Hormones and Guilt

I was blessed to get a great price on a weekend cruise from San Diego to Cabo San Lucas. I decided to take my daughter, who is a single mother of three and under a lot of stress, and went with two other friends. We had a great time, so good, in fact, that at times I felt guilty that I hadn't been able to bring all of my children on the cruise. No matter that I couldn't have afforded it, no matter that they were all busy and it probably wasn't a good time for them anyway, no matter that they were all happy I was able to have a good time and that I was able to share it with Tina. The guilt was there anyway.


Yesterday my son invited me to his son's pack meeting that evening to see him receive an award. I got out of work late and was exhausted. It took at least 40 minutes to get to their house if there was no traffic. It takes me an hour and a half to get home from their house. I decided to go home and take care of myself, but immediately felt guilty. No matter that I would probably be late and miss the awards anyway. No matter that I had that same grandson over the weekend before to spend two nights for his birthday. I felt the guilt anyway.

Many of us women, and some men, though studies show it is much higher in women, tend to feel that we have to be all things to all people, that we have to do everything well, that we should sacrifice ourself for the benefit of others. And we feel guilty when we can't do it all, which is almost all of the time.

One of the things many women are feeling guilty about right now is the use of hormone replacement therapy (HRT) for their menopausal symptoms. For years women have been told that taking estrogen after menopause will help them, not only with relieving hot flashes and other menopausal symptoms, but that it will reduce osteoporosis, heart disease, and even help them keep their youth. They did discover that using only estrogen (in the form of horse estrogens) increased the incidence of uterine cancer, so they invented progestins (a man-made chemical that attaches to progesterone receptors) which, when taken with the estrogen, stopped that risk. Though some women had unpleasant side effects, most women felt much better on hormones, especially in relation to stopping hot flashes, reducing vaginal dryness, and especially assisting in regulating mood swings.

As discussed in the previous blog, in the last few years new studies have come out that show that taking estrogens (in the form of horse estrogen) and progestins increases the risk of breast cancer, heart disease, blood clots, dementia and stroke. Many doctors stopped prescribing hormones, and women were left to go through their menopausal symptoms without relief, feeling guilty that they had risked their health by taking them so long, but secretly wishing they could go back on. Others, who continued to take the hormones "because I would rather die of breast cancer than go crazy" now feel guilty for taking them.

These studies have been heavily scrutinized over the last 5 or so years, and at the American Society of Reproductive Medicine in Jan. 2008, guidelines were given on the use of HRT. According to this algorithm, HRT should primarily be offered to treat hot flashes. HRT should be recommended for those who are at low risk for cardiovascular disease and are within 5 years after menopause. HRT should not be the first choice when someone is 10 or more years past menopause. Transdermal estrogen (no first-pass effect, therefore less clotting effect) is the preferred delivery route. Treatment should be started with the lowest effective dose and preferably should last less than 5 years.

The problem with this is that this is just putting off the agony. It has been shown in studies that when HRT is discontinued, the symptoms return. So a woman may use HRT to reduce her symptoms for up to 5 years after menopause starts, but then she'll have to suffer with them.

There are other options to assist with the symptoms of menopause other than horse estrogens and progestins. Bioidentical hormones have been hugely promoted since Suzanne Summers recommended them in a recent book. Bioidentical hormones are natural hormonal preparations extracted from plants (for example, soy, or wild or Mexican Yam). They are called bioidentical because the molecules are identical to the molecules found in the human body, unlike the horse estrogens. They can be customized; women can tailor the dose to the severity of their symptoms. Bioidentical estradiol, estrone, estiol, progesterone, testosterone, DHEA and pregnenolone are all available and can be delivered by various routes such as tablet, cream, transdermal, sublingual, etc. They are often made into custom compounds by compounding pharmacists as prescribed by a physician. Many women have had great symptomatic improvement using bioidentical hormones.

However, these compounds have recently been criticized by the FDA and the medical community. Their complaints are that they do not have government approval because individually mixed formulations have not been tested to prove that they are absorbed appropriately or provide predictable levels in blood and tissue. Moreover, there is little scientific evidence concerning the effects of these hormones, and as the preparation methods vary from one pharmacist to another, and from one pharmacy to another, patients may not receive consistent amounts of medication.

