Does cervical spine instability worsen menopausal symptoms?

Ross Hauser, MD

Your natural balance between stress and calm or “homeostasis” is under the control of the autonomic nervous system. The autonomic nervous system is divided into two parts, a stress part and a calm part. The first part is the sympathetic nervous system which relays messages of danger, conflict, and demands, and allows us to handle stress (fight-flight). The second part is the counterpart nervous system, the parasympathetic nervous system which winds the body down from danger, conflict, and stress to a state of rest and digest. The energy required to digest food requires the body to divert resources to digestion. The parasympathetic nerve system is the domain of its “cellular network” the vagus nerves. In the illustration below we see the vast reach of the vagus nerve in managing body systems.

Let’s review this paragraph.  The autonomic nervous system tries to help us through periods of stress, danger, anxiety and panic. As we cannot live in that state constantly, the parasympathetic nerve system calms us down. But what if the parasympathetic nervous system and vagus nerve are not functioning correctly? Do we not calm down? How does this worsen menopausal symptoms?

What has this to do with menopausal symptoms? According to research and clinical evidence, the vagus nerve may have a lot to do with it, but a lot is still unknown.

Now let’s remind ourselves that part of the nervous system helps us cope with stress and part of the nervous system winds us down. That part of the nervous system that winds us down with a calming affect is dominated by the vagus nerve. To be clear there are two vagus nerves, a left side of the body and right side of the body vagus nerve.

The illustration below depicts the extreme reach of the vagus nerve. While the vagus nerve starts in the brainstem and its headquarters or command center the nodose ganglion sits near the top of the neck at C1, the functional impact throughout the human body is clear. It may be easy to understand that if the vagus nerve suffers from an impingement, it may cause a multitude of symptoms.

The extreme reach of the vagus nerve - does it impact menopause?

Is there a connection between the vagus nerve dysfunction and menopausal symptoms?

What then is the impact on menopausal symptoms? Surprisingly there is not by way of research exploring this subject. We often see premenopausal, menopausal, and post-menopausal women who suffer from a constellation of dozens of symptoms and conditions. In my article Vagus nerve compression in the neck: Symptoms and treatments, I discuss the Neurological-like problems, emotional stress: anxiety, depression and panic attacks, cardiovascular-like attacks, gastrointestinal-like and digestive problems, headaches, immune disorders, urinary and bladder problems, POTS, and respiratory disorders. In my articles I point to neck instability and nerve compression as a culprit if not main culprit in many of these symptoms and conditions. Let’s examine the research and clinical observation.

A composite view of what women tell us.

vagus nerve dysfunction and menopausal symptoms

A woman will contact us and they will describe problems of feeling faint or being lightheaded when they eat, get up from a chair or bed or suddenly become dizzy for no apparent reason. They will have problems with heat, skin temperature regulation, problems of tremors, and anxiety. They will be sent to endocrinologist for hormonal or menopausal symptoms but they get bounced from specialist to specialist because little is resolving their problems. They will also be seeing chiropractors for neck pain.

Other woman may report that have suffered from hot flashes for decades, they never shut off. They have been on hormonal therapy for just as long for “menopausal and post-mesopause problems). But there is more to the story. Anxiety, depression, panic attacks, allergy, digestive disorders, chronic sinus pain, balance problems caused by inner ear fluids, (please see my article Neck Pain Chronic Sinusitis and Eustachian Tube Dysfunction,) and cough. They also report that they are on many medications. Here menopausal symptoms are just part of the many problems the women faces.

The severity of these symptoms from woman to woman vary greatly. Some women will have headaches and hot flashes along with some neck pain. They will find relief from simple medical care or at least manage their symptoms to a tolerable level. Even at this level however, many can make a whole body connection to their symptoms. Meaning that somehow these symptoms are connected to each other and may have a common cause. It may not be just poor diet as being on a healthy diet has not helped as much as one would have helped. It should never be a medication deficiency in that they are not taking enough medication.

One aspect that most of the medical community can agree on in treating these women is that in many of their problems, “little is known” about connections and treatments.

Little is known about the connection of hot flashes on cardiac autonomic regulation (the control of the heart rate).

The vagus nerve controls heart rate and heart function. I discuss this subject at length in my article Can cervical spine instability cause cardiovascular-like attacks, heart palpitations and blood pressure problems?

A 2013 paper in the journal Menopause (1) looked the connection between the vagus nerve and hot flashes. The researchers wrote: “Little is known about the impact of hot flashes on cardiac autonomic regulation (the control of the heart rate), particularly vagal (vagus nerve) control.” The researchers then assessed if a connection existed between this heart function and hot flashes occurring when perimenopausal women slept.

