CASE STUDY 1
Summary of Consultation:
The client presents with tiredness, bloating, mood changes, poor concentration, intermittent amenorrhea, insomnia, constipation, food cravings and musculoskeletal complaints. Blood pressure is normal.
Client has a very stressful and responsible job; drinks lots of coffee and eats a lot of chocolate and fatty food. Children are young adults, still at home, still fairly dependent. The client appeared somewhat tired and lacking in energy, said that she was ‘fed up’.
The clients symptoms are indications of PMT, however due to her age, the irregularity and nature of her menstrual flow and the feeling of being hot during the night, I suspect that the early stages of onset of the menopause (perimenopause) is more likely to be the case. The fact that she has missed a couple of periods is the main factor that distinguishes her symptoms from PMT. PMT type symptoms could be an indication of endometriosis, which was considered and ruled out through a process of differential analysis.
There is a natural decline in both oestrogen and progesterone, as is to be expected with the onset of menopause. However progesterone levels are much lower than the oestrogen levels causing a hormonal imbalance with the domination of oestrogen being the possible cause of a variety of symptoms such as those similar to PMS.
Both of these hormones are responsible for menstrual cycles with oestrogen producing the follicle stimulating hormone required for the first part of the menstrual cycle when proliferation of tissue and blood inside the uterus occurs. The second part of the cycle which begins around two weeks before menstruation, results in an increase in progesterone which stimulates the shedding of the lining of the uterus, leading to menstruation.
The typical menopausal symptoms such as insomnia, hot flushes, joint pain, mood changes, lack of sleep and difficulty ‘coping’ can be due to a negative feedback system. When this happens low hormone levels trigger the brain to tell the pituitary gland to increase levels of luteinizing hormone and follicle stimulating hormone.
The heaviness of her periods is likely to be due to a build up of tissue and blood that has not been shedded due to low levels of progesterone (due to anovulation) which causes a build up and causes the ‘dragging’ sensation just before she menstruates, which is a symptom usually associated with congestion.
The stiffening of joints is also associated with menopause, however her father’s history of osteoarthritis is also a factor to consider. The fact that she often feels cold during the day may be due to low thyroid function due to reduced progesterone levels.
The liver is responsible for processing and removing hormones via the bowel by binding them to bile. The liver may need support at this time, due to extra high levels of LH and FSH needing to be processed, in order to ensure that the overload does not exacerbate her symptoms.
Her digestion is likely to be compromised due to stress as it suppresses the secretion of stomach acid and the fact that she drinks lots of coffee and eats a lot of chocolate and fatty food will further compromise her digestive function. The constipation itself will be adding to the problem due to reabsorption of toxins and hormones into the system as feces sit in the bowel.
Due to her digestive function there will be poor absorption of vitamins and minerals that are needed for conversion of hormones. Probiotics in the bowel manufacture B vitamins that are necessary for adrenal hormone production and for the nervous system and for general hormone balance, therefore recolonisation of the bowel may help to bring her body back into balance.
She has a ‘highly stressful job’ which will have had a great impact on her adrenals especially if she has been under stress for a long period of time. As well as the ovaries, the adrenal gland is responsible for producing a weaker form of oestrogen called oestrone and is responsible for increasing bone density. Therefore it is important to support her adrenal system as levels of oestrogen produced by the ovaries fall so that oestrogen production from the adrenals is optimal, therefore reducing the risk of oesteoporosis in her post-menopausal years to come.
- Improve digestive function
- Improve liver function
- Restore nervous system
- Restore adrenal system
- Balance hormones
- Aid sleep by treating hot flushes
- Provide diet and lifestyle advice during menopause
- Give reassurance
- Monitor progress
Outcomes at 6 weeks:
The client’s increased ability to get to sleep and stay asleep has alleviated the feelings of tiredness, poor concentration and says she feels “more in control” of her emotions.
Constipation and bloating have been resolved, although constipation and sugar cravings can still return in a milder form prior to periods which continue to be intermittent. The client accepts that this is a normal phase of her life and no longer feels that the menopause will not be a “ball and chain” over the next few years. I have encouraged her to keep making incremental changes to her diet rather than relying on herbal intervention throughout her menopausal years.
Musculoskeletal symptoms for which I referred her to a trusted acupuncturist who specialises in this area. She is finding the yoga poses gives a feeling of more stability and self-massage with herb infused oils helpful in reducing pain and inflammation in the meantime.
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