June 2013

Chinese Medicine 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 becoming more popular to learn how Traditional Chinese Medicine views the changes during this transition.

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

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). 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. These are important factors for a woman to consider in her menopausal time.

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, supporting a woman with individualized treatments and tailoring herbal medicine specifically to their presenting symptoms.

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. 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.

Let's explore how these symptoms can be differentiated.

Diagnosis and treatment for menopause in Chinese medicine

TCM doesn't view menopause as as one labelled condition, 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 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? You will be asked questions specifically regarding your experience, which symptoms predominate for you.

The following are common patterns for menopause and each pattern comes with a particular Chinese herbal formula that is customized to meet your needs.

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.

HRT and Chinese herbal medicine

It is possible to take HRT with Chinese herbal medicine because they work differently. The HRT "tricks" the hypothalamus to think the ovaries are still ovulating, so the hypothalamus will stop stimulating the pituitary gland to secrete FSH. Chinese medicine theory is different in that it aims to taget the Kidney in it's function. Taking Chinese herbs daily will need to be taken at separate times from HRT.

Research on acupuncture and menopause

There has been an international interest in the effectiveness of acupuncture on menopause and typical menopause symptoms. A recent study:

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. Avoid these foods during menopause: highly saturated fats and trans fats, foods high in cholesterol (increases risk of heart disease), dairy foods.

Food source nutrients that are most important in treating menopausal discomfort

Wheat germ (high in Vitamin E), whole wheat products (calms and stimulates adrenal function in order to produce hormones but caution with gluten intolerances), mung bean, mung bean sprouts, string bean, seaweed, spirulina, millet, black bean, tofu, kidney bean, barley, black sesame seed.

Balancing the body during menopause

1) Don't overwork, avoid emotional stress: working long hours, worrying, taxing your body and irregular eating habits potentially worsen symptoms of hot flashes and dryness. Excessive emotional strain affects the balance of our bodies.
2) Use 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. Worsens the dryness that the body is already experiencing.
5) Drink only moderate amounts of alcohol: alcohol inflames the intenstines and contributes to a more thermal environment in the body.
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. Coffee in particular is quite drying to the body and therefore encouraging a more thermal environment.

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 yourself on the importance of relaxing and taking time away when you need it, you 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!

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Patricia Kowal is an AHPRA Licensed Acupuncturist, Chinese Herbal Practitioner in Noosa on the Sunshine Coast.

Disclaimer: please follow up with your practitioner if you are unsure or are having questions about the information contained in this material.

Reference:

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.