Female Question Re: Fatigue and TOM

[SueK]

I'm really hoping someone can provide some input to me. For the past 6 or 7 months, the two or three days before TOM, I am absolutely drained of energy. I mean, to the point where I feel I could sleep 24/7. In fact, last month I started out to do some errands, and found myself falling asleep at the wheel, so turned around and went back home! Then once I get my period, I'm fine.

I had thyroid tests run a few months ago, since I was post-partum and two of my female family members are on thyroid meds. All the tests came back fine.

I am active, drink at least 70 or so oz of water every day, take multi-vitamins, only have 1 cup of caffeine, and eat a pretty healthy diet, plus I do get at least 7 hours of sleep each night.

I'm really frustrated about how just these few days a month completely zap my energy. I'm also frustrated because this week will be the week it hits me, and DH is gone the entire week. I'm not looking forward to having to drag myself through the end of the week.

I'd really appreciate any suggestions as to what I could possibly do to help my energy level right before TOM. I do have my yearly exam next month, so will ask her as well, but thought I'd throw this out, too.
TIA!

[Member10000]

This article http://www.psychguides.com/DinW%20PMDD.pdf could be helpful to you - premenstral dysphoric disorder. I'm not an expert though, just a good read.

[SueK]

Thanks for the link! Oddly enough, my mood is fine during this time, but I was interested in the portion of the article that talked about dietary changes. Off to do a Google search on the disorder...thanks again!

[wallycat]

How old are you?

I have read that this is a very common PMS symptom.
You've also said you are Post-partum....I am not sure how long since you've hd your child but it does take a while to get back to your old self.

[SueK]

Well....I'll be 40 in May.

My daughter is 15 months now, and so the symptoms started when she was 8 or 9 months old, and that's when I had thyroid tests done.

I have to say that mid-cycle, during ovulation, my mood is awful and I get so bloated and crampy and have headaches, compared to just a few years ago. I pop Pamprin like they're M & Ms. There's no fatigue involved mid-cycle at all, though.

Also (sorry if this is TMI) my periods are much lighter and shorter in duration for the past two years or so as well.

I can handle the changes that are coming with age...it's just this *@(#% exhaustion that is killing me each month.

[wallycat]

Although most women experience some perimenopausal symtpoms as early as their mid-30's, most experience it entering their 40's.
There's a BB for perimenopause and I cannot tell you how many ladies post that they have CRUSHING fatigue.

My step-daughter said after she had her second child, her hormones/periods have not been the same and she is struggling....so maybe different symptoms but same cause...???
I'd talk to your gyn about this and see if there is something they can suggest.

[SueK]

Ana- thanks for the info. I guess it's nice to know it isn't just me. Would you be willing to PM me with the URL for the BB you mentioned? TIA, I really appreciate the input.

[DocAgocs]

In my opinion (and I have many of them, as I'm sure we'll soon find out), PMDD is a sales tool to sell, well, drugs that "treat PMDD."

I've posted on these subjects numerous times before, so try a search in some of my old posts for more info, or PM me your email address and we can chat more in depth, but...

If I had to pose a guess based on the limited info you posted, I'd have to go with your adrenal glands are probably completely wiped out. Stress causes increased hormone production in the adrenal glands. Increased hormone production, particularly over long periods of time, causes increase in size of the adrenal glands. Adrenal hormone cortisol, which is a "stress hormone" causes a variety of things, including fatigue, PMS symptoms, reduced immune function and thyroid suppression. Low sodium and low choletserol diets will exacerbate this problem. Why? Because without cholesterol in your system the body will use the adrenal glands to make sex hormones, which usually use cholesterol as a precursor. So, this is further stress on the adrenals. Adrenal fatigue is the first step toward "chronic fatigue syndrome" and gives you the feeling of just being a worthless worm who should stay in bed all day long!

I would:
1) Work on adrenal health
2) Work on female hormone imbalance

I've had many, many patients with the same complaints. They all have different functional problems and different individual biochemistries. They all get regular chiropractic adjustments. Some get one of two herbal formulas for adrenal fatigue. Some get Chaste Tree to enhance natural production of progesterone, some get glandular extracts like Desiccated Adrenal or Drenamin® and some minerals. Every single one resolves well.

