Bottom Line/HEALTH: So there you are – you get a little bit hot sometimes. Suddenly you can’t sleep quite as well as you used to, and all those regular monthly cycles aren’t so regular anymore. Is it menopause? It may be. What are the top symptoms that you need to know so that you know if you’re in menopause?

I’m Sarah Hiner, President of Bottom Line Publications, and this is our Conversation With the Experts, where we get the answers to your tough questions from our leading experts.

Today I’m talking to Dr. Holly Lucille. She’s a leading naturopathic physician and expert in integrative medicine. Dr. Lucille was listed in Time Magazine’s ALT list as one of the top 100 most influential people and is the author of Creating and Maintaining Balance: A Woman’s Guide to Safe Natural Hormone Health. You can learn more about Dr. Holly Lucille at www.drhollylucille.com.

So welcome, Dr. Lucille.

Holly Lucille, ND, RN: Sarah, it’s so good to see you, and it’s great to be here.

Bottom Line: Good. Okay, so let’s jump right into it, because there these poor women are – are they having a bad day? What’s going on? What are, I’ll call it, the five major symptoms that somebody should be alert to?

Dr. Lucille: I have to say, as a practitioner, I’ve seen it, but everybody goes through this lovely, natural and normal process differently. But the top five I would give you, they’re called vasomotor symptoms. One would be hot flashes and night sweats. Maybe a little bit of memory loss. I call it “losing a noun,” person, place or thing, you can’t think of it anymore. Sleep disturbances for sure. Vaginal dryness. The vasomotor symptoms.

Bottom Line: And mood.

Dr. Lucille: And mood swings, exactly. Yes.

Bottom Line: All right, you know what? Let’s start first, let’s talk about memory. As far as memory, is it that they just can’t remember someone’s name? What are the symptoms when you think it’s menopause, and again, what are the symptoms when you really have to get it checked? I once heard somebody say to me if you forget something and then you remember it 5 seconds later, then it’s not a serious Alzheimer’s kind of issue.

Dr. Lucille: Correct. It’s a great question. The distinction, like I said, would be this dropping a noun. Like I was actually in a patient visit – this would be a perfect example. She was talking to me; I was getting back into her story and her health history. This is what she did. She said, “It was in the ’60s, it was that music festival, it was in New York…” And we both looked at each other like this… forever. Both of us, for 6 minutes.

Finished up the visit, I went outside to the front office and I had my next patient sitting there, and I was like, “Seraphina! Music festival…” She said, “Woodstock?” And we went, “Woodstock!” So that is an example of this dropping a noun type of thing that is very common around menopause.

Now, I unfortunately have an aunt that is actually in that situation where we needed to get it checked because her leaving the stove on, really not remembering where she parked, not remembering how to turn the lights on – you’d really want to get that evaluated for sure.

Bottom Line: Okay, great. Very important to have that distinction. Thank you. All right, let’s go on to hot flashes, because that’s the one that people complain about all the time. Seems to actually be the thing that annoys women the worst. So when does that become a real thing?

Dr. Lucille: It becomes a real thing and it becomes a real problem when it starts decreasing quality of life. Usually, you end up getting into that situation if they’re night sweats, because the night sweats will wake you up. And if you are not getting to sleep and staying asleep, you’re not getting that restorative, reparative sleep, and you really start to suffer throughout your days. So that becomes a big problem.

Bottom Line: How do you know if it’s a hot flash? When I had them, it was this whoosh of sweat that just started pouring out of every pore for like a minute or two, and then went away.

Dr. Lucille: And then it goes away. I’ve had them; that’s exactly what they feel like. Some people actually get them for a little bit longer in duration of time, but for the most part, that is it. Once again, to your point as being able to distinguish, hey, if somebody’s running a fever or they’re having night sweats and they also have unexplained symptoms or signs like a chronic cough or a dry cough; you want to get that checked. We can’t just say, “Oh hey, this is menopause.”

But, usually, the vasomotor symptoms are the first things that really show up and start getting people’s attention and scratching their head, like “I wonder if I’m perimenopausal” – “peri” just meaning around menopause.

Bottom Line: Just starting to. Okay, so how about vaginal dryness? You wouldn’t necessary notice that. Do you notice that as dryness, or do you notice that as suddenly you’re having some pain during intercourse or a tampon insertion or something like that?

Dr. Lucille: Sure, many things could get your attention. The pain during intercourse could be subsequent to the vaginal dryness, and usually that’s the case. Once again, we’re looking at all of these hormone receptor sites.

In this natural phase, this normal life phase of menopause, we’re having progesterone and estrogen and other hormones are involved, but they’re starting to naturally decline. So depending on your overall vitality and health, vaginal dryness can definitely be another symptom that you see around menopause.

