Just as nature has cycles, so do we! In Traditional Chinese Medicine (TCM) women have seven year cycles whilst men have eight year cycles. Each stage represents and marks a new phase, both emotionally and physically. The first four cycles are associated with growth- Yang energy dominates. But by the fifth cycle (35-41 years) Yang energy begins to decline. The fifth cycle is a time for self reflection; a need to re-evaluate how life is going, what has gone well and what needs to be changed. Preparation for the next cycle, when menstruation will stop, begins in the body both mentally and physically. TCM regards this time in a woman's life as being an important one in which to strengthen the main organs so that the transition to the next cycle is smooth and symptoms are kept to a minimum.
From the age of 42 women enter the sixth cycle, which in Western medical terms starts slightly earlier at around the age of 40 and is referred to as 'peri-menopause'. During this cycle, hormone levels begin to change and the ovaries gradually stop working. TCM considers this a time to detoxify, reflect on life events, process any trauma and look forward to being wiser!
Menopause- The age of wisdom
The seventh cycle heralds the end of menstrual periods (age 49-55 years). 'Menopause', according to the World Health Organisation (1), is a label used to identify the stage when a woman experiences 'no menstrual bleed for twelve consecutive months'. As soon as the year of no menstrual bleed ends, Western medicine labels women as being ‘post-menopausal’. Interestingly, in the UK the average age at which the menopause occurs is 51 years old whilst in India it is 48. 'Premature menopause' is a label used for menopause which begins before the age of 40. This can occur for a number of reasons, including a hysterectomy where the ovaries are removed.
In terms of the five elements (Fire, Earth, Metal, Water, Wood), the seventh cycle brings us back to the Water element which is associated with the Kidneys and winter. It is Yin in nature which means a time to go within, reflect, recuperate, nourish and look forward to new beginnings.
Perimenopause & Menopausal Symptoms
Whilst symptoms can vary, the most frequently mentioned have been popped into the box below.
Interestingly, there are variations in symptoms reported across the world:
Hot flushes, night sweats, weight gain and problems sleeping appear to be higher in the UK, USA & Canada (2)
Women in Japan report fatigue and stiff shoulders (3)
Nigerian women report hot flushes as the biggest symptom (4)
Women in India experience muscle and joint pain, fatigue, back pain, memory issues as well as sleep issues. (5)
Dealing with perimenopausal and menopausal symptoms....The Western medical approach
Western medical practitioners suggest that menopausal symptoms are due to fluctuations in oestrogen production which leads to a disruption in the communication between the hypothalamus, pituitary gland and adrenals (HPA axis). Much of the research to date has focused on the decline of oestrogen in the body. The treatment provided is Hormone Replacement Therapy (HRT) which manages oestrogen and progesterone levels.
Understanding Hormone Replacement Therapy (HRT)
Pessaries, creams, patches, tablets, gels or rings......HRT can be administered in so many ways! Some are taken without a break whilst others are switched between oestrogen and progesterone every few weeks.
HRT can be divided into the following groups:
The hormones used in HRT can be either Body Identical or Bio-Identical. Interestingly, both are plant-based (yam/soya bean) and look identical under a microscope. So what is the difference?
Body Identical hormones are created by pharmaceutical companies as standardised and licensed products, and are available on prescription. Bio-identical, on the other hand, are hormones which are created specifically for the individual based on blood and salivary tests which measure hormone levels. There is some debate as to the accuracy of the tests used to determine the required level of hormone as hormones fluctuate naturally during the day.
Whilst HRT can be very effective at reducing symptoms for some women, it can have a very limited/no effect on others. So is it the all encompassing solution it is touted to be? (Sorry Davina McCall!). I have spoken to numerous women who take HRT and find it makes little or no difference but continue to take it because they have been told it has benefits, with very little/no discussion about the side effects. Some doctors encourage women to take HRT because research has indicated it reduces the risk of osteoporosis. One criticism of prescribing HRT to prevent osteoporosis is that bone density is not checked prior to prescription to determine if it is needed. Which raises the question... why take HRT if there is no family history of osteoporosis or evidence of low bone density?
The side effects of HRT
A major topic of discussion in relation to HRT has been the risk of breast cancer. It seems that one month we hear the risk is reduced, followed a few months later by a headline claiming the opposite. The National Institute for Health and Care Excellence (NICE) website states that there is 'a small increase in the chance of getting breast cancer when taking combined HRT'. The risk reduces after HRT is stopped. The solution.....have regular breast cancer screening. Women who have had or are being treated for breast cancer are advised NOT to take HRT.
