Acupuncture and Chinese Medicine Articles
Acupuncture and Menopause
by Patricia Kowal, Licensed Acupuncturist in Noosa
Menopause is a normal process that women go through as they age, the hormonal changes involve during this time takes a toll on the well being of many women. Their periods slowly stop arriving and multiple symptoms are presented: hot flashes, night sweats, insomnia, irritability, restlessness, emotional mood fluctuations, dryness, fatigue, lowered libido and others. Women often seek medical attention from Western conventional medicine, and it is thankfully becoming more widely known that Traditional Chinese Medicine can address these uncomfortable symptoms and changes that women face during this transition. This article will focus on menopause from the view of Western and Traditional Chinese Medicine, how acupuncture and Chinese herbal medicine can benefit in helping ease these symptoms. First let's talk about it from a Western medical viewpoint.
Western Conventional Medicine and Menopause
The characteristic symptoms of menopause occur due to the decline in the body's production of the hormone estrogen. This decline in estrogen disturbs the function of the hypothalamus (responsible for regulating body heat and metabolism) which is where the characteristic hot flashes and the increase in weight frequently accompanying menopause. The hormonal imbalance takes its toll emotionally on a woman, feeling that they are beginning to age and that life has 'caught up with them'. Mood fluctuations and feelings of depression follow this change in hormone production. The severity of a woman's menopausal symptoms can be worse if her diet is imbalanced and if she engages in overwork and stress for several years before starting menopause. According to Maciocia, "...some gynecologists say that, strictly speaking, only hot flushes and vaginal dryness are oestrogen-deficiency-related manifestations; according to their view, most of the other manifestations are due to increased stress at this time of life."
Western Medical Treatments for Menopause
Firstly, from my clinical experience as a practitioner of acupuncture and Chinese herbal medicine, each patient's doctor offers various treatments in regards to a patient's menopausal symptoms. Western medical treatments for menopause include: estrogen derived from animals, synthetic HRT (Hormone Replacement Therapy used to offer the body another source of hormone), biophosphates (used to block the occurrence of bone loss from osteoporosis), SERM (selective estrogen receptor modulator, used for prevention and treatment of osteoporosis), and Clonodine (used for the relief of hot flashes). Unfortunately, these treatments come with side effects and adverse affects on a women's body that is already going through many changes emotionally and physically. Studies have shown that supplements with estrogen have been shown to increase the risk of health imbalances (gall bladder disease, cancers of the breast, uterus and liver). Our adrenals naturally produce hormones, and taking estrogen inhibits them from developing their capacity to produce estrogen.
Research on the Safety of Estrogen Replacement Therapies
Stay informed! The US National Institute of Health has started a Women's Health Initiative, looking at the safety of hormone replacement treatments and using large scale studies of post menopausal women that either took or didn't take estrogen or other hormone replacement therapy. Their studies show an increase risk of ovarian cancers and other harmful conditions.
Download the NIH Fact Sheet, "Facts About Menopausal Hormone Therapy", regarding menopausal therapy and its risks. "Choosing whether or not to use menopausal hormone therapy (MHT) can be one of the most important health decisions women face as they age. This 24 page brochure summarizes the latest evidence as of Summer 2005 to offer guidance about the risks and benefits of MHT. It is designed to provide patients with information to help them communicate more effectively with their care providers and determine the best course of treatment on an individual basis."
How can a woman decide on medicine for their menopausal symptoms when there are potential side effects and possible adverse affects for their future? Do the risks outweigh the benefits of treatment with Western drug therapy? The answer that makes the most sense to me as a practitioner is individualized treatment, meeting women where they are and with the most non-invasive measures possible. This is where Traditional Chinese Medicine (TCM) shines: the ability to treat women individually and tailor acupuncture treatments and Chinese herbal medicine specifically to their presenting symptoms, naturally.
Chinese Medicine View of Menopause
Similar to the Western view, the most common symptoms of a decline in estrogen (dryness, hot flushes and night sweats), from the Chinese point of view are due to the physiological decline of what is called 'Tian Gui'. The Su Wen is is an ancient Chinese medical text that has been treated as the fundamental source of source information related to the views of Chinese medicine. Here, the "Tian Gui" can be seen as an expression of ovarian activity and of oestrogen that determines puberty and menopause.
"Tian Gui is discussed in the very first chapter of the Su Wen which says that, in girls, it arrives when she is 14 and it dries up when she is 49: "At the age of 14 the Tian Gui arrives, the Ren Mai begins to flow, the Chong Mai is flourishing, the periods come regularly and she can conceive… At the age of 49, the Ren Mai is empty, the Chong Mai depleted, the Tian Gui dries up, the Earth Passage [uterus] is not open, so weakness and infertility set in."
