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Telepsychiatry with an office coming soon!
Dr. Alisson Richards
Psychiatrist and Child & Adolescent Psychiatrist
Tel: 802-232-2672
info@evenstarpsychiatry.com
Menopause and Women's Health
Menopause and Perimenopause
Hormones
Nutrition
Exercise
PMS/PMDD
Menopause is defined as the final menstrual period and the cessation of the menstrual cycle for one year. Perimenopause and this transitional time can precede the final period by up to 10 years. During this transition there are fluctuations in our hormonal balance including estrogens, progesterone, testosterone, and sometimes thyroid hormone. Treating perimenopause and menopause offers numerous benefits including helping you feel better and improve your emotional and mental well being in addition there are numerous physical benefits that are preventive and have the potential to help protect you from heart disease, osteoporosis, recurrent urinary tract infections, and cognitive decline and Alzheimer's disease.
Perimenopause and Menopausal Symptoms
A list of some of the many symptoms you may experience. This list is not inclusive!
Women's Health Initiative (WHI) in an ongoing study
WHI study used synthetic hormones including Conjugated Equine Estrogen (CEE) aka Premarin and Medroxyprogesterone acetate (MPA) which are not bioidentical and which are pro-inflammatory.
Menopause Symptoms
If you haven't watched or followed Dr. Mary Claire Haver, I suggest that you do! She is a major leader in menopause and perimenopause education and a board certified OB/GYN.
GLP-1s
Body weight and the impact on both physical and mental health can be overwhelming and emotionally dysregulating for individuals. Dr. Richards works with each individual to do a psychiatric assessment and then make appropriate recommendations including lifestyle, nutrition, exercise, and medications for weight loss including the GLP-1s such as semaglutide and tirzepatide.
Huberman Lab
Dr. Zachary Knight: The Science of Hunger & Medications to Combat Obesity
I am attaching an excellent podcast on the GLP-1s. It is a must listen.
Huberman Lab
Dr. Zachary Knight: The Science of Hunger & Medications to Combat Obesity
I am attaching an excellent podcast on the GLP-1s. It is a must listen.
Menopause and Osteoporosis
Dr. Haver reviews data on the harm that is associated with losing our estradiol and the loss in bone density and flexibility. She also mentions how to prevent--HRT, collagen, protein intake, resistance training, and weighted vests.
Dr. Tyna and semaglutide
She has so many videos on semaglutide
Menopause and Mental Health
Dr. Haver reviews an article supporting the menopause transition and fluctuating levels of hormones playing a role in the rise in mental health symptoms. All the more reason to use hormones to address the symptoms at a functional level as opposed to using a patch of traditional psychiatric care such as antidepressants.
Menopause and Alzheimer's
Dr. Haver reviews the protective effects of estradiol on our brain health. Starting estradiol early will help reduce the "brain fog" symptom and protect against dementia.
Menopause and heart disease
Dr. Haver reviews an article published by the American Heart Association that talks about the link between menopause and heart disease.
Menopause and the loss of estradiol
An image to demonstrate the loss of estradiol throughout our life cycle.
Statin therapy and Women
The loss of estradiol in menopause leads to increases in LDL cholesterol and lower HDL cholesterol. Oral estradiol helps to lower LDL and raise HDL. Statins were not tested in women and are associated with developing insulin resistance, aka diabetes and women experience more significant side effects typically.
Bioidentical hormones can be an excellent option for addressing various symptoms that affect our emotional and physical health. Bioidentical hormones can be either FDA approved or from a compounding pharmacy. These hormones are structurally identical to the ones produced by our bodies, making them a wonderful solution to optimize our well being!
You will notice I use both Estrogen and Estradiol throughout and they are essentially the same for the purposes of the website.
Estrogen Matters is a must-read, or listen!
Estrogen Matters explores the benefits of estrogen to reduce risk of breast cancer, Alzheimer's disease, cardiovascular disease, and osteoporosis.
