Fertility, Hormones, Headaches, Oh My

A little endometriosis and fertility advice below, but otherwise, this is a perimenopause & migraine post.

Did you know there are entire blogs devoted to perimenopause and menopause? That's how big an issue it is in a woman's life. Mine is a small blog with mostly anonymous readers; I can't even guess how many of you are in your forties, but if you are one of those lovely ladies, read on.

My research taught me that a woman will start skipping periods after a big hormone surge--kind of a last hurrah. Last month was my worst headache experience yet, so I thought "The last hurrah. It's here!"

But alas, on day 13 my ovaries performed as usual--something which used to be a blessing to me (feeling that familiar pain in my side). This time I only dreaded the headaches to follow. (At this phase, I do not ovulate every month now, but the cycles come at regular intervals, still.)

Researchers have recently pinpointed the one symptom that signals the start of perimenopause--perimenopause being a phase that, on average, lasts four years. That symptom is a change in flow--usually heavier. Some women begin this phase in their late thirties, and some women not until their late forties or early fifties.

I had endometriosis in my teens and twenties, characterized by heavy, painful periods, but a couple years after I married and started my family, I was either pregnant or nursing and experienced few to no periods for 10 full years, during which my endometriosis disappeared.

If you have endometriosis I recommend you nurse as long as possible and try to conceive your next baby as soon as signs of ovulation return, so as not to allow the disease to make a comeback. Monthly periods allow endometriosis to continue to grow. Continue this sequence--pregnancy, long-term nursing, pregnancy--until you've completed your family.

I actually think a women is very fertile in the window right after her ovulation resumes during nursing, which can be anywhere from 6 months to 18 months, or sooner for some women. You can nurse while you are pregnant for as long as your baby is interested, as long as you monitor your diet for adequate nutrition.

In my forties--around forty-five I think--I thought endometriosis had returned, but in fact, those symptoms were the start of perimenopause. Around that same time, I began to get powerful mood swings and surprisingly strong anger flashes, but those are gone now.

The next phase was these migraine headaches that go for days and days. Now I can't wait for the whole thing to be over, although when hot flashes come I might feel differently. I imagine those will add some laundry and much aggravation. I get hot and cold sometimes during the winter, but it seems to be more related to patterns of inactivity while schooling the kids, mixed with frenzied chore time.

I nursed my last child until I was 47, so my experience with estrogen levels in the forties was probably unusual. My youngest daughter has an autoimmune disease, so she needed the antibodies from breastmilk longer than most children do.

On Migraines and Hormones

I've perused many articles to find headache answers, but most focus on hormone replacement therapy, which is dangerous, in my view. My mother had a small cancerous breast lump removed in her sixties, partially because she was on hormone replacement therapy for over 10 years. She also has been a heavy drinker and smoker for years, and has been sedentary but not overweight. The hormone therapy is known to cause breast cancer. My mother has had no recurrence since, thank God. She has five sisters all older than her, none of whom have any breast cancer. Her mother was also clear, and lived free of any cancer up until her death at 88.

Headache/Hormone Connection: Female migraine sufferers typically get more headaches before and after periods begin. That is when hormone levels are falling. Again in perimenopause, estrogen levels are falling, so headaches are present more days per month.

My research has led me to a few remedies, some of which might bring hope to you:

~ Focus on other migraine triggers, since you can't do much about the hormone trigger: adequate sleep, same wake and bedtimes, keep blood sugar levels steady, avoid hunger, avoid stress (ha ha), exercise regularly, stay hydrated, don't smoke, cut back on caffeine and alcohol

~ Dietary supplements: feverfew (not during pregnancy or nursing), butterbur, B-2 (riboflavin), co-enzyme Q-10, and magnesium

~ Try naproxen (Aleve) during the days you get the worst hormone headaches. This has been proven to cut back on the headaches because it inhibits the release of hormone (same reason NSAID's like ibuprofen work best for menstrual cramps). It is typically prescribed for 2 days before the flow and for 3 days into the flow, Of course NSAID's come with side effects, but doctors say for this small window we aren't to worry. My window of headache days would be higher than the five mentioned above, but I plan to try this for this month and see what happens.

