The Wisdom of Menopause

by Christiane Northrup

  The following letter from Terri, one of my e-letter subscribers, is typical of how midlife heart palpitations often present.

  I am a forty-eight-year-old female with no major health problems. I do not take any prescription medicine. I walk five times a week and go to the gym about twice a week to do some light weight lifting. My periods are still fairly regular. I have a fairly healthy diet, although it could be better. I drink about a cup of coffee a day but usually don’t drink soft drinks. About a month ago, after a fatty fast-food meal and a large cup of coffee in the early evening, I started experiencing heart irregularities. I felt like my heart was skipping a beat and was going to beat out of my chest! This went on for a couple of days and I went to see my doctor. She did an EKG, which was slightly abnormal, and scheduled me for a stress echocardiogram and Holter monitor. Of course, by the time I had these tests, the palpitations had stopped and the results were normal. Then about a week later, they started again. I have cut out drinking coffee and started doing more yoga. I have also started taking more magnesium in addition to my multivitamins. I have monitored what is going on with my life and I can’t seem to find any pattern to when these occur. Most nights when I lie down in bed they usually start up, especially when I lie on my left side. My doctor wants to start me on a low dose of a beta-blocker. I told her I would like to start using natural progesterone cream routinely for a couple of months because I feel these palpitations may be related to hormonal changes. I would really like to avoid taking heart medications. However, these palpitations can interrupt my sleep and are very uncomfortable. Are these palpitations hormonally related?

  My suggestion to Terri was that she go through the program for creating heart health I outline in this chapter. Her midlife heart is obviously becoming very sensitive, alerting her to the need to balance freedom and connection and also to nourish her heart fully. I concur with her intuitive desire to start on some natural progesterone as a way to balance potential estrogen dominance. Besides, progesterone is known to be very calming to the nervous system. It may well help her with sleeping. In addition, her heart is telling her to stop caffeine. The caffeine in one cup of coffee can take up to ten hours to be metabolized in women, so it exerts a stimulatory effect on the central nervous system and the nerves of the heart for quite some time.

  For many women, heart palpitations stop as soon as they begin to take progesterone cream or estrogen, stop caffeine, and also normalize blood sugar and insulin levels through dietary change. (See chapter 7.) But it’s also important to find out what your heart is yearning for. One of my patients with heart palpitations found that they stopped soon after she asked for a promotion at work, something she hadn’t had the courage to do before. She got the promotion and finds her work more fulfilling than ever. Her heart no longer has to speak so loudly.

  FIGURE 19: THE HEART-EMOTION CONNECTION

  Emotions have direct physical effects on the heart and cardiovascular system, via the sympathetic and parasympathetic nervous systems.

  The Brain-Heart Connection

  Recall that the emotional and psychological changes of the perimenopausal years are to the entire life cycle as the week before one’s period is to the monthly cycle. All the issues that have been occurring premenstrually and which perhaps had been avoided previously—“Should I quit my job?” “Should I stay in this relationship?”—now come up and hit us between the eyes rather relentlessly, demanding that they be dealt with. Though women with palpitations often tell me that they have examined their lives and there don’t appear to be any personal issues bothering them, my experience has been that our bodies speak to us only when we can’t seem to “hear” them any other way. When issues of love, issues of the soul, or issues of a woman’s unmet passions cry out for attention, they often take the form of heart palpitations. If we are willing to be open to their meaning, we will be giving our hearts a chance to be heard. If we act on what we hear, the symptom often goes away.

  In his foreword to the book The HeartMath Solution (Harper-Collins, 1999), Stephan Rechtschaffen, M.D., writes that “the heart is a physical object, a rhythmic organ, and love itself.”11 We need to think of our hearts as all these things simultaneously and care for them with this perspective in mind. Because of the intricate connections between our brains and our hearts, our thoughts and emotions can and do have a powerful effect on the heart’s rhythm.