Ten Key Problems with the Women’s Health Initiative (Bluming and Tavris 238-241)
Rushed publication to press without telling co-investigators or their approval
Finding that HRT increases risk of breast cancer was not statistically significant
Study sample was not representative of menopausal women–63 years. Generalized conclusions to peri and menopausal women
Study sample was not healthy–nearly ½ were smokers, had high blood pressure, and 70% were overweight or obese
Findings were inconsistent and contradictory
Study used data mining–statistical practice that is unacceptable in scientific studies and analysis.
Claimed women weren’t helped by HRT but women were post menopausal
Claimed HRT increased heart problems in the first year, then claimed women who start in 10 years following the last menstrual period have a reduced risk!
Concern about strokes was not supported by WHI’s own data safety and monitoring board. Also when independent reanalysis done to control for statistical manipulations, supposed increased risk of stroke vanished.
WHI continues to promote alternatives to HRT: bisphosphonates and calcium for osteoporosis, statins for heart disease, physical and mental exercises for Alzheimer’s, and a healthy diet. But bisphosphonates and statins have their own side effects.
Dr. Loiuse Newson interviews Dr. Avril, Blume.
Ten Key Problems with the Women’s Health Initiative (Bluming and Tavris 238-241)
Rushed publication to press without telling co-investigators or their approval
Finding that HRT increases risk of breast cancer was not statistically significant
Study sample was not representative of menopausal women–63 years. Generalized conclusions to peri and menopausal women
Study sample was not healthy–nearly ½ were smokers, had high blood pressure, and 70% were overweight or obese
Findings were inconsistent and contradictory
Study used data mining–statistical practice that is unacceptable in scientific studies and analysis.
Claimed women weren’t helped by HRT but women were post menopausal
Claimed HRT increased heart problems in the first year, then claimed women who start in 10 years following the last menstrual period have a reduced risk!
Concern about strokes was not supported by WHI’s own data safety and monitoring board. Also when independent reanalysis done to control for statistical manipulations, supposed increased risk of stroke vanished.
WHI continues to promote alternatives to HRT: bisphosphonates and calcium for osteoporosis, statins for heart disease, physical and mental exercises for Alzheimer’s, and a healthy diet. But bisphosphonates and statins have their own side effects.
Dr. Loiuse Newson interviews Dr. Avril, Blume.
Estrogen deficiency and neuroinflammation
Attached in one of many articles demonstrating the science and protection of estradiol on our brains throughout our lives.
Progesterone benefits
Dr. Mary Claire Haver and Dr. Gabrielle Lyon discuss progesterone and some of its benefits.
DHEA and Systemic Lupus Erythematous
Sharing a research article out of Harvard which shows improvement when using DHEA with standard care vs placebo, A total of 381 women with SLE were enrolled. Among patients with clinically active disease at baseline (SLEDAI score >2), 86 of 147 in the prasterone group (58.5%) demonstrated improvement or stabilization without clinical deterioration, as compared with 65 of 146 in the placebo group (44.5%) (P = 0.017).
THYROID HORMONE
Thyroid disorders are common in women and 1 in 8 women will develop a thyroid disorder in their lifetime. The thyroid gland in your neck secretes T4 in response to signals from your pituitary. We can measure the signal, called Thyroid Stimulating Hormone (TSH) as well as levels of T4 and the active form it converts to, T3. The thyroid makes hormones that control how energy is used in the body. Symptoms of low thyroid are dry/itchy skin, thinning hair, weight gain and difficulty losing weight, constipation, cold intolerance, fatigue, depression, among others.
Link to Dr. Westin Childs describing subclinical hypothyroidism.
Link to Dr. Westin Childs describing subclinical hypothyroidism.
Testosterone benefits
Dr. Kelly Casperson, a board certified urologist, discusses testosterone with Dr. Lauren Streicher.
Educating women about testosterone is important, as there are many misconceptions surrounding its use.