I had a patient who was just in two weeks ago scared to death because, after a month on my Chaste Tree product, she was having a pain-free period without fatigue, bloating, "bitchiness" (her words, not mine!), water retention, depression or sugar cravings, for the first time in her life. Not bad for a 3 month supply of herbs for $37, in my opinion, and an adjustment every week.

So, these tend to be functional disorders, not diseases that need the drug du jour. Fix the problem and the symptoms go away. Hormone balance is extremely complicated, but fixing it doesn't have to be complex at all, assuming the doctor has an idea of what's going on.

I'd look into an Adrenal Stress Index test from Diagnos-Techs labs to start with, also maybe an Expanded Female Hormone Panel, but the first test is $98 and the second is $220, and it sounds to me like your adrenals just get killed during your period, then catch back up the other three weeks of the month. Eventually they'll stop catching up, though.

Just my 2 cents. Tough to say without knowing the full story, and I certainly don't expect you to take this info as anything other than information. It is not intended to diagnose, treat or cure any disease or replace the diagnosis or treatment of any other doctor. Download the article "Winter Health Alert" at the bottom of my webpage at http://www.agocschiropractic.com/newsletters.html for some more info related to adrenal fatigue. Let me know if you find it informative, please.

Also, just because this is my opinion doesn't mean it's right! I've made an awful lot of assumptions about this, so it could be lots of other issues, but I thought I'd share the most obvious choice, from my perspective, which you may want to at least explore.

[karen w]

Sue,

It's highly unlikely your adrenal glands are "wiped out" as this is referred to as an Addisonian Crisis which is a true medical emergencey requiring prompt treatment or death!

Furthermore, In my DH's 10+ years of practice as a board certified radiologist he has never seen an enlarged adrenal gland from causes other than a tumor. You'd think that if stress caused an enlarged adrenal gland, he would have seen a few over the years as there is quite alot of stress in the world!

And if it's any reassurance to you, I am also 40 y.o(an M.D, too, not that this matters) and the symptoms you describe both at ovulation(bloating, moodiness etc...) and right around TOM(tiredness) are exactly what I experience with my cycles. Last month I had an insurance physical, and all my lab results were perfect. So my bet is that you are just as abnormal as the rest of us!!!!

I hope this is of some reassurance to you.

Karen(an M.D. and her DH, also an M.D.)

[DocAgocs]

KarenW, I'm glad you brought this up. We're looking at the same problem through different colored glasses. When I say the adrenals are wiped out, I'm not talking about full blown Addison's Disease, but rather a functional disorder of the adrenal glands. Addison's Disease is at the far end of the spectrum, perfect function is at the other end, and the body has to progress from one to the other. Along the way there are a lot of irregularities in the hormone production of the adrenal glands. It's rather complicated. Similar things go on with the thyroid. Blood is normal, so doctor says "You're fine" and meanwhile the patient has a rock bottom axillary temp in the morning and all the signs and symptoms of a thyroid problem. Dr. Barnes covered this pretty well.

The blood is probably the most highly controlled tissue in the body, so many "functional disorders" don't show up on standard medical blood tests because the body will do all it can to regulate all aspects of blood. As chemical components of blood changes, pH changes, and small changes in pH mean, well, death, so the body will "mask" functional problems quite nicely when using blood tests as the sole dx of these sorts of problems.

I would disagree that the statement "maybe you're abnormal like the rest of us" makes sense. Not everyone has to be like this, regardless of whether the medical profession considers it "normal" or not. Just because something happens to a lot of people doesn't make it normal. Most people get back pain, but most doctors don't consider it to be normal, either. Same goes for fatigue, PMS, etc.

Like I said, I certainly didn't want to say my opinion is the only way to look at a problem, or that it was even valid in this case. Feeling like a zombie isn't normal, though, and it doesn't have to be that way. "Alternatives" (I'd prefer to think of them as adjuncts, myself) to standard orthodox medicine exist, frankly, because standard orthodox medicine is not real good at dealing with functional problems. By functional problem I mean problems that the patient is having that don't show up on standard diagnostics. Endocrine problems that don't show up in blood tests yet... back pain where there is no disc problem, curves are all normal and there is no degeneration... crushing fatigue yet "nothing is wrong"... and the list goes on.

