This is The Health Show, a presentation of national productions.
Most of the time on this program, I feel like I can hold my own in most discussions.
There are some topics, however.
Take menopause.
Whenever we talk about this part of a woman's life, I feel like half the audience is saying,
yeah, what do you know about it?
That's why I call on smart people to help me.
I like to refer to their emotional state as an emotional tornado because their moods
are fluctuating widely, frequently, unpredictably.
On today's health show, we'll talk about menopause or more accurately, perimenopause.
We'll also hear the story of a Midwestern farming family who solve financial and health problems
by going organic and hear why there is discussion going on about certain medical practice
guidelines.
I'm Dr. Nina Sachs.
I'm Bob Barrett and this is The Health Show.
This year, about 60 million American women between the ages of 39 and 53 will become
perimenopausal.
Nearly half will show signs of clinical depression and anxiety disorders associated with the onset
of perimenopause.
In her new book, The Fifth Decade, is this just my life or is it perimenopause, Dr. Deborah
Wagner offers women and their families a guide to the phases that define the turbulent
years of perimenopause, as well as inside to navigate the intense, unpredictable emotional
swings that define the dreaded change.
Dr. Wagner and I spoke recently and we started by talking about the misuse of the word
menopause.
Yes, perimenopause is the three to ten years that precedes menopause.
Menopause is really a momentary event.
Menopause is when a woman has not had her period for a year, then she's in menopause
and immediately thereafter she's in postmenopause.
So it's just that one second in time and then you're done.
Pretty much, yeah.
Now, how is our understanding changed?
How much have we really learned about this over the past, say, ten twenty years?
I would say most of the learning has been done in the last ten or so years before that
there was very, very little information available for women and more and more is coming out
now as more research is being done.
But a lot of women and even more men and women don't know anything about it.
In your book, you share a lot of great stories from different people.
How did you find these people and get acquainted with their stories?
Well, a lot of people I know through social means, some through my practice, some family,
some people are saying that I'm in that age range.
There are a lot of people that I rub elbows with that have been talking and as I talked
more and more about my book, people were more and more willing to come forth with their
stories.
In the book, you also talk about the four stages of perimenopause.
Walk us through those if you could.
Well, the first stage is perimenopausal initiation and that's when perimenopause is just beginning.
Only women don't even understand that they are in perimenopause because the symptoms
really are under the radar.
And that can begin as early as the late 30s, early 40s.
Women might see some very minimal changes in their menstruation.
PMS is getting a little bit worse, but on the emotional front, they're finding that
their thresholds for tolerating unpleasantness is a little bit lower than it ever was before.
After perimenopausal initiation, they start to go into stage two, which is emotional disruption.
And that's when something being off really is on the radar.
That's now when women start to consciously realize that they're feeling more distressed,
that they're emotional.
They use this shorter, the daily stresses and challenges of life create much more of a reaction in her.
She might find herself impatient with her job or husband or children.
In terms of her menstrual cycles, she's seeing more fluctuations.
She may find cramping in the middle of her cycle.
And now what enters the picture is a lowering of libido.
Women start to really feel different about their sexual relations with their partners.
So in emotional disruption, things are really starting to get a little bit dicey.
Then they get into the worst stage of perimenopause, which is stage three turbulence.
Now they're deeply in the throes of the menopausal transition.
Their hormones are all over the place, up and down, vacillating wildly.
I like to refer to their emotional state as an emotional tornado
because their moods are fluctuating widely, frequently, unpredictably.
And it's not just before they get their period, it's throughout the entire monthly cycle,
if there is even a cycle.
Psychologically, we see a lot of anxiety and depression in this stage.
And it's often not understood that this is attributable to the hormonal imbalance,
which is what my greatest concern is.
Some women who have had anxiety or depression before they started their hormonal changes
now get into serious trouble because everything intensifies.
So you might see women with panic attacks, with severe depression.
They start to suffer from insomnia, turbulent dreams.
And on the libido front, it's pretty much gone.
All hope is not lost because then they get into stage four, which is quiet,
and that's when the hormones really start to stabilize at a much lower level.
