I've been a practicing physician for more than 10 years now, and have unfortunately treated many patients whose stories were just heartbreaking. One patient, however, stands out so indelibly in my mind; her story, so very sad, and so very preventable.
I met Marian, a 33-year-old nurse and wife, one year after the birth of her first child. She had some medical difficulties during her pregnancy, including high blood sugar, which was brought under control with healthy diet and exercise. Personally, things weren't much better, either. Her husband had lost his job shortly after Marian found out she was pregnant. However, when their healthy baby boy was born via C-section nine months later, everything seemed to be going on a better path for the family.
However several days after giving birth, Marian became very depressed and anxious. She simply couldn't stop crying and found it very difficult to care for her child. Marian's doctor diagnosed her with postpartum depression -- a fairly common condition that affects around 13 per cent of pregnant women and new mothers. Though it took several months of treatment, Marian successfully pulled through and was acting like her "old self" again in no time.
When Marian decided she wanted to try for a second child, she came to me, her internist, for a regular physical exam and to seek advice on living a healthier lifestyle.
When I saw Marian, I was shocked. One year after giving birth, she was 35 pounds heavier than her pre-pregnancy weight. She also felt very stressed, and was unable to sleep soundly at night, despite successfully completing treatment for postpartum depression. She had lost any sexual desire, had not menstruated since giving birth, and suffered from skin itchiness, crankiness, breast tenderness and bloating.
Both Marian and her husband felt that she had become a different person after becoming a mom.
Puzzled, I reviewed some of Marian's medical records. The results astounded me. Her blood test from nine months prior showed low estrogen levels, and her progesterone levels were extremely low. A more recent test showed that Marian had little to no estrogen at all and even lower progesterone levels than before. I couldn't imagine why her OB/GYN hadn't addressed these results with Marian. Perhaps it's because the news was so devastating.
Marian, at age 34, was clearly post-menopausal. Any chance of giving birth to another child was definitively out of the picture.
Post-menopausal. At age 34. Unfortunately, cases like Marian's are not uncommon. She had been mismanaged by an uninformed OB/GYN who should have recognized the signs of early menopause.
This is a warning to all women in their late 30s and early 40s -- during this age group, many women see a dramatic drop in their fertility. If you notice symptoms similar to Marian's, get yourself to a doctor immediately.
As for Marian, her menopause was caused by premature ovarian failure. It became extremely important to control her symptoms (insomnia, hot flashes, night sweats, anxiety, low libido). I put her on a regiment of bioidentical hormones, which are structurally-identical to the hormones made by the body. Thus the body recognizes them, has receptors for them throughout and is adept at breaking them down. Marian applied an estrogen cream to her inner arms and took a progesterone pill by mouth every evening. I also supplemented her with DHEA, a prehormone to enhance her muscle to fat ratio. DHEA also helps to raise a woman's production of testosterone and can raise one's sex drive.
After a month, Marian was reporting improvement, but she still wasn't completely herself. Blood work showed low testosterone, although the DHEA had raised it by 30 per cent. I then supplemented her with a low-dose bioidentical testosterone cream.
On follow-up three months later, Marian felt much better. Nothing could excuse the misdiagnosis of premenopause in this young woman, but I was at least able to return her libido, help her lose weight and make her feel more like herself.
The onset of early menopause can be triggered by a number of other factors -- women can even go into menopause spontaneously. If caught early enough, however, early-onset menopause is completely treatable with the help of a good physician and bioidentical hormones.
If you're curious about how menopause could potentially affect you, a great resource is Suzanne Somers' new book I'm Too Young For This!, which talks about bioidentical hormone replacement therapy.
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Soothing music before bedtime can really do the trick. A 2005 study found that older people who listened to 45 minutes of soft tunes before hitting the hay reported a 35 percent improvement in their sleep problems. But it doesn't have to be Brahms, if that's not your style. As long as the music was soft and slow -- around 60 to 80 beats per minute -- it can spur physical changes known to promote sleep, like a slower heart rate and breathing, the BBC reported. "We know that when a person closes their eyes they induce a certain frequency of brain waves," says Decker. Slow music may have a similar effect, he surmises, leading to sleep onset. Flickr photo by Llima
It was once thought that a glass of warm milk at bedtime would help send you off to dreamland because of the tryptophan, The New York Times reported, but milk and other protein-rich foods actually block tryptophan's sleepiness-inducing effects. However, there might still be a psychological benefit to that warm milk, the Times concluded, calling it "as soothing as a favorite old blanket." "There have been some studies showing that when infants receive warm milk before bed, they'll dream a little bit more," says Decker, but the results don't hold true in adults. "It may be one of those myths that because it happens in children, adults think it may be true for them, too," he explains. However, many adults are actually at least slightly lactose intolerant, he says, meaning a warm mlik at bedtime may just lead to discomfort. Flickr photo by julianrod
If your goal is to bore yourself to sleep, you might try counting sheep, or counting backwards by multiples of three or any of a number of other counting-related mind-numbers. But a 2002 study found that imagining a more relaxing scene might be more effective. The study observed 41 people with insomnia over a number of nights and asked them to try a variety of different sleep-inducing techniques, like counting sheep. On the nights they were told to imagine relaxing scenes like a beach, a massage or a walk in the woods, they fell asleep an average of 20 minutes sooner than on the nights they were told to count sheep or were given no instructions, Mental Floss reported. Decker agrees. "Counting sheep in and of itself may not help," but can act as a ritual that prepares us for sleep, making it not unlike meditation. Counting sheep -- or more relaxing guided imagery -- helps us "focus on something other than life's stressors," he says. "Thinking about a soothing environment may be more restful than the way you spent the last eight hours!" Flickr photo by Kr. B.
Focusing on the breath, whether it's as part of a pre-bed yoga sequence or just a tuned-in awareness, can also have meditation-like effects in preparing for bed, says Decker, like lowering the heart rate. Flickr photo by Perfecto Insecto
Your body temp dips about two hours before bedtime, Health magazine reported, a natural change that "triggers our brain for sleep onset", says Decker. Soaking in a warm bath beforehand boosts your temperature temporarily, but results in a dramatic, rapid cooldown after you get out that relaxes you and eases you into sleep. It's not necessarily the bath that lulls you to sleep, it's that resulting cooling of your body temperature, Decker emphasizes. Research shows that people who take a warm bath before bed not only fall asleep more quickly, but also report better quality of sleep, he says.
Many people swear by a drink to unwind at the end of the day, but alcohol before bed can actually disrupt your sleep. You'll be more likely to wake up more often in the early-morning hours, wake up and not be to fall back to sleep or have disturbing dreams. "As alcohol is metabolized by the liver, it has a disruptive effect," says Decker. It takes a few hours to metabolize, he says, so a drink with dinner shouldn't be a problem, but anything too close to bedtime can be counterproductive. Flickr photo by Rob Qld
It sounds crazy -- how will you ever get to sleep if you're not even in bed?! -- but it works, says Decker. "When a person stays in bed and they can't sleep, the bedroom can induce a certain level of anxiety," he says. "We say after 15 or 20 minutes, get out of bed, sit in another part of the house until you feel a little groggy, then go back to sleep," he says. "Staying in bed can condition you to become anxious in bed." A small 2011 study published in the Archives of Internal Medicine found that among the adults studied who reported trouble sleeping, those who spent less time in bed had better sleeping habits. Flickr photo by Perfecto Insecto