Archive for fatigue
Menopause is well known to interfere with aspects of our lives that we would like to remain stable and routine. Talking about sleep problems during menopause leads most women to think about their disruptive, night time hot flashes. These are certainly a major cause of sleep deprivation for women as they age.
A more insidious cause of insomnia may be present though, and this cause has far more serious health implications. I am talking about Obstructive Sleep Apnea.
Nobody wants to sleep with a mask over their face, attached to a pump making noise throughout the night. Many women do not want to even discuss, much less get tested for OSA because of this device, called a CPAP machine.
There is a surprising prevalence of OSA, with 1:7 women aged 55-70 having severe sleep apnea. This is in part because of weight gain that typically occurs as we age as well as when we go through menopause. It is also caused by the aging process itself, weakening the muscles in the roof of the oral cavity which suspend the tissues.
The typical symptoms of OSA are snoring and sometimes breathing cessation following by a loud gasp; then resumption of snoring. This is often diagnosed by sleeping partners! Fatigue during the day and not awakening feeling refreshed is a common complaint among people with undiagnosed or treated OSA.
You may wonder what the big deal is, so you snore a little!
According to a recent article published in Sleep; women will have more health problems from their sleep apnea than men. Studies have shown an increase in depression, as well as more damage to parts of the brain associated with mood and decision making. This has been demonstrated in studies by alterations on MRI scans. OSA can also eventually cause enlargement of the heart, hypertension, and lung disease.
How can you prevent sleep apnea? The biggest prevention is weight control. Weight gain in the neck, face and shoulders can place increased pressure on the muscles that help suspend the roof of the mouth. As we lay down to sleep, gravity can cause the soft tissues of the roof of the mouth to partially collapse and obstruct or block the airway. This decrease of air, and more importantly oxygen, reaching the outer portions of the lungs can put a strain on the heart.
As a part of weight control is exercise which also helps the sleep cycle. Adopting as healthy a lifestyle as possible will help strengthen heart and lungs.
What if you have done all this and your sleep test still shows OSA. The CPAP machine helps to increase the pressure on the roof of your mouth and throat, preventing collapse of tissues. There are many devices, and luckily technology advancement has created some very small and quiet devices.
Using a CPAP machine can dramatically improve your health through lowering the blood pressure, reducing stress on the heart and improving the function of the lung. All of this results in improved energy, better sleep, reduction of headaches. It can even help facilitate weight loss.
Many people imagine treatment of OSA to resemble sleeping with a gas mask, but this is not the case any longer. I encourage you to share with your provider any symptoms or suspicions that you may have sleep apnea.
Fatigue can be a major part of the menopausal transition. It can be one of the first things that happens, often sneaking up on women without any identifiable cause.
Your fatigue can be from a variety of reasons, and most people will blame it on the inability to sleep that can occur with menopause. As many of us know, sleep is often a tenuous event every night. There are hot flashes that wake us up, and sometimes we find ourselves wide awake in the middle of the night for no reason.
The fatigue that occurs during menopause can lead you to reduce the exercise or activities you participate in, because you are just too tired. This can lead to weight gain; and weight gain can lead to diabetes, HTN, diabetes. All of this can predispose you to sleep apnea.
Sometimes fatigue is just from lack of sleep, and we are familiar with this form of weariness. But sometimes fatigue can be due to poor quality sleep that is a result of sleep apnea. You may feel that you stay asleep all night, but awaken worn out; as if you have not slept at all. This can be a sign of sleep apnea, as is snoring or interrupted breathing while sleeping.
It is important to address your fatigue with your medical provider. Other reasons for fatigue can include:
- anemia-both iron deficiency and B12 deficiency
- joint disease or connective tissue disease
- breathing problems such as asthma, COPD, lung infections
- nutritional deficiencies and excessive dieting
Sleep apnea can occur to anyone as they age, but it is more likely to occur with being overweight. This can place stress on the oropharyngeal structures, which result in collapse and obstruction of the breathing passages when laying down. Prolonged sleep apnea can then lead to a condition called pulmonary hypertension.
What can you do the prevent sleep apnea?
