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Dr. Anna Garrett
14 Years of Hot Flashes and Night Sweats?? Say It Isn’t So!
Healthy Living
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    In case you missed it, PBS recently interviewed the lead researcher about her study of women and the duration of hot flashes and night sweats.

      And the news wasn’t good.

      Her team studied nearly 1500 women (aged 42–52 at baseline) who reported frequent vasomotor symptoms (6 days or more over a 2-week period) at least once during roughly 13 years’ follow-up. Vasomotor symptoms include hot flashes and night sweats.

      The most common duration of VMS was 7.4 years. Women who were premenopausal or early in perimenopause when they first reported frequent VMS had the longest total VMS duration (most common duration >11.8 years) and these symptoms most commonly lasted 9.4 years after the last menstrual period.

      That’s a lot of “personal days at the beach”.

      Women who were postmenopausal when they first experienced symptoms had the shortest duration of problems (3.4 years).

      African American women reported the longest total VMS duration (10.1 years). Additional factors related to longer duration of VMS were younger age, lower educational level, greater perceived stress and symptom sensitivity, and higher depressive symptoms and anxiety at first report of VMS.

      What’s a Girl to Do??

      VMS are one of the problems my clients most commonly complain about (right after weight gain and insomnia). Hormone replacement therapy helps, but I most commonly work with women who are hesitant about going this route for a variety of reasons.

      Pharmaceutical manufacturers would have you believe that hormones and antidepressants are the way to go, but the truth is that lifestyle changes can be very effective. These include:

      • Avoiding caffeine and alcohol. These 2 are huge and in some cases have completely eliminated hot flashes and night sweats.
      • Avoiding spicy foods.
      • Avoiding processed foods. Eliminating sugar and lowering carbohydrate intake can be very effective.
      • Exercising regularly. In perimenopausal women, frequency is more important than duration.

      Consider the Alternatives

      What’s interesting to me is the link between stress, anxiety and depression, and length of symptoms. Given this relationship, it’s clear that learning to de-stress and take personal time outs can make a difference in your experience.

      Depression and anxiety are symptoms of perimenopause, but the study wasn’t designed to delve into whether or not the women in the study were suffering from clinical depression or a hormone imbalance. Distinguishing between these is important because the treatments are very different. Antidepressants can be useful for hot flashes, but they don’t solve the underlying imbalance.

      Alternative practices such as acupuncture, mindfulness and meditation can also help reduce suffering. And using specific breathing techniques has been shown to reduce hot flashes by 44%. That’s better than any thing else that’s been studied (and it’s free!). Read more on that here.

      Herbs and Supplements Can Make a Difference

      The data on supplement use is lacking, but it’s unlikely that large scale studies will be done to prove efficacy. Supplements to consider include chasteberry, black cohosh, soy, clary sage oil, crinum latifolium (Crila®), fish oil, dong quai, DHEA, and progesterone cream. Many of these supplements are not appropriate for women with a history of estrogen sensitive cancer (breast, uterine), so if you have a personal history of this, ask your pharmacist before taking them. In my experience, clients have gotten the best results with progesterone cream.

      As with all supplements, quality matters. Make sure you are buying from a quality manufacturer. You can read more about choosing supplements wisely here.

      And remember, just because the symptoms CAN last up to 14 years doesn’t mean they will for you. Each woman’s journey is very unique. If you’re having trouble managing your symptoms, don’t suffer in silence. There are well-trained practitioners out there who can help you find relief. If you’re looking for a different direction for your menopause experience, I’d love to chat with you

      Dr. Anna Garrett
      What To Do When Hormone Imbalance Torpedoes Your Sex Drive
      Love & Sex
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      Of all the changes perimenopause brings, lack of interest in sex due to hormone imbalance is one of THE most common (and least discussed symptoms).

      How Perimenopause Creates Hormone Imbalance

      Thanks to progesterone production, Mother Nature gives us a natural increase in the desire for sex beginning just prior to ovulation. This lasts for several days afterwards to make sure our bodies take full advantage of prime time for conception. But as we enter perimenopause we ovulate less frequently and lose that regularly scheduled boost.

      A decrease in circulating estrogen can bring your sex drive down for the count AND cause thinning of the lining of the vagina which makes sex very painful for some women. Testosterone production also declines as we age. This is the hormone we typically think about when it comes to sex drive.

      Sprinkle some negative thoughts about aging or weight into the mix and it’s no wonder things come to a screeching halt.

      This is not a recipe for fun times!

      Ready to Ditch the Dry Spell?