The FDA admitted that no adverse event involving bioidentical estriol, the estrogen that is most prevalent in the commonly prescribed "Tri-Est," has ever been reported. In fact, a research study involving 15,000 women found that women who produced the most estriol during their first pregnancy had 58% less breast cancer over the next 40 years.

There have been studies on bioidentical hormones which show that they seem to have protective effects in that they do not increase cancer or cardiovascular risk, but the large studies which were done on the horse estrogens (Premarin), and progestins (Provera) or their mixture (Prempro), have not been done on the bioidentical hormones, so there is not unequivical proof that these compounds are safer.

Also, transdermal progesterone alone, without estrogen, long touted as protective against osteoporosis, has been shown in recent studies that, although it slightly slows the reduction in bone mass after menopause, it does not stop it.

However, if your menopausal symptoms are severe, and you are considering using HRT anyway, I believe that the use of hormones that are identical to your own is likely safer than using horse estrogens which are up to 1,000 stronger, or synthetic hormone-like substances that are unfamiliar to the body. Maybe this will help reduce your guilt :-) However, it is important to find a physician who is knowledgable in the testing and use of these products.

To read the compounding pharmacists concerns related to the new FDA rulings on bioidentical hormones go to http://www.iacprx.org/.

There are also special tests that can test the metabolites of estrogen in your body. There are some metabolites that increase the risk of cancer and others that decrease the risk. This test will show how you break down the estrogen and if you're at higher risk. Even if you don't get the test, some of the things you can do to change your metabolites to the healthier type are: eat more cruciferous vegetables (broccoli, cauliflower, cabbage, brussel sprouts, etc.), take fish oil, eat ground flax seed, lose weight, exercise, eat soy. One study showed that mice who were bred to always get breast cancer didn't get breast cancer when they were fed fish or flax oil.

Other methods that may reduce your symptoms include plant based phytohormones. Soy is especially high in phytohormones, which attach to the hormone receptors in the body and help reduce symptoms. However, be aware that there is some evidence that soy may reduce thyroid function in some people if used over a long period of time. The herbs black cohosh, dong quai (Angelica sinensis), chaste berry (Vitex agnus-castus) and red raspberry leaves can also have hormonal effects. Acupuncture and Chinese herbs can be quite effective for some women. Homeopathic medicines can be useful. Though there is not one medicine to one disease in homeopathy, the most common menopausal remedies for hot flashes are Sepia and Lachesis. Supplements that have been shown to help are Vitamin E, Evening Primrose Oil, and Omega 3 oils. I will have another blog discussing osteoporosis later.

This is the end of my menopausal blogging at this time. Make sure, if you have any questions, to click on comments below and ask them!

"Finding Joy"

Assignment Four: Use remorse and let go of guilt. Remorse is a godly sorrow that brings us to strive to change ourselves and make amends. It lifts us, and allows us to feel better. Guilt is causes us to continually punish and belittle ourselves, but does not bring about change. Many people believe they have to hold onto guilt or they won't ever be better, but in reality it is BECAUSE they hold onto guilt that they don't ever get better. Holding guilt causes us constantly focus on the negative. What we focus on is what we attract to ourselves. It causes us to lose faith in ourselves, in others, and in God. Remorse allows us to build faith.

1. If you really have done something that has wronged someone, remorse assists in correcting it. There is often a feeling of "I feel badly that I did this. How can I make it better?" Ask yourself why you did it. If you can't figure that out, talk to someone or get professional assistance to discover your hidden motives for that type of behavior. Then make amends--to that person or people, to God, to yourself. Acknowledge what you have learned. Then LET IT GO! If you continue to hold onto the pain of what you have done, it becomes guilt. If you do it again, go through the same process again, and then LET IT GO!
2. Recognize the need to please. My guilt concerning my grandson was my need to please all people at all times. However, I am only human, and this simply is not possible.
3. Recognize your own needs. Often we sacrifice our own needs to the needs of others so often that we fail to even realize when we are going beyond our capabilities. Then we crash, either emotionally or physically.
4. Find time to nurture yourself. We are not required to run faster than we are able. It is important for us to recognize our limitations and take care of ourselves.
5. Create a win-win. Recognize when you truly need to nurture yourself. If you are like most of us, there will be demands on your time which may tempt you to sacrifice your needs for someone else. Often you can create an alternative which will satisfy both needs, though maybe not in the expected way. In this case, I will be seeing this grandson in a few days. I will have him tell me all about his experience in receiving this award, and be a part of it in that way. There may be other times when you choose to do this other thing. Then make it a point to make another time to nurture yourself, and KEEP YOUR PROMISES TO YOURSELF!
6. Be kind to yourself. We often treat ourselves more harshly that we do others. We call ourselves names and punish ourselves for little things. Our thoughts about ourselves are constantly negative, and we often don't feel that we deserve to do anything to nurture ourselves. Treat yourself as kindly as you treat others, and you will find yourself treating others even better!
7. Recognize the difference between selfishness and being self-loving. They are not the same thing! Selfishness is not wanting to give to others, or giving to self without any thought or care about the effect on others. Being self-loving is taking care of yourself so that you have the energy and ability to give to others. WE CANNOT GIVE WHAT WE DO NOT HAVE!