Menseration is ending, moods start to calm down, anxiety and depression are alleviated,
and they start to feel their sexual drive again,
although it's not as sexually driven but more centrally driven.
And women in stage four, quiet, you'd often find that the after is even better than the before
because they feel more self-assured, they feel stable internally and have a new sense of themselves.
Plus, at that point, they've come out the other side and it's like, we made it.
Absolutely.
And I think a lot of husbands are saying the same thing.
Well, it's interesting because in your book, you do have a section for men,
which is kind of unique in a book like this.
And was it interesting talking to men about the topic?
Well, it was very interesting talking to men.
And the reason why I put in that section is because I've had so many male patients who have come in
and said, what's going on with my wife?
You know, she's not herself. This is not the woman I married.
You know, she doesn't want sex. She doesn't want to be near me.
She's yelling at me all the time. She's depressed.
I don't recognize her.
So I felt that men really need to become informed about these changes just as much as women do
because if men don't understand that this is a hormonal change that women don't want to be going through,
they don't want to feel the way they feel, then they might take it very personally.
And that can really be disruptive for a relationship.
One of the chapter names in that section is, okay, I will take directions.
Just tell me what to do. I love that. That was great.
I have felt that way in my life.
Tell me about some of the actual physical changes.
Right. Well, there are changes in how she digests food.
There are changes in what foods and substances she can tolerate.
For example, you might have a woman who was accustomed to having three or four cups of coffee a day.
Now if she has one cup of coffee at 9 a.m., she actually may not have processed the caffeine
when she goes to bed at night.
So her whole system is changing.
Her hair will change. It will become drier and more brittle.
Her skin becomes less elastic and she might, during perimenopause, have breakouts of rosacea.
Her figure changes as the female hormones that originally cause the womanly shape now start to disappear.
Her waist will second and she'll gain weight much more easily.
So there are a lot of changes in her body and women don't understand that this is all part of the hormonal changes that go on.
You talk to about the relationship between estrogen and the thyroid and how going through perimenopause may put a strain on some thyroid health.
A lot of women develop thyroid problems. Typically it's hypo thyroidism, which means that the thyroid gets sluggish.
It's largely due to the loss of progesterone as you progress through perimenopause, which helps support healthy thyroid function.
And that can create symptoms that are very similar to depression.
So when women all of a sudden start to feel sluggish and tired and they lose some of their luster for life,
it can be due to the hormonal changes, but it could also be due to the changes in the thyroid.
So it can become a very blurred picture.
It appears you don't spend much time in the book talking about hormone replacement therapy. Why is that?
Well, hormone replacement therapy is not the most popular resolution to hormonal changes in perimenopause right now.
And that is because there was a 15 year study called the Women's Health Initiative that was actually stopped before it was finished,
because they found that in this study when they gave women hormone replacement therapy, they were much higher risk for heart problems, certain types of cancer, pulmonary embolism,
and it was so dangerous that they stopped the study before they had completed it.
You know, there were some questions now about how the study was done and who was included in the study,
but it was such a scary outcome that hormone replacement therapy was really taken off the table as the first and best solution.
We do hear reports about puberty beginning earlier in girls. Is is perimenopause beginning earlier in women?
Actually, there's no evidence that it's beginning earlier.
The reasons for puberty beginning earlier in girls is believed to be due to the estrogens that we're all getting in our food supply and even in toxic forms,
like in terms of pesticides and whatnot.
And a lot of these chemicals act like estrogen in the body, and that's what's bringing on puberty earlier.
Most milk, most meat, you know, animal products are from animals that were injected with estrogen or estrogen-like hormones to fatten them up,
and we get this in our food supply, so that's really the reason for earlier puberty in girls.
If there was anything that a couple would complain about during this, it seems to me it would be trying to get a good night's sleep.
Yes, that is absolutely one of the huge challenges because as women go through perimenopause and they start to have the infamous night sweats,
they're awakening at night and tossing and turning, and that affects their spouse.
I've heard stories of men who have to go to bed with gloves and socks and long underwear on because they're
wives or lowering the temperature in the house, so low that they are like popsicles.