More research is needed to fully understand the benefits and risks of testosterone therapy in women.
Testosterone may have potential benefits for bone health, brain function, and overall well-being in women.
Lab tests for testosterone levels are not always reliable indicators of the effects of testosterone in the body.
Safety is a key consideration in testosterone therapy, and individualized treatment plans are necessary. Testosterone therapy can be used to address various symptoms in women, but the dosage and approach should be individualized.
High levels of sex hormone binding globulin (SHBG) can reduce the effectiveness of testosterone therapy, and it may be necessary to explore other options or address underlying causes.
Thyroid dysfunction can masquerade as menopause symptoms, so it's important to check thyroid levels in women experiencing hormonal changes.
Hormone pellets are not recommended due to the potential for side effects and lack of control over hormone levels.
Education and communication are crucial in women's sexual health, and there is a need for adult sex education to address common misconceptions and provide accurate information.
Hormone therapy should be seen as a preventive measure rather than a treatment for existing health issues, and it should be part of a comprehensive approach that includes lifestyle factors like exercise and nutrition.
Educating women about testosterone is important, as there are many misconceptions surrounding its use.
More research is needed to fully understand the benefits and risks of testosterone therapy in women.
Testosterone may have potential benefits for bone health, brain function, and overall well-being in women.
Lab tests for testosterone levels are not always reliable indicators of the effects of testosterone in the body.
Safety is a key consideration in testosterone therapy, and individualized treatment plans are necessary. Testosterone therapy can be used to address various symptoms in women, but the dosage and approach should be individualized.
High levels of sex hormone binding globulin (SHBG) can reduce the effectiveness of testosterone therapy, and it may be necessary to explore other options or address underlying causes.
Thyroid dysfunction can masquerade as menopause symptoms, so it's important to check thyroid levels in women experiencing hormonal changes.
Hormone pellets are not recommended due to the potential for side effects and lack of control over hormone levels.
Education and communication are crucial in women's sexual health, and there is a need for adult sex education to address common misconceptions and provide accurate information.
Hormone therapy should be seen as a preventive measure rather than a treatment for existing health issues, and it should be part of a comprehensive approach that includes lifestyle factors like exercise and nutrition.
DHEA
Symptoms
Low libido
Fatigue
Vaginal dryness and atrophy
Memory problems
Mood swings
Depression and anxiety
Dryy, thin hair, and skin
Metabolic syndrome (high LDL/low HDL cholesterol, fat gain around middle, rising insulin and/or blood levels)
Weight gain
Weak bones
Benefits and potential improved Quality of Life (QOL)
Increased immune function
Improved insulin sensitivity
Decreased skin aging and increased skin thickness
Decreased arterial stiffness and inflammation reducing risk for heart disease
Improves memory and learning
Decreased abdominal fat
Increased energy levels and decreased fatigue
Improves connective tissue/autoimmune conditions like lupus, by reducing flare ups and lowering need for prescription drugs
Improves mood and well being
Decreased anxiety and depression
Improves vaginal dryness and atrophy
Decreased bone loss in women over 70
Increased sex drive in older women
Low libido
Fatigue
Vaginal dryness and atrophy
Memory problems
Mood swings
Depression and anxiety
Dryy, thin hair, and skin
Metabolic syndrome (high LDL/low HDL cholesterol, fat gain around middle, rising insulin and/or blood levels)
Weight gain
Weak bones
Benefits and potential improved Quality of Life (QOL)
Increased immune function
Improved insulin sensitivity
Decreased skin aging and increased skin thickness
Decreased arterial stiffness and inflammation reducing risk for heart disease
Improves memory and learning
Decreased abdominal fat
Increased energy levels and decreased fatigue
Improves connective tissue/autoimmune conditions like lupus, by reducing flare ups and lowering need for prescription drugs
Improves mood and well being
Decreased anxiety and depression
Improves vaginal dryness and atrophy
Decreased bone loss in women over 70
Increased sex drive in older women
Melatonin for more than sleep
Melatonin is important to our body's sleep-wake cycle-aka the circadian rhythm. It is also important as an immune modulator, mood enhancer. It can be used for jet lag and travel so contact me if you are interested in this! I use compounded micronized SR melatonin.