What they found was: “Heart rate increased by, on average, 4 beats/minute with the occurrence of a hot flash . . .Physiological hot flashes per se, recorded during undisturbed sleep periods and independent of any arousals, are associated with increased heart rate and decreased cardiac autonomic vagal activity. These data support the hypothesis that the parasympathetic (the rest and digest governing body) of the autonomic nervous system is involved in the cardiac response to a hot flash.”

What does this mean? The vagus nerve is involved in hot flashes. A dysfunctional vagus nerve can make hot flashes worse.

Menopause or cervical spine instability?

Here is another person’s profile. Let’s be clear that not all menopausal-like symptoms are caused by cervical spine instability and dysfunction of the vagus nerve / nervous symptoms. However, research is showing us that there are common problems.

Metabolic parameters effecting menopausal symptoms include body mass index, waist circumference, cholesterol levels, blood pressure, glucose levels, and insulin resistance.

We are going to briefly talk about the heart, heart rate and blood pressure.

A February 2021 paper in the Clinical and experimental hypertension (2) studied the link of decreased baroreflex sensitivity to cardiometabolic risks and prehypertension status in postmenopausal women during their early menopausal phase.

Explanatory note for the image below: Baroreceptors, which are blood pressure sensors located in the aortic arch and internal carotid arteries contribute to short-term HRV. When a person inhales, heart rate increases, and blood pressure rises in about 4-5 seconds later. Baroreceptors detect this rise and fire more rapidly. When you exhale, the HR decreases, and blood pressure falls 4-5 seconds later. The baroreflex makes this acceleration and deceleration of the heart, or sinus arrythmia possible. Simply put, the baroreflex links heart rate, blood pressure and vascular tone.

The baroreflex makes this acceleration and deceleration of the heart, or sinus arrythmia possible

Fifty-five premenopausal women and fifty early-postmenopausal women between 40 and 55 years were recruited for the study, a complete battery of autonomic function tests (AFT), baroreflex reflex, hormone levels, and cardiometabolic risk parameters were measured and compared between two groups.

Results: There was a significant difference in autonomic function tests and metabolic parameters between premenopausal and postmenopausal women.

Explanatory note: Metabolic parameters are weight, body mass index, waist circumference, cholesterol levels, blood pressure, glucose levels, and insulin resistance.

Sympathovagal imbalance (increased sympathetic and decreased parasympathetic) was prominent in early-postmenopausal women. Decreased baroreflex reflex, the marker of cardiovascular risk was found to be significant and correlated with various cardiometabolic parameters in early-postmenopausal subjects. Analysis demonstrated that decreased baroreflex reflex is independently linked to parameters of decreased vagal activity, inflammation, and oxidative stress in early-postmenopausal group. Decreased baroreflex reflex could predict prehypertension status in early-postmenopausal subjects.

Hot flashes, hormones, and psychosocial factors contribute to insomnia risk in the context of the menopausal transition

A 2015 study wrote (3): “Hot flashes, hormones, and psychosocial factors contribute to insomnia risk in the context of the menopausal transition. Stress is a well-recognized factor implicated in the pathophysiology of insomnia; however the impact of stress on sleep and sleep-related processes in perimenopausal women remains largely unknown.”

In this study, researchers investigated the effect of an acute experimental (artificially created stress)  on pre-sleep measures of cortisol and autonomic (chronic) arousal in perimenopausal women with and without insomnia that developed in the context of the menopausal transition.

Here is where the inner conflict occurs:

In simplest terms, the insomnia women had greater stress less and the vagus nerve could convince the parasympathetic nerve system to calm them down.

The controversy of nerve blocks in treating hot flashes.

We are going to take another brief, two decades long journey to understand the research connecting a nerve block into the stellate ganglion. The stellate ganglion is a nerve bundle located in your lower neck, specifically in the front of the C7 vertebra and the first rib. The stellate ganglion provides branches or nerve highways into the C7 and T1 spinal nerves, vertebral artery, and the heart via the inferior cardiac nerves. Injections into this nerve bundle (given at C6 levels) are used to treat pain in the head, neck, arm and chest. The stellate ganglion injection is also considered a Vagal Nerve Stimulation technique. Doctors are trying to get the vagus nerve to function better.