  Let’s take the dramatic example of sudden, unexpected cardiac death. This condition claims more than 450,000 lives per year in the United States, and research, which focuses on the physical condition of the heart itself, has made relatively little headway in decreasing these numbers. Sudden cardiac death is caused by a fatal arrhythmia known as ventricular fibrillation (VF), a disorganized, self-perpetuating electrical instability of the heart muscle that results in a failure to pump blood.

  VF can occur spontaneously in a completely normal heart and is usually seen when there is some pathological hindrance to the flow of blood in the heart vessels, a condition that often happens in humans in association with some psychosocial stress, such as bereavement, job insecurity, or marital strife. Whether or not a stressor affects the heart physically is dependent on the meaning that stress has for a given individual.12

  APPRECIATION AND GRATITUDE ARE TONICS FOR THE HEART

  The Institute of HeartMath, a nonprofit research and education organization in Boulder Creek, California, has been on the forefront of demonstrating and applying the intimate connection between our emotions and what is called cardiac coherence. Cardiac coherence refers to the beat-to-beat variability of the heart—a measure of the balance between the parasympathetic and sympathetic nervous systems. I like to think of the parasympathetic nervous system as the brake and the sympathetic as the gas; too much of either one causes irregularity of the heart rhythm. This can also happen when the activity between the two gets out of sync, which can happen when we get angry or emotionally upset. Over time, this irregularity can lower cardiac coherence, which is highly predictive of heart attack even when there are no other risk factors. But when the beat-to-beat variability is ordered and balanced, the resulting harmonic activity in the heart rhythms translates into optimal cardiac function.

  It is now well documented that the electromagnetic field of the heart is 5,000 times more powerful than the electromagnetic field of the brain.13 And that is why, no matter what we think, what we actually feel is what matters most. Every time. No exceptions. You might be able to fool your brain, but you can’t fool your heart. HeartMath has developed an ingenious biofeedback system known as emWave that displays your heart rhythm patterns (including a measurement of your heart’s beat-to-beat variability) and, more important, teaches you how to stabilize and optimize this variability by learning how to cultivate positive emotions in your heart area. You do this by activating the feelings you have toward someone or something that you love unconditionally. Over time, and with practice, you will be able to see how profoundly your emotions affect your heart.

  But it goes further than that. The function of the heart actually influences the function of hormones. Rollin McCraty, Ph.D., HeartMath’s director of research, has demonstrated that fifteen to twenty minutes of cardiac coherence practice per day is associated with increased levels of the hormone DHEA.14 DHEA, which is produced mainly in the adrenal glands but also in the ovaries, is the building block of the sex steroids. With enough DHEA, your body can then produce the right amounts of estrogen, progesterone, and testosterone. This is very significant proof that our thoughts have powerful physical effects on our bodies and that we can’t afford to ignore them. For more information or to order an emWave system, visit HeartMath’s website, www.heartmath.org.

  GENDER BIAS AND HEART DISEASE:

  OUR CULTURAL INHERITANCE

  For thousands of years our culture has valued male hearts more than female hearts. The heart-strengthening dreams, desires, and aspirations of women, as well as the vulnerable and tender hearts of men, have all suffered as
a result. Here are the facts.

  ~ The vast majority of research on both heart disease and its treatment has been done on men, even though the female’s cardiovascular system is different from the male’s.

  ~ Women’s brain connections to the heart are different from men’s. Men’s brains are more lateralized than women’s, which means that in general most men use only one hemisphere at a time, usually the left, which is associated with linear, logical thinking. Women, on the other hand, use both hemispheres simultaneously, and they have more frequent access to their right hemisphere. The right hemisphere is associated with music, emotions, intuition, and a deep experience of oneself. Here’s where things get interesting. There are more neuronal connections between the heart and the right hemisphere of the brain than between the heart and the left hemisphere. So in any given moment a woman has a greater neurological and emotional connection to her heart than do most men.

