Benjamen Clancy L.Ac, Dipl. Ac.

Are you experiencing menopausal symptoms or know someone who is? Menopausal symptoms may include hot flashes, night sweats, pain during intercourse due to vaginal dryness, anxiety and/or irritability (Webmd, 2014). These symptoms can severely affect the quality of one’s life. Western medical intervention may include hormonal therapy (HT) and/or antidepressants; however these often come with unwanted side effects both short term and long. I would like to share with you how Traditional Chinese Medicine (TCM) including acupuncture and Chinese herbs can help to ameliorate menopausal symptoms with little to no associated side effects. In this article we will explore Western Medical and TCM perspectives of the causes (both natural and induced) of menopausal symptoms. We will also identify treatment strategies of both Western Medical therapy and TCM for this condition.

Jumping right in, a Western physiological explanation of menopause as described by PonJola Coney, MD (2014) is by definition the cessation of menstruation. Menopause is diagnosed by the absence of menstruation for 12 months (Butler, Santoro, 2011; Santoro, Randolph, 2011). Menopausal symptoms typical occur on the average between 50-51 years of age, however, may begin as early as 45.5-47.5 years (McKinlay et al 1992; Cramer et al,1995). Natural menopause symptoms begin due to a lack of ovarian sensitivity to gonadotropin stimulation which includes luteinizing hormone (LH) and follicle-stimulating hormone (FSH).

To be thorough, I would like to give a complete description of a women’s normal menstrual cycle to better understand the hormonal feedback interactions, if physiology is not your thing please just skip over the next two paragraphs.

In the female, egg production begins with hormonal stimulation, the same as the male; however, the eggs develop in ovaries in contrast to testes. The life cycle of an egg develops over a period of a month (28 days) and contains four phases including the proliferative, ovulatory, secretory, and menstrual (Rathus, Nevid & Fichner-Rathus, 2005, p. 87). The menstrual cycle begins with the proliferative phase, when the hypothalamus receives information that hormone levels (estrogen and progesterone) vie the blood are low, the hypothalamus releases a hormone called gonadotropin releasing hormone (Gn-RH); this hormone tells the pituitary gland to release FSH (Rathus, Nevid & Fichner-Rathus, 2005, p. 89). When FSH reaches the ovaries the hormone stimulates graafian follicles to mature and release estrogen; when the follicle has fully matured it ruptures and produces a mature egg (Rathus, Nevid & Fichner-Rathus, 2005, p.89). The estrogen stimulates the endometrium (inner membrane of the uterus) to grow; providing a future home for the egg to further mature once inseminated with a sperm cell. The ovulatory phase begins approximately 14 days after with the rupture of the graafian follicle releasing an egg “near” a fallopian tube (one of two tubes that carry the egg to the uterus) (Rathus, Nevid & Fichner-Rathus, 2005, p.89).

The ruptured graafian follicle under the influence of LH remains in the ovary (at this stage termed corpus luteum) and begins to release high levels of progesterone and estrogen (Rathus, Nevid & Fichner-Rathus, 2005, p.90). When the hypothalamus detects high levels of estrogen it triggers the pituitary gland to release FSH and LH; LH triggers hair like projections from the end of the fallopian tubes (fimbriae) to gather the egg into the fallopian tubes; beginning the secretory phase (luteal phase) (Cleveland Clinic, 2010). During the secretory phase hormone levels reach the highest levels approximately day 20 or 21 of the cycle. The hormones cause the endometrium to secrete nutrients intended to sustain a fertilized egg; however, if the egg does not become fertilized the hypothalamus responds by signaling the pituitary gland to cease production of FSH and LH (Rathus, Nevid & Fichner-Rathus, 2005, p.90). The final phase (menstrual phase) begins when hormone levels i.e., progesterone and estrogen drop to a level that can no longer support the uterine lining; thus again stimulating the hypothalamus to release Gn-RH that stimulates the pituitary to release FSH; the FSH the stimulates the ovaries to release estrogen and the cycle begins anew (Rathus, Nevid & Fichner-Rathus, 2005, p.90).

Done! Ok, now we have a better understanding of the complexity of hormonal interactions occurring in our bodies, which are truly amazing! Menopause is a normal occurrence in women; aging follicles become desensitized to gonadotropin stimulation. This eventually results in anovulatory cycles (menstrual cycle during which the ovaries do not release an oocyte), which causes LH and FSH hormones to rise and increase estrone levels and a decrease in estradiol levels. Estrone and estradiol are two of the three types of estrogen hormones, estriol being the third and is made from the placenta (Webmd, 2014). However, Estrone is the predominate form of estrogen found circulating in the body after menopause (Webmd, 2014).

So, now that we have a good understanding of menopause and its symptoms, let’s explore how Traditional Chinese Medicine (TCM) views menopause and what it has to offer in terms of symptom relief. From a TCM perspective proper health or lack of health is described by a Taoist philosophy of duality and balance i.e., yin and yang. TCM often uses archaic terminology to describe human physiology. Why is this necessary? Good question! In my opinion, TCM terminology is a complete diagnostic package, if one begins to alter what has been practiced effectively for thousands of years, the results can distort the diagnostic pattern and thus lead to an incorrect diagnosis. Correct diagnosis leads to a correct treatment and therefore encourages the chances of a positive outcome.