Part of Chinese medicine theory views menopause as a declining of the Kidney energy, which is responsible for development, growing and the process of aging. This can manifest as typical menopausal symptoms and are carefully differentiated and diagnosed according to you and your severity of symptoms. As our Kidney energy declines we can become dry, our ability to regulate our temperature is imbalanced and our ability to relax our bodies and minds is challenged as well. This can lead to dryness, loss of libido, hot flashing, insomnia, mood fluctuations, dizziness, night sweats, fatigue, incontinence, weakness and soreness of the lower back and others. Wow! That is quite the list of symptoms to experience. In Chinese medicine, the Kidney represents an energetic as well as physical organ that has senses, emotions, temperatures and parts of the body associated and connected to it. My role of the acupuncturist is to find out where you are imbalanced, whether you are having dry symptoms predominating, weakness and pain predominating, temperature imbalances predominating, or a combination of all of them. I will then create a treatment that will address moisture, bone weakness, temperature and use acupuncture and Chinese herbs to support the adrenals and kidneys.
Let's see in this next section how these symptoms can be differentiated and what types of acupuncture and Chinese herbs are used to treat them.
Diagnosis and Treatment for Menopause in Chinese Medicine
TCM doesn't view menopause as as one labelled condition, rather it views it as a set of symptoms and conditions specific to each woman. Every woman that walks through the door for acupuncture and Chinese herbal medicine will receive a different treatment based on their unique set of symptoms. The following patterns in TCM guides the acupuncturist towards a customized treatment for your presenting symptoms. Each pattern comes with a particular Chinese herbal formula for menopausal symptoms and acupuncture point combination. Can you identify with one or more of these patterns? Upon seeking treatment for the relief of menopausal symptoms, you will be asked questions specifically regarding your experience, which symptoms predominate for you and my role as an acupuncturist is also to address the underlying imbalances you may have that is causing or worsening particular symptoms.
The following are symptoms that acupuncture may assist in relieving:
> fatigue, insomnia
> hot flashes, night sweats
> mood swings, irritability, depression, anxiety, poor concentration
> appetite fluctuations, weight gain, craving sweets or carbohydrates
> menstrual irregularities in timing and bleeding
> aches and pains
The following are common patterns for menopause, and each comes with a particular herbal formula that can be customized even further to meet your needs otherwise (digestive, respiratory, etc.).
> Kidney Yin and/or Yang Deficiency: (most common) this pattern presents with temperature fluctuations (night sweats, hot palms and soles, itchy skin), insomnia, dryness, hair loss, periods ceased or almost ceased. Heavy menstrual bleeding, edema, low back soreness and weakness, obvious feeling of cold, loose stools and urinary incontinence.
> Liver Qi Stagnation: the key to this pattern of more of an irritated and frustrated presentation with symptoms such as emotional instability, weakness, constipation, palpitations of the heart, insomnia, nervousness.
> Blood Deficiency: this pattern presents with symptoms and with a weaker presentation and the practitioner will differentiate it by looking at the tongue and pulse. Symptoms here are insomnia, dizziness, nervousness, sweating, hot flashes, pale complexion.
> Uprising Deficiency Heat: this presentation will be very evident by extreme hot flashing and night sweats, irritability and nervousness of a jittery nature.
> Kidney Essence Deficiency: this pattern's key is weakness of the bones, lower back soreness, weakness in the legs, inability to stand and decreased bone density. In Western terms it is characterized mostly by a presentation of someone with osteoporosis.
Chinese Herbs for Menopause
The above patterns each have specific formulas that help those particular set of symptoms. My role as an herbalist is to customize your formula to you and your needs, what symptoms are predominating at the time and what your goals are in seeking treatment for your menopausal symptoms.
Can I Take HRT with Chinese Herbal Medicine?
It is possible to take HRT with Chinese herbal medicine because they are working differently. The HRT is "tricking" the hypothalamus to think the ovaries are still ovulating, so that the hypothalamus will stop stimulating the pituitary gland to secrete FSH. Chinese herbs, however, work by gently nourishing the Kidney to decrease the effects of a woman's transition. In the short term this is an okay transition, but is not advised as a long term treatment. Patients must realize that this can be a slow transition if they are to chose to go off HRT and use only Chinese herbal medicine. Chinese herbal medicine can typically be taken long term with no side effects, it is advised if someone is taking them long term that they take a break of one month every six to nine months.
