Even if supplemental thyroid hormone does help alleviate the existing hypothyroidism, in a significant portion of these cases the symptom of depression persists, for a separate and rather surprising reason: depression itself can result in thyroid dysfunction. Treating the hypothyroidism, in other words, may be treating a symptom rather than the underlying cause.
Allow me to explain. The thyroid gland is located in the fifth chakra, the part of the body related to our creative expression, timing, and will. Let’s start with creative expression. Though every one of us is creative by nature, we tend to link with creativity artists. It’s no secret that there are far more successful and well-known male artists, writers, composers, and musicians than female ones. This is because, up until very recently, women’s creative expression, including the words we’re longing to speak, have not been as highly valued or as well received as those of men. We’re afraid that we won’t be heard or that what we have to say will be discounted. And so, to keep the peace, we learn to swallow our words or to edit out the parts that we fear others won’t be able to hear.
Then there’s the issue of timing. Our experience of time directly affects every cell of our bodies, including our thyroid. How often do we say, “I don’t have time,” “I’m running out of time,” or “There’s never enough time”? We are currently living in a culture in which each of us has to process more information in a day than our grandparents had to deal with in an entire year. Time, it seems, is speeding up, with more and more to do and less and less time in which to do it. When I wrote the first edition of Women’s Bodies, Women’s Wisdom, I didn’t have a cell phone, and the Internet was just getting started! The only way to stop this headlong race to nowhere is to change our relationship to time. Psychologist Gay Hendricks suggests that we adopt “Einstein time” and see ourselves as the place where time comes from. He also points out how subjective our experience of time really is. If your hand is on a hot stove, every second feels like an eternity. When you’re making love, time flies. Hendricks points out that we never have enough time to waste it on the things we don’t want to do. This is especially true at midlife, when we must find a way to participate in those activities that feed our souls—activities in which time seems to stand still for us.
What about will? Midlife is a time when you must surrender your ego’s will to your soul’s Divine will. A friend of mine told me that her thyroid problems started when she began to view her job as a mother and business owner as a supreme test of her will. How could she get her husband, children, and boss to do what she wanted them to do? “When I was in college,” she said, “I felt as though I was part of a Divine plan. I looked to my Higher Power to guide my actions. But when I got married, I forgot all about Divine will and instead let my life be ruled by some antiquated idea of what a mother was supposed to do.” My friend realized that she was unconsciously following in her own mother’s footsteps. Her mother spends hours each week entertaining people whom she claims she doesn’t even like and doing tasks for her church that she feels duty-bound to carry out even though they bring her no joy whatsoever.
As you can clearly see, thyroid balance is multifaceted. In order for this complex, entangled state of affairs to be resolved, a woman might need to take not only supplemental progesterone, thyroid hormone, and iodine, but also an unblinking look at what parts of her life and interpersonal relationships need to change.
MENOPAUSE AND ADRENAL FUNCTION
The two thumb-sized adrenal glands secrete three key hormones that help us withstand many of the stresses and burdens of life. However, if a woman has lived for a long time with the perception that her life is inescapably stressful, or if she is chronically ill, then chances are she has asked too much of her adrenal glands and has not given them adequate time to replenish themselves. She may be one of the many today who enter menopause in a state of adrenal exhaustion.
To understand what chronic exhaustion may do to the body and how it affects your menopausal experience, it’s important to know what the adrenal glands do for you on a day-to-day basis, through the effects of three distinct but complementary hormones they secrete.
~ NOREPINEPHRINE (adrenaline) is the fight-or-flight hormone, produced when something is threatening you (or when you think that something is threatening you). It makes your heart pound, your blood rush to your heart and large muscle groups, your pupils widen, your brain sharpen, and your tolerance for pain increase, so you can be at your best in battle. In modern-day life your battles are likely to consist of daily challenges such as pushing your body to keep going when it’s fatigued, dealing with a stressful job, and reacting with quick reflexes to avoid a traffic accident. Think of these adrenaline surges as withdrawals from a bank, to help you get through life’s rough spots. If you have gotten into the habit of withdrawing adrenaline from your account too often, you’ll eventually be overdrawn. Your adrenal glands will be overwhelmed, and you’ll have too little adrenaline when you really need it.
~ CORTISOL increases your appetite and energy level while taming the allergic and inflammatory responses of your immune system. It stimulates the liberation and storage of energy in the body, helps the body resist the stressful effects of infections, trauma, and temperature extremes, and helps you maintain stable emotions. Synthetic versions of cortisol—prednisone and cortisone, for example—are prescribed often in human and veterinary medicine to help the patient perk up and feel better so he/she will eat, drink, and move around more and therefore be better able to fight off illness or heal from an injury. Ideally, cortisol is released into the system only on an occasional basis, rather than in response to chronic stress. Undesirable side effects can occur if cortisol levels become too high for too long. These include loss of bone density, muscle wasting, thinning of the skin, decreased ability to build protein, kidney damage, fluid retention, spiking blood sugar levels, weight gain, and increased vulnerability to bacteria, viruses, fungi, yeasts, allergies, parasites, and even cancer. If you’ve ever seen anyone on high-dose prednisone, you’ve seen how this drug can adversely affect the body.