  ~ Given the difference in their brain-heart connections, women with heart problems have different symptoms than men.15 Men who are having a heart attack typically present with chest pain that begins under the breastbone and spreads to the jaw and the left arm. Women with heart attacks may not have chest pain at all. Instead, they may experience primarily jaw pain and indigestion. (By the way, a recent study by critical care nurse Martha Mackay at the University of British Columbia School of Nursing reported that during non-emergency angioplasty procedures, men and women were equally likely to report chest discomfort, but women were significantly more likely to report discomfort outside the chest, such as pain in the neck, jaw, or throat.)16 The first sign of a heart attack in women may also be congestive heart failure, with no evidence of the heart attack preceding it except for telltale changes on an electrocardiogram. They may die from this “silent” heart attack.17 Women who do have chest pain often experience more functional limitation than men, but fewer women are referred to cardiologists for a complete workup.

  ~ Until very recently, most doctors have not appreciated this difference. Consequently, serious heart problems go underdiagnosed and undertreated in women. In fact, women are only half as likely as men to undergo acute catheterization, angioplasty, thrombolysis, or coronary bypass surgery. The risk of dying of heart disease in a hospital is two times as great for a woman as it is for a man.

  ~ When a woman with chest pain or a racing heart shows up at a doctor’s office or emergency room, she may appear anxious and depressed, and an affective disorder rather than heart disease may be the first diagnosis considered. While it is true that affective disorders, including depression, phobias, and panic and anxiety, are twice as common in women as in men, they aren’t “just in women’s heads”—they affect the body as well. One of my most vivid memories of my maternal grandmother is how she often wrung her hands at night. Though she always maintained a wonderfully friendly and cheery demeanor, her hands belied her outward peacefulness. She died of a sudden heart attack at age sixty-eight.

  ~ If a man shows up who appears to be under stress, his symptoms are more apt to be correctly associated with heart attack—even if he acts hostile.

  ~ Women’s blood vessels are smaller and have a different organization from men’s. This is one of the reasons why coronary bypass surgeries and angioplasties don’t work as well in women as they do in men and also why more women die after these procedures. More women than men with so-called normal coronary arteries also have heart attacks, angina, and myocardial ischemia. As a result, a normal angiogram (blood vessel study) in a woman with symptoms doesn’t necessarily mean that she is free from heart disease.

  ~ The rate of early death after heart attack is higher for women than men, even if the women receive treatment. Researchers don’t know if this difference is caused by older average age at diagnosis, narrower vessels, greater frequency of coexisting illnesses, or inadequate or delayed medical care.

  ~ The thought patterns and behaviors that are associated with heart disease in women are different from the patterns associated with heart disease in men. In research on men, sudden death from heart attack is related to hostility—so-called type A behavior. This hasn’t yet been demonstrated in women. This doesn’t mean that men are inherently more hostile than women. In women, hostility just gets expressed differently. Recent studies have shown a correlation between hostility and hardening of the arteries in both men and women starting as young as age eighteen.18 But men tend to act out their anger and frustration physically in the outer world, whereas women are taught that this is unacceptable and unladylike. Therefore women learn to hold these feelings inside, where they ultimately can set the stage for a great deal of heart trouble.19

  Let’s use the analogy of two pots of water on a stove. The pot on the right—the woman—is on simmer, with a lid on top. The pot on the left—the male—has no lid, and the heat is on high. The heat of the male’s anger will cause the water in the pot to boil vigorously, with a lot of steam and noise. In a typical male heart attack, the pot boils over. The woman’s pot will never boil over, but the heat is there nonetheless, and the next thing you know, the water has evaporated and the pot has cracked. But because there was no noise and steam, no one was alerted to the problem. The same thing happens with a woman’s cardiovascular system.

  In the past few years, health care providers have been warned about these differences and have been urged to do a full cardiac evaluation of women with symptoms such as anxiety and chest pain. As we move toward a partnership society, our awareness of gender bias in heart disease treatment is becoming stronger. It is encouraging to know that the National Institutes of Health and the FDA have called for the inclusion of women in cardiac-related clinical trials. And the government has also founded the Office of Research on Women’s Health, which sponsored the Women’s Health Initiative.

