actual intensity (41).

Magnesium supplements have been shown to lessen the number of, and intensity of hot flashes, increase  the ability to sleep and lessen night sweats (194) and reduce the severity of hormone related migraines (201).  It can also help treat arrhythmia or disturbances to heart beat (201). Magnesium is also needed for Vitamin D to be properly absorbed (201).

Recommended oral intake of magnesium for adults (not breast feeding or pregnant) is 310 to 350 mg (194), and specifically 320 mg per day if female and over age 31 (198).  Magnesium supplements come in different forms.  These are the ones that absorb most easily: Magnesium citrate, magnesium lactate, and magnesium gluconate (198).   Epson salts have magnesium in them and some of it is absorbed via the skin.  This may explain why Epson salts relieve muscle pains, inflammation and swelling (198).

Keep in mind that magnesium supplements can interact with medications, so only take them under a health care provider’s supervision.  If you have kidney disease you may not be able to take magnesium supplements.  Too much magnesium can result in the following: lowered pulse rate and low blood pressure, problems breathing, nausea and vomiting and fatigue.  Fee Infrequently it has caused coma and death (197). Hormone replacement therapy (HRT) may lessen the loss of magnesium (196; 198; 201).

Foods high in magnesium are: seaweed, green leafy vegetables (spinach & beat greens), bananas, chocolate & coco powder, legumes (including peanuts), seeds (poppy, fennel, cumin, celery, pumpkin & squash), nuts (Brazil, almonds, cashews, pine, black walnuts), and whole grains (whole wheat flour, wheat bran, oat flour, oatmeal, and bran cereals), and fish, diary, tofu and soybean flour (197;198).

Herbs and spices high in magnesium: marjoram, tarragon, savory, basil, sage, dill weed, coriander, and blackstrap molasses.

Magnesium is also in some medications (199) like laxatives, heart burn medicine (Rolaids Extra-strength) and diarrhea medications (Phillips’ Milk of Magnesia).

Hormone replacement therapy (HRT) is also a good treatment for vasomotor symptoms, but it is also potentially problematic as it may increase the likelihood of developing   other health problems (294).

REFERENCES UPON REQUEST

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