~ DEHYDROEPIANDROSTERONE, also known as DHEA, is an androgen that is produced by both the adrenal glands and the ovaries. In both women and men, DHEA helps to neutralize cortisol’s immune-suppressant effect, thereby improving resistance to disease. (Cortisol and DHEA are inversely proportional to each other. When one is up, the other goes down.) DHEA also helps to protect and increase bone density, guards cardiovascular health by keeping “bad” cholesterol (LDL) levels under control, provides a general sense of vitality and energy, helps keep the mind sharp, and aids in maintaining normal sleep patterns. Like norepinephrine and cortisol, DHEA also improves your ability to recover from episodes of stress and trauma, overwork, temperature extremes, and so forth. And if a woman is experiencing a decline in libido due to falling testosterone levels, often it is declining DHEA levels that are at the root of the testosterone deficiency, as DHEA is the main ingredient from which the body manufactures testosterone.
There is a price to pay for making too many demands on your adrenal glands. Excessive exposure of the body to adrenaline and cortisol can result in mood disorders, sleep disturbances, reduced resistance to disease, and changes in vital circulation, all of which are common complaints in today’s living-on-the-edge lifestyle. And because these side effects are not uncomfortable enough to be intolerable, the self-destructive lifestyle often continues. DHEA, which helps the body recover from this sort of chronic abuse, finds itself on duty full-time instead of only episodically. Gradually the adrenal glands become seriously exhausted, with the first and most profound effect being their waning ability to produce DHEA. As levels of this restorative hormone fall, cortisol and adrenaline levels begin to fluctuate as well, as the adrenal glands attempt to fill increasingly impossible orders for more support. One of the cardinal signs of adrenal exhaustion—relentless, debilitating fatigue—becomes a prominent complaint. Though this fatigue is often accompanied by depressed mood, irritability,
insomnia, and loss of interest in life, this doesn’t mean that the adrenal problem is necessarily the cause of the mood change, any more than similar problems are always caused by thyroid malfunction. That is why these emotional symptoms do not always go away with treatment—the underlying issues remain unresolved.
A woman in a state of adrenal exhaustion is likely to find herself at a distinct disadvantage when entering perimenopause, because in the simplest terms perimenopause is another form of stress. Furthermore, adrenal exhaustion suggests that there are long-standing life problems in need of resolution. These issues will loom all the larger when seen with the no-nonsense mental clarity of perimenopause, but not only will adrenal exhaustion make the transition needlessly unpleasant, it also can deprive a woman of the resources she needs to address those issues and to take full advantage of the creative promise of the second half of her life.
If a woman is feeling chronically tired or depressed, if she begins her day feeling inadequately rested, or if she finds that ordinary stresses are having an impact that is out of proportion to their importance, she may be suffering from adrenal gland dysfunction.
Adrenal Testing
Salivary or serum DHEA and cortisol levels can be easily tested through accredited laboratories. (Laboratories that can do this with a doctor’s prescription include Genova Diagnostics, 800-522-4762, www.genovadiagnostics.com; and ZRT Laboratory, 503-466-2445 or 866-600-1636, www.zrtlab.com.) Conventional blood tests, taken at whatever time your doctor has scheduled your appointment, might indicate that your adrenals are “normal.” However, a better diagnostic approach will test your levels at different times of the day, which is much more likely to reveal an out-of-whack pattern of cortisol or DHEA secretion. This is a case in which saliva testing is far easier than having multiple blood tests in a day! If you want to be tested for adrenal function, see a health care practitioner who understands the complexities of adrenal testing. (Health care practitioners trained in functional medicine are a good choice. See the Institute for Functional Medicine’s website, www.functionalmedicine.org, for referrals.)
ADRENAL STRESSORS
The following stressors can lead to fatigue and, ultimately, adrenal dysfunction—which may, in turn, make some stressors worse:
~ Excessive, unremitting worry, anger, guilt, anxiety, or fear
~ Depression
~ Excessive exercise
~ Chronic exposure to industrial or other toxins
~ Chronic or severe allergies
~ Overwork, both physical and mental (this applies only if you’re doing work that doesn’t fulfill you)
~ Chronically late hours or insufficient sleep
~ Unhealed trauma or injury
~ Chronic illness
~ Light-cycle disruption: shift work
~ Surgery
How to Restore Your Adrenal Function
If, after testing, you find that you are producing inadequate levels of adrenal hormones, there are several available routes for increasing either DHEA, cortisol, or both. One is by taking the hormone directly. The other—which is ideal whenever possible—is to restore adrenal health and function so that these glands are eventually able to produce the hormones you need without outside supplements. That will require making changes in the lifestyle that caused the adrenal depletion. If you supplement your adrenal hormones in dosages that are too high, or if you take supplements for too long, the result can be permanent depression of adrenal function.
DHEA: DHEA is available as tablets, transdermal creams, or sublingual tinctures. Though DHEA is available over the counter in natural food stores, quality varies widely. It is always best to work with a health care provider who can help you monitor your dosage and your blood or salivary levels. Also, I recommend making sure you are taking pharmaceutical-grade DHEA. (See Resources.) Regardless of how you take your DHEA, blood or salivary levels should be retaken regularly until they return to normal. When levels return to the normal range, the dose should be gradually tapered until you’re off the hormone completely.