Bottom Line: Okay. Now, sleep. Is it a pattern that occurs versus you have a lot on your mind? Is there a specific type of sleep interruption that occurs with menopause?

Dr. Lucille: Once again, when somebody is really starting menopause, they might – and they probably will – have not just one of these symptoms. So sleep, identify and treat the cause: is it because there’s night sweats going on and sleeplessness is there?

Once again, I’ll go back to the overall cortisol in our adrenal glands, which are so important during menopause. But we kind of blow right through them, blow right through our reserve before we get to this incredible endocrine change.

What happens is cortisol also sets your sleep/wake cycle. I call it sometimes people are having inappropriate nocturnal cortisol spikes. Cortisol is supposed to be low when we’re sleeping, but if we’ve got a lot on our mind, if we haven’t exercised or moved but we’re still stressed out during the day, sometimes these little cortisol spikes either keep you awake at night, don’t let you go to sleep, or you get to sleep and guess what? You wake up about 5 hours later, wide-eyed and bushy-tailed. It’s too, too early to get up.

Bottom Line: Will good sleep hygiene patterns, habits like going to bed at the same time every night, things like that, try to minimize that?

Dr. Lucille: Yes. Absolutely. One of the things that we do when people are having sleep disorders, treat the least invasive methods first. Use those. So definitely creating a good sleep hygiene environment, the things that we all know – even the light from the LED on your phone can disturb your pineal gland, your melatonin. So sleep hygiene, absolutely number one that you start to get that in shape.

Bottom Line: Gotcha. Okay, last one, so #5 of 5, mood. This is actually one of the biggest and most difficult to identify, the mood changes.

Dr. Lucille: That’s right, because a lot of people, especially in that time of our lives, have a lot going on. It’s usually a sandwich generation. Like for me, I have a huge full life here in Los Angeles, and my parents are three-quarters of the way across the United States and they’re not well.

Bottom Line: They’re a plane ride away. They’re not around the corner.

Dr. Lucille: Yeah, exactly. They’re on my mind all the time, and I actually have to fly back for a multitude of reasons for their life right now. So there’s a lot going on. There are financial issues, relationship issues. It’s hard to identify, is this an intrinsic mood shift that I’m having because of menopause? Because if you go back in the Native American teachings, this is a metamorphosis. There is a pull inward. Here, though, in our modern day, we might think of that introspective pull as “depression.”

One of the things I get really hyped up about is when we pathologize this process. Yes, people are uncomfortable, there are uncomfortable symptoms associated with menopause, but we’ve got to be able to honor the process as being a very normal hormonal change and then mitigate these symptoms for sure.

Bottom Line: I think that’s a really important point, because how many women do I know that are running to the doctor, looking to be medicated? And it really is important that this really is a process, and we’re now moving on to the next stage – and needing to deal with it. It’s hard.

Dr. Lucille: It’s hard, and I think also with the mood shifts, there is a connotation around this time that – and there’s reasons why; we’ve had messaging delivered to us, believe it or not.

There was a book by a New York gynecologist, Robert Wilson. He was hired by pharmaceutical companies to write this book called Feminine Forever, and in the book it actually says – you have to see it – it says women who don’t take prescription medication around menopause will die prematurely as unattractive hags. That was written by doctors. We all read this, Feminine Forever.

So there’s a connotation around this time that we’re going to lose our sexuality and we’re going to lose our youthfulness, and it’s so not true. I think that’s such an important thing. In fact, we stop concentrating these hormones below our waist, and we’re able to ascend up into our higher brain centers. That’s why they call it the golden years; that’s why they call it the crone years.

You think about creativity, intuition – after we metamorphosize, meaning there is a little process and a shift and change, it starts to become on fire, amazing, and you get this menopausal zest.

Bottom Line: All right. One other quick question: how many symptoms do they have to have for it to be officially menopause? If they have one, two, three? What’s the break point?

Dr. Lucille: The break point actually as defined by our medical textbooks is an entire year, so 12 months, without menstruating.

Bottom Line: It just means read the bellwethers that it’s coming on.

Dr. Lucille: Yes, that is it basically – there’s a process. Like I said, everybody goes through it differently. There’s a couple laboratory markers that you can actually run – FSH is follicle-stimulating hormone – to perhaps predict where you’re at in this process. But we have to treat people; we can’t treat lab tests. So it’s a very fluid process. But the medical definition for menopause: 12 months without menstruating.

Bottom Line: All right, thank you, Dr. Holly Lucille. The bottom line? Five major symptoms of menopause: mood swings, hot flashes, vaginal dryness, memory loss, and sleep disturbances. But those are just the bellwethers. Menopause comes on in many different ways, but it’s not a disease, and it’s not the end of your life. Menopause is the start of a new phase of your growing and evolving life. This is Sarah Hiner with Bottom Line.