While you cannot prevent yourself from aging, limiting weight gain as you age may be the most important deterrent to sleep apnea. This is best achieved through healthy diet and exercise. It is the weight gain in the neck which primarily the culprit bringing on sleep apnea.
Keep in mind that sleep apnea is not just a condition for men, woman are susceptible also! See your provider if you have unexplained fatigue, and work on healthy diet and exercise to control weight and improve your sleep.
A reader recently posted a question:
What do you do when your health requires you to stop taking your hormone therapy?
Many specialists would simply say, stop your medication and in essence, deal with it. Your gynecologist or family practitioner could no doubt offer more advice than that. My first advice would be to contact your regular provider to ask their advice on controlling symptoms.
The time of menopause is also the time of increase risk of stroke, heart attacks, cancers, and blood clots or DVT ( deep vein thrombophlebitis). Estrogen and progesterone can cause inflammation of blood vessel walls, thus helping to cause stroke, blood clots, and heart attacks. Estrogens can fuel a breast cancer or other cancers of the female organs. Since having one cancer places you at risk for any other cancer, it makes sense to discontinue estrogen for any cancer a woman may experience.
So what do you do when you are told to suddenly stop the therapy which is helping you feel sane and in control?
There are many other therapies which are safe and can help control symptoms, but first you must check with you provider. One thing which will be vital for controlling the symptoms of menopause is a healthy life style. Because of how food is metabolized during this time, it is important to limit foods high in sugar as this can lead to fatigue and sometimes fuel hot flashes. It is also important to limit caffeine and alcohol as these items can trigger hot flashes both daytime and nighttime. Alcohol also causes difficulty with sleep mostly due to the sugar content.
We all know a bad night sleeping can lead to
- fatigue, which leads to
- low energy and avoidance of exercise,
- leads to convenient food choices for comfort and ease of preparation.
- lack of sex drive
- difficulty concentrating
- all of the above leading to low self esteem and possibly depression over lack of control
How do you gain control of all this?
A diet high in antioxidants helps. This means fresh fruits and vegetables, brightly colored or deep leafy green. Consuming less sugar, caffeine, and alcohol. If you are sensitive, a diet low in dairy. If you are not sure how dairy sensitive you are, stop all dairy for 1-2 months and see how you feel. You may have more energy, less respiratory problems and skin problems. Exercise of any kind that gets your heart beating faster and uses your muscles in a way not normally used in your average day.
For medical help when the above measures are not enough, there is clonodine or effexor (low dose) which can help with hot flashes. There are sleep aids which are generally safe for short periods of time. Doing cross word puzzles or other memory type games can help some with “brain fog”, as does some low dose antidepressants if applicable. Herbal products should be used with extreme caution if they contain soy or black cohosh; these products can theoretically be irritating to blood vessel walls as they are estrogen like in their action.
There are measures you can take to control your symptoms, nothing may be as completely relieving as hormone replacement therapy. Talk to your medical provider to get advice targeted to your health situation. Then, write us back and let us know what worked for you! Share your successes with our readers.
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Hypothyroidism, or slowing of the thyroid, is a common problem as women age.
Many women develop this condition prior to the onset of the menopausal transition. The effects of aging on hormones can precipitate this condition and it is important for you to talk with your medical provider about testing for this if you are experiencing excessive fatigue.
The thyroid gland is located at the base of the neck and is responsible for the rate at which your body systems function. Symptoms of hypothyroidism include:
- dry skin
- slowing of mental functions or difficulty thinking
- hair loss
- feeling cold
These are a few of the symptoms, there are many biological changes which occur that can be measured or evaluated by your provider. The reverse condition, called hyperthyroidism, is much less common and is not as associated with aging.
The thyroid gland produces the hormones, T3 and T4. This is regulated by the pituitary gland through production of TSH (thyroid stimulating hormone). The regulation of thyroid function in the pituitary gland(in the brain) is in turn regulated by the hypothalamus (also in the brain) by production of thyrotropin releasing hormone. It is through the action of elevated cortisol that this finely tuned system is altered.