Until we meet again,
Dr. Judi

Hormonal Changes in The Change of Life

A new granddaughter entered my life last week, December Lynne Moore. I am so excited to have this new addition to our family; out of 17 grandchildren she is only the fourth girl.

My son and daughter-in-law already have 3 little boys age 5 and under; a new daughter will certainly change the dynamics of their family! Derrick, the oldest, is the little helper, and is doing what he can to help Mommy and his baby sister, and he asks frequently to hold her. Skyler at first didn't even want to see his sister. He's not sure about this new addition to the family that is taking Mommy's attention and he would rather ignore her. Collin, just two, has always had separation anxiety when either of his parents leave. As long as Mommy or Daddy stay with him, he seems ok having this toy baby around. But life has changed for all of them, and there is nothing any of them can do to change it back to the way it was before.

I've been without hot water for a week and a half. Something is wrong with the hot water heater. There were some problems so they couldn't get the part up until Friday. Then the part didn't work. They said they wouldn't be back until Monday. No matter how many calls I made, I couldn't get anyone to come up on Saturday. I'm still without hot water and I can't change it.

So many things happen in our lives, in our relationships, with our health, that no matter what we may do, we can't change. Things are out of our hands; we have no control over them. Going through "the change of life," or menopause, is one of them. We can't control the fact that our bodies are changing. But there are things we can do to make those changes easier to deal with.

As I said in the last blog, menopause is defined as that point in time when our periods stop permanently. Hormonal changes begin to occur before the actual menopause, and this period is called perimenopause, and may last from two to eight years.

Contrary to popular opinion, estrogen levels often remain relatively stable during perimenopause. They usually don't decrease until less than a year before the last menstrual period. During the menstrual years, the primary strong estrogen that the body produces is estradiol. During perimenopause, the primary strong estrogen changes to estrone, produced both in the ovaries and in the body fat. Estriol is another estrogen that is produced in fairly large amounts, but has a weaker affect on uterine and breast tissue. Estriol is the primary estrogen produced during pregnancy.

Testosterone levels usually do not fall during perimenopause unless there is excessive stress in a woman's life, at which time DHEA (precursor to testosterone) levels may fall, leading to less testosterone.

On the other hand, progesterone levels do begin to fall in perimenopause, often long before changes in estrogen or testosterone. This will often cause changes in the length, duration or heaviness of the periods, and is actually the most significant issue for many perimenopausal women.

All though reproduction is usually no longer an important goal during perimenopause, the "reproductive" hormones continue to play vital, health-enhancing roles in the body, evidenced by the fact that there are hormone receptors found in almost every organ of our bodies.

Among many other roles, estrogen, androgens (like testosterone and DHEA), and progesterone are important in maintaining strong and healthy bones and muscles and resilient vaginal and urethral tissue. Both estrogen and progesterone are important for maintaining a healthy collagen layer in the skin.

Progesterone is necessary for the body to make cortisol, the hormone that deals with physical and emotional stress, cortisone, the body's own anti-inflammatory, and aldosterone, which helps regulate fluid levels in the body.

Because the risk of heart attacks is much lower in women than in men until menopause, it has long been felt that these hormones played an important role in preventing heart disease.

Because of these reasons, for years women have been told that hormone replacement therapy (HRT) was the best thing for them as they reached the menopausal years, with the belief and sometimes evidence that there was positive effects on menopausal symptoms, cardiovascular disease, osteoporosis, vaginal and urinary symptoms, Alzheimer's disease, and possibly aging itself.