Here is an excellent summary from the American Headache Society on treating Menstrual Migraine:

If you've had no success with your headaches, I recommend you take this article to your doctor for discussion. In reading it, I discovered that my doctor didn't prescribe Topomax for me correctly. In both the first and second attempts, the dose was too low. Here is the full article, most of which I've pasted below--but do go to the link for the rest of it, so you can read about preventative methods and print it out for your doctor. And if your headache status changes because of anything on this article, could you share that with me, please? It might just help me and others. Thank you!

Menstrual migraine is divided into 2 types:

1. Pure Menstrual Migraine: migraine without aura that occurs exclusively
during the 5-day perimenstrual window of -2 through +3. This affects
approximately 14% of female migraineurs.

2. Menstrually Related Migraine: migraine without aura that occurs during
the 5-day perimenstrual window of -2 through +3 but occurs at other times
of the cycle as well. This is present in approximately 50% of female
migraine patients.

ACUTE TREATMENT

Treatment for acute menstrual migraine is similar to non-menstrual migraine acute treatment. However, many women report that their menstrual migraines are more difficult to treat. The clinical desired end-point of headache-free in 2 hours is a reasonable treatment goal for evaluating the effectiveness of acute therapy. The following is a list of commonly used treatment options: 

1. Acetaminophen-Aspirin combinations with and without caffeine (e.g. brand name Excedrin; the caffeine can potentiate the analgesic effect)
2. Naproxen (Aleve) 250 mg 1-2 every 8-12 hours prn
3. Ibuprofen (Advil/Motrin) 800 mg every 8-12 hours prn
4. Naproxen (Naprosyn) Rx strength 500 mg every 12 hours prn
5. Ketorolac (Toradol) 30-60 mg IM prn to rescue (NSAID)
6. Triptans-oral; nasal spray; injectable.
a. Almotriptan (Axert) 12.5 mg every 2 hours; max 25 mg in 24 hrs
b. Naratriptan (Amerge)2.5 mg every 4 hours; max 5 mg in 24 hours
c. Frovatriptan (Frova ) 2.5 mg every 2 hours; max 7.5 mg in 24 hours
d. Sumatriptan (Imitrex) 50-100 mg every 2 hours; max 200 mg in 24 hours
e. Rizatriptan (Maxalt) 10 mg every 2 hours; max 30 mg in 24 hours
f. Eletriptan (Relpax )40 mg every 2 hours; max 80 mg in 24 hours
g. Zolmitriptan (Zomig)) 2.5-5 mg every 2 hours; max 10 mg in 24 hours
h. Sumatriptan (Imitrex) 20 mg nasal spray 1 spray 1 nostril; may repeat in 2 hours to max of 40 mg in 24 hours
i. Zolmitriptan (Zomig) 5 mg nasal spray 1 spray 1 nostril; may repeat in 2 hours to max of 10 mg in 24 hours
j. Sumatriptan (Imitrex) 4-6 mg injectable; may repeat in 1 hour to max of 12 mg in 24 hours
7. Triptan/NSAID combination such as Sumatriptan (Imitrex) 100 mg & Naproxen 500 mg (Naprosyn)
8. DHE/dihydroergotamine (Migranal)1 spray each nostril; repeat in 15 minutes
9. Butalbital-containing products with or without codeine such as Fiorinal plain or Fiorinal with codeine; not a good choice unless patient can’t tolerate the triptans and the ergots/ergot alkaloids which are more migraine specific
10. Narcotic such as Hydrocodone (Vicodin) sparingly to rescue only: 1-2 of the 5 mg every 6 hours prn severe migraine only (suggest limit max 15/month)

Recommendations: 
1. Mild-moderate menstrual migraine: OTC NSAID/combination product; Rx NSAID, e.g. Naproxen 500 mg prn
2. Moderate-severe: triptan +/- NSAID
3. Rescue: Sumatriptan 4-6 mg sq; Ketorolac 30-60 mg IM; DHE .5 mg NS each nostril; repeat in 15 minutes; DHE-45 .5-1 mg IM or IV every 8 hours


SHORT-TERM PREVENTIVE STRATEGIES 

This treatment approach is ideal for many women who suffer from menstrual migraine. The majority of women report they have migraines outside of the menstrual window; however, their non-menstrual migraines are often easier to treat. Many may report that their normal acute treatment for migraine does not work for menstrual migraine. Additionally, many are afraid they will take the full allotted amount of triptan medication for their menstrual migraine which can last 3-7 days. An effective short-term preventive approach should lessen both the severity and duration of the menstrual migraine. Common short-term preventive strategies:

1. Magnesium 360-400 mg during the luteal phase of the cycle; i.e. begin around day 14 of the cycle. Limiting potential side-effect: diarrhea.
2. Naproxen 500 mg twice a day; begin several days before the anticipated onset of menstrual migraine; continue until at least day 3 of cycle. Advantage: low cost. Potential side-effect: nausea/GI.
3. Triptan (one of the 7) dosed in a bid fashion. Begin several days before anticipated onset of menstrual migraine. Use the highest dose of the triptan. May combine with a NSAID such as naproxen 500 mg. Use for 5 days in most cases. Be aware, this extended duration use of triptans is not FDA-approved and information on long-term safety is not available for triptans when dosed in this mini-prophylaxis manner. 
4. Increase does of daily preventive that the woman is already on; e.g. if on topiramate (Topomax) 50 mg hs to prevent headache, increase to 75-100 mg during her vulnerable menstrual migraine time of cycle. Advantage: the patient does not feel they are taking an unnecessary dose of their preventive during their non-menstrual time of month.
5. Estradiol patch .1 mg (name brand Climara .1 mg; Vivelle dot .1 mg) to wear for at least 1 week to prevent the drop in estradiol that is often a catalyst for the menstrual migraine; the women should apply the patch on approximately day -3 and stop when menses complete. This can be done
in conjunction with an oral contraceptive if the contraceptive is taken cyclically. The transdermal estradiol patch can also be used in women who don’t take contraception as it will help prevent the natural endogenous drop in estradiol.
6. Oral estradiol tablets the week of menses. However, they don’t give as even a level of estradiol as the transdermal patch and are only recommended if women can’t tolerate the transdermal estradiol patch. Dose: Estradiol 1 mg dose dosed qd or bid.

Recommendations: 
1. Magnesium 360-400 mg qd; Naproxen 500 mg bid; begin day 14 of cycle; continue through completion of menses
2. Triptan for 5-6 days; e.g. Frovatriptan (Frova) 5 mg loading dose followed by 2.5 mg bid for 5 days; begin -2 of cycle
3. Alternative triptan: Naratriptan (Amerge) 2.5 mg bid or ½ tablet bid for 5 days

PREVENTIVE TREATMENT --see link for the rest of this portion

This approach is ideal for women who suffer from a lot of non-menstrual migraine as well asmenstrual migraine or for women who are suffering despite optimal acute and short-term treatment. Preventive treatment can be broken into 2 categories: traditional daily preventive medication and hormonal manipulation.

Most common preventive treatment (traditional): 
1. AED’s (Anti-epileptic) medication such as topiramate (Topomax) and divalproex sodium (Depakote). For Topamax, start with 25 mg qd; increase by 25 mg/week until 100 mg or until clinical desired end-point. If necessary increase up to 200 mg daily dose. Dose bid or all at bedtime if sedation noticed. Most common side-effects: paresthesias (usually mild and transient); sedation; word-retrieval problems; appetite suppression and weight-loss.

Exciting: Shoebox Time Again

It's time to pack shoeboxes for Operation Christmas Child! This year we packed a box for a boy and a girl, and I found Target to be very helpful.

Operation Christmas Child has two resources on their site for gift ideas, and I have pasted them below. I will also tell you what I found at Target. 

I find it strange that the Operation Christmas Child list never includes Playdoh. Any children I work with are wild about Playdoh--up to 12 years old sometimes. I bring our Playdoh each time I work at church, and the four year olds play with it the whole playtime. It's hard to drag them away!

I did not look at the Operation Christmas Child list this year before we went to the store, and I see that I didn't buy enough that was specifically for school. However, a lot of these children cannot afford the fees for the local schools, unless they are in some sort of child sponsorship program. Education is not free in the third world, and without the fees children can't attend. The fees include uniforms, books, and supplies. Compassion International is one organization that takes care of all these fees and more, through their child sponsorship program.

This is the first year I did not get a stuffed animal or small doll, and I do regret that. This year I also neglected to get a toothbrush and soap. My kids were sick this week and we waited too long to go to the store. Do your shopping early, by all means, so you have time to peruse all the departments. We had a deadline to work with as we do this for our AWANA program.