Prolonged stress and the resulting production of CRH ( corticotropin releasing hormone) causes prolonged elevated amounts of cortisol. This in turn inhibits TSH production and secretion. The elevated levels of cortisol in the blood stream also inhibit conversion of the thyroid hormone T4 to T3. Our bodies need both forms of this thyroid hormone to function normally. T3 is produced in lower quantities but is 4 times more powerful than T4.
This could be the cause of what is termed the “sick euthyroid” syndrome. In this setting, people have all the symptoms of hypothyroidism but their thyroid lab work is normal. Some people can have difficulty converting T4 to T3 due to lack of an enzyme. So let’s put this together.
If you are a person who is genetically susceptible to these conditions, and you are entering peri menopause without a very healthy lifestyle. You are having trouble sleeping, your life is stressed and you are taking no time for yourself. You eat convenience food because you don’t have the time or energy to exercise and plan detailed meals. So your cortisol levels go up and you start gaining weight. Then it all spirals downward with more fatigue because your thyroid is not working well. What can you do to stop this?
Most of our previous posts have dealt with this very issue.
Important lifestyle changes to consider:
- eat a diet low in processed foods, sugars and saturated fat
- limit alcohol, caffeine, nicotine
- exercise and/or find ways to add physical activity into your daily routine
- practice techniques to lower stress
- sleep enough hours to allow you to feel rested; 7-9 hours nightly
- take vacation days periodically through the year
- laugh with friends and family
Speak with your provider about how you are feeling and what you would like to have checked medically. Voice your concerns so you are heard!
Tell us your story. What good or bad experiences have you had with fatigue and thyroid issues? Leave your story, questions or input in the comments section.
We have talked about cortisol in prior posts, and many of you may be wondering why this particular
hormone is so important during menopause. We often think the cause of all our problems is from low estrogen. This is only part of the reason for your symptoms.
Cortisol is the stress hormone that we need when our bodies are under stress.The problem comes when our bodies have been under prolonged stress such as caused by hectic lives lacking adequate sleep and relaxation.
- Cortisol increases heart rate,
- slows digestion,
- slows cell repair and regeneration,
- breaks down healthy muscle and bone
- weakens the immune system.
This increase in cortisol can wreck havoc on the balance of the different hormones that has been maintained. The falling estrogen levels also contribute to the stress response, as estrogen is involved in many functions within the body.
Cortisol is produced in the adrenal glands along with other hormones such as progesterone, some forms of estrogen, adrenaline, and testosterone. These hormones all come from the same parent hormones. What this means is that one hormone can be produced in excess at the expense of other hormones. When the body is under stress, the adrenals will cause the progesterone to be broken down to cortisol alone which leads to a reduction of DHEA (parent compound of estrogen and testosterone).
This cortisol then helps the liver to produce glucose because the body is anticipating the need for action and is providing the energy for this. In our modern day world, this kind of physical action rarely occurs, so what happens to all that excess glucose (sugar)? You guessed it, it is stored as fat. Usually visceral fat.
The adrenals also play a role in attempting to maintain estrogen levels as the ovaries are declining in function. The elevated cortisol levels will cause visceral fat to be made and stored in the abdomen. This visceral fat produces estrone, which is a form of estrogen. The adrenals produce estrone and belly fat produces estrone. This may very well be why all of a sudden, around the time of menopause, you have belly fat (or more belly fat)!
The adrenals do not act on their own, they have help from the brain. The brain, specifically the hypothalamus and pituitary, are the master controllers of our endocrine functions. Without these areas controlling and regulating, the separate organs may produce too much or too little of whatever hormone they are responsible for. During stress, the brain is attempting to reduce reproductive capacity, growth and thyroid function. This is done to help with survival. In this country and in this day and age, we are rarely in a position of having our very survival threatened. So the stress of our lives are unnecessarily causing all these problems.
So what do you do?
Reduce stress, reduce stress, reduce stress. This will reduce cortisol, which will hopefully reduce visceral fat production and reduce glucose production. This in turn will reduce heart disease, insulin resistance, and improve endocrine function of the non-stress hormones produced in the adrenals.
Reduce stress in a way that is enjoyable to you. Therefore you will be likely to make this part of your daily routine. Exercise, mediation, yoga. You must get adequate sleep, at least 7 hours a night. Your diet is important also, reduce sugar, alcohol, caffeine as these items can contribute to elevated cortisol levels.