Let’s start in 2005, here researchers writing in the Journal of women’s health (4) investigated whether standard C6 stellate ganglion blockade (nerve block) might provide relief from hot flashes associated with menopause. Six women were involved in this study with severe menopausal hot flashes.

Results: Initial stellate ganglion block was successful in all 6 subjects. The successful treatment caused complete alleviation of hot flashes for times ranging from 2 to 5 weeks. Patients returned for follow up nerve block after mild hot flashes returned. A second nerve block produced additional asymptomatic periods of relief ranging from 4 to 18 weeks. In each case, repeated block provided hot flash relief equal to or greater than that of the initial block. Two patients who submitted for a third SGB reported 15 and 48 weeks of relief.

As evidenced by this small study the nerve block into the nerve center that is connected to the vagus seemed very successful.

Another intriguing connection – successful treatment of hot flashes seems to improve brain and cognitive health

It is important to understand that researchers are just now exploring the connections between hot flashes and cognitive health. Let’s look at a September 2020 study in the journal Frontiers in neurology (5). It comes to us from researchers at the University of Illinois and University of Pittsburgh.

“Most studies of menopause and brain aging have focused on the role of the sex steroid hormone, estradiol, as a key mechanisms contributing to cognitive and brain aging in women. An emerging literature demonstrates that beyond endogenous estradiol levels, menopausal symptoms, particularly vasomotor symptoms (hot flashes), are also key determinants of menopause-related changes in cognition and brain function. . . .Currently, it is premature to make a causal claim about vasomotor symptoms (hot flashes) and memory dysfunction, but initial findings raise the possibility that women with vasomotor symptoms might experience an improvement in cognition with vasomotor symptoms (hot flashes) treatment. More generally, these findings underscore the utility of investigating female-specific risk factors for cognitive decline.”

As these researchers point out, it is premature to suggest a connection between hot flashes and cognitive function and memory. However one connection is clear. Cervical spine instability can cause symptoms of both.

Summary

The importance of the vagus nerve as related to overall health cannot be overstated. While researchers continue to explore the many symptoms and conditions related to cervical spine instability including those of more severe or long lasting hot flashes and other menopausal symptoms, structural deficiencies in the neck should be addressed with treatments aimed at restoring the structural alignment and integrity of the cervical spine. It is possible in some that these treatments may be able to reverse many of the chronic symptoms menopausal women suffer from.

Do you have a question about this article or need help?
Get help and information from our Caring Medical staff

1 Subhashri S, Pal P, Pal GK, Papa D, Nanda N. Decreased baroreflex sensitivity is associated with cardiometabolic risks and prehypertension status in early-postmenopausal women. Clinical and Experimental Hypertension. 2021 Feb 17;43(2):112-9. [Google Scholar]
2 de Zambotti M, Colrain IM, Sassoon SA, Nicholas CL, Trinder J, Baker FC. Vagal withdrawal during hot flashes occurring in undisturbed sleep: Hot flashes and autonomic activity. Menopause (New York, NY). 2013 Nov;20(11). [Google Scholar]
3 de Zambotti M, Sugarbaker D, Trinder J, Colrain IM, Baker FC. Acute stress alters autonomic modulation during sleep in women approaching menopause. Psychoneuroendocrinology. 2016 Apr 1;66:1-0. [Google Scholar]
4 Lipov E, Lipov S, Stark JT. Stellate ganglion blockade provides relief from menopausal hot flashes: a case report series. Journal of Women’s Health. 2005 Oct 1;14(8):737-41. [Google Scholar]
5 Maki PM, Thurston RC. Menopause and brain health: hormonal changes are only part of the story. Frontiers in Neurology. 2020 Sep 23;11:562275. [Google Scholar]

 

Make an Appointment |

Subscribe to E-Newsletter |

Print Friendly, PDF & Email
SEARCH
for your symptoms
Prolotherapy, an alternative to surgery
Were you recommended SURGERY?
Get a 2nd opinion now!
WHY TO AVOID:
★ ★ ★ ★ ★We pride ourselves on 5-Star Patient Service!See why patients travel from all
over the world to visit our center.
Current Patients
Become a New Patient

Caring Medical Florida
9738 Commerce Center Ct.
Fort Myers, FL 33908
(239) 308-4701 Phone
(855) 779-1950 Fax

Hauser Neck Center
9734 Commerce Center Ct.
Fort Myers, FL 33908
(239) 308-4701 Phone
(855) 779-1950 Fax
We are an out-of-network provider. Treatments discussed on this site may or may not work for your specific condition.
© 2022 | All Rights Reserved | Disclaimer