Menopause

SUBMITTED BY: Katie Donnelly

PATIENT: Female, 56 years old

CASE STUDY: Menopause 

INITIAL PRESENTATION:

Female presenting with recurring hot flashes and night sweats. She has described this as occurring intermittently, up to 5-6 times per day. Menstruation has been absent for over 12 months. The client has identified that alcohol is a trigger. She often wakes due to sweating at around 2am - 3am, and returning to sleep has been a challenge. She often gets up for a glass of water and may use the bathroom, then describes a “racing mind”, making it hard to return to sleep. The client finds sleep disturbance is impacting her energy levels and finds it difficult to get comfortable when she is experiencing a hot flash.

The client is also experiencing notable changes in mood, with increased irritability towards her husband and reduced tolerance. She finds they are arguing more frequently over trivial issues, such as having the TV too loud, and she has minimal intention to resolve disagreements. Bouts of anxiety and depression described, and history of mild depression. No treatment or diagnosis sought.

No medications are being taken at present. Client was taking encapsulated Actaea racemosa (black cohosh) for the past 12 months to support mood, self-prescribed from the pharmacy. Taking 2 per day at Described feeling “… like I’m going crazy…” prior to this supplementation. Has since ceased as she developed a rash that dissipated on stopping black cohosh six weeks ago. No further issues or other symptoms. Recommended we take a break from this herb but may be able to safely revisit in the future.

Client is hesitant in her ability to cope with a liquid herbal formula, so we will start low and gradually increase.

HERBAL TREATMENT - Menopause blend

Asparagus racemosa Shatavari 60mL 1:2

Hypericum perforatum St. John’s wort 40mL 1:2

Salvia officinalis Sage 40mL 1:2

Leonurus cardiaca Motherwort 30mL 1:2

Glycyrrhiza glabra Liquorice 40mL 1:1

Total 210mL

Dosage

2.5mL three to six times daily, with a small amount of water or juice. Work up to 5mL, three times daily or 7.5mL twice daily. Shake well.

GENERAL TREATMENT RECOMMENDATIONS

• Focus on removing alcohol and saving this for a special occasion rather than every night. Start by reducing from three glasses of white wine (standard pour) to one glass.

 

• Try to go to bed at a regular time each night, and keep a glass of water near the bedside to prevent the need to get out of bed if a hot flash occurs.

 

• Practise breathing exercises and gentle daily exercise to support the stress response, particularly when feeling irritable. Exercise will also support muscle structure and bone integrity.

 

• Try to reduce excess sugar, caffeine, and hydrogenated fats to support mood regulation and overall wellbeing.

FOLLOW-UP - 2 weeks later:

The client has described improvements in reduced intensity of hot flashes but not in frequency. Has noticed her tolerance and temper has improved, and is overall feeling positive. She is struggling to reduce alcohol intake, as she feels as though this balances her mood. Also struggling to incorporate exercises.

• Go for a 20 minute walk, twice a week. If the hills in your area are too steep, drive to a local area where you can walk on a flatter surface. This can be a gentle stroll – it all counts.

 

• Cut back by ONE glass of wine per evening as a positive way to incorporate change. Follow this glass with another drink – this might be a juice or mocktail. Having an alternative that you enjoy can help to shift the habit and still provide a sense of enjoyment.

 

• Introduce an evening herbal formula now that you are comfortable with taking herbs. This can help with calming the mind and support return to sleep.

 

• Repeat menopause blend.

HERBAL TREATMENT - Sleep blend

Passiflora incarnata Passionflower 40mL 1:2

Zizyphus spinosa Zizyphus 60mL 1:2

Melissa officinalis Lemon balm 60mL 1:2

Scutellaria lateriflora Skullcap 40mL 1:2

Total 200mL

Dosage

Take 7.5mL before bed and 7.5mL if you wake during the night. Keep this by your bed with a glass of water for easy consumption.

FOUR WEEKS LATER:

Client is feeling notable improvements in mood, hot flashes and sleep. She has started to enjoy taking her herbal formulas and has described improved temperament and reduced anxiety. Still wakes at times around 3am, but takes a dose of 10mL sleep formula to help her go back to sleep (easier to measure). Discussed liver health and suggested dietary support to aid in alcohol clearance, as client is still having two glasses of wine per evening, impacting waking.