Complementary care tends to work in this VERY gray area and, well, it works. It only works, however, when the doctor knows what they're looking at and is doing a good differential diagnosis of the problem is. When you go to some guy who diagnoses everything under the sun as a "candida" infection, I would wonder what is really going on.

But, I see and help people with functional endocrine problems very frequently and almost every single one has a diagnosis of "nothing's wrong" and completely normal blood tests, yet they're tired, depressed, have GI conditions, skin problems, blood sugar issues, etc etc etc. Certainly you'd agree, karen, that there is something on that spectrum between perfection and complete breakdown of the tissues? Just like there's something between birth and death.

Anyway, that's my 2 cents, and I know it generally isn't popular to the medical personnel on this board, but my colleagues locally have been pretty happy with the people who we've co-cared for, so that's what matters to me.

[karen w]

I'm glad your colleagues are pleased with your work, Doc. Different strokes.....etc..etc...

Karen

[DocAgocs]

Karen, I mean the MD's who refer patients to me when I say colleagues, FWIW.

This is the unfortunate "rubbing one another the wrong way" aspect of health care. It happens quite a bit interprofessionally, of course, but probably just as much within the same profession, too. It's part of the "game" I suppose.

The thing I've always had a tough time with is that my undergrad background is in chemistry, a hard science. In chiropractic school I was very focused on biomechanics, pain control, pretty straightforward stuff. never got into a lot of the typical "alternative health" topics like systemic candida infections because, frankly, if you can't show me candida in a tissue, I can't see how you can say that candida is affecting that tissue, for example!

But, once I got into the real world, I started to see the types of patients that make it into the typical chiropractic office: desperate people, people who've been to lots of other doctors and treatments didn't work, or were told they were normal, people really on the verge of "crashing," I suppose. Through my study of nutrition, but probably more so through my interest in herbal medicine (if you think it's hokey, please do yourself the favor of getting the book Principles and Practice of Modern Phytotherapy by Kerry Bone and it will change your outlook considerably), I've discovered this whole realm of "functional medicine" that I never really wanted to have much to do with: thyroid cases with completely normal blood tests, adrenal cases with completely normal blood tests, estrogen dominance cases with completely normal blood tests, symptoms in the presence of negative labs, films and blood tests, etc.

Realizing that the "gold standard" of medical diagnosis is the blood serum test, it's tough for me to explain, then, how someone with totally normal blood tests for thyroid, for example, has every hypothyroid symptom under the sun, and when I apply a nutritional or herbal protocol to the person they feel better and their thyroid symptoms go away, and their blood test is still normal.

I think there are two problems with the blood test:

1) It's parameters are set to see major medical problems, i.e. the end stage of disease processes, so it may not be sensitive enough or be calibrated toward picking up on a "functional" problem and

2) Blood is the most highly regulated and controlled tissue in the body.

There is disagreement between types of testing, too. Broda Barnes, the medical doctor who felt axillary temperature was a better determinant of thyroid function than a blood test, is really the guy who sort of brought this to light. I can have a patient with a blood test that shows perfectly normal progesterone and estrogen levels, but has every sign and symptom of estrogen-dominance. I have her do an Expanded Female Hormone Panel, which is a salivary test taking 11 samples throughout the patient's cycle to see the free fractions of estrogen, progesterone, testosterone, DHEA, FSH and LH and the picture is completely different.

I give the patient a prototcol to fix the functional problem, and they get better, their test results improve, etc.

So, this part of health care is the double-edged sword. Most patients lie in a very gray area. They aren't exhibiting the objective criteria medical doctors want to see on blood tests or films, but they have the signs and symptoms you would expect to see with XYZ disease process. This is the area that most "alternative" (I prefer complementary) health care providers deal with and it's a tricky world to negotiate because it's sort of the Wild West of health care! It's a wonderful opportunity to help people who have no hope and have been told there is nothing wrong with them (but feel awful), but it's difficult to figure out what works and what is garbage (i.e. does every patient really have candida and parasites, or not?).

