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6. Perimenopause: Ear, Nose, and Throat (ENT) with Lindsay Means, CNP
55 Plays1 month ago
Welcome back to Our Womanity! In this episode, Dr. Rachel Pope sits down with Lindsay Means, CNP, a nurse practitioner at the Ear, Nose, and Throat Institute at University Hospitals Cleveland Medical Center. They explore how perimenopause and menopause affect ENT health and the common issues women face during this time.
Lindsay Means earned her Master's in Nursing at Malone College and became a Family Nurse Practitioner in 2009. She began her career at University Hospitals in Cleveland in the department of Gyn/Oncology. She remained in that specialty until 2015, when she transferred to the ENT department, working for the division of Neurotology. She currently manages patients with a variety of ear-related issues, including dizziness.
Key Takeaways:
- Dizziness & Balance Issues: Lindsay discusses how dizziness is one of the most common complaints she sees in women during perimenopause and menopause, with a focus on vestibular migraines and balance problems.
- Understanding Vertigo: Learn the difference between vertigo (spinning sensation) and other balance issues, and why many women mistakenly associate dizziness with vertigo when they’re actually experiencing lightheadedness or unsteadiness.
- Hormonal Changes & Migraine: How perimenopausal women may experience vestibular migraines without traditional headaches, with hormonal fluctuations potentially making these symptoms worse.
- Meniere’s Disease vs. Migraine: Lindsay explains the overlap between Meniere’s disease and migraine-related ear symptoms, and the importance of proper diagnosis to avoid confusion between the two.
- Ear Health and Dryness: Perimenopausal women may experience itchy ears due to dry skin and changes in earwax production. Lindsay shares practical advice, including oil drops to alleviate symptoms.
Why You Should Listen:
This episode highlights how perimenopause and menopause impact different systems of the body that are often overlooked, such as ENT health. Lindsay’s insights into balance disorders, migraines, and ear-related issues provide valuable information for women navigating this stage of life.
Remember, you don’t have to suffer through it! Seek help if you’re experiencing these symptoms, and don’t hesitate to reach out to healthcare professionals like Lindsay who specialize in ENT and balance disorders.
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Transcript
Introduction of Guest and Topic
00:00:00
Speaker
Okay, welcome back everyone to Our Womanity. I'm so excited to have Lindsay Means here. As you know, menopause and paramenopause affects women from their head to their toes. And we have estrogen receptors throughout our entire body. So it's... It totally makes sense that every field is actually affected by perimenopause and menopause, whether we've talked about it, acknowledged it or not And Lindsay is a nurse practitioner with the Ear, Nose and Throat Institute at University Hospitals Cleveland Medical Center. And I'm so excited to have her on today. Welcome, Lindsay. happy to be here.
00:00:35
Speaker
Lindsay and I go way back. She used to be in a different field altogether, if I could say so. She's a nurse practitioner with GYN oncology, and that's how we met each other. And we live the same neighborhood. So we bumped into each other at the playground and started talking about some of the things that Lindsay sees in her office for women going through perimenopause and menopause. And I'm like, okay, we got to talk about this on the podcast because people need to be aware of this.
00:01:00
Speaker
Yeah. but So thanks so much for being here, Lindsay. Absolutely. And I'd love to just hear you you know some of that stuff that we were chatting about, things that come up for people. So what do you see in your office?
Understanding Dizziness in Menopause
00:01:13
Speaker
The biggest thing that I see related to perimenopause, menopause is dizziness. So as an ENT provider, my specialty is otology, neurootology. So just ears,
00:01:26
Speaker
So anything ear related, including balance. So I am the front line for our team. Anybody referred for any type of balance issue usually comes through me first.
00:01:37
Speaker
ah There's a few things that, you know, expedite people in to see the surgeons, but primarily most of the dizzy patients that get referred do not actually have an inner ear disorder. One of the ah things that would be great to clarify for everyone out there is the difference.