Start with little changes, pick one new thing you will do and do it daily for a few weeks. When that is a common practice for you, pick another item you want to change. Change can be slow, this is often the more effective way to make changes that stick.
Write in the comments section and tell us your stories on changes you have made. Your story will most likely help and inspire someone else to make a change!
Fatigue is one of the most common problems that women voice as they are moving through the menopausal transition. We have discussed in previous posts the causes of fatigue in peri and post menopausal women. The reasons can be numerous and multifaceted.
The commonly thought of causes include sleep disturbance from hot flashes, restless leg syndrome and obstructive sleep apnea.
Women can become anemic from irregular and heavy menses in peri-menopause, this can certainly cause fatigue.
Often times women on are medication to treat disorders and diseases, and these medications can cause fatigue.
Thyroid disorders can cause fatigue, as the thyroid hormones are responsible for setting our metabolic rate (the rate at which our bodily functions work).
Lastly, depression and anxiety can cause fatigue mostly through the chemicals in our brain not being in enough supply or in the correct proportion.
Let’s talk about hormones and how they can affect fatigue. The steroid hormones are hormones produced for an action, production is stimulated by the brain, and they are meant for immediate use by the body. The hormones I will discuss are produced in both the ovaries and the adrenal glands. The hormones that are primarily responsible for the change in how you feel during menopause are:
- thyroid hormone T3 and T4
Cholesterol is the precursor for all of these hormones with the exception of thyroid hormones. Cholesterol is broken down into basically 2 parent compounds which then go through changes to become the above list with the exception of thyroid hormones.
One parent compound, pregnenolole eventually becomes
- cortisol and
The other parent compound becomes Adrostenedione which eventually becomes
Why is this important for me to know?
Because knowledge is power. Once you understand what might be going on, you can decide to make changes to help relieve yourself of some of the symptoms you are experiencing.
Pre-menopausal, the production of these important hormones takes place in 2 places, your ovaries and your adrenal glands. Estrogen and progesterone in the ovaries and also in the adrenal glands, the rest are produced by the adrenals.
The adrenals are small organs which sit atop the kidneys. When the ovaries stop working, the production of progesterone starts a slow steady decline. The estrogen level falls rapidly but can also rise as the ovaries sputter along.
Many symptoms of bloating, fatigue and mood disturbance can be linked to not enough progesterone early in peri-menopause. While hot flashes, brain fog and fatigue can be linked to fluctuating and then low levels of estrogen. Prior to menopause, healthy estrogen levels help the action of cortisol which also helps to prevent cortisol excess. When estrogen falls, it leaves the cortisol unopposed and therefor in excess.
Why is excess cortisol bad?
Excess amounts of cortisol for prolonged periods of time can cause the following ill effects:
- weaken the immune system
- slow healing and normal cell repair
- impair digestion
- break down healthy muscle and bone
- interfere with the normal function of other hormones
- interfere with sleep
- increase appetite
Cortisol is a very important hormone when it is needed for immediate action or a stress response. Today’s stressful lifestyles can cause prolonged increase levels of cortisol and as a result, the above list of problems can occur.
So what can a person do to decrease the effects of hormonal changes and stress?
There is, of course, medication to treat the different symptoms. This you can discuss with your medical provider, it may mean you could be taking several different pills for all these different symptoms. What your medical provider may not have time to talk about are the lifestyle changes that can help all of this. (If you would like to talk to me about lifestyle changes, send me an email via out contact form. Click on the word contact on the black navigation bar at the top of this page.)
The following are all suggestions sited by the experts on how to change your lifestyle to help facilitate relief:
- decrease your stress response through measures such as yoga, meditation, prayer, anger management counseling, therapeutic massage
- exercise-this helps lower cortisol, lowers blood pressure, helps with stress, helps the cardiovascular system and your muscles remain healthy
- sleep-studies have shown people who get less than 4-5 hours of sleep are 72% more likely to be obese. This is due to hormones also
- a diet low in sugars and refined carbohydrates can lower the entire cascade of hormones which help to create obesity and elevated cortisol levels.