      If you’re ready to put some sizzle back into a sagging love life, check out these suggestions:

      • Rule out medical reasons. Get tested for low thyroid function and iron deficiency anemia. These are two common disorders that can affect sex drive.
      • Find out if your hormones are imbalanced. You may have low testosterone which can be replaced with compounded cream. You’ll need a prescription for this.
      • Look in your medicine cabinet. If you are taking an SSRI antidepressant drug, birth control pills or diabetes medications, these may be contributing to lack of interest. You may have other options that won’t cause this side effect, so talk to your doctor or pharmacist about this.
      • Put estrogen on the spot. Using estrogen cream in the vagina soothes vaginal tissue, and allows the secretions necessary for comfortable sex. Estrogen is available as suppository tablets, creams, or “rings,” which sit inside the vagina and give off small doses of the hormone over time.
      • Vitamin E. When used locally in the vagina, Vitamin E can help rehydrate tissue and may possibly increase sensation. No need for a prescription here. Just stick a pin in a vitamin E capsule and apply to the vagina several times a week, even if you’re not having sex. And be sure to use a lubricant when you are having sex – either vitamin E or a commercially-prepared product such as K-Y Jelly or Astroglide.
      • Go nuts for coconut. Coconut oil (organic/expeller pressed) is very helpful as a moisturizer and lubricant. Proceed with caution if you’re also using latex condoms. Many oil-based lubricants can increase the risk of condoms breaking.
      • Talk to your partner. Open communication is always important…this is especially true in this situation. None of us wants our partner to feel rejected and that’s exactly what can happen if we’re not talking to each other! Explain what’s going on and the options you have to improve things. Approaching the problems as a team will help alleviate anxiety and fear.

      Mojo that is MIA in menopause can be frustrating. But fortunately, there are a variety of options to try. Once the underlying cause is identified and addressed, you’ll be back on track!

      Dr. Anna Garrett
      Is Perimenopause Sneaking up on You?
      Healthy Living
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      My client, Sarah, is ready to kill her teenage children. Her nerves are shot and her patience left the building long ago.

      On the days she’s not in a murderous mood, she can barely drag herself out of bed.

      And she is wondering what the hell is going on.

      If you feel like your once-pleasant personality and your mojo have skipped town together, you’re not alone. The likely explanation is that perimenopause has kidnapped them.

      Perimenopause is sneaky.

      Some days she’s subtle, but other days she plows through your body like a pack of alien invaders.

      AND she is the mistress of disguise.

      Signs of perimenopause can start as early as your mid-late 30’s. While you’re in the thick of raising kids (or considering having more), your ovaries may be looking toward retirement.

      Maybe you notice that you’re just a little grouchier or that your periods aren’t quite as regular. Your PMS symptoms, which were once mildly annoying, are now raging. You gain weight even though you’re exercising and eating right.

      Is This Normal?

      Hormones begin shifting naturally around the age of 35 when estrogen and progesterone start to taper off very gradually prior to menopause. Because this is usually such a slow shift, many women may hardly feel this change happening in their bodies. However, for many women, these hormonal shifts may overwhelm the body’s ability to maintain balance. The result is severe symptoms that can go on for years. There are some very lucky women who don’t experience any of this until much later…and their symptoms are mild or non-existent. That’s normal too.

      Is It PMS or Perimenopause?

      Many of the symptoms of PMS overlap with perimenopause. In both cases, hormonal swings are the culprit. The difference is that PMS happens during the second half of your cycle. Perimenopause symptoms can happen at any time. Keeping a journal of your symptoms may help you sort this out if you’re not sure what’s going on.

      How Can I know for Sure if I’m in Perimenopause?

      The short answer is…you can’t. Lab tests in perimenopause can be unreliable because your hormones are bouncing around constantly on any given day. A lab test only gives a snapshot of what’s going on, and results can vary depending on the timing of the test. Many a woman has been dismissed with “your lab tests are normal” when she is, in fact, in perimenopause. You know your body better than anyone, so don’t settle for this if you feel like something is off.

      If you do have blood tests, your doctor will most likely test your FSH (and maybe your estrogen or progesterone levels). The closer your FSH is to 50, the closer you are to menopause.

      It’s a Hormone Problem, not a Prozac® Deficiency

      It’s important to recognize what’s going on because many a woman has ended up on antidepressants or sleeping pills because she (and her healthcare provider) did not recognize that these problems were related to a HORMONE IMBALANCE and not true depression. Antidepressants won’t fix the root cause of the problem.

      Misbehaving hormones can often be corrected with lifestyle, herbal and nutritional supplements. In some cases, hormone replacement may be necessary, but that’s not usually the place to start. The first step is to get tested to see what your imbalance is. This is important because signs of imbalance overlap. Low progesterone can look like low thyroid; high cortisol can look like low progesterone, etc.

      What If That Doesn’t Work?