Hormones over 60? Is It Ever Too Late for Hormone Replacement?
Dr. Susan Hardwick-Smith discusses the topic and research related to starting hormones after age 60.
Normal isn't Optimal
Dr. Rouzier summarizes research on hormones and discusses how hormones can enhance your quality of life.
Good nutrition is essential during perimenopause and menopause. Have you noticed you can no longer eat the same foods without becoming bloated and gassy? Our bodies and digestive tracts change as does our proclivity towards Insulin Resistance (IR). Check out important links below for information on how to shift and make changes in your diet to help reduce your IR and feel better!
Omega-3 Fatty Acids for Depression
Our bodies cannot make Omega-3 Fatty acids, thus they are and ESSENTIAL fatty acid necessary for brain health and whole body health that we can only get from ingesting them from food sources that contain them or a dietary supplement. Food sources are Fish and other seafood (especially cold-water fatty fish, such as salmon, mackerel, tuna, herring, and sardines)
Nuts and seeds (such as flaxseed, chia seeds, and walnuts). I have another slide on other sources of section on polyunsaturated fatty acids (PUFAs) and inflammation which talks about fats that can lead to inflammation.
Nuts and seeds (such as flaxseed, chia seeds, and walnuts). I have another slide on other sources of section on polyunsaturated fatty acids (PUFAs) and inflammation which talks about fats that can lead to inflammation.
Polyunsaturated Fatty Acids (PUFA) and inflammation
As you are probably aware when reading this, the recommendations about what makes up a "healthy and nutritious diet" have changed several times during our lifetime. The idea that saturated fats (derived from animal sources like butter, red meat, bacon, etc) are not healthy and other fats including PUFAs (vegetable oils and shortenings) are better is erroneous. This article from the Journal Lipids discusses the pro-inflammatory basis of PUFAs. "Ideally, even though these PUFAs in both families are essential to the human body, consuming higher n-6 than n-3, as is now mostly happening in modern westernized diet styles, has been shown to exert an effect on human health and in fact contribute to the emergence of many modern chronic inflammatory diseases, cardiovascular diseases, and some cancers, providing that inflammation is at the base of most of the modern diet-related chronic diseases."
Protein!
Optimizing protein intake under catabolic conditions
The optimum amounts of protein that are higher than the RDA
As adults get older, the efficiency of protein goes down
Period of inactivity increases the need for protein
Metabolic dysregulation with a higher protein and lower carb diet can change glycemic balance
Many literature reports that optimum intake of protein can even be double the RDA
The importance of Leucine
Protein distribution through the day, utilizing the first meal of the day
Creatine
Dr. Susan Hardwick-Smith talks about Creatine. Creatine is a naturally occurring peptide consistent of 3 amino acids, and has been widely studied for its numerous benefits and low side effect profile.
In fact creatine is the most studied supplement in the world. Well known to improve muscle mass and sports performance, creatine is particularly relevant in midlife when losing muscle and bone accelerate, and gaining muscle can be more challenging.
As well as the numerous health benefits related to muscle and bone, creatine also has important implications for brain health including improving memory, dementia risk and recovery from brain injury.
In short, creatine is one supplement that I recommend for just about everyone!
In fact creatine is the most studied supplement in the world. Well known to improve muscle mass and sports performance, creatine is particularly relevant in midlife when losing muscle and bone accelerate, and gaining muscle can be more challenging.
As well as the numerous health benefits related to muscle and bone, creatine also has important implications for brain health including improving memory, dementia risk and recovery from brain injury.
In short, creatine is one supplement that I recommend for just about everyone!