Research on Acupuncture and Menopause
There has been an international interest in the effectiveness of acupuncture on menopause and typical menopause symptoms. Recent studies show very positive results:
> Dr. Susan Cohen, D.S.N., APRN, University of Pittsburgh: through a set number of acupuncture treatments hot flashes went down by 35% and incidence of insomnia decreased by 50%. In a follow-up study the hot flashes were significantly decreased in the acupuncture group as compared to the group getting routine conventional care. "Acupuncture using menopausal-specific sites holds promise for nonhormonal relief of hot flushes and sleep disturbances."
> Research abstract, PubMed: http://www.ncbi.nlm.nih.gov/pubmed/14650571
Nutrition for Menopause
Foods that are drying and thermal in nature will create more heat and worsen hot flashes and temperature changes. This means staying away from hot, spicy and excessively fat food, alcohol, cigarettes and coffee. Instead, go for dark leafy greens, whole grains, deeply colored fruits and dry beans.
Food source nutrients that are most important in treating menopausal discomfort: wheat germ (high in Vitamin E), whole wheat products (has a calming affect and stimulates adrenal function in order to produce hormones, caution with gluten intolerances), mung bean, mung bean sprouts, string bean, seaweed, spirulina, millet, black bean, tofu, kidney bean, barley, black sesame seed.
Avoid these food during menopause: highly saturated fats and trans fats, foods high in cholesterol (increases risk of heart disease), dairy foods.
Seven Ways to Stay Healthy During Menopause
1) Not to overwork and avoid emotional stress (working long hours, worrying, taxing your body and not having a healthy or regular eating habit will worsen symptoms of hot flashes and dryness. Excessive emotional strain will affect the balance of our bodies and may worsen hot flashes)
2) Have moderate exercise
3) Maintain a healthy weight and regular diet (excessive amounts of dairy intake and greasy foods leads to phlegm in the body, this impedes our circulation and worsens symptoms.
4) No smoking (harmful to your lungs and kidneys and worsens the dryness that the body is already experiencing)
5) Drink only moderate amounts of alcohol
6) Have tea and coffee in moderate amounts (these are all thermal and drying in nature and should be avoided in order to minimize these symptoms from being aggravated)
Vitamins and Nutrients for Menopause
Vitamins E stimulates the production of estrogen and can be found in wheat germ and wheat germ oil. Part of going through menopause is the risk of osteoporosis, this is because there is a decrease in calcium absorption during the first stage of menopause. Therefore, adjusting your diet with adequate amounts of Magnesium and Vitamin D is important.
Lifestyle Recommendations for Menopause
Menopause can be a strain on our emotions as we transition emotionally and physically to another phase in life. Perhaps this is a time to commit to something in our lifestyle that offers us relaxation to try and eliminate the stress and anxiety that accompany this time. By learning how to effectively cope with stress and educating ourselves on the importance of relaxing and taking time away when we need it, we may be able to cope with stress easier and lessen your experience of the symptoms on your body and mind.
Ideas to help you transition through menopause are: daily or weekly commitment to yoga classes (personal practice at home or with a teacher), starting slowly with a 5-19 minute meditation everyday before bed or in the morning, a daily walking/exercise routine, joining a casual dance class in your community. The possibilities are endless! Try one of these today, find one that works for you, so it doesn't feel like 'work', you may find the benefits are even further reaching then just helping ease symptoms of menopause!
In conclusion, in my clinical experience, acupuncture and Chinese herbs may offer a natural alternative to Western medical treatments that may present you with side effects and adverse reactions. TCM can offer safe, customized approaches to the treatment of menopause and its wide variety of symptoms. Contact my clinic today to start your treatments of menopausal and pre-menopausal symptoms, in whatever stage of it you may be in currently.
Are you interested in addressing menopause naturally and looking for a natural alternative for menopause? Contact our clinic today, we are happy to answer questions about how acupuncture and Chinese herbs can help you get through these times.
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> Patricia Kowal is an AHPRA Licensed Acupuncturist, Chinese Herbal Practitioner in Noosa on the Sunshine Coast.
Please follow up with your practitioner if you are unsure or are having questions about the information contained in this material.
John Chen, PhD, PharmD, OMD, LAc: Acupuncture Today, May, 2002, Vol. 03, Issue 05, Menopause: Western and Traditional Chinese Medicine Perspectives, Part I and II.
Paul Pitchford: Healing with Whole Foods, 2002
Letha Hadaddy: Asian Health Secrets, 1996
Acupuncture and Menopause, By Diane Joswick, L.Ac., MSOM
Pubmed: http://www.ncbi.nlm.nih.gov/pubmed/14650571, Can acupuncture ease the symptoms of menopause?
Giovanni Macocia, The Treatment of Menopausal Problems, Sept. 4, 2012
Wikipedia, Su Wen, http://en.wikipedia.org/wiki/Su_wen
Women's Health Initiative, NIH Publication Number 05-5200. June 2005.