The site also adds that there is a small increase in the chance of getting a blood clot if the tablet form is taken. This is not the case with the gel or patch form of HRT so it is important to consider which one you use if there is a history of blood clots in your family. HRT tablets are also linked to a slightly higher risk of Stroke.
Is menopause the cause of the symptoms?
Time restrained and overworked medics often need to make a quick diagnosis and so can, understandably, overlook other factors which may be the cause of some of the symptoms experienced during perimenopause/menopause and even post-menopause. As soon as a woman hits the age of 40 it is assumed that symptoms are linked to the onset of peri-menopause, with little or no consideration to lifestyle, diet and family history. This means that HRT can be prescribed when it wasn't needed! Even research into the menopause can ignore other factors. One study comments that:
'In virtually all research paradigms, menopause has been detached from the rest of life, particularly what precedes it. Most research on menopause begins at the earliest in the late premenopause, and often ignores reproductive and dietary history that may be expressed/manifested in the menopausal body.' (6)
A list of common experiences at this stage of life which can cause symptoms and need to be considered include those listed below :
(a) Women in their forties and early fifties (the 'sandwich generation') are often dealing with teenagers as well as elderly parents whose needs are increasing. Worry, stress and exhaustion can lead to insomnia, weight gain and depression.
(b) Issues with self image can arise due to weight gain which can be due to a reduction in exercise because of work and family demands and/or a slowing down in metabolism. Dietary advice and exercise may be of greater benefit than prescribing HRT.
(c) 'Empty nest' syndrome means that women experience a period of 'no identity'/'not knowing who I am anymore'. Reflection and exploring dreams and hopes in a talking therapy can be of greater benefit than HRT.
(d) Work-life balance is often the focus of evaluation at this stage of life. We naturally want to slow down or want a change. A change in career or moving home can be common at this age. This comes with its own set of issues and emotional responses, all of which can affect stress levels and health.
(e) Boredom...life has been the same for a couple of decades and there may be deep seated desire for change but a feeling of not knowing which direction to take.
If any of the above are relevant then a talking therapy, nutritional advice and exercise advice from qualified professionals would be of benefit.
The approach taken by Traditional Chinese Medicine (TCM)
Whilst the medical understanding of the menopause focuses on the level of oestrogen in the body, TCM considers this change in the body as being caused by a decline in the Kidneys due to age. Kidney Yin begins to decline and the balance of Yin & Yang is altered. Transitioning from having periods to not should, according to TCM, be smooth and non-disruptive.
Unlike the Western medical approach, TCM considers every aspect of a woman's life in order to make a diagnosis; lifestyle (past and present), diet, medical history, menstrual cycle history, trauma and stress levels It is important to look at the whole person along with symptoms.
Many people aren't aware that acupuncture doesn't just focus on imbalance at a physical level but also at an emotional one. The channels connect organs physically as well as energetically. Each organ has its own emotion; Kidneys-fear, Heart-joy, Spleen-worry/anxiety, Liver-anger/resentment, Lungs-grief/sadness. So acupuncturists don't just focus on physical symptoms, they look at life events and how you feel emotionally to work out what may be out of balance. Acupuncturists consider it crucial to identify and address the root cause of an imbalance as well as resolve symptoms.
Acupuncture needles are applied to specific points on the body to activate the body's own response to resolve an imbalance or heal. In a Tui Na session points are stimulated by specific massage techniques and Qi is moved along acupuncture channels and sinews. Acupuncture & Tui Na may help to reduce stress levels, re-balance the body and mind and so make it easier to deal with any stressors. It may also help you feel in control again and, therefore, help you to deal with change and moving forward.
Acupuncture to treat HOT FLUSHES & NIGHT SWEATS
One of the most commonly reported symptoms during both perimenopause and menopause, hot flushes can range from a feeling of heat rising with a little sweating to full blown heat with profuse sweating. The latter can affect work and sleep. Night sweats can occur several times a night in more severe cases which is very disruptive to sleep meaning tiredness then becomes an issue as well. TCM aims to treats both of these symptoms by nourishing Yin and supporting the Heart (Fire) & Kidney (Water) connection. Water controls Fire so, if it is not strong enough, Fire can get out of control- hence hot flushes! Night sweats are seen as a sign of a lack of Yin. Research findings suggest that acupuncture can be very effective at reducing hot flushes and night sweats (11).
Acupuncture for a loss of sense of self/anxiety/depression
An empty nest, changes in career or direction, a desire to change the pace of life/move home as well as a fear of change can all impact our sense of self, causing anxiety and even depression. Our focus shifts at this stage of life from surviving to a desire to connect to our purpose. Acupuncture focuses on re-establishing the connection to our authentic self; who we are at our core and not what we are expected to be. Acupuncture has been found to be effective after six weeks of treatment (7, 8).