You can do this on your own and drop off your box at one of the designated drop off locations, or you can build a box online and choose the toys you want to go in your box. If you do it on your own and buy the usual items, it runs about $40 to $50 a box for a tween- or adult-sized shoebox (postage is paid by our AWANA program). If you build it online, it appears to be only $25, but perhaps there is a postage fee later, I am not sure.

Now on to what Target has right now in their dollar bins:

In the front of the store there are many $1.00 bins, but it is not all cheap stuff. I found the following things, useful for Operation Christmas Child, or blessing children in the hospital, or in shelters, perhaps?

1.  Wonderful, step-by-step learn-to-draw books, one each for farm animals, safari, sea life, and reptiles

2.  Blank sketch pads with princess covers, Sesame Street covers, Doc McStuffins covers

3. Learn-to-write pads with kindergarten lines

4. silly putty

5. marbles

6. Disney ankle socks

7. Kindergarten crayons

8. 24-piece puzzles in different themes (for 4-9-year-old category)

9. slinky

10. small fleece blankets for girls and boys (says for pets but they would fit baby to preschoolers)

11. Hello Kitty small spiral notebooks

Other things we got from the regular toy department are Playdoh and Hot Wheels car sets, with the purple cars going to the girls. We also always get smallish balls, and gummies for candy. I recommend the Twistable Crayola crayons because they will last the longest! The others will get broken and be a disappointment fast.

I get socks every year, but today as we drove home, I thought about all the third-world country children I've seen in flip flops, and I vowed to remember Operation Christmas Child in the summer when flip flops are in the stores. Perhaps they live in too hot a climate for socks? Perhaps they can't even afford sneakers? Next time I'll put in fewer socks, so I have room for a pair of flip flops.

The age categories are 2-4, 5-9, 10-14

Post Script: Oh, no! Is it too humid in the third world for Playdoh? Have I disappointed kids for four years with my Playdoh obsession...taking up room in these boxes?

From the Operation Christmas Child site:

SOMETHING TO LOVE
Teddy bear, doll, soft toy, etc.

SOMETHING FOR SCHOOL
Exercise book, pencil case, pens, pencils, colouring pencils, sharpener, eraser, chalk, etc.

SOMETHING TO WEAR
T-shirt, shorts, underwear, cap, beanie, sandals, thongs, etc.

SOMETHING TO PLAY WITH
Tennis ball, cars, skipping rope, marbles, musical instrument, yo-yo, slinky, finger puppets, wind up torch, etc. (No battery operated items)*

SOMETHING FOR PERSONAL HYGIENE
Soap and face washer, toothbrush, hairbrush, comb, hair-clips, scrunchies, etc.(No toothpaste)*

SOMETHING SPECIAL
Carry bag, sunglasses, bangles, necklaces, craft kits, stickers, note or photo of yourself.

TOYS: Include items that children will immediately embrace such as dolls, toy cars, stuffed animals, kazoos, harmonicas, yo-yos, jump ropes, balls, toys that light up and make noise (with extra batteries), etc.

SCHOOL SUPPLIES: pens, pencils and sharpeners, crayons, markers, notebooks, paper, solar calculators, coloring and picture books, etc.

NON-LIQUID HYGIENE ITEMS: toothbrushes, bar soap, combs, washcloths, etc.
ACCESSORIES: t-shirts, socks, hats, sunglasses, hair clips, jewelry, watches, flashlights (with extra batteries), etc.

A PERSONAL NOTE: You may enclose a note to the child and a photo of yourself or your family. If you include your name and address, the child may be able to write back.

DO NOT INCLUDE: Used or damaged items; war-related items such as toy guns, knives or military figures; chocolate or food; out-of-date candy; liquids or lotions; medications or vitamins; breakable items such as snow globes or glass containers; aerosol cans.

Black Bean Soup & Modern Nutrition

For years I've been dismayed that in line at the grocery store, I've never once been behind someone who put enough real food in their grocery cart. Mostly, people buy boxed, frozen, and bagged junk. They're either too busy, too ignorant of nutrition, they don't know how to cook, or they're not interested, or all four. I'm not judging them so much as feeling sadness about how far our country has veered from former wholesome times.