DHEA can also be increased by focusing more on loving thoughts that bring you pleasure (such as thinking about loved ones, favorite pets, a delicious meal, or a sweet memory) and less on thoughts that are stressful. This learning to “think with your heart” may be challenging at first, but because it short-circuits the harm done by the body’s physiological reaction to stress, it’s a valuable skill. I recommend the training programs and books from the Institute of HeartMath. (For more information on HeartMath, call the institute at 800-711-6221 or visit www.heartmath.org; I also recommend the book The Amazing Power of Deliberate Intent [Hay House, 2006] by Esther and Jerry Hicks.) In addition, do more things that bring you pleasure and make you laugh and fewer activities that feel like obligations. Spend more time with people who make you feel good and less with people who are draining. Dwell more on what you like about yourself and less on what you see as your limitations. In short, have more fun! Make pleasure a priority instead of a luxury. This takes courage, and it’s worth it.
CORTISOL: Some individuals require very small doses of hydrocortisone, which can be used safely and effectively if prescribed by a health care provider knowledgeable about how and when to use it.15
DIET: The food plan outlined in chapter 7 is designed to support and recharge your adrenals, among other benefits. Be sure to get enough protein; every meal or snack should contain some protein. Remember that caffeine whips your adrenals into a frenzy; avoid it altogether. Also avoid fasting or cleansing regimens.
NUTRITIONAL SUPPLEMENTS: Supplement your diet at the higher ranges of the nutrients listed in chapter 7, pages 261–262, for at least three months for best results. After that, you can reduce them depending upon how you feel. Be sure you’re taking plenty of vitamin C (1,000 to 2,000 mg a day in divided doses), a B complex (25 to 50 mg a day), zinc (15 to 30 mg daily), and magnesium (300 to 800 mg per day in divided doses—in fumarate, citrate, glycinate, or malate form). My colleague Norm Shealy, M.D., Ph.D., has had much success with transdermal magnesium (which you can order from his company, Self-Health Systems; for more information, call 888-242-6105 or visit www.selfhelpsystems.com or www.normshealy.com). Dr. Shealy’s Youth Formula supplement is specifically designed for raising DHEA.
SLEEP: Sleep is the most effective approach to achieving high adrenaline levels. Sleep restores adrenal function better than almost anything else. When I’m stressed, I routinely sleep ten hours or more a night! Shoot for at least eight solid hours per night.
EXERCISE: Regular light to moderate exercise, but not so much that you feel depleted afterward.
SUNLIGHT: Exposure to sunlight not only is good for your adrenal glands, but it boosts vitamin D as well. But do this wisely. Sunbathe with as much of your skin exposed as possible, starting out in the early morning or later afternoon, not at midday, and never enough to burn your skin. Work up to ten to thirty minutes of exposure three to four times per week. (Timing will depend on your skin tone. Those with dark skin need more exposure time.) Use sunscreen if you’re out longer than that. This prudent sunbathing will not increase your risk of skin cancer.
HERBAL SUPPORT: Because one of the components of Siberian ginseng is related to a precursor for DHEA and cortisol, taking this herb can be very helpful in restoring proper adrenal function. Try one 100 mg capsule two times a day. It can have a stimulating effect, though, so if it interferes with your sleep, take it before 3:00 p.m. Licorice root can also help your adrenals because it contains plant hormones that mimic the effects of cortisol. Take up to ¼ teaspoon of 5:1 solid licorice root extract three times a day. Licorice tea is another good alternative. I prefer Traditional Medicinals’ Organic Licorice Root tea. It’s fine to drink three to four cups per day if your blood pressure is stable.
FIGURE 8: MENOPAUSAL SYMPTOMS TIMELINE
WHAT TO EXPECT IN YOUR TRANSITION
Despite the fact that there are stacks of books describing the “normal” symptoms of perimenopause, many women e
scape most or all of them. Nonetheless, there are a number of symptoms that women in this culture report frequently, and you may want to review the list on the following pages in order to be informed and prepared. It may also decrease your anxiety about a particular symptom to know that it is related to a normal transition.
Bear in mind the following caveat: it is possible for your expectation of your menopausal experience to become your reality simply because it’s what you believe will happen. Remember that in some cultures women rarely report any symptoms from perimenopause, and it is not necessarily written into your biological script that you will have any discomfort, either.
Remember also that your mother’s menopause experience probably created a powerful unconscious blueprint for you. One of my readers told me that her mother always said that her life improved dramatically after menopause and that it was the best thing that ever happened to her. So when she herself went through it, she felt exactly the same way as her mother. If your mother’s experience was negative, on the other hand, you need not assume that you will follow in her footsteps. Focus instead on the ways in which you are different from your mother, and choose a new and improved script for yourself. (See my book Mother-Daughter Wisdom [Bantam Books, 2005] for information on how to update the beliefs and behaviors you learned from your mother.)
The Wisdom of Menopause Page 17
