Menopause, a natural biological transition in women, begins with the perimenopause phase and can induce heightened levels of stress due to the fluctuating levels of estrogen and the resulting symptoms like hot flashes, depression, memory loss, and decreased libido. Although historically, hormone replacement therapies were widely used to mitigate these symptoms, misconceptions, and misinterpretations of their risks led to a decline in their prescription. This lapse in effective treatments and a lack of comprehensive menopausal education in medical schools left many women without proper guidance, further exacerbating their stress. Instead of beneficial hormone treatments, many women are prescribed a "Menopause Cocktail" comprising various drugs like anti-depressants and sleeping pills, which might not directly address the root cause of their symptoms. Additionally, societal perceptions and commercial biases have often influenced and even misled understanding and management of menopause, causing undue stress and confusion among women seeking effective relief and understanding of their body's changes.
Calming an Overactive Brain
Brian E. King Ph.D Continuing education 9/18/2023 Tulsa, Oklahoma
22% of Americans report stress at an 8 on a scale of 1 to 10. Top symptoms of stress: Irritability, anxiety, fatigue, sadness, no energy.
Amygdala: part of brain concerned with threat appraisal
Nucleus Accumbens; makes behavioral decisions.
Prefrontal cortex: your thoughts, part of the brain that sends inhibitory signals to the amygdala. Happiness is found here.
Understanding stress can be acute or chronic. Acute stress causes the quick release of epinephrine and norepinephrine. Chronic stress involves the release of cortisol. This is such a huge problem because we are often maladapted to modern society. Our body can’t differentiate between being chased by a bear or being stuck in traffic.
Having elevated cortisol puts long term building projects on hold. Cortisol inhibits systems irrelevant to acute survival. Long term exposure to stress negatively affects our body.
digestive system: reflux, nausea, ulcers, loss of appetite
reproductive system: loss of libido, decreased sperm production, infertility
musculoskeletal system: aches and pains in joints and muscles, decreased cellular repair immune system: reduced ability to fight and recover from illness
sleep: sustained cortisol prevents stage 4 sleep, slow wave, deep sleep
Chronic stress also leads to structural changes in the brain. The prefrontal cortex and hippocampus decrease in size. When they shrink it makes it harder to change behavior. Whereas the amygdala increases in size when under stress or when depressed. Recall that this is the part of the brain concerned with threat appraisal. The amygdala is always working and evaluating stress. When a treat is detected, the sympathetic nervous system is activated.
The Nucleus Accumbens is a tiny part of the brain which influences behavioral reactions to threats. It is activated by dopamine and makes behavioral decisions. Dopamine tells you how much benefit you can expect from doing a habit.
GABA in the Limbic System: The primary inhibitory neurotransmitter in the brain, prevents the stimulation of neurons. Calms the nervous system. Think benzodiazepines or the hormone Progesterone.
What is a habit? Auto pilot, 95% of behavior is habitual. We learn it and we maintain it. Thoughts can be a habit. Habits are focused on immediate well-being, not long-term benefits. Dopamine neurons alert the habit system and the executive system (the prefrontal cortex).
Delaying Gratification: Inability to delay rewards can reflect a dopamine deficiency. Which means you are bored. Get a hobby, find some wonder in life.
Reducing Cravings: Willpower is usually not enough. You need to increase your dopamine level so complexity and delayed gratifications will win. Greater firing of dopamine neurons occurs when the opportunity for pleasure is novel and encourages exploration.
Traditional brain-based therapies for calming an overactive brain include:
Counseling
Cognitive Behavior Therapy
Prescribed medicines for pain, sleep or depression.
However, medications relieve symptoms, but behavior still needs to change.
Other ways to calm the brain? Gratitude journal, self-care, touch, dance, play.
Vagal Breathing: Practice slow vagal breathing, deep and slow breathing which stimulates the vagal nerve and reduces anxiety and increases the PSNS Take about 6 breaths a minute. Breathe in deeply from your diaphragm. The stomach should expand outward then slowly exhale out.
Thought Journaling: Write down 5 thoughts. Situation, automatic thoughts, behavior, consequences, thoughts after dealing with the consequences.
Gratitude: Happy people communicate gratitude to their friends & family to strengthen bonds. Count your blessings. Each day write down three good things that happened to you today.
Acceptance: Learn to accept in others flaws that are unlikely to change and move on. This reduces regret and the tendency to ruminate. Accept your own limitations, quit striving for perfection and stop criticizing yourself.
Mindfulness: The calming effects of attending to the present and witnessing thoughts without judging them. Can reduce pain, distress and stress. Associated with greater acceptance and improved sense of control over stress.
Meditation: twice a day for 5 to 10 minutes. Choose a time of day that you are most alert. Sit upright, spine straight. Focus on your breathing and the sensations it triggers. Concentrate on the tip of your nose, if your mind wanders, return your focus to your breathing.