But, I've seen enough patients of various types to know that "normal" PMS symptoms aren't normal.

Hope this makes sense to you, Karen, and this is the main reason I hesitate any time I offer my perspective to try to help someone/arm them with another perspective. Clearly, my perspective isn't 100% wrong as is often suggested because: 1) I have a practice full of happy patients and 2) Complementary/alternative health care providers see MANY more patient visits as a total each year than conventional medical doctors, so we must be offering something that works and something that is lacking in orthodox medicine. It's good to have options.

[Leslie Ferguson]

Not much personal information for me (because I'm another male and not an MD or doctor of any kind) to add to the discussion but I'll throw in my two cents worth and a husband's perspective (been married 21+ years) of how TOM affects my wife particularly. I've lived with and through quite a few years of extreme PMS and it's symptoms and a fully diagnosed case of PMDD (yes, PMDD is a very nasty and real disease). In my observations I've noted that hormones do play a significant part in my wife's energy levels during the various stages of her cycle. It is quite possible that your condition is explanable and treatable without too many side effects (my wife started with very mild BC pills to help her energy levels and they worked for a few years).

I'll echo what was said early on in the discussion - there are lots of folks out there who have the same conditions and symptoms and you may be able to find help through discussions with them.

Just a couple experiential (and not scientificly backed) thoughts on the subject from a male point of view.

Peace,
Les

[kima]

Hi Sue!!!

I hear you! I have never suffered from PMS- breezed through my periods, pregnancies- everything! Then about two years ago (I am 47) I began experiencing that same terrible fatigue two days before I get my period. It literally feels like someone has pulled my energy plug! All I want to do is sleep- it feels like the early days of pregnancy. I love to exercise but on those days I just can't muster up the ooph to do any. I also get a terrible headache which now seems to hang around longer than it use to.
I have just been living with it. I dread it when I know I will be travelling at that time or have a big event that requires energy and focus. Just being with other people is exhausting.
I haven't done anything except tough it out-I tried progesterone but got lazy with it and it didn't really sem to help anyway.

So you aren't alone. Oh and I had all the tests too and everything is fine. When you find a cure let me know!!
And I really feel for you having this with a child in your life. I had my kids when I was very young and I often wonder how I would manage feeling the way I do now. Hang in there!

[kima]

Wallycat- do you have an address for that BB? Thanks

[wallycat]

Maureen,
here it is....this is their home page and you need to scroll down and find "Menopause" for that specific board.
I think they also want you to sign on if you want to post.

http://www.healthboards.com/boards/

[kima]

Thanks Ana.

I have been so spoilt with good health all my life. It's hard even accepting that the big M might actually apply to me.

[DocAgocs]

I tried progesterone but got lazy with it and it didn't really sem to help anyway.

I would shy away from "natural" progesterone products. "Natural" progesterone is actually Progesterone USP, manufactured by Pharmacia, I think, or maybe Pfizer (or are they the same, now?). While it is an identical chemical to preogesterone, for whatever reason it does not get handled by the body the same way that your own progesterone does. It can build up in the body and evetually cause symptoms of progesterone deficiency, ironically, leading toward Chronic Fatigue Syndrome and fibromyalgia.

Using bioidentical hormones made by companies like Bezwecken or compounding pharmacies is a different story, though, but I would definitely stay away from the creams.

[wallycat]

Originally posted by kima
Thanks Ana.

I have been so spoilt with good health all my life. It's hard even accepting that the big M might actually apply to me.

I too have been lucky health-wise overall...and at 47.5 my symptoms aren't bad yet but I have noticed changes.

The big M happens to all females lucky enough to live a long, happy life
It isn't a disease and fortunately there are treatments for symptoms that make life seem impossible for a few years.
If you've been healthy all your life, chances are you will quickly be your old self.
I used to think it wasn't fair but after hearing all the stuff men deal with getting older, it's pretty even