However, recent studies have discounted some of these effects. Most of these recent studies have used a combination of horse estrogens and synthetic progestins, (brand names Premarin, Provera, and Prempro). Premarin is made from estrogens from pregnant mare's urine. The principle horse estrogen in Premarin is called equilin, which is not found in humans. Equilin's effects on the lining of the uterus are up to 1,000 times stronger than the effects of human estrogen, and it also has much strnger effects on breast tissue.

Provera is a synthetic molecule that is similar to progesterone but not similar enough to call it progesterone. The molecule is called a progestin, meaning that it attaches to the progesterone receptors in the body and has a few progesterone-like effects. Studies have shown Provera to increase the risk of heart attacks, and it has several unpleasant side effects.

It has been shown that combination HRT with these "un-human" hormones seems to increase the risk of breast cancer, blood clots, stroke, and heart attacks. This has many women wondering how to deal with the symptoms of menopause and how to treat osteoporosis if they choose to not use or discontinue HRT.

It is important to remember that menopause is a natural process for the female body, and not a disease. Many women experience the cessation of their periods without any symptoms, receiving no treatment, and go on to live long, healthy and productive lives. Hormones continue to be produced (though in smaller amounts) in the ovaries, and may also be produced by the adreanl glands, body fat, liver, breast tissue, pineal gland and even hair follicles!

Whether or not a woman experiences symptoms during perimenopause and menopause depends on numerous factors, including but not limited to overall physical health, emotional and spiritual well-being, nutritional status, lifestyle and diet, how stress is dealt with, and genetics.

We will continue the discussion of hormone replacement therapy in the next blog, and talk about "bio-identical" hormones.

"Finding Joy"

Assignment Three: When difficult things or people seem impossible to change and life seems out of control, remember three things:

1. There are always an infinite number of possibilities.
2. Act, don't react.
3. I can always change my attitude.

I used to believe that when I came to a stuck place that I didn't seem to be able to change, I would only have one or two choices to make, and often neither of them would work. Then I learned from my friend, Hans, that in actuality there are always an infinite number of possibilities to work through problems. A simple example: I wake up to find my car won't start. I have a very important meeting at work. Living alone with no one else to drive me, the only choice appears to be that I will have to call someone to come fix the car and be late and miss the meeting. I'm stuck. I can't change the fact that my car doesn't work.

But if the meeting is that important to me, I can now put on my thinking cap and brainstorm. I think of every possible way I could get to work, whether they are practical or not. I could ride my bike, call a friend to take me, call a taxi, ask the repair place to take me, rent a car, call a co-worker to get me; or possibly I could call my work and rearrange the time of the meeting. or do the meeting over the phone on a conference call while the car is getting fixed, etc. etc. When I start to think of all the possibilities, suddenly the "unchangable" becomes possible.

When something seemingly bad happens that I can't change, I can either react to the situation with anger, frustration and fear, or act to resolve it or accept it. When I found out I wasn't going to have hot water for another four days, I reacted for a moment with anger. Then I decided to let the anger go and work on resolving it by finding another plumber. When I couldn't find a plumber to come on a Saturday, I started reacting with frustration. I decided to let it go and imagined myself as a pioneer heating my water for washing and bathing.

Then I began to see how very blessed I was, because unlike the pioneers, I didn't have to go out in the snow to the well for water. I didn't have to haul all the water into the house in buckets. I didn't have to chop the wood and build a fire to heat the water on. And I knew that this was going to end in four days. And my attitude about the situation changed, so I didn't have to hold onto the anger and frustration. Gratitude is the best attitude adjustment there is!!

Until we meet again,

Dr. Judi

Menopause and Letting Go

We have two dogs at our house. Bruce, pictured here sharing his food with a friend, loves playing "fetch" more than anything in the world. He will bring a stick, a ball, a piece of plastic, anything he can find, and lay it at your feet and implore you with his eyes to pick it up and throw it. Once you do, he'll never leave you alone. Playing "fetch" 24 hours a day would be his idea of heaven.



"Fetch" requires several things of a dog. First, they have to chase after and find whatever is being thrown. Next, they have to bring it back to the thrower. Third, they have to let it go so the thrower can throw again.



Now Zeke also loves playing "fetch," but he lacks one of the skills necessary for a good game. He and Bruce will compete in this game, seeing who can get to the stick first. When Zeke gets it first, Bruce becomes very agitated, because he knows the game has ended. Because Zeke hasn't learned how to let go. He chases, fetches, brings it back, and then holds onto it. Letting go is too scary for him. He might lose it to Bruce if he lets go. But because he won't let go, the game and the fun ends.