00:01:54
Speaker
but Like what is vertigo? Right. Vertigo just means spinning. Either I myself feel like I'm on a spinning ride or literally see the world spinning around me. That's vertigo. It just means spinning. It's not a disease. It's a symptom.
00:02:09
Speaker
ah Lots of people come in and say, oh, I went to the ER. They diagnosed me with vertigo. Did you feel spinning? No, i was really lightheaded. I'm like, then you don't have it. Right.
00:02:20
Speaker
So there's a big difference in the things that can cause vertigo. Vertigo versus other balance issues. So people may experience lightheadedness, unsteady, off balance.
00:02:34
Speaker
One I get a lot is like bobbleheaded, like my head is floating above my body, disconnected from my body. Yeah. Disconcerting. Yeah. or you know, and then to full on spinning. So yeah but the best thing to do is to get a good history. What do you feel?
00:02:53
Speaker
Okay, when this is happening, how long do you feel it nonstop? How often is this coming? That really tells me a lot. And I'm always amazed when I look at other people's notes, like it's just they complain they're dizzy. That's it.
00:03:07
Speaker
Yeah. o c I get a lot of referrals for elderly patients that tell me I get lightheaded when I stand up. I'm like, well, that's not at all the same thing. Yeah.
Migraines and Hormone Changes
00:03:16
Speaker
Yeah. So ah big cause of dizziness, especially in women is migraine and that you can have a vestibular migraine. So it affects your balance centers.
00:03:30
Speaker
huh can make you feel absolutely horrible, but you may not have any headache at all. wow So there's lots of people that as soon as I say migraine, they stop listening because they're like, well, I don't have headaches.
00:03:41
Speaker
So it can't be that. And I use this as the best example of this is how migraines can change. So many women will describe terrible premenstrual migraine headaches.
00:03:54
Speaker
Right. I went through menopause and my headaches went away. So I don't have migraines anymore. know Now you have a different migraine. Oh, interesting. What does that mean? What happens to them? Chemically, I don't know.
00:04:06
Speaker
No, I mean, but like but just the symptoms are changing. Is that? Yes. Yes. So nobody knows chemically, right? Like you know we look at perimenopause and menopause and we're like, I don't know. It could be anything happening. Yeah.
00:04:21
Speaker
Yeah, I just tell them, you know, those hormones are shifting and changing. Yeah. And that can trigger this. Yeah. So generally speaking, you know, so migraines can manifest in a lot of different ways. And I'm not a migraine expert. I'm the ear expert.
00:04:36
Speaker
So... really getting that good history. Tell me what happens to you. So I have a whole list of questions that I ask people. But basically, people having migraine type tend to have very long lasting episodes. I'm feeling very dizzy spinning for eight hours, 12 hours, days at a time, weeks at a time. I may always feel some component of spinning. yeah They tend to be very sensitive to other stimuli. So bright lights, loud sounds, similar to regular migraine, visually intolerant. So scrolling on my phone makes me nauseous and sick.
00:05:11
Speaker
Going to the grocery store where there's just so much visual stimuli, it's overwhelming. I don't feel good. I got to get out of here. Okay. Another one, one of my partners always used as an example was like coming down an escalator and they're just all of that ah the stimuli coming at you visually and make you feel nauseous and sick.
00:05:28
Speaker
So any of like that happens during PMS is bound to get worse during perimenopause, right? Like right that's, that's the really bad news that perimenopause can last about 10 years and that can get way worse during that time. Even if with menopause it goes away.
00:05:46
Speaker
Yeah. So I'm sure you see a lot of women in parapines. It's interesting too. There is a little overlap too, between Meniere's disease and some of the migraine type of symptoms. So migraines can give you ear symptoms like pain in your ear, fullness, a clogged sensation, yeah ah ringing in the ears, but they should never change your hearing.
00:06:12
Speaker
Okay.