      If changes in lifestyle don’t help, then it may be time to test your sex hormone levels and your cortisol levels. High cortisol levels can keep the rest of the musicians in your body’s orchestra from playing their best, so it’s important to have a picture of how you handle stress and address that first. Testing can be done with saliva, blood or urine (there are plusses and minuses for each method). Knowing your specific imbalances allows your hormone care provider to create a unique management plan for you.

      Dr. Anna Garrett
      Why You Can’t Diet and Exercise Past a Hormone Imbalance
      Healthy Living
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      One of the most common complaints I hear from clients (and most women in midlife for that matter) is that they can’t lose weight no matter how much they diet and exercise. This is incredibly frustrating!

      The thing is, it may not have anything to do with what you’re doing or not doing.

      It may be your hormones.

      Any and all hormonal imbalances lead to difficulty losing weight and an increased risk of obesity. Unfortunately, the most common imbalances can’t be solved by dieting alone. In fact,they can prevent successful fat loss even when great diet and exercise plans are in place. If you haven’t been successful in the past, chances are, one or more the following hormonal imbalances could be the problem:

      1. Inflammation

      Digestive disorders, allergies, autoimmune disease, arthritis, asthma, eczema, acne, abdominal fat, headaches, depression or sinus disorders are ALL associated with chronic inflammation, which has become recognized as the root cause of obesity and most diseases associated with aging.

      Inflammation causes production of cortisol which is associated with that muffin top you just can’t lose.

      2. Insulin excess

      Insulin’s main function is to process carbohydrates in the bloodstream and carry it into cells to be used as fuel or stored as fat. There are several reasons for excess insulin, but the main culprits are: stress, consuming too many nutrient-poor carbohydrates (the type found in processed foods, sugary drinks and sodas, packaged low-fat foods and artificial sweeteners), insufficient protein intake, inadequate fat intake, and low fiber consumption.

      Heart palpitations, sweating, poor concentration, weakness, anxiety, fogginess, fatigue, irritability or impaired thinking are common short-term side effects of high insulin. And our body typically responds to these unpleasant feelings by making us think we’re hungry, which causes us to reach for high-sugar foods and drinks. It’s a vicious cycle which only furthers weight gain and our risk of diabetes and heart disease.

      Click here to learn more about insulin and weight gain.

      3. Depression or anxiety

      Serotonin exerts a powerful influence over our mood, emotions, memory, cravings (especially for carbohydrates), self-esteem, pain tolerance, sleep habits, appetite, digestion and body temperature regulation. When we’re depressed or down, we naturally crave more sugars and starches to stimulate the production of serotonin. And then we become more depressed because we’re gaining weight. The stress of this creates more cortisol which creates more cravings!

      4. Chronic stress

      Under situations of chronic stress – whether the stress is physical, emotional, mental or environmental, real or imagined – our bodies release high amounts of the hormone cortisol. If you have a mood disorder like anxiety, depression, post-traumatic stress disorder or exhaustion, or if you have a digestive issue such as irritable bowel syndrome, you can bet your body is cranking up your cortisol…even if you don’t FEEL stressed.

      Through a complicated network of hormonal interactions, prolonged stress results in a raging appetite, metabolic decline, belly fat and a loss of hard-won, metabolically active muscle tissue. In other words, stress makes us soft, flabby and much older than we truly are! And it wears out our poor little adrenal glands, resulting in adrenal fatigue.

      Click here to find out if your adrenals are fine or frazzled.

      5. High levels of estrogen

      Researchers have identified excess estrogen (in both sexes) to be as great a risk factor for obesity as poor eating habits and lack of exercise.

      There are two ways to accumulate excess estrogen in the body: we either produce too much of it on our own or acquire it from our environment or diet. We’re constantly exposed to estrogen-like compounds in foods that contain toxic pesticides, herbicides and growth hormones. A premenopausal woman with estrogen dominance will likely have PMS, too much body fat around the hips and difficulty losing weight.

      Menopausal women and men with too much estrogen may experience low libido, memory loss, poor motivation, depression, loss of muscle mass and increased belly fat.

      To compound all of this, fat cells MAKE estrogen…so the more fat you have, the higher your estrogen is likely to be.

      6. Low testosterone

      Testosterone enhances libido, bone density, muscle mass, strength, motivation, memory, fat burning and skin tone in both men and women. When testosterone is low, an increase of body fat and loss of muscle may still happen – even with dieting and exercise.

      Testosterone levels tend to taper off with age, increased obesity and stress, but today men are experiencing testosterone decline much earlier in life – an alarming finding, considering low testosterone has been linked to depression, obesity, osteoporosis, heart disease and even death.

      Endocrine-suppressing, estrogen-like compounds used in pesticides and other farming chemicals may be to blame for the downward trend in male testosterone levels. Phthalates, commonly found in cosmetics, soaps and most plastics are another known cause of testosterone suppression.