Letting go is an integral part of life, even in nature. Clouds become so filled with water they have to let go of it. That water feeds the spring-time trees, allowing the leaves to bud and flowers to blossom. The flowers let go of their petals to turn into fruit, the trees let go of the fruit so they can bear more in the future. Then they let go of their leaves so that they can have a period of rest. Letting go is part of the cycle of life.



Our hands are so miraculous. There are a multitude of tasks, way too numerous to mention, that our hands can accomplish. But think what would happen if our hands could pick something up, but couldn't let it go. We would be stuck. When we refuse to let go of things in our lives, we become stuck. The game ends.



Menopause is a time time of letting go. We women get to let go of the cycles of our physical creative powers. This is a time when we also may need to let go of the image we have created about ourselves. Generally, around the time of menopause, our lives as well as our bodies are also changing. "The Change" is often not understated!



This may be the time frame when many of us are also letting go of one of the most important roles we have played, that of mother. Children are leaving the home; they don't need us in the same way anymore; they don't want our advice; their energies are on their studies, their jobs, their relationships, their own new families. We may find ourselves alone more. We may have to redefine ourselves as life shifts around us. We may begin to see, whether we have children or not, that the expectations we had out of life, out of our relationships, or even out of ourselves, are not coming to fruition. We may find ourselves letting go of these long-held expectations.



One of the changes most of us rejoice in is the letting go of the monthly bleeding. Menopause is defined as the time when there has been no menstrual periods for 12 consecutive months and no other biological or physiological cause can be identified. It is the end of fertility, the end of the childbearing years. Unlike men, who produce sperm "on the spot," so to say, women are born with a certain number of eggs in their ovaries. As the eggs begin to "run out," the hormone levels naturally begin to drop, causing the changes present in "perimenopause."



Perimenopause is a period of time before actual menopause, which begins about 6 years before the natural menopause. This is a time when the levels of hormones produced by the aging ovaries fluctuate, leading to irregular menstrual patterns (irregularity in the length of the period, the time between periods, and the level of flow) and hot flashes (a sudden warm feeling with blushing). Other changes associated with the perimenopause and menopause include night sweats, mood swings, vaginal dryness, fluctuations in sexual desire (libido), forgetfulness, trouble sleeping and fatigue. Except for the bleeding, many symptoms can carry over into the menopausal period for a time.



Natural menopause occurs when the ovaries naturally begin decreasing their production of the sex hormones estrogen and progesterone. Induced menopause occurs if the ovaries are surgically removed or damaged by radiation or drugs. Due to the abrupt cutoff of ovarian hormones, induced menopause may cause the sudden onset of hot flashes and other menopause-related symptoms. A "simple" hysterectomy (when the uterus but not the ovaries are removed) before natural menopause should not affect the production of sex hormones and so not cause menopause (unless the nerves or blood supply to the ovaries is damaged during the hysterectomy), though, of course, there will be cessation of bleeding.


In the western world the average age for menopause is now 51. Natural menopause can, however, be in a woman's 30s or 60s. Factors influencing the time of menopause include heredity (genetics) and cigarette smoking. Smokers (and former smokers) reach menopause an average of 2 years before women who have never smoked. High levels of physical and/or emotional stress can also cause menopause to start earlier. High levels of stress may also stop a woman's bleeding cycles even if she is not menopausal, so it is important to test any early cessation of bleeding.


There is no relation between the time of a woman's first period and her age at menopause. The age at menopause is not influenced by a woman's race, height, number of children or use of oral contraceptives.



Usually the symptoms and cessations of periods are adequate to "diagnose" menopause, but if there are questions, usually a blood test measuring the follicle stimulating hormone (FSH) and the luteinizing hormone (LH) is done. These levels become very high when the estrogen and progesterone levels drop.



On the next blog, we will discuss the pros and cons of hormone replacement therapy, both traditional and bio-identical.



"Finding Joy"

Assignment Two: identify the stuck places in your life and determine what is important to let go of in order to move forward. These may be in the areas of health, relationships, spirituality, jobs, home, etc.

Some of the things I've had to let go of:

• the expectation of having someone always there to take care of me; I've found joy in being independent.


• the expectations I've placed on some of my children; I am learning how to love at new levels, how to love and respect my children and all of my relationships exactly how they are.