- a diet high in fresh vegetables and fruits, preferably produced locally so nutrients have not degraded, provides you with healthy anti-oxidants and other substances which the cells of our bodies utilize for healthy functions.
All this discussion of hormones and cortisol may seem mysterious and I will try to shed some light on the intricate interplay of these hormones in a future post. It is important to understand that you can change much of what is happening during menopause that is undesirable through your lifestyle.
It takes work and change and many people do not want to do this. The rewards of making changes and gaining some element of control over what is happening to your body can be very empowering. Every patient I have seen that successfully makes these changes have been immensely satisfied by the changes they have made. So ask yourself, what is stopping you from making the changes you know you should make?
I would like to hear from you in the comments section below. Things you can do are ask me
questions, tell me about your experiences, relate an epiphany you had or a way you have improved your energy. If you don’t want to do that, then share this with your friends on Facebook, Twitter or email by using one of the icons below.
Fatigue is a problem which plagues all age groups, but becomes especially troublesome as we age. We want to blame many things for our fatigue, and we may be right much of the time.
Causes of fatigue as shared with me in the Family Practice clinic where I work include:
- not getting enough sleep
- working too many hours
- depression or anxiety
- unknown causes
To the above reasons, many of us can say yes, I have those problems. Many of us can devise a plan, or at least an idea of a plan, to help reduce or lessen these pr0blems.
We all know…
- if we go to bed earlier
- draw boundaries on work obligations and stick to them
- get a little exercise
- stretch some
- have some fun or at least spend time daily doing what we like
We will feel better and not be so tired.
After all, most of us feel just fine when we are on vacation!
What about that grinding fatigue that hits even though you are doing everything right. There is a name for this fatigue, crashing fatigue. Its name says it all! This is the fatigue that hits you all of a sudden, makes you feel that if you do not go lay down now, you will drop where you stand. That fatigue that makes you feel you cannot go on at that moment.
Fatigue causes and treatment?
The medical providers that recognize Crashing Fatigue do not exactly know the causes for it. It is not even recognized by many mainstream medical providers. For anyone who feels it… Crashing Fatigue Exists. The cause is most likely related to the complicated interplay of hormones which run the body, and that are changing now that you are going through menopause. This is often the basis for what is termed Adrenal Fatigue, another condition not recognized by mainstream medical providers. There has been little research regarding the possibilities for these conditions, and until something is proven by the medical establishment it is often not recognized as a valid illness.
This doesn’t change the fact that for many of us, something very different is going on with our bodies. This difference is often not met or explained by standard medical testing and treatment. This is the basis for the alternative branch of medicine which investigates problems through testing in unconventional routes, such as saliva testing. Use of specialized, compounded creams and pills are formulated to match your specific hormonal imbalance to improve symptoms. This practice has helped many women feel much better with their symptoms of menopause. The potential problem arises due to the relatively unregulated nature of this testing, medication manufacturing and prescribing. This form of treatment is being hotly debated between mainstream providers and alternative providers. I suspect that it is an issue which will be resolved in some fashion over the next decade.
Just as the causes for fatigue can be numerous, so are some of the treatments. There is no one pill which can correct this, although many women have obtained relief through hormone replacement. It is vital that you take care of yourself, just as you take care of loved ones! Eat nourishing, healthy meals containing foods packed with nutrients. Get plenty of rest, and I mean relaxation as well as sleep. Elevated cortisol levels from stress can cause fatigue as well as a host of other problems. And get some exercise! Even when you are tired, exercise can increase your energy.
I will talk about the different hormonal changes happening during menopause in future posts, I would love to hear from readers about their experience with fatigue, compounded hormone preparations and any experience with Integrative/Functional Medicine. Please write in the comments section and tell us your stories!
Ovarian cancer is the 9th most common cancer women can have and is the 5th leading cause of cancer deaths in women.
It is difficult to diagnose early, which can make it one of the more dismal gynecologic cancers a woman can have. Research is ongoing on methods of early diagnosis and detection, as well as trying it identify risk factors to aid in prevention.
- The American Cancer Society predicts that in 2010, 21,880 women will receive a new diagnosis of ovarian cancer and there will be 13, 850 deaths from ovarian cancer.