MTHFR mutation and mental and physical health
From Psychology Today, "This post may be of greatest interest to those who have been diagnosed with one of the mental health issues linked to having an MTHFR mutation, such as depression, bipolar disorder, schizophrenia, attention-deficit hyperactivity disorder (ADHD), or autism. MTHFR mutations also increase the risk of several physical health problems, including but not limited to cardiovascular disease and stroke, recurrent early miscarriage, migraine with aura, osteoporosis, and some cancers. So, it’s worth knowing about this mutation even if one or more of the above conditions run in your family."
Pilates!
Peace of Mind Pilates is a welcoming studio with no judgment! Pilates is the best way to strengthen your core!
Located in the Essex Experience with numerous offerings
https://www.peaceofmindpilatesvt.com
Located in the Essex Experience with numerous offerings
https://www.peaceofmindpilatesvt.com
Strengthen your body!
Fit by Mik is a fun and easy way to get some strength into your routine. Start with light weights (~2-3 pounds) if you are a beginner and increase as able. Our grip strength and bone and joint strength are essential as we age.
HIIT in 10 minutes!
HIIT in 10 minutes can be as effective as a 40 minute sustained work out.
HIIT improves Heart Health
High Intensity Interval Training (HIIT) improves your cardiorespiratory fitness even in a short amount of time. Low intensity sustained exercise is ALSO GOOD for you but if you don't have time in your busy life, starting your morning routine with a 10-15 minute HIIT workout will get your metabolism going for the day.
https://wevibebetter.com/hiit-workouts-vs-low-intensity-routines-why-both-may-be-beneficial/
https://wevibebetter.com/hiit-workouts-vs-low-intensity-routines-why-both-may-be-beneficial/
Weighted Vest for Strength!
Rukr is one option for a weighed vest you can wear around the house while cleaning or out on walks and hikes.
Exercise Snacks!
Exercise "snacks" are a term suggested by Dr. Howard Hartley, a cardiologist and Professor at Harvard, to include small bursts of exercise into your routine that even if only adding then a few times a week, can improve your cardiac and respiratory health.
Interval Walking
Interval walking is a great way to get that intensity burst but low impact and in a "snack" size bite. This is something you can maintain during the winter as you can do it inside.
Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder( PMDD) are hormonal syndromes which can cause a myriad of emotional and physical symptoms each month during the week or two before your period starts. Typically either not addressed by medical providers or treated with medications such as SSRIs, many women do not respond to these medications. See below for options including hormonal treatment with progesterone which many women find helpful.
Premenstrual Dysphoric Disorder
Many women are dismissed when they struggle with their hormones related to their cycle. Some women experience extreme mood swings and sometimes suicidal ideation. This video from BBC listens to the stories of women with PMDD. Bioidentical hormone therapy can help when antidepressants don't treat the source of the problem.
A review of progesterone for PMS
This review highlights that there is not enough research into using progesterone to treat the symptoms of severe PMS or PMDD. Only 2 studies were found to meet the criteria for the review. However, many women find BHRT with progesterone helpful when taken continuously. Progesterone impacts our levels of GABA (a calming neurotransmitter): "Gama amino butyric acid (GABA) produced by inhibitory neurons calms symptoms of anxiety, irritability and aggression. Part of the receptors, called GABA(A) on the neurone surface, necessary for GABA to have its effect, cannot be made without the break-down products of progesterone (Smith 1998). The occurrence of severe symptoms has been correlated with falling levels of progesterone metabolites. Therefore, progesterone could relieve the symptoms of PMS by preventing falling levels of progesterone metabolites and loss of GABA(A) enhancement (Monteleone 2000; Wang 1996)."
Hormones during a typical cycle
The International Association For Premenstrual Disorders (IAPMD) was formed to bring awareness and support to those suffering from premenstrual symptoms. One theory is that the changes in progesterone and the sudden drop lead to the symptoms of PMDD.
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