By Dr. McKenzie Nisbet, ND

Menopause: The Basics

MENOPAUSE: THE BASICS

Millions of women experience menopausal symptoms each year, however there is often confusion over when menopause starts, what’s happening below the surface and what options we have for testing and treatment. Let’s start by defining a few terms.

DEFINING THE TERMS

PREMENOPAUSE starts at puberty and continues into your 40s (typically). During this time, you (should) have regular cycles.

PERIMENOPAUSE marks the time before menopause when hormones are shifting. This typically occurs in your 40s and 50s and symptoms often start here.

MENOPAUSE is reached after 12 consecutive months with no period. Symptoms can carry through peri-menopause into menopause.

THE HORMONAL SHIFT

During perimenopause hormones such as progesterone, estrogen and testosterone decline.

PROGESTERONE is ONLY produced when we ovulate. In a perfect world this happens predictably once each month. During perimenopause women ovulate less consistently and our cycles become less predictable. No ovulation means no progesterone spike. Less progesterone can trigger issues such as insomnia and feelings of anxiety due to less GABA receptor simulation.

ESTROGEN levels gradually decline during this time as well. This decline can be at an irregular pace, which is why symptoms can vary. The reduction in estrogen increases the risk for osteoporosis and cardiovascular disease and can trigger vasomotor symptoms such as hot flashes and night sweats, brain fog and vaginal dryness.

TESTOSTERONE naturally declines as we age. Testosterone peaks in our 20s and continues to decline through perimenopause and menopause. Proper sleep and resistance training are important to support hormone production.

This hormonal shift can be unpredictable. Some days or months can be good and some days or months can be full of symptoms. For some women this transition is easy for others it’s a roller coaster ride of symptoms including:

  • Hot Flashes
  • Night Sweats
  • Irregular Cycles
    • Heavier or Lighter Periods
    • Longer or Shorter Cycles
    • Increased or Decreased Cramping
    • Increased or Decreased PMS
  • Insomnia
  • Weight Gain
  • Anxiety
  • Depression
  • Migraines
  • Vaginal Dryness
  • Reduced Libido

If you are one of the lucky ones with a smooth transition – fantastic. If you are one of the many facing these symptoms – get to know your testing and treatment options.

INVESTIGATING YOUR TRANSITION

Every woman presents with difference symptoms. Knowing your numbers helps create a more targeted treatment plan.

TRACKING. Track your symptoms. These can vary day to day and month to month. Monitoring the number of hot flashes, severity of night sweats, sleep changes, cycles, etc. can help us understand your unique picture.

COMPREHENSIVE TESTING. The DUTCH test is my favourite for getting an overall picture of your sex hormones and adrenal function.

BLOOD WORK. Depending on your specific symptoms, we can use different blood parameters to uncover imbalances and deficiencies. Here are some of the parameters I commonly run with my peri-menopausal patients:

  • Thyroid Panel (TSH, Free T3, Free T4, Anti-TPO, Anti-TG). Often run when symptoms of under-active thyroid are present (fatigue, dry skin, hair loss, etc), or when weight is a major concern.
  • Insulin, Glucose and Leptin. These parameters are used to determine if there is an underlying insulin resistance or leptin resistance contributing to weight gain.
  • Vitamin B12 and Iron. These are commonly used when fatigue is a major concern, when there is abnormal bleeding, or when thyroid concerns are present.
  • Vitamin D. Risk of osteoporosis increases with menopause due to the reduction in estrogen levels. We want to ensure adequate Vitamin D levels are maintained to support bone health.
  • Cholesterol and HbA1c. Lipid levels can shift during peri-menopause. Running a full lipid panel and HbA1c (blood sugar) lets us monitor for any unwanted increases/declines. We can then intervene with diet, lifestyle or supplement support as needed.

TREATMENT OPTIONS

It is important to remember that what was working for you at 20 or 30 may no longer be working at 40 or 50. Adjustments to diet and lifestyle are often needed as we enter this transition.

Depending on your symptoms experience and lab results we can create a treatment plan unique to your goals. Treatment can include dietary and lifestyle changes, nutraceuticals, herbal medicine (to support thyroid, adrenal and sex hormones), and/or bio-identical hormone therapy (BHRT) such as topical progesterone cream.