- These statistics are close to past years stats on diagnosis and death, although the rate of ovarian cancer has been declining slightly.
- 93% of women diagnosed in early stages of ovarian cancer live 5 yrs or more, however, only 19% of women with ovarian cancer are diagnosed in the early stages.
- Lifetime risk of developing ovarian cancer is 1 in 71, lifetime risk of dying from ovarian cancer is 1 in 95
- 50% of women diagnosed with ovarian cancer are over 60, risk is higher in white women over African American women.
- 3 in 4 women diagnosed with ovarian cancer survive at least 1 year, 46 % survive 5 years; women younger than 65 fair better than older women.
SYMPTOMS OF OVARIAN CANCER: many of the symptoms listed below can be present for completely normal or benign reasons, their presence does not ensure an ovarian cancer. Experts suggest however, that if many of these symptoms are new, unexplained, present daily or almost daily, last more than a few weeks; that evaluation is needed.
- Bloating, upset stomach, early satiety or difficulty eating a full meal, and constipation
- pelvic and/or abdominal pain, as well as back pain, pelvic or abdominal pain during intercourse
- Changes in menstrual pattern and especially post menopausal bleeding
- urinary frequency or a change in the pattern of urination, urgency to urinate
- unusual or unexplained fatigue
WHAT ARE RISKS OF OVARIAN CANCER?
- AGE: as mentioned above, incidence increases with age
- OBESITY: studies suggest a BMI of over 30 increases risk and death from ovarian cancer, although this has not been proven. Likewise, studies have suggested a diet low in fat and high in vegetables has shown a lower rate of ovarian cancer
- CERTAIN DRUGS: the use of fertility drugs for over 1 year especially if pregnancy was not achieved is associated with a higher incidence of low malignant potential tumors. These are tumors of the epithelial cell type which tend to grow slowly. Use of androgens (Donazol) has suggested a higher risk in a small study, however a larger study did not confirm this. Use of HRT, especially estrogen alone for more that 5-10 years has been associated with a higher rate of ovarian cancer.
- FAMILY HISTORY: 10% of ovarian cancers are from the genetic mutation on BRCA1 and BRCA2, many causes of epithelial ovarian cancers, which are the most common, are caused by inherited gene mutations and therefor identifiable through genetic testing. This is recommended for a family history of breast, colon and ovarian cancer even if on father’s side of the family.
- PRIOR BREAST CANCER: many of the same risk factors for breast cancer also exist for ovarian cancer, primarily the gene mutations mentioned above ; and possibly use of HRT. The presence of a prior cancer suggests a problem with DNA replication.
Other factors that have been looked at are use of talcum powder, use of analgesics, smoking and alcohol consumption. The use of talcum powder applied to the genital region, as well as sanitary napkins containing talcum powder; has been suggested as one possible cause of ovarian cancer. It is speculated that talcum powder used more than 20 years ago contained trace amounts of asbestos, which is a known carcinogen. The FDA has required all talcum powder to be asbestos free, and there is no association with use of corn starch containing personal hygiene powders with increased risk of ovarian cancer. Studies have failed to demonstrate and increased risk of ovarian cancer with use of aspirin, acetaminophen products, alcohol or smoking.
How can a woman reduce her risk of getting ovarian cancer? There is not a lot of data to give concrete answers but studies doe suggest that the following strategies can be considered:
- Use of oral contraceptives for 5 years or more seems to reduce risk by 50% over non users of birth control pills. Likewise, risks goes down with each pregnancy as well as breast feeding. This is most likely associated with lack of ovulation, or continued activity within the ovary month to month.
- Gynecologic surgery such as bilateral tubal ligation and hysterectomy is also associated with lower risk, exact reasons are unknown. These tests should only be done for valid, medical reasons.
- Genetic counseling is very important if there is a family history of cancer including the BRCA gene mutation. this is a complicated issue, but can identify women at risk and allow them to take recommended surgical action.
It is most important to see your medical provider for any new signs and symptoms of ovarian cancer, even if there is not a family history of cancer. Long term survival is best when this particular cancer is diagnosed and treated in the early stages. Regular exams and good dialogue with a medical provider you trust is key, tell your provider everything you are feeling even if it seems trivial!