Self-Care Strategies for Post-Menopausal Women: Addressing Sleep and Hormonal Issues

Self-care issues after menopause?

Hello Dr.
Chang,
I have two concerns I would like to consult you about: 1.
Sleep and tinnitus, 2.
Hormones.
I wake up at 3 AM and find it difficult to fall back asleep.
If I do manage to sleep again, it is only for a short time and filled with dreams.
This situation began after I sustained an injury before the age of 30, which led to a herniated disc that compressed the nerve in my right leg.
Due to improper treatment, I also suffered a back sprain.
Since then, I have had difficulty sleeping every night due to discomfort and pressure in my back.
For the past two to three decades, I have needed to take naps to compensate for my sleep, also to allow my chronic lower back pain to rest.
However, this year, I have frequently experienced insomnia even during my naps.
Additionally, after experiencing a "transient ischemic attack lasting about one minute" in September of the year before last, I began to have tinnitus in both ears.
Earlier this year, I visited an ENT specialist, and after hearing tests showed no damage and blood tests were conducted, the doctor firmly stated that my tinnitus and sleep disturbances were caused by "menopause." I was prescribed Vivelle-Dot and a sedative.
Since I do not have severe symptoms like hot flashes or night sweats, I am okay as long as I can get enough sleep.
I am nearly sixty years old and have experienced a transient ischemic attack, and I am currently taking anticoagulant medication.
I am uncertain if hormone therapy is suitable for me.
I would like to ask Dr.
Chang: In my post-menopausal condition, are there other treatment options besides hormone therapy? Some have suggested taking soy isoflavones; I drink two cups of concentrated soy milk daily, which provides 130 mg of isoflavones.
Is this sufficient supplementation? I have also heard about taking royal jelly along with calcium, magnesium, and vitamin D to prevent osteoporosis.
I sincerely request your guidance on how to take care of myself after menopause.

Wu Tai, 50~59 year old female. Ask Date: 2021/05/16

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, if you have experienced improvement in your symptoms after using Veenina tablets and sedatives, but are not suitable for hormone replacement therapy due to the risk of thrombosis, you may try the methods you mentioned to see if they are effective.
However, if your symptoms have not improved after using Veenina tablets and sedatives, it may be due to other causes of tinnitus and sleep disturbances, and you should consult a physician for further evaluation.
Thank you! Wishing you peace and health.
Dr.
Zhang

Reply Date: 2021/05/16

More Info

Navigating the challenges of post-menopausal symptoms, particularly sleep disturbances and hormonal changes, can be quite complex. It’s essential to approach these issues holistically, considering both medical and lifestyle interventions.

Understanding Your Symptoms
From your description, it seems that your sleep issues are compounded by a history of physical injuries and the onset of tinnitus (ear ringing) following a transient ischemic attack (TIA). The fact that you have been experiencing difficulty sleeping since your 30s, alongside chronic pain, suggests that your sleep disturbances may not solely be due to hormonal changes associated with menopause. However, hormonal fluctuations during menopause can exacerbate existing issues, leading to increased insomnia and discomfort.

Hormonal Considerations
You mentioned that your doctor prescribed hormone replacement therapy (HRT) with a medication called "維妮娜錠" (likely a form of estrogen). While HRT can be effective for many women in alleviating menopausal symptoms, it is not suitable for everyone, especially those with a history of blood clots or cardiovascular issues. Given your history of TIA and ongoing anticoagulant therapy, it’s prudent to discuss the risks and benefits of continuing HRT with your healthcare provider.

Alternative Treatments
1. Lifestyle Modifications:
- Sleep Hygiene: Establish a consistent sleep schedule, create a restful environment, and limit screen time before bed. Consider relaxation techniques such as deep breathing or meditation to help ease into sleep.

- Dietary Adjustments: Incorporating foods rich in phytoestrogens, such as soy products (like your soy milk), can be beneficial. The amount you mentioned (130 mg of isoflavones) is generally considered a good intake, but individual responses can vary. It might be helpful to consult a nutritionist for personalized advice.

2. Supplements:
- Calcium and Vitamin D: These are crucial for bone health, especially post-menopause when the risk of osteoporosis increases. Ensure you are getting adequate amounts through diet or supplements.

- Magnesium: This mineral can help with sleep quality and muscle relaxation. Consider discussing magnesium supplementation with your doctor.

- Royal Jelly: While some women report benefits from royal jelly, scientific evidence is limited. It’s essential to monitor how your body responds to any new supplement.

3. Cognitive Behavioral Therapy for Insomnia (CBT-I): This is a structured program that helps individuals address the thoughts and behaviors that contribute to sleep difficulties. It has been shown to be effective for chronic insomnia and may provide long-term benefits without the side effects associated with medications.

4. Physical Activity: Regular exercise can significantly improve sleep quality and reduce symptoms of anxiety and depression. However, be mindful of the timing; vigorous exercise close to bedtime may disrupt sleep.

5. Pain Management: Since chronic pain is a significant factor in your sleep disturbances, consider discussing pain management strategies with your healthcare provider. This could include physical therapy, acupuncture, or medications specifically aimed at managing chronic pain.

6. Tinnitus Management: For the tinnitus, sound therapy or hearing aids can sometimes help mask the ringing. Cognitive behavioral therapy can also be beneficial in managing the distress associated with tinnitus.

Conclusion
In summary, while hormonal treatments can be effective for managing menopausal symptoms, they may not be the only solution for your sleep and tinnitus issues. A combination of lifestyle changes, dietary adjustments, cognitive behavioral therapy, and possibly alternative supplements could provide a more comprehensive approach to improving your quality of life. Always consult with your healthcare provider before making any significant changes to your treatment plan, especially considering your medical history. Your well-being is paramount, and a tailored approach will likely yield the best results.

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