The Joyful Brain: When you are happy you are resilient. Happiness implies the presence of something positive, not just absence of negativity. You can’t be happy and stressed at the same time. Resilience is a STRONG correlate of happiness.
Benefits of being happy?
more likely to stay married
more social & energetic
earn more money
more productive
stronger immune system
more resilient
live longer
Smiling and laughing manage stress. Expressive writing increases Optimism and reduces Worry.
Pearls of Wisdom with Cortisol
Your adrenal glands manage stress and secrete 6 hormones which can all be measured:
norepinephrine
epinephrine
cortisol
DHEA
pregnenolone
aldosterone
Your adrenals have no brakes.
Unhappy adrenal glands:
poor sleep (wake up between 2 and 4 AM every night)
overworked
poor diet,
no exercise
environmental toxins
unhappy liver=unhappy adrenals
zero relaxation practices ….. yet watch hours of television.
We humans don't have just acute stressors: we have long term stressors such as pollution, deadlines, families, finances, sick parents and illness.
Cortisol is intended to shunt cellular activity away from long term metabolic processes. Long term building projects are put on hold ….. you send 50% less blood to the stomach to digest food, your bones suffer, your sex hormones decrease, your immune system doesn't work as well.
Stress makes you seek a diet high in sugar, carbs & caffeine.
Stress and hormones: In some ladies balancing estrogen & progesterone is not enough. We start a patient on hormones and she is better but still complains of fatigue, apprehension, can't concentrate, cravings and insomnia.
Modern medicine is not good at treating stress. Consider this scenario? Patient is fatigued, bone tired and can't exercise. They go to the doctor and their GP tests for thyroid and anemia. If those are normal the patient will be referred to their Ob-Gyn who says if it isn't estrogen, progesterone or testosterone it is out of their field. Refer on to an endocrinologist. The endocrinologist rigidly looks at Addison's Disease or Cushing's Disease which are actually quite rare. Patient is now sent for a "psyche consult”.
Why does stress cause belly fat? Belly fat is the body's answer to stress. Three things linked to an increase in belly fat: estrogen dominance, stress, Vit D deficiency.
An elevated cortisol response causes an increase in gluconeogenesis, fat and protein mobilization. Induced cortisol response decreases insulin sensitivity, growth hormone, T3 and immune inflammatory response. All of these make belly fat.
Fixing cortisol levels is not a weekend fix….it may take up to a year.
Ways to help your stress level? products from the Pharmacy
Magnesium glycinate 400 to 800mg a day. Mg has 300 functions in the body…..but the best one is it relaxes the cerebral cortex to produce calmness.
Progesterone: Optimize upstream hormones. 20mg of progesterone cream can convert to 7.5mg of cortisol. Oral progesterone does not convert and works best for adrenal stress not adrenal fatigue.
Dose of progesterone in a man is 5 to 10mg hs. This is helpful for the executive who cannot shut down at night to go to sleep.
Estrogen can be anti-inflammatory or pro-inflammatory depending upon when you start them. If you transition a perimenopausal woman with estrogen it helps her memory and mood. But if you wait 15 years down the road it doesn't seem to work as well.
Pregnenolone: Really low cortisol? Add pregnenolone. Start low and go slow. 10mg a day with food. Titrate up in 10mg increments every 2 weeks. Max dose us 50mg.
DHEA: is a glucocorticoid antagonist that balances cortisol. When DHEA levels are low you see further damage from cortisol. There is a link between low DHEA and IBS, Rheumatoid Arthritis, mood disorders, chronic fatigue and fibromyalgia.
A patient with low DHEA and cortisol can see a 50% decrease in thyroid receptors.
Levels decline as we age however it is disappointing an anti-aging panacea. Side effects include acne, hirsutism and weight gain. Can be especially helpful in autoimmune conditions. For example in systemic lupus 200mg is used. For women, don't go above 10mg orally.
Vitamin C: is an adrenal rebuilder…. you can't synthesize it or store it. Daily dose is 3,000 to 4,000mg
Decrease inflammatory signaling: Curcumin, turmeric, omega 3 fatty acids, CBD oil.
Adaptogens: Natural products that can reduce stress.
Ginseng: Offers immune support (immune-modulators) to help reduce inflammation, which relieves pain. In addition, it can combat stress and boost your nervous system which improves how your body responds to stimuli (fight or flight). May also reset dopamine receptor levels which can regulate your mood.
Ashwagandha: Has a positive effect on the endocrine, nervous, immune and cardiovascular systems by regulating metabolism and helping you relax by calming how your brain responds to stress. Offers protection for your cells as an antioxidant and reduces swelling (an anti-inflammatory reaction). Optimizes thyroid function and reduces anxiety.
Rhodiola: Helps with fatigue, anxiety and depression. Makes people nice.
Theanine: Active ingredient in green tea. Stops racing thoughts.
How long will it take to reverse the stress in my life?
How many things are you willing to change?