It can be a little humorous if you look at the light side of it, but yes, it does affect sleep quite a bit.
Okay, well it seems like, you know, trying to get through all this, it's a lot of communication between woman and doctor, woman and spouse,
and probably woman and herself too.
And women and other women because so many women when they talk to each other and they say,
oh my goodness, you're coming through this also. I didn't know. I thought I was the only one.
And that's what I really want to accomplish is to get people talking about this and let people understand that this is a normal natural life transition.
And, you know, we have to roll with it, but we can still support each other.
Dr. Deborah Wagner is a developmental psychologist in private practice in Ridgewood, New Jersey.
Her new book is called The Fifth Decade. Is it just my life or is it Perry Menopause?
You can also read her blog at yourmentalhealth.info
Still to come, a Midwestern farming family found an answer to their financial problems.
Get healthy. That's next on the health show.
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This is the health show. I'm Bob Barrett.
And I'm Dr. Nina Sacks. Chris Gosening and her husband were like most of their neighbors
in Northwestern Oklahoma. Conventional farmers relying heavily on chemicals to produce their crops.
But 15 years ago, in an effort to weather a difficult economic moment in agriculture,
they stumbled into organic farming. This discovery blossomed into a lifelong commitment
to healthy soil, healthy crops, healthy livestock, and healthy people.
This piece was produced by this land press Oklahoma's first new media company.
Anhydrous ammonia is a fairly common soil input prior to planting wheat.
Recently in our hometown, there was a leaking valve to anhydrous ammonia tank.
All at once, there's, you know, long-forced manifitals all over the place and they're shutting
down the roads. They're thinking about evacuating people from their homes.
And then the very next day, that same chemical is deliberately applied to fields where
there's going to be seeds planted and a plant's going to grow. And then that plant's going to be harvested.
People say, you are what you eat.
I'm Chris Gossney. I husband and I operate John's farm. John's farm is a sustainable, certified organic farm.
We have about 300 head of livestock, 12,500 acres of wheat, and then we raise a little bit of organic
alfalfa. We were conventional farmers for years and years. If we had a bug problem, why we sprayed
on an insecticide. If we had a huge wheat problem, we sprayed on chemical to kill the weeds and
we used that anhydrous ammonia. We were doing what? 99.9% of everybody in our county was doing because
there were only two organic farmers in major county. There was an older gentleman and that
alfalfa had been farming organically all of his life. We would see more weeds and his fields
than in ours or any of the other conventional farmers. We couldn't figure that out. Why would you
do that? We kind of thought that was silly. We actually thought that the standard for good farming
was a clean field. We didn't understand that the soil was half dead. That's just that we thought
it looked good. On 1996, a neighbor of ours, he asked us to take over his farming operation and
the one stipulation was that we would farm it organically. The economy of agriculture was poor.
We watched many of our neighbors lose their farms and we weren't far from it. We thought, well,
maybe this organic thing. We agreed to rent the fellows land and start farming a little bit organically
and then very next year. Here come the old gentleman. One comment he made was, as long as I am alive and
have any say, I want my farms to be organic. He said to John, my health is declining. Since you rent
that other guy's organic farm, I want you to rent mine too and farm it. So we took that one on.
In a lot of ways, we have become what he represented.
I have been asked many times, why is it that more people are transitioning and doing more of what
you're doing. I'm really not sure, but I know for us, we could see that a soil can actually rebuild
itself if it's cared for in a sustainable way. To think about that plant growing in a healthy soil
is going to produce a healthy food. It's still a financial struggle. It may always be. I don't know.
But the goals and goals seems more worth it. That story was produced by this land press. You can
hear more at thislandpress.com.
The term practice guidelines is pretty self-explanatory and they're everywhere in health care.
The rise of evidence-based medicine has resulted in a considerable growth in the number of
guidelines developed and issued over the past decade. In the October 2012 issue of the journal
Clinical Chemistry, Dr. Patrick Basoud published an editorial suggesting that there is room for
improvement in practice guidelines issued by the National Academy of Clinical Biochemistry. Dr. Basoud
is the head of the Department of Clinical Epidemiology and Bio Statistics at the Academic Medical Center
of the University of Amsterdam in the Netherlands. We spoke recently and talked about practice guidelines.