Get to know your options. Schedule your Free 15-Minute Meet & Greet here and lets chat!

By Dr. McKenzie Nisbet, ND

Biohacking for Better Sleep

BIOHACKING FOR BETTER SLEEP

 

Do you have insomnia? Studies show over 40 million Canadians have at least 1 symptom of insomnia. Insomnia can be trouble falling asleep, staying asleep or early morning awakening. The number one question you should ask yourself to determine if you are getting adequate sleep is: do you feel rested when you wake?

Insomnia is extremely individualized. It can be linked to hormonal imbalances, nutrient deficiencies, muscle pain, digestive upset, temperature dysregulation, poor sleep hygiene, blood sugar changes, and an irregular circadian rhythm to name a few. We are going to focus on tips and tricks everyone can do to improve their sleep by biohacking their circadian rhythm.

 

Circadian rhythm is essentially a dark-light (or sleep-wake) cycle that affects our behaviour and physiology. This 24-hour “clock” is located in our brain and can be influenced by our environment. When this rhythm becomes disrupted it can impair our health.

Two key players in your circadian rhythm are cortisol and melatonin. You have probably heard of cortisol referred to as your stress hormone and melatonin as your sleep hormone. Too much or too little of either can disrupt your sleep. You need both to ensure proper sleep and waking. Cortisol is your daytime hormone and melatonin is your nighttime hormone.

Cortisol spikes first this in the morning. This is what helps you get out of the bed in the morning, ready to start your day. If your cortisol is not rising in the morning you may feel groggy and have difficulty getting out of bed. It should then begin to fall, reaching its lowest point at night, allowing you to fall asleep. It should remain low until the next morning when it spikes again.

Melatonin is the dominant hormone at night, helping you fall asleep and stay asleep, until the morning where cortisol takes over.

It is important that we are doing everything we can to ensure cortisol is supported during the day (specifically in the morning) and melatonin is supported at night (specifically at bedtime).

 

HOW DO YOU SUPPORT CORTISOL?

Cortisol (the daytime hormone) is stimulated by blue light. Think of the bright blue light outside during the day – this is what supports cortisol production and suppresses melatonin production. Getting a ‘dose’ of light first thing in the morning can help support the cortisol spike and waking.

 

BIOHACKING CORTISOL

NATURAL LIGHT EXPOSURE. Get direct natural light for 20-30 minutes each morning. Open your blinds and allow light into your home. This can be easier said than done during the Canadian winter.

 

LIGHT THERAPY. Adding a light device to your routine can help ensure you are supporting your cortisol – no matter the time of year or amount natural light available.  There are many products and sizes available on the market, some are large units others are portable. One popular product line is the HappyLight by Verilux. Be sure the product you choose is 10,000 lux for best results. Try using yours each morning for 20-30 minutes, 16-24 inches away from your face. This can be done while getting ready in the morning, or while eating breakfast.  Light therapy has also been shown to improve the symptoms of Seasonal Affect Disorder (SAD).

 

HOW DO YOU SUPPORT MELATONIN?

Melatonin is suppressed by blue light and cortisol. Picture what the natural light is like when you are trying to fall asleep at night – we get a red-tone during twilight hours and then darkness. This type of light supports melatonin.

To bio-hack your body to produce more melatonin we need to ensure our cortisol remains low at night by reduce the amount of cortisol-stimulating blue light. At night this blue light is coming from technology – phones, tablets, computers, TVs, etc . This blue light tricks our body into thinking it is daytime. Try using some of the techniques below to limit your exposure.

 

BIOHACKING MELATONIN

SET A SCREEN CURFEW. Set two alarms each night. Once 90-minutes before bed and one 60-minutes before bed. The first one serves as your warning: you have 30-minutes left of screen time. The second serves as hard-stop: all screens must be turned off. A full 60-minutes can be challenging at first so work yourself up starting at 15-minutes and adding 5-15 minutes at a time as you begin to adapt to this new tool.

As you work to turn off your screens earlier at night there are other tools you can implement to block the blue light and reduce melatonin suppression.