Exploring Meniere's Disease
00:06:13
Speaker
so you know, many people will see neurology and they'll come and see me just to make sure it's not many ears when what they described doesn't sound like many ears. But if there's any ear symptom with it, they're going to come to me and you should come get your hearing tested if you have ear symptoms.
00:06:28
Speaker
But definitely you can have that kind of fullness ringing that affects one side. maybe both. But the thing with Meniere's is you should have a low pitched hearing loss on your test.
00:06:40
Speaker
Okay. And it can be a little tricky because in the early phases, the hearing drops during a Meniere's attack and then goes back to normal. So you come see me, your hearing test is normal, yeah but you describe these things happening. So true classic Meniere's patient will describe feeling fine. And then all of the sudden,
00:07:00
Speaker
That bad ear is full clogged ringing their hearing drops. I can't hear out of that ear anymore. wow And then I spin for 20 minutes to a few hours. Wow. My goodness.
00:07:11
Speaker
Yeah. Wow. So I wonder... ah For those who are having, you know, if it's truly hormone related vertigo or the migraines, like you mentioned, I wonder if they would do better with hormone therapy. I'm curious because was telling you in the park that when I was pregnant, I had vertigo for the first time in my life. And mean, I assume because it's the hormone fluctuations that that happened in pregnancy and it's very debilitating. Like I could not drive. Yeah. And I was like, what the hell is happening happening mean right now? Exactly. yeah
00:07:45
Speaker
Yeah. And thank God for ENTs who did the maneuvers on me, which i was telling Lindsay, it's like voodoo. Like if throw you back, turn your head to the side, watch your eyes start to spin.
00:07:59
Speaker
And then all of a sudden they fixed it. You're fixed. Yeah. And so it's amazing sort of what can happen, I'm assuming because of hormone fluctuations. And I just wonder if anybody who's having perimenopausal effects that affect their ear, nose and throat, that if they're eligible for hormones, I wonder if helping them have like more of a stable hormonal, I guess, landscape during that time would
Managing Symptoms and Treatments
00:08:24
Speaker
help. yeah Because I am assuming that a lot, and at least for premenstrual migraines, I'm assuming they're because the huge drop in hormones there. happens during that time so yeah for my patients who have premenstrual symptoms you know we either have them on birth control pills or estrogen depending on their goals and contraceptive needs and so i just i'm so curious maybe we should do some research i keep a list of them and see exactly yeah
00:08:50
Speaker
play Have you been trying to figure out how to take your health into your own hands while you're waiting for a healthcare professional to see you for perimenopause or menopause?
00:09:01
Speaker
Or do you feel like you're just too young for perimenopausal treatments or too old maybe for hormone therapy? Or you just want to kind of dabble in something that's a supplement?
00:09:12
Speaker
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00:09:30
Speaker
Don't delay another minute. Check out MIM at HeyMIM.com or on Amazon. HeyMIM.com. Another thing, an interesting thing with Meniere's disease is, you know, many women that have that, that's a fluid retention issue inside the inner ear. Okay. So very salt sensitive. And that's kind of a test too. Like, you know, if my patients, if there's some overlap between migraine and Meniere's, like, well, if you eat a bunch of salt, does anything happen to you?
00:09:55
Speaker
Right. Because that's really the key with Meniere's is salt. If I have a patient that I think has migraine or There have been a number of women over the years that have had kind of an overlap. So I say, I don't know if you have Meniere's or migraine, and I can't test you in any way and say, oh, you're positive for this and not that. So I will give them dietary modifications. And with Meniere's, it's all salt, salt, water balance, migraines. We have a diet sheet that we give our patients, and I'm always amazed at how many patients have have a long history of migraine and may see neurologist, but have never really talked about the dietary stuff.
00:10:32
Speaker
So there's a lot of foods, even healthy foods. It's not just red wine and chocolate, you know, anything fermented, you know, people drink a lot of kombucha these days, avocados, onions are on our list.