Well, practice guidelines are systematically developed statements to help health care professionals
and their patients in making the appropriate decisions in health care. These are statements that
tell health care professionals what the best line of action is in their specific circumstances.
And that way they're informative for patients as well telling them what not to do and what to do
in specific circumstances. And these practice guidelines used to be based on consensus
on the seniority by senior people but nowadays there aren't being developed based on the
current best available evidence from the scientific literature. And over the past few years,
we've seen the number of practice guidelines grow. Why is that? Well, there are a number of reasons
actually that you can mention for that process. One is that it's no doubt that health care costs
have been rising and there have been several studies that pointed out practice variations.
And that means that for one particular procedure is used very often in one area and far less often
in another area without actually a clear indication for that difference. So these developments
actually have started people to doubt whether health care professionals were behaving in an appropriate
way. So practice guidelines could help to contain costs and reduce practice variability.
Now, on the other hand, if you believe in evidence-based medicine that the health care
practice should be based on the best available evidence, it's very difficult for an individual
to be on top of the literature to know about all of the research that has been done in a particular
area. So practice guidelines actually can help to improve quality, reduce waste in health care,
and at the same time being based on the synthesis of the current best available evidence from
the scientific literature. So there can be a real help for the health care professionals and
their patients. Your editorial comments on an evaluation of guidelines developed for laboratory
professionals. In that paper, the authors use the so-called agree process or a pre-isle of guidelines
for research and evaluation. What were the conclusions from that evaluation? Yes, the authors have
analyzed 11 guidelines that have been developed by the National Academy of Clinical Biochemistry.
And their conclusion actually was not very positive in the sense that their conclusion
said that the quality of these 11 guidelines was generally rather poor. Actually, they're using
the agree incident. They were forced to sign quite low scores for these guidelines clinical biochemistry.
Well, how do you explain the poor state of those guidelines in clinical chemistry in laboratory
medicine? Well, unlike actually for pharmaceuticals or for other types of interventions,
there's usually very little direct evidence that links the actions of people in clinical
chemistry and laboratory medicine to health outcomes of patients. So people actually usually do
not get better from taking a laboratory test in itself. There should be other actions by other
healthcare professionals. And if these people make the appropriate decisions, people would get better.
So unlike, for example, other areas in medicine where we have randomized trials to guide
practice, actually, there are very few randomized trials to guide practice in laboratory medicine.
And that's why the people that have developed these guidelines in clinical biopin, I think,
could not rely on a very firmly developed methodology for developing practice guidelines.
And it's interesting to know that only the last guideline, actually the one on diabetes,
actually received quite high scores by these investigators, by this Canadian group that you see
pre-instrument. Well, finally, then, let's look ahead what needs to be done in order to improve
the state of guidelines in laboratory medicine. Well, the author of that bit is analysis,
have a number of recommendations. And in general, their recommendation comes down to a more
systematic method for developing practice guidelines. Because practice guidelines should be
systematically develop the statements to guide healthcare professionals, actually, which my
response to your first question. So these guidelines in biochemistry in laboratory medicine should be
developed in a more systematic way. And if that happens, actually, they probably will have more
impact on the laboratory medicine in general and will lead to better health outcomes in patients.
Dr. Patrick Besoud is head of the Department of Clinical Epidemiology and Biostatistics of
the Academic Medical Center of the University of Amsterdam in the Netherlands. You can read his
editorial on guidelines in the October 2012 issue of the journal Clinical Chemistry.
That's all the time we have for this week's health show. If you'd like to listen again,
join us online at healthshow.org. You can explore the archive for any programs you might have missed
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And if you have any questions or comments about the program, send them in. Our email address
is letters at healthshow.org. I'm Bob Barrett and I'm Dr. Nina Sack. Stay healthy and be sure to
join us next time for another edition of the health show. Dr. Nina Sacks is a practicing member of
the American College of Gastroenterology. Bob Barrett is producer of the health show. Dr.
Alan Chartock is executive producer. The health show is a presentation of national productions,
which is solely responsible for its content.
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