• the idea of being really thin again; after bearing six children, I appreciate and love my body the way it is and work to maintain it in the best health possible.


• the belief that my children want my advice on how they raise their children; I've come to the realization that God gave their children to them and not to me for a purpose:-)


• the belief that I have to sleep 8 hours night in order to function; before I let go of this belief I was tired all of the time. When I chose to let go of it, I found that I can function fine even if my menopausal body doesn't give me 8 hours of uninterrupted sleep.


• the belief that I have to be spiritually fed by others; I found that my spirituality comes from within, and all life and every event can be an opportunity for spiritual growth.


• the belief that I need other's approval and love to be good enough and to be happy; I now realize that my worth and my happiness depend solely on me.

Until we meet again,

Dr. Judi

Snowstorms and Menopause

The snow keeps coming. Over a foot last night and it's still coming. This is my deck. It was completely cleared 3 weeks ago. I spend hours shoveling my driveway so I can get out of my garage and down the mountain, and overnight all my work seems in vain.




























3 weeks ago we had a mini avalanche. Over two feet of snow suddenly fell off of the roof of our garage and fell on the arbor between the house and garage. The arbor wasn't strong enough, and crashed. The mess is so big we'll have to wait until the spring thaw to remove it. The snow continues to pile on top of it. This picture is Bruce, this morning, surveying the view from our porch. The garage is peeking over the pile of snow and logs.






I chose to live here. I've always loved the mountains; I've always loved the snow. I love my mountain cabin, and feel a great peace when I am here. Last winter it snowed a lot, and I thought, I can do this! Of course, the neighbors warned me that it was a mild winter. Now I see what they mean! This winter has brought more snow than has been seen in years, and there are many moments when I feel overwhelmed. I shoveled for hours this week, and it snowed more. My son came and helped shovel the driveway yesterday; today it needs it all over again. At times I wonder if I really knew what I was getting into when I moved up here. At times I wonder if I'll make it through the winter. At times I want to just hide in bed and let the snowstorm envelope me and not have to go to work. Then, the snow stops, I dig myself out once more, muttering, complaining, but when all is done, I feel very pleased with myself. I conquered again! And I love it here.



How often has my life been like this winter? I struggle and overcome something, just to get slammed all over again. I struggle and get out of that, and pow! something else comes along. I often feel overwhelmed. I thought I overcame that weakness, and then today I'm dealing with it all over again. At times I wonder if I knew what I was getting into when I chose to come to this planet. At times I wonder if I'll make it through this life. Then, the current storm subsides, I dig myself out once again, muttering, complaining, but when this crisis is passed, I feel very pleased with myself. I conquered again! And I love this grand adventure called life.



To many women, menopause is one of the snowstorms of life. To some the storm is light and the snow melts quickly. To others it is a major blizzard, and they feel like they will never dig out of it, that they will never be rescued from being stranded in the deep snows. Their physical symptoms: hot flashes, night sweats, racing heart, difficulty sleeping, dryness, difficulty losing weight, poor memory, etc. are bad enough. Coupled with the emotional mood swings, irritability, increased anxiety and/or depression, we may wonder why we were assigned to this miserable state of womanhood.



This is the first in a series of blogs I will be writing about menopause. Today I am talking about the emotional issues that often accompany the peri-menopause and menopausal time period. I'll get into the definitions and physical problems and treatments later.



As we go through menopause, the changing hormonal patterns actually change the physical brain and the brainwave patterns. Issues that we could deal with before now may really bother us. The way we could memorize and our thought processes and ability to focus may seem to be more difficult. But in reality, it is simply different, and it all seems hard because we are not used to this new pattern.



I compare the cycles in a woman's life to the tide of an ocean. When the tide is in (the hormones are in balance) we can handle life. We are floating. We feel on top of things. As the tide goes out (pre-menstrual period), we may get stuck in the crashing waves. Or we are tripping over the rocks and shells on the bottom of the ocean that didn't bother us before. As we start into menopause, the tide stays out longer and longer, until it is permanently out, and we may find ourselves surrounded by the rocks and shells of life that we can no longer float over. Life becomes hard. Everything bothers us. We can't hold in our anger, our frustrations. We feel guilty for not being that "I'm going to please everyone" person anymore. The snowstorms don't quit. We feel overwhelmed. We don't know how to dig out of the deep snow and move forward again.



