Estrace

Letters from AFI Readers

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How can I reduce anxiety?

DEAR AFI: I'm having some problems balancing my hormones after a hysterectomy in October, 2002, at the age of 45.1 was prescribed Estrace, but 1 had a terrible time functioning. I was very irritable and experienced severe PMS symptoms. I was also on Ativan for anxiety, prescribed before my hysterectomy. I'm now taking half the dose of Estrace and I'm much better. Unfortunately, I'm still having trouble with anxiety. Could it be that Estrace is reducing the effectiveness of the Ativan? I tried the Climara patch and this worked better with the Ativan, but I found I was experiencing a little bit of depression. I've also tried Effexor, but I found it difficult to think clearly. I realize that all of this is trial and error before I find what works for me. Can you offer any insight or assistance? E.C.

AFI: You seem to be dealing with two, rather complicated problems. The first is your anxiety and the second, balancing your hormones. These issues may or may not be related. It seems that since you have been dealing with anxiety before your hysterectomy, it is unlikely that the operation is the cause of your anxiety. However, there is some question as to whether or not the lowered hormone levels that a woman experiences after a hysterectomy make anxiety worse. Only you can judge whether this is the issue for you or not. With respect to the use of hormones in your circumstance, some women find that using a patch is better for mood problems because it provides a more constant level of hormone. (There is some question as to whether the fluctuating hormone levels from a pill may contribute to mood problems.) I would suggest that you might want to try another patch, since the Climara did not work for you, and see if that is better for you. The hormones from a patch have less effect on your liver, and as a result, may not interfere with other medication that you are taking for other reasons. Anxiety is a common problem, but medication is not the only way to deal with it. Counselling, group therapy, meditation, yoga, exercise, and even some modification of your diet, such as slowly cutting out caffeine, can be even more effective for decreasing anxiety. Good luck and please let us know what worked for you.

I need help sleeping!

DEAR AFI: I am looking for information on preventing sleepless nights. I have tried meditation, adjusted my diet by cutting out alcohol, coffee and spicy food. I use earplugs and I exercise. So I am looking for other suggestions. I picked up a women's magazine at the airport that suggested I get up in the night and do watercolours! As much fun as that would be, I need to try other possible solutions because I work full time. What can you recommend? D.B.

AFI: Sleepless nights are a well-known problem for women around the time of menopause. Figuring out what is keeping you from sleeping can help you find strategies to address it. If you are a worrier whose mind chatters incessantly, your meditation should help you quiet your thoughts. Practising meditation daily makes it more effective. You may also find that spending 20 minutes writing down everything you need to remember and are worried about, then setting it aside, may help. If it's your body that won't give in to sleep, then you may want to consider your diet and exercise routine. You are already cutting out caffeine and alcohol, which is a good thing. But did you know that pain medications contain caffeine, too? Some women swear by a warm glass of milk at bedtime to relax them. Regular exercise is important, but it should be done early in the day not in the evening, to keep from feeling too stimulated. Some women have reported that keeping their bedrooms absolutely pitch dark helps with sleep. It may be worth investing in black-out blinds to see if that helps you rest better. Finally, try not to worry so much about how much sleep you are or are not getting. The human body appears to need less sleep as we age. Perhaps accepting this, and using that extra time for quiet enjoyable activities, such as reading, may help. Fretting about how tired you are going to be may only contribute to feeling tired. Instead of dwelling on the fact that you are exhausted because you didn't sleep, it may be useful to tell yourself that you got as much sleep as your body wanted and that you will cope with that, (see Bookmarked, on p. 8, for more helpful ideas.)

More tips for hot flashes

DEAR AFI: I am one of your long-time subscribers and I welcome your new editor. In your March/April 2004 issue on hot flashes, it did not contain one very important piece of advice for women: keep a diary of when the hot flash begins, and particularly, where it begins on the body as this is an important coping strategy for how one dresses, for example, in layers. Tracking the event that precedes the hot flash is important, too. Each woman will have a unique set of triggers such as hot beverages, alcohol or spicy foods. Other events may also trigger flashes such as sitting in front of a computer terminal that emanates heat, trying to find something that one has lost in the house, or rushing to an appointment. Once a woman understands what triggers a hot flash, she can then truly try to modify her behavior. My book, Menopause Me and You: the Sound of Women Pausing, may also help. Good wishes, Ann M. Voda.

AFI: Thank you for your helpful advice. Being aware of triggers and keeping a diary are excellent ways of building a strategy to live with hot flashes. We highly recommend your pioneering work to all our readers.

Copyright Initiatives for Women's Health, Inc. Sep/Oct 2004
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