00:10:43
Speaker
So not just bad things. I had a patient once who is vegan and she's like, there's no way like my diet is super healthy. And I'm like, well, look at these aren't all bad things. And she was kind of like, oh,
00:10:55
Speaker
Yeah, I need to eliminate some of these things. That's all i mean okay. Yeah. So many of the foods that trigger migraines happen to have a lot of sodium. So you know, it's a chicken or egg kind of situation and they come back in and they follow the diet and they come back and they're like, I lost 20 pounds and I feel great.
00:11:13
Speaker
And I don't know which one it was, but following the diet makes them feel better. That's fascinating. can do And that's the other thing I kind of wanted to bring up is that if you are having an issue, it would be so worth it to see someone like
Miscellaneous Symptoms and Integrated Approaches
00:11:28
Speaker
you. and i you like I was telling you about someone that I knew sick.
00:11:33
Speaker
having vertigo frequently and just taking meclizine, which helps the symptoms, but doesn't get to the underlying cause taking it every day, just in case the vertigo spell would happen.
00:11:44
Speaker
was like, why would you do that? Get yourself evaluated and get the underlying cause. Yes. Figuring out the cause that's, that's number one. And taking that good history yes how you get there. And then there's There's other testing that we do. Obviously, when you come see me, you get a hearing test to make sure, yeah you know, lots of people are like my hearing is fine. i don't need a test, but they can have changes that are very subtle that they may not even notice. You have to kind of cross a threshold to really be bothered by hearing loss. So sometimes that pattern is there and they had no idea.
00:12:17
Speaker
Again, if I'm more concerned for migraine, it's important to show like your hearing is totally normal. And another thing that can kind of throw ah red herring into it is TMJ dysfunction. People that have jaw joint issues often have ear symptoms like painfulness ringing.
00:12:35
Speaker
So somebody may classically present like a migraine patient, but they're like, oh, my ear is full and it rings. Yeah. Again, without an exam and a hearing test, I can't tell you if you have hearing loss or not.
00:12:47
Speaker
But oftentimes those symptoms are coming from the jaw, totally separate from any dizziness. Wow. That's so interesting. Okay. I have a random one to throw at you. I always hear people talk about itchy ears and they're like, so my ears have become really itchy during perimenopause. Have you, have you seen that? Yes.
00:13:06
Speaker
What the hell? It's dry skin. it's dry skin Oh, see, menopause is all about dryness. Yeah. Whole body, decrease of fluid.
00:13:17
Speaker
Yes. So as I counsel patients, even men, you know, they're like, I never had an earwax problem. Why do i have an earwax problem now? It's because as we age, our skin is drier.
00:13:28
Speaker
But again, especially in that perimenopause phase, there's a, you know, big change. Dry skin makes dry wax. Dry wax can get stuck. Or, you know, the dryness itself makes our ears itchy.
00:13:39
Speaker
So I have patients just put some oil in there. ah Any kind of oil, as long as your eardrums are intact, baby oil, olive oil, sweet oil, yeah any kind of oil, just a couple of, I tell patients it's easy to remember. You have two ears, two drops, two times a month.
00:13:57
Speaker
That's awesome. Two, two, two. Yeah. but she's Like a cotton swab or something, just something. Just still like a little medicine dropper if you have it. Oh, okay. That is so interesting.
00:14:08
Speaker
know. I think this is the thing. We have been working in silos for too long where three division and department of, of in medicine is separate from one another in menopause spans all of them. all of it yeah and we're finally starting to connect the dots.
00:14:26
Speaker
Thank you for sharing your expertise. Thank you for raising awareness about this absolutely I so appreciate your time. And if you have more questions, I will put some resources up for our listeners on looking at your nose and throat, looking at vertigo, looking at migraines and trying to do some self-assessments.
00:14:45
Speaker
i'm just Those changes are happening for the first time in perimenopause or worsened in perimenopause or menopause. Reach out. Don't suffer through it. Right. There's caring people like Lindsay out there ready to help you.
00:15:00
Speaker
So thanks so much for your time. You're welcome. This was fun.