If I had to guess about the trends leading to this, I'd first point to the women who entered the workforce to help out during World War II, and stayed there after the war ended, possibly due to widowhood. Next, there were women who entered the workforce after the birth control pill was introduced in the 1960's. Finally, some women began working full-time when credit card use increased during the financial boom and increased materialism of the 1980's, which enticed many into debt and larger houses, thereby forcing families into dual-career households. Rising health care costs attributed to the trend as well, as more money was taken from paychecks to cover employee health plans.

With more women trying to balance career and home responsibilities, convenience drove food industry trends, and fewer women grew up knowing how to cook. As a single teacher for nine years, I knew how to cook just a few different dishes. I loved to read, not cook. My mother wasn't interested in imparting any cooking techniques to her daughters, and I never asked for any lessons. She did a combination of convenience and from-scratch cooking.

As a "modern" woman, my identity wasn't tied up in a domestic package. I didn't feel inadequate that I couldn't cook well until I became a stay-at-home mother.

I began following cookbooks semi-regularly when my firstborn was 2 years old, but it wasn't until five years ago that I reformed my ways for good. It finally dawned on me that I was responsible for my family's health. The Lord had given me that responsibility as a keeper at home, and I needed to take it seriously for the glory of God.

You think I'm exaggerating about my grocery store experiences, but I'm still waiting for a consumer to appear in front of me who actually cooks from scratch, or cooks much at all. I guess it's the sociologist in me interested in societal trends.

But really, this post is about black beans.

Dried legumes are truly a wonder food, and Americans don't eat enough of them, although those living in the southwest do better than people in other parts of the country. I remember living in California all those years, especially in San Diego, sans husband and children, where there were fabulous trendy Mexican restaurants, especially one called El Torito, which featured a scrumptious black bean soup.

Black beans are the healthiest legume.  Here are the facts on dry beans as a whole.

I made a black bean soup last night, in a hurry to make dinner in under 30 minutes, on the first snowy day of the year, in a 66-degree house.

Easy Black Bean Soup  

Note about spiciness: Beans are very plain, but nevertheless, taste the soup after adding each teaspoon or can of a spicy item, so as not to over spice and turn your family off. The recipe below is pretty spicy, so cut the spices in half if you prefer it more bland.

Ingredients

4 15-oz cans black beans, preferably low-salt variety
2 small cans mild Rotel, or 2 small cans diced tomatoes with green chilies
2 T dried minced onion
2 tsp. garlic powder
2 tsp. chili powder
1 tsp chopped cilantro
1 tsp cumin
1/2 cup chicken broth (optional, I just had some to use up)

On the side ingredients:

Sour cream
fresh diced onion
grated cheese
cilantro
tortilla chips or cornbread


Directions

Pour beans with their juices into a large sauce pan. Add all other ingredients, and cook on medium heat until boiling. Turn off heat, and take out two cups of the soup and put it through a blender. Return to sauce pan and simmer soup on low about 20 minutes. Serve with sour cream, grated cheese, diced onion, and perhaps tortilla chips or cornbread. If you don't serve with fresh diced onion, you could saute some diced onion and put that in the soup at cooking time, instead of the dried minced onion.

What About the Children?

If your children do not like diced tomatoes and/or chilies, you might put those through the blender as well to mask them. My children were not enamored with this soup, but I'm not giving up. It was mostly the look of it. It may take this winter to get them used to it.

I've noticed when we have the neighbor kids over for dinner, most of them will eat very little real food. The 9-year-old we babysit is sent over with Bob Evan's mac n cheese, hot dogs, and a banana and juice boxes, or five or six breakfast sausage links and a fruit cup, or nothing at all, and he won't eat what we eat. If we eat pasta, he will only eat plain pasta noodles. One night I made homemade chicken noodle soup, thinking certainly every child would eat that, but he said he only eats it "from the store".

I have my own picky eaters--Paul won't eat any berries or oatmeal or eggs--but I know not to give up, and not to give them substitute dinners. I should mention that the neighbor boy's grandmother has to pick her battles. She works many hours and is in her sixties, so I can't blame her for his diet; he's a handful.

We all have to pick our battles. In the summer, for example, it's more important to keep kids hydrated, then to force them to drink only water.