      7. Hypothyroidism

      Without enough thyroid hormone, every system in the body slows down. People who suffer from hypothyroidism feel tired, tend to sleep a lot, and experience constipation and weight gain. Other common symptoms include extremely dry skin, hair loss, feeling cold, brittle hair, splitting nails, and decreased libido.

      If you think you may have a thyroid condition, make sure your doctor assesses you and your full range of symptoms, not just your blood work. Even levels of TSH (an indicator of thyroid function) within the normal range have been proven to accelerate weight gain and to interfere with a healthy metabolic rate in both men and women.

      Click here to find out more about thyroid’s effects on weight.

      If you’d like to know more about the complexities of weight gain in midlife, please join me TONIGHT for Cracking the Midlife Weight Loss Code: Your 3-Step Plan to Stop the Yo-Yo FOREVER! You can find all the details right here.


      Dr. Anna Garrett
      Menopause Myth-Busting 101: The Top 5 Debunked
      Healthy Living
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      Myth #1: Menopause begins at 50

      The average age of menopause is 52…but there’s a huge spectrum of experiences out there. Some women sail through with nary a hot flash. But others begin having symptoms like weight gain, irritability, fatigue, anxiety and insomnia in their mid-30’s. And perimenopausal symptoms can last for more than 10 years!

      That’s why it’s critical to pay attention to your body. If you start feeling like aliens have abducted you, consider the possibility that hormone shifts are beginning.

      Perimenopause can last from a few months to up to 13 years prior to menopause. Some women experience more symptoms during perimenopause than during menopause itself. This is because your sex hormones, estrogen, progesterone, and testosterone naturally fluctuate more during this time. And these hormones are very sensitive to abnormal adrenal function which occurs with ongoing stress.

      And remember, suffering is optional! Hormone testing can help identify imbalances and a large percentage of women can be helped with lifestyle changes and supplements.

      Myth #2: Weight gain is inevitable in menopause

      Weight gain is very common in menopause because hormonal shifts make weight loss more complex. It’s no longer as simple as “calories in, calories out.”

      As you transition into perimenopause and menopause, your ovaries make fewer sex hormones, and your body may respond by trying to protect itself. Its preferred method of protection is to store fat, especially around the waist, hips, and thighs. Fat stored in these areas also produces more estrogen, which in turn, leads to more weight gain. Add stress to the mix with higher cortisol production and it’s a recipe for weight gain around the waist.

      Despite these changes, you can still achieve a healthy weight. One of the best things you can do to help yourself is eat! If your first reaction to weight gain is to cut back calories, think again. That throws your body into stress mode and cortisol kicks in. Excellent nutrition and lowered carbohydrates help women balance their hormones and gradually return to their natural weight. One of my recent Lose Fat over 40 clients lost 32 lbs in 12 weeks by working with me to get her hormones balanced and eating a low glycemic index diet.

      Myth #3: There’s no difference between natural menopause and “surgical” menopause

      If you’ve had a hysterectomy, you probably know this is UNTRUE. A hysterectomy creates hormone imbalance overnight instead of over months or years. This is very hard on your body.

      Even if your ovaries are left intact, there’s likely disruption of the blood supply to them which will keep them from fully functioning. Changes may be less severe when you keep your ovaries, but they are unpredictable. Many women need estrogen, progesterone and testosterone replacement to feel their best after a hysterectomy.

      And don’t let your doctor tell you that you don’t need progesterone. You have progesterone receptors all over your body (not just in your uterus). They need love too.

      Myth #4: Sex is a thing of the past after menopause

      Sex can be enjoyable and healthy at any age. But I hear from women that they’ve been told that a decrease in sex drive is a “normal” part of aging. Decreased interest in sexual activity is often a sign of hormonal imbalance, which can cause both physical and emotional symptoms that have an effect on your sex life.

      Approximately 50% of post-menopausal women will experience vaginal dryness which can make sex painful. This can be helped greatly by using an estrogen vaginal cream (you’ll need a prescription.)

      Myth #5: The first sign of menopause is hot flashes

      There are approximately 34 symptoms of perimenopause…any of which could be your first sign that your hormones are shifting. Common ones include:

      • Fatigue
      • Anxiety
      • Irregular periods
      • Irritability
      • Mood swings
      • Depression
      • Anxiety
      • Weight gain
      • Hair loss
      • Cravings
      • Fuzzy thinking
      • Low libido
      • Forgetfulness
      • Heavy periods

      With such a wide variety of symptoms, it’s no wonder that many of us don’t connect these to a perimenopausal hormonal imbalance. I hear from women all the time who are desperate to find out what’s going on with their bodies. And it’s always a relief for them to learn that what they are experiencing is normal!

      If you’re looking for relief, let’s talk. There’s so much misinformation out there and having someone to guide you through this transition can be helpful and comforting.