In terms of how yin/ yang perspective relates to the body, the term yin is used to describe the blood and various body fluids, whereas, yang is used to describe one’s energy or thermic qualities. From a TCM perspective, menopausal symptoms fall under unique patterns e.g., a deficiency yin would manifest symptoms including night sweats, hot flashes, vaginal dryness, insomnia and irritability. Another pattern often seen is blood deficiency which manifests symptoms including: hot flashes, insomnia, dry skin and hair loss. A liver pattern may also be seen which includes symptoms including: irritability, hypochondriac pain (pain in the rib area), insomnia and nervousness. Finally, a pattern called deficiency heat manifests with hot flashes, irritability and dizziness. If you have noticed, several of the patterns symptoms overlap. TCM utilizes four diagnostic methods to correctly identify the pattern including inspection, auscultation and olfaction, inquiry as well as pulse-taking and palpation.

Once the pattern/ patterns are correctly diagnosed treatment can be rendered e.g., acupuncture, Chinese herbs, life style recommendations including dietary recommendations, exercise and various stress relieving practices. There have been several studies which have demonstrated acupuncture/ Chinese herbals ability to alleviate menopausal symptoms. A meta-analysis of randomized controlled trials concluded that acupuncture improves hot flash frequency and severity, menopause-related symptoms, and quality of life (in the vasomotor domain) in women experiencing natural menopause (Chiu et al, 2014).

An exact physiological explanation of hot flashes is still poorly understood; however, the author’s Chiu et al (2014) hypothesize acupuncture is able to modify levels of hormones and thus influence menopausal symptoms. The author’s Lomax, Schonbaum, Rebar and Spitzer (1993; 1987) state, a reduction of estrogen as seen in menopause can deplete the amount of β-endorphin (a neuropeptide found in the cells of the central and peripheral nervous system – in the hypothalamus of the brain) which is associated with the symptoms of hot flashes. Acupuncture has been found to increase estrogen and central β-endorphin activity (Andersson and Lundeberg, 1995). Since acupuncture is able to increase β-endorphins, thermoregulation becomes stable and thus a reduction of vasomotor symptoms decreases (D’Amico et al, 1991; Melis et al, 1994).

To summarize, menopause can be an incredibly life upsetting time in a woman’s life; however this doesn’t have to be the case! Acupuncture and Chinese medicine have a great deal to offer women struggling with these symptoms; including reduction of hot flashes, sweating, insomnia and various emotional symptoms. It makes sense to give something which has worked for thousands of years a try. TCM including acupuncture come with very few side effects, in contrast to pharmaceuticals. I personally have witnessed the powerful effect of TCM on this condition and have been able to help numerous patients struggling with natural or induced menopausal symptoms. If you or someone you know struggle with any of these symptoms, please share this article and have them give me a call. The solution to a more comfortable life is a phone call away 502-710-9088.

References

Andersson, S. and Lundeberg, T. (1995).“Acupuncture—from empiricism to science functional background to acupuncture effects in pain and disease,” Medical Hypotheses, vol. 45, no. 3, pp. 271–281.
Butler L, Santoro N. (2011). The reproductive endocrinology of the menopausal transition. Steroids;76(7):627-35. [Medline].
Chiu, H., Pan, C., Shyu, Y., Han, B., Tsai, P. (2014). Effects of acupuncture on menopause-related symptoms and quality of life in women on natural menopause: a meta-analysis of randomized controlled trials. Retrieved July 31, 2014, from website: http://www.ncbi.nlm.nih.gov/pubmed/25003620
Coney, P. (2014). Menopause. Retrieved July 31, 2014, from website: http://emedicine.medscape.com/article/264088-overview#aw2aab6b4
Cramer, D., Harlow, B., Xu, F., Fraer, C, Barbieri, R. (1995). Cross-sectional and case-controlled analyses of the association between smoking and early menopause. Maturitas. Sep 1995;22(2):79-87. [Medline].
D’Amico, J., Greendale, G., Lu, J. and Judd, H. (1991).“Induction of hypothalamic opioid activity with transdermal estradiol administration in postmenopausal women,” Fertility and Sterility, vol. 55, no. 4, pp. 754–758. View at Scopus
Lomax, P. and Schonbaum, E. (1992). “Postmenopausal hot flushes and their management,” Pharmacology and Therapeutics, vol. 57, no. 2-3, pp. 347–358, 1993. View at Scopus
McKinlay, S., Brambilla, D., Posner, J. (1992). The normal menopause transition. Maturitas.;14(2):103-15. [Medline].
Melis, G., Paoletti, A. and Gambacciani, M. (1994). “Evidence that estrogens inhibit LH secretion through opioids in postmenopausal women using naloxone,” Neuroendocrinology, vol. 39, no. 1, pp. 60–63. View at Scopus
Rathus, S. A., Nevid, J.S., and Fichner-Rathus, L. (2005). Human sexuality in a world of diversity. (6th ed.) Boston: Allyn and Bacon.
Rebar, R. and Spitzer, I. (1987).“The physiology and measurement of hot flushes,” American Journal of Obstetrics and Gynecology, vol. 156, no. 5, pp. 1284–1288, 1987.
Santoro, N., Randolph J. (2011). Reproductive hormones and the menopause transition. Obstet Gynecol Clin North Am. Sep 2011;38(3):455-66. [Medline].
Webmd (2014). Normal Testosterone and Estrogen Levels in Women. Retrieved July 31, 2014, from website: http://www.webmd.com/women/guide/normal-testosterone-and-estrogen-levels-in-women.
Webmd (2014) Understanding Menopause-symptoms. Retrieved July 31, 2014, from website: http://www.webmd.com/menopause/guide/understanding-menopause-symptoms