 

CELLPHONES – NIGHT SHIFT MODE. Most phone companies have some type of night mode built into their newer models. Apple, for example, has “Night Shift”. Go to your settings and ensure it is at its max and is set to turn on around 6-7pm. This will enable your phone to shift away from blue light and more towards at red-tone at this hour.

 

CELLPHONES – BRIGHTNESS. If your eyesight allows, turn your phone to the dimmest setting at night. You can take this one step further and enable dimming below factory setting by overriding the “Zoom” mode on your iPhone.

 

COMPUTERS – F.LUX. Similar to how Night Sift works on your phone, you can shift from blue light to a red-tone on your computer too. Download the application called: F.Lux. After downloading set F. Lux to shift to its maximum red-tone (or to your tolerance) at 6-7pm. This will help reduce the stimulation of cortisol and suppression of melatonin.

 

COMPUTERS – BRIGHTNESS. As with your phone, be sure to reduce the brightness to the lowest option at night to reduce light stimulation.

 

BLUE LIGHT BLOCKING GLASSES. For all other screens where Night Shift and F.Lux are unavailable you can use blue light blocking glasses. Instead of working on the source of the blue light it works by filtering out blue light before it reaches your eyes. There are numerous blue light blocking brands on the market in a variety of styles ranging anywhere from $30 to hundreds depending on the brand/frame.

 

SLEEP HYGIENE. The last and most classic way to bio-hack your sleep is using Sleep Hygiene techniques. These help your body stay true to its circadian rhythm and create the optimal environment for you to achieve a deep and restorative sleep. How many of these sleep hygiene techniques do you follow?

1. Create a Regular Sleep Schedule

  • Go to sleep at the same time each night, ex 10pm
  • Wake at the same time each morning, ex. 7am
  • Avoid sleeping in (even on weekends)
  • Use a calming alarm: wake to light or the sounds of birds, rather than your phone alarm. Try ‘Philips Sunrise Simulation Light’.

2. Cut Down Time in Bed

  • Avoid forcing yourself to sleep: only get into bed when you are tired
  • Use your bed for sleep/sex only
  • Avoid reading or watching TV in bed

3. Make Your Bedroom Comfortable

  • Turn the temperature down: ex. 65 degrees
  • Keep your room quiet: use earplugs if necessary
  • Keep your room dark: invest in black out drapes and cover all ‘technology glow’ (such your alarm clock)

4. Give Yourself Time to Relax and Wind Down

  • Deal with worries before bedtime: set aside ‘worry time’ for at least 30 minutes before you get into bed – write down what’s on your mind, such as your current stressors or your to-do list for the next day
  • Listen to relaxation tapes (classical music, natural sounds) – Try an app like “Sleep Bug” (free)
  • Yoga: do some gentle yoga at bedtime before entering your bedroom
  • Meditation: get yourself in the right mindset for sleep – Try an app like “Headspace” (free)
  • Use Progressive Muscle Relaxation: tighten then relax each muscle group individually (begin at your feet and work up to your head)

5. Reduce Sleep Disrupting Habits

  • Do not exercise within 90 minutes of bedtime. Do your vigorous exercise in the morning or late afternoon, and relaxing exercises before bed
  • Avoid over-stimulating activities just before bed: no competitive games or exciting movies/TV shows
  • Avoid caffeine after lunch (the half-life of caffeine is over 4 hours for most people): avoid chocolate, coffee, caffeinated tea, and soda
  • Do not eat a heavy meal within 2 hours of bedtime
  • Avoid excessive fluids immediately before bed
  • Do not use alcohol to induce sleep: it actually worsens insomnia
  • Do not check the clock if you do wake at night
  • Do not turn on lights when getting up to use bathroom

 

Supporting cortisol production in the morning and melatonin production at night helps regulate your circadian rhythm to flow more smoothly. This will help you fall asleep and stay asleep at night and allow you to wake feeling rested in the morning!

 

If your insomnia is persisting despite proper sleep hygiene and biohacking it’s time to book an appointment with your health care practitioner to get to the root of your insomnia.

Interested in knowing your sleep options? Book your free 15-minute consult and let’s get started!

 

 

Resources: https://www.ncbi.nlm.nih.gov/pubmed/21959029, https://www.ncbi.nlm.nih.gov/pubmed/11584554
Menopause: The Basics
Biohacking for Better Sleep