This is when many women seek help. They go on hormone replacement therapy, they take anti-depressants, anti-anxiety medicines, sleeping pills. Sometimes these work beautifully for a while. Sometimes they don't.



But, if we choose, this snowstorm can allow for great growth, can become a blessing, can assist us into becoming wise women, wise grandmothers of the world that can affect such great change just by being who we are. I view the medicines as a great band-aid, something to help stop the bleeding while we work through the issues we are faced with. For now is the time when we are forced to look at each rock and shell, to determine which ones work for us, which ones we want to keep and make a rock garden out of, or to create a shell wreath with, or to line our path, and which rocks and shells we want to throw out. This is the time when we are forced to learn to swim as the waves are crashing over us so that we don't drown. This is the time when we can come into our own, learn who we really are for ourselves rather than being someone's wife or mother or sister or daughter or employee. This is the time when we can learn to BE WHO WE REALLY ARE.



This can all be very scary. Many of us have carried the belief that without our children, our spouse, our job, without being able to keep the house spotless, our bodies in shape, our neighbors cared for, and everyone around us in control, we are worthless. It is seemingly impossible to see ourselves as having any personal inherent worth at all. Our worth has always been in our relationships and how we serve them. But suddenly we resent all of that. The harder we try the more we seem to fail. Things don't work the way they used to. We often feel taken for granted, isolated, without emotional intimacy. We fear that if we find the Real Me inside we may not like it.



But the truth is, that part of us that is truly ME and not defined in relationship to someone else, not defined by what I do, that part of ME that I believe is connected to God, that part is inherently beautiful, loving, and wise. If we connect to that true inner self, rather than having to try to be better, we are naturally better. As we come more into alignment with our true selves instead of identifying with our ego mind that tells us we are never good enough, the more our gifts shine through and our weaknesses become less evident.



How do we shed the rocks and shells of our lives? How do we dig out of the snowstorm of changing hormones and changing brains? It is not a simple process, but it is very possible to be what we desire to be. For the next while, at the end of each blog I will put an assignment for "Finding Joy." We will do it together, because advise is easily given, but not as easily followed. I need them as much as anyone. These steps can be used by anyone facing a snowstorm of life, a difficult menopausal period being one of them.



"Finding Joy"



Assignment One: Count your successes and be excited about them



At the end of each day, I choose to take a moment to review what didn't work that day. If there was anything that I did during the day that was unlike love--any anger, fear, judgment, negative thoughts about myself or anyone else, I choose to ask for forgiveness and the strength to work on that aspect of my life again. But I choose not to dwell on these things, on my weaknesses. When this is complete, I choose to review what did work during the day. I choose to count my successes, what went well during the day. I choose to focus on these things rather than on my weaknesses and pains of life.



Sometimes simply getting out of bed is a success. I may not have gotten the dishes done but I did get the sink cleaned out, and that clean sink is beautiful! I may have gotten angry at a loved one, but I apologized, not for communicating my feelings, which is important, but for doing it in anger and defensiveness, which never can communicate love. I am pleased that I was able to admit my mistake and work through the issue. I may not have had anyone tell me they loved me, but I told myself that I loved me, in spite of my weaknesses, and I'm pleased about that I could do that, even when I didn't totally believe it. I may have had some negative thoughts about myself, but I did think that I did a pretty good job with that one assignment. I choose to focus on that.



I choose to focus on the positive, the successes, the gifts, the good things people do for me or say to me, the beauty in the world surrounding me, rather than on my and others' weaknesses, and the hard things that are happening.



This morning I was in fear that with the snow continuing the way it was I wouldn't be able to get to work tomorrow. I worried about what would happen to my patients, about if I could make enough money if I couldn't work.



My success? It happened when I bundled up and went out to the garage to get something out of the freezer. The path that I had shoveled yesterday through the arbor mess almost didn't exist. I sunk in the snow up to my knees, and then I started laughing! I realized that this is quite the adventure, and I was going to have fun. I stomped through the snow, parts of it higher that I was, shoveling a new path. I noticed the beauty, and laughed at the dogs sinking themselves while they tried to play.



I choose to believe that all is in divine order. I choose to believe that everyone and everything will be taken care of. I choose to believe that I'm OK. I choose to trust in God. That is what works for me, that is what brings me joy.



Until we meet again,

Dr. Judi



PS--If you have a question or comment, just click on __ comments below.

