Poor sleep, brain fog and constipation
Lauren, a 45-year-old female, was experiencing typical peri-menopausal symptoms. She had sleep issues that were getting worse, falling asleep easily but then waking up for hours. Perhaps as a result of this poor sleep, she also complained about extreme fatigue, brain fog and depression. Additional issues included thinning hair and constipation.
All of these symptoms slowly crept in after the birth of her third child. Her periods were starting to become irregular and the only solution her gynecologist offered was a prescription for Loestrin birth control. She tried them for three months but all she got was PMS, breast tenderness, and more irritability.
Lauren saw her primary care physician next, hoping they could at least help with her mood issues. That doctor’s answer was an anti-depressant, which she tried for a few months with a little improvement in her mood but a major downer for her libido. She finally came to me at Shalva Clinic asking for help, saying “is this my life now?” Of course, I said no! I’ve seen and helped so many women with the same issues.
As background, Lauren’s lifestyle factors were pretty good. She had no other health issues and was eating well. Her exercise could have been improved but she certainly wasn’t sedentary (what mom with three children is?) walking about 5 days/week.
Initial tests
In addition to a deeper dive into her health history, family health history and lifestyle, I ordered comprehensive bloodwork. This list looks long, but it’s really the best way to get a full picture of what’s going on in a patient and any potential variables, beyond sex hormones, that could be contributing to the symptoms. This is a serum blood test that’s often covered by insurance. I recommend my patients push for this in their annual exams, even if their physician isn’t experienced reading the results (many aren’t.) Tests I ordered:
· CBC with differential
· Comprehensive metabolic panel
· Lipid panel and Hemoglobin A1c
· Ferritin
· Comprehensive Thyroid: TSH, Free T4, Free T3, Total T4, Total T3, Reverse T3 & TPO Antibodies
· 25-OH Vitamin D
· Vitamin B12
· Folate
· CRP-hs
· Magnesium, RBC
· Sex hormones: Progesterone, Estradiol, DHEA-S, Testosterone (Total, Bio and Free)
· Cortisol
I also added on the Dutch Test – it uses urine to measure and shows me all the metabolites and gives a great baseline measurement of hormones and on-going monitoring if hormones are prescribed.
Follow-up
Labs revealed that Lauren was anemic due to a B12 deficiency. Her mostly Pescatarian diet – fish and little red meat, was likely contributing factor. We gave her a couple of B12 injections to get her levels stable and then switched to a maintenance does of sublingual B12.
Her labs also revealed very low Vitamin D – her level was 17 – which has been shown to contribute to depression. I put her on daily 5,000 IU’s Vitamin D + K2, which helps with absorption.
Her sex hormones DHEA and testosterone were low on both the serum and Dutch test. We decided not to add topical testosterone yet, adding in 10 mg. of oral DHEA which can help with testosterone. Progesterone was also very low, likely a contributing factor to her sleep issues. I started her on 100mg. of bio-identical progesterone at bedtime.
Lifestyle
I suggested Lauren add resistance training 2-3 days/week which she’ll try to do on her own at home with weights and YouTube videos. Weight training supports testosterone levels, floods some endorphins into the body, boosting mood and promotes healthy bone density.
I also suggested she incorporate at least one tub of leafy greens each week to help with the anemia and for fiber to address her constipation. Because her magnesium levels were on the low end of normal, I put her on some magnesium citrate in the evening before bed which moves the bowels and is also a relaxant, double duty support!
Three-month follow-up
When I next saw Lauren, she reported that things were moving in the right direction. She’s experiencing less constipation thanks to her leafy greens, magnesium and consistent exercise. She is struggling being consistent with her weight training but overall her energy levels are coming up because she’s been consistent with her vitamin B12 and DHEA, which supports the adrenals for better stamina. She’s also sleeping better. All of these additions and lifestyle changes are great for Lauren to incorporate and the early stages of peri-menopause. Good habits now will pay off, hopefully, in a smoother transition as she completes this cycle. A reminder: you’re considered in menopause once you’ve passed one year without having a period.
Cost
Office visit: Naturopathic doctor fees can range but our practice, Shalva Clinic in Westport, CT & NYC, charges $550 for a 90-minute visit; first follow-up visit (1 hour) is $400; and any other follow-up visit (½ hour) is $200.
Labs: Cost depends on healthcare coverage/plan; self-pay panels can range from $200-350 for blood tests.
Prescriptions: Compounded prescriptions range between $30-100.
Lifestyle: We always try to recommend the easiest and low-cost solutions! Walking for exercise is free; YouTube exercise videos (try Move with Nicole for pilates or POPSUGAR Fitness.) The Peloton app for phone or iPad (no bike required!), is just $12.99/month for unlimited yoga, walking, running, weight workouts and more. Also, you don’t need anything to meditate – just find a quiet space, close your eyes and breathe in and out. But, if you’d like some guided help, search Spotify or YouTube for great options.