  REDUCING YOUR RISK FOR HEART DISEASE

  It’s quite easy to reduce your risk for heart disease. The first step is to understand what it is and how it develops over time. Let’s start with the anatomy of an artery. Arteries carry blood away from the heart to all the organs and tissues of our body. They are lined with endothelial cells, all of which produce a gas known as nitric oxide (also discussed in chapter 9). When nitric oxide is produced in the lining of healthy blood vessels, it travels virtually instantly to all parts of the body simultaneously. Nitric oxide dilates blood vessels, thus increasing circulation. But it does even more than that. Nitric oxide is the über-neurotransmitter, influencing and balancing the levels of all the other neurotransmitters, including serotonin, dopamine, and betaendorphin, to name just a few. Neurotransmitters, as you will recall from chapter 2, are the molecules the brain makes when it thinks. But these same chemicals are made throughout the body. In fact, the bowel makes more neurotransmitters than the brain does. The nitric oxide connection is yet another reason why the heart is such a powerful regulator of mood and behavior. (Note that the role of antidepressants such as Prozac is to increase serotonin. Nitric oxide from your blood vessels is designed to do this naturally under the right circumstances.) Nitric oxide levels are increased by regular exercise, healthful pleasures of all kinds, antioxidant supplements, fruits and vegetables, and positive thoughts and emotions. In fact, one twenty minute episode of aerobic activity in women has been found to increase nitric oxide levels for up to twenty-four hours thereafter. The connection between nitric oxide and health is so powerful that I wrote an entire book about it, called The Secret Pleasures of Menopause (Hay House, 2008).

  In addition to nitric oxide, the endothelial lining of blood vessels also secretes anticoagulants (molecules that prevent blood clots, coronary occlusion, heart attacks, and embolic strokes) as well as pro-clotting proteins (which prevent bleeding or hemorrhagic strokes). If this endothelial lining is damaged and can’t produce adequate amounts of nitric oxide or overproduces the pro-clotting factors associated with stress and subsequent cellular inflammation, the risk for heart attack or stroke rises.

  As already mentioned, the entire cardiovascular
system, including all the arteries, is influenced starting in the womb and in childhood by diet, genetic tendencies, and ease of emotional expression. The following describes the three stages of development of arteriosclerosis.

  1. DEPOSITION OF FATTY STREAKS. These can be found in children. Immune cells called macrophages on the surface of the blood vessel endothelial cells swallow LDL cholesterol as it floats by. The fat droplets accumulate, causing fatty streaks to develop in the coronary arteries and the aorta. LDL cholesterol and other components of arterial plaques won’t stick to the endothelial lining of vessel walls unless there is some kind of damage to these walls in the first place—usually the result of free-radical damage to cells from a refined-food diet, the wrong kind of dietary fat, environmental toxins (such as cigarette smoke), chemicals caused by stress, a nutrient-poor diet, or a combination of all these.

  2. FORMATION OF FIBROUS PLAQUES. Over time, the fatty streaks enlarge, causing scarring in the underlying endothelial lining, and these scars can eventually grow into plaques, which are elevated areas of scarred or fibrous fatty tissue in the aorta, the coronary arteries, and the carotid arteries in the neck that bring blood to the brain and are often involved in strokes. These domelike bulges have a central core of cholesterol crystals.

  3. COMPLICATED LESION. In time, the dome of the lipid plaque grows large enough to significantly narrow blood vessels, which eventually results in decreased blood flow and thus decreased flow of nutrients and oxygen to tissue—in the same way that mineral buildup clogs plumbing. The calcified plaque may begin to ulcerate. When this happens, there is a much greater risk for blood vessel rupture and bleeding, resulting in a stroke or hemorrhage. Bits of calcified artery can also break off and be propelled by the flow of blood into distant areas where they lodge in a vessel and further cut off blood flow, thus resulting in stroke (dead brain tissue), heart attack (dead heart tissue), or dead tissue in other areas of the body.