Short Answers to Complicated Questions

I have received several interesting questions. It being Christmas Eve Day I'm not going to spend a lot of time answering, because each one could be worth several blogs, and they each are very important. So I will give some short answers to these complicated questions and go into detail about them in the coming New Year.

For those of you expressing difficulty figuring out how to send a comment: At the end of the blog it says "__ of comments posted." Click on this and it will give you a space where you can make comments.



"My question involves my wife. She is 59 and is taking female hormones. She took them to prevent the swetting. If she quits will she start swetting again? Her Doctor has left the decision to her. she can continue or she can quit. What will be her experience if she quits? Is it good for her to continue to take the hormones at her age? Thank you for your assistance."

The most common use for female hormones is for hot flashes, which can range in the peri- and post-menopausal woman from none or minimal to very severe and extremely uncomfortable. The common misconception, however, is that if a woman takes the hormones for a few years until "the change" has passed, that she can then stop taking the hormones without any further hot flashes.

No one knows what truly causes hot flashes, though there are many theories. But hot flashes are usually more severe in women with a lot of stress, depression and/or anxiety in their lives. They can be affected by diet. If there is no hormone replacement, the majority of women stop having hot flashes or have them only rarely after about 2-5 years as the body adjusts to the change in hormone levels. However, if a woman is replacing the hormones that are naturally decreasing in her body, she will still go through the menopausal symptoms if she stops taking them in the future. I usually recommend that a woman who desires to stop hormone replacement therapy wean off gradually, decreasing the dose slowly over 6 months to a year to allow the body time to adjust to the changing levels.

Is hormone replacement good for your wife? It would depend on what kind she is using and how she is metabolizing them. That will have to be in another discussion. Also at another time I will talk about other things that can be used to reduce menopausal symptoms besides hormones, and the difference between Premarin and Provera vs. bio-identical hormones.



"This is the season of colds. What is the best thing to do for a cold? Do the homeopathic remedies available over the counter (Zicam, zinc tablets, Cold eaze, etc.) work? Or is it just rest, liquids, time, and a little chicken soup?"

The first thing to do for a cold is prevention. Though there are other reasons, the most common reason that people get colds is that they allow themselves to get run down by not allowing themselves enough down time, relaxation time and/or sleep. I like to imagine my body telling me, "If you don't take time to slow down a little I'll make you slow down!" And then if I don't listen and keep going full speed in spite of the cold, my body may say, "You made it through this time but it will come back again soon!" Or it may say, "Since you're not slowing down with this warning, I'll give you bronchitis or sinusitis or even pneumonia so that you'll HAVE to rest!"

Another common cause is eating a lot of sugar. Sugar reduces the activity of the phagocytes (the little pac-men inside our blood stream that eat foreign invaders like bacteria and viruses). The amount of sugar in one can of soda can reduce phagocyte activity for 4 hours! So if we are eating sugar all day, our immune system isn't functioning fully.

Once you get a cold, what do you do? The most effective treatment, the one that none of us have time for or want to do, is take a day off to rest. Rest and sleep, along with self-pampering, are the best healers. Beyond that, yes, studies show that Vitamin C, Zinc, echinacea, Vitamin A, and chicken soup all reduce sick time for the common cold. I usually recommend 500 to 1000 mg. of Vit. C every 1-2 hours while sick. If the cold starts with or is accompanied by a sore throat, sucking chewable vitamin C and zinc lozenges help. I usually recommend 50 to 75 mg. of zinc, and up to 100,000 IU of Vit. A (not beta carotene). If you are pregnant, don't use over 5,000 IU of Vit. A. These higher doses can be used for 3-4 days without any toxicity.

There are various somewhat expensive over-the-counter cold remedies with these combinations, and they often help reduce symptoms faster, especially if taken immediately.

Homeopathic occillococcinum has also been shown in studies to stop a cold or flu more rapidly than placebo if taken at the first sign of symptoms.

In the future I would like to write a column on the individual homeopathic remedies for colds and flu, and the indications to take them.


For those of you who commented on the design, you are right. I was in a hurry just to get the site up and didn't spend much time on it. However, my dear daughter Monica, the design expert, will be working on it. If anyone would like to see samples of her webpage designs go to http://www.monicastrang.com/. I'm quite proud of her work!

Please send this site to your family and friends!

Until we meet again,
Dr. Judi