The best thing is never to start the unhealthy trends to begin with. When making changes, be patient and persistent. And train your kids to train their kids with best practices from the start.

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An Approved Worker: Mom Edition

2 Timothy 2:15 Do your best to present yourself to God as one approved, a worker who has no need to be ashamed, rightly handling the word of truth.

I'm no Bible scholar, but "rightly handling the word of truth" strikes me as an important part of this verse. As mothers we can get so busy with to-do lists a mile long. Allowing household chores, laundry, or grocery shopping to get behind can be pretty stressful for the whole family. We tend to allow the tyranny of the present to rule us, because it's no fun having someone beg us for clean socks or underwear, or for more milk.

But what is more shameful, really? Getting behind on these temporal things, or getting behind on our time with the Lord?

Let us aim to be workers "who have no need to be ashamed". Let us plan for a devotional time, not just hope that it happens.

An "approved worker" is intentional about the eternal things, like Bible reading, prayer time, and discipling children.

An "approved worker" stores up treasure in heaven, and doesn't chase after earthly praise.

All other spiritual fruit will spring forth from these spiritual disciplines: Bible reading, prayer, discipling our children. 

After we have our hearts in order, God will certainly help us efficiently get our homes in order. He knows what we need, and he is faithful to provide it in due time, in due measure, after we sit at his feet.

Mary at Jesus' feet

Organizing Your Sonlight School Day

Our Sonlight Homeschool curriculum comes with a complete schedule/calendar of assignments in Bible, history, literature/readers, read-alouds, and science, so that every single day of our school year is already planned out, which is great if you never get sick and never have appointments. Sonlight doesn't use specific dates, but instead numbers the school weeks and days (week 1...day 2, etc.) on their calendars.

It doesn't take long before you're all over the place on their calendars--i.e. week 13 of history, week 15 of literature, week 11 of science, week 16 of Bible--which makes it hard for kids to find where they are each day. Not to mention, kids can be hard on those heavy, bulky Sonlight binders. If you let them loose with the binders, you really need page protectors on each page, which is time consuming and expensive.

It becomes essential for Mom to come up with a system to streamline the Sonlight school day.

Here is what works for us:

1. Make copies of your Sonlight schedule so you can write on it (essential if you plan to resell your curriculum at some point). I copy 6 weeks at a time and staple the pages together. As an assignment gets completed, I check mark that box.

2. Get a manila file folder or a school folder and label it accordingly--such as Sonlight Core G. Open it up and on the left side staple or place the Book List page so you know what books you'll start in which weeks. Place your stapled schedule pages into this manila folder, along with any review questions that come with your curriculum, which in our case is just science questions.

We keep the science questions in the science manila folder, along with the science schedule pages. I copy and staple all the science questions for each week. When they're completed, I take them out of the manila folder and file them for our end-of-year portfolio review. I then copy the science questions for the next week, staple them, and place them in the manila folder.

The manila folders get placed in this wire shelf, along with the books needed. I'm looking for a better shelf, as this isn't sturdy or big enough. We are out of book shelf space, and don't really have space for another book shelf, so it can't be much bigger than this.

3. I have two boys in Core G right now, and two girls in Core B. Rather than the kids going through the manila folders themselves, risking that they'd get lost around the house, I go through them and write out their assignments for two days ahead. If I go any further ahead than that, we get messed up due to appointments and unforeseen interruptions. Two days ahead works well.

I write the assignments on a weekly calendar sheet for the boys, which gets tacked to a wall. They also have a quick check-off sheet that includes chores and each subject, but not specific assignments. It only takes about 10 or 15 minutes to write the two days' assignments on the weekly calendar, if I keep up with checking off the completed assignments on the Sonlight schedule. We've had nasty colds this week and only done spotty school, so I started this calendar schedule for tomorrow, 11/14, continuing it on Monday, 11/17.

We've also tried writing the assignments on a daily chart that had a space for each boy to check off (including chores). I placed that chart on a clipboard that was supposed to be kept on the dining-room table, but it just didn't work. Someone was always misplacing the clipboard ( we have ADHD here), so I realized all assignment sheets or check-off sheets had to be kept on walls.

The simple check-off sheet (not pictured) just has a blank check-off line next to each chore and subject so I know where each child is in his or her day (for the girls it just includes chores, as I still run their school days).

How do you organize Sonlight for your family?