Menopause TCM

As we enter Spring, a time for transition and renewal, I thought it fitting to touch on an important transition in a woman’s life – menopause.

At seven times seven a woman’s heavenly dew wanes;
the pulse of her Conception channel decreases.
The Qi that dwelt in the baby’s palace moves upward into her heart,
and her wisdom is deepened.

This is a translation of a passage from the first chapter of The Yellow Emperor’s Classic of Internal Medicine. It describes what we refer to as menopause: At about 49 years, menstruation (Heavenly Dew) ceases, and the ability to conceive fades. The vitality that was needed in the uterus (Baby Palace) now moves up to the heart, providing a deeper wisdom, a ‘Second Spring’.

In China, menopause is referred to as a ‘Second Spring’. This Second Spring is viewed as a positive time of creativity and new beginnings, when women often find a new and more confident voice. It is a time to reflect on the new found life that is possible for the woman, as she enters a stage where she is able to begin to move her energies away from nurturing others and finally direct them towards nurturing herself.

This idea of menopause whilst ideal is not always the most commonly experienced one. For some women, the transition to menopause is marked by hot flashes, night sweats, mood swings, heart palpitations, insomnia, irregular bleeding, vaginal dryness, fatigue, and depression, among other things. These symptoms may begin 4 years before menstruation ends and may last into the late fifties.  In Australia, the average age of menopause is 51 years and 57% of all women will experience hot flashes and night sweats during their menopause years.

Western medicine explains the main cause of natural menopause as a change in a woman’s reproductive hormones leading to a decrease in the hormone oestrogen once the ovaries cease their function. Menopause Hormone Therapy (MHT) (also known as Hormone Replacement Therapy) is the most common treatment pharmaceutical medicine offers menopausal women. MHT contains oestrogen plus a progestogen, or oestrogen alone for women who have had a hysterectomy. MHT can be an effective short-term remedy for reducing hot flushes and night sweats and may improve sleep and quality of life. It also protects bones from osteoporosis and reduces the risk of fracture, but only while it is taken. Most healthy women around the age of natural menopause can safely take MHT for up to 5 years, but there is an increased risk of breast cancer with prolonged use of the combined MHT (oestrogen plus progestogen) and stopping MHT may lead to a resurgence of menopausal symptoms.

Chinese Medicine offers a natural alternative to MHT and can help facilitate a smooth transition into menopause and beyond. A meta-analysis of randomized controlled trials in 2015 found that acupuncture reduces the frequency and severity of hot flushes and these beneficial effects persisted for at least 3 months after treatment. Studies on Chinese herbal medicine have also shown promising results in the treatment of menopausal symptoms such as mood changes and pain symptoms co-occurring with hot flushes.

In addition to acupuncture and herbs, nutrition and lifestyle play a major role in a woman’s menopause experience. According to Chinese Medicine, the root of menopause is related to a decline in the Kidney energy and many of the symptoms of menopause can be linked to a deficiency of Kidney yin.  Yin is the moisturising, nourishing, cooling, fluid aspect of the body.  In some ways, yin is similar to oestrogen. Think of yin as the cooling fluid in a car radiator. Too little coolant and the radiator overheats. Extending this analogy to the human body, without sufficient yin, our fire aspect (yang) flares up and leads to a host of heat related symptoms such as hot flashes, night sweats, dry skin and vaginal dryness. 

Menopause: A Second Spring

Yin is nourished or depleted from the food and drink we consume and our lifestyle. If we eat poorly, work too hard, sleep too little and do too much in a day, yin is depleted. Chronic and low-grade, or sudden and intense physical or emotional stress causes yin-deficiency. Alcohol, coffee and other strong stimulants, most recreational drugs and cigarettes also deplete our yin. The classic sign of the yin being damaged is someone who is so wired they don’t remember the sensation of tired. Those that are yin deficient rely on caffeine and nervous energy to accomplish their long to-do lists and have a tendency to get sick on vacations when their body slows down for a full day. Women with tired adrenals (often from years of overuse, overwork, and stress) often experience worse symptoms during menopause. 

Hence, it is essential to make certain lifestyle, dietary and mental adaptations in preparation for the menopausal years. Nourishing yin (with lifestyle, diet, acupuncture, herbal medicine, exercise, avoiding coffee and reducing stress levels etc) is a crucial part of treatment for a smoother, symptom-free transition. It is important to recognise that menopause is not a disease but a naturally occurring transition that allows a woman the possibility of remaining in relatively good health as she ages. It is a significant time for self-discovery and renewal and need not be accompanied by any discomfort. In the Chinese perspective, this is a time for celebration in a woman’s life, when she is possessed of wisdom and graceful beauty.

Sincerely, Renee

References:

Australian Menopause Society, www.menopause.org.au, retrieved 30 August 2019.

Australian Menopause Centre, https://www.menopausecentre.com.au/hot-flushes/, retrieved 30 August 2019.

Royal Women’s Hospital, https://www.thewomens.org.au/health-information/menopause-information/managing-menopause#a_downloads, retrieved 30 August 2019.  

Chui, HY et. al. Effects of acupuncture on menopause-related symptoms and quality of life in women in natural menopause: a meta-analysis of randomized controlled trials. Menopause: 2015 Feb;22(2):234-44.

Taylor-Swanson et. al. Effects of traditional Chinese medicine on symptom clusters during the menopausal transition. Climacteric. 2015 Apr;18(2):142-56.

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