Acupuncture for insomnia or poor sleep during perimenopause/menopause/post menopause
Sleep can be affected by hot flushes, anxiety or the need to go to the toilet during the night. TCM views this change in sleep patterns as being caused by the effect of disharmony between the Kidneys and Heart and/or a need for Blood and Qi to be nourished in order to rebalance Yin and Yang. Studies have shown that acupuncture is helpful in improving sleep quality (9, 10, 12).
Acupuncture whilst on HRT
Many women who are on HRT often have acupuncture alongside their treatment. The acupuncture focuses on dealing with any side effects of the HRT (including spotting, sore breasts, nausea, depression, bloating and headaches) as well as rebalancing Yin & Yang and strengthening the organs.
Self-help to reduce menopausal symptoms
Take time out for yourself
Stepping away from the hub-bub off life allows you time to reflect and think about what you would like in this next phase of life. Meditate, take a walk in nature, read or watch something light or funny, keep a gratitude journal, meet friends, take up a new hobby....do anything that makes you happy as endorphins are released and cortisol levels drop when we are happy.
Diet
Avoid greasy foods as these are Phlegm forming. Phlegm can exacerbate hot flushes, cause brain fog and affect sleep.
Limit
Limit caffeine and alcohol as both are warming in nature and can, therefore, make hot flushes worse. Limit or stop smoking. The smoke inhaled is hot.
In TCM body fluids includes plasma. Plasma is a vital component of Blood. The heat dries body fluids which in turn affects the movement of Blood through the body.
Foods to include in your meals
Include a range of vegetables in your diet to help build blood and fluids.
Nuts: Black Sesame seed
Vegetables: Sweet potato, asparagus, cucumber, seaweed, kelp, tomato, mung beans, bean sprouts, Kidney beans.
Fruit: pomegranates, watermelon, apples, avocado, mango, blueberries.
Oils: olive, almond or flaxseed.
Restrict: garlic, ginger, onions, coffee, lamb, prawns, citrus
Avoid: Alcohol (too warming!). Hot and spicy food (also too warming!)!
Interesting articles for further reading
Medscape UK recently reported that an NHS wide policy on menopause could reduce the number of female doctors leaving the profession because of the effects of menopause. Access the article here.
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REFERENCES
(2) Minkin, M. J., Reiter, S., & Maamari, R. (2015). Prevalence of postmenopausal symptoms in North America and Europe. Menopause, 22(11), 1231-1238.
(3) Ishizuka, B., Kudo, Y., & Tango, T. (2008). Cross-sectional community survey of menopause symptoms among Japanese women. Maturitas, 61(3), 260-267.
(4) Ozumba, B. C., Obi, S. N., Obikili, E., & Waboso, P. (2004). Age, symptoms and perception of menopause among Nigerian women. J Obstet Gynecol Ind, 54(6), 575-8.
(5) Bairy, L., Adiga, S., Bhat, P., & Bhat, R. (2009). Prevalence of menopausal symptoms and quality of life after menopause in women from South India. Australian and New Zealand Journal of Obstetrics and Gynaecology, 49(1), 106-109.
(6) Melissa K. Melby, Margaret Lock, Patricia Kaufert, Culture and symptom reporting at menopause, Human Reproduction Update, Volume 11, Issue 5, September/October 2005, Pages 495–512, https://doi.org/10.1093/humupd/dmi018
(7) Zhao, F. Y., Fu, Q. Q., Spencer, S. J., Kennedy, G. A., Conduit, R., Zhang, W. J., & Zheng, Z. (2021). Acupuncture: a promising approach for comorbid depression and insomnia in perimenopause. Nature and science of sleep, 1823-1863.
(8) Avis, N. E., Coeytaux, R. R., Isom, S., Prevette, K., & Morgan, T. (2016). Acupuncture in Menopause (AIM) study: a pragmatic, randomized controlled trial. Menopause (New York, NY), 23(6), 626.
(9) Hachul H, Garcia TK, Maciel AL, Yagihara F, Tufik S, Bittencourt L. Acupuncture improves sleep in postmenopause in a randomized, double-blind, placebo-controlled study. Climacteric 2013;16:36–40 [Taylor & Francis Online], [Web of Science ®], [Google Scholar]
(10) Fu, C., Zhao, N., Liu, Z., Yuan, L.H., Xie, C., Yang, W.J., Yu, X.T., Yu, H. and Chen, Y.F., 2017. Acupuncture improves peri-menopausal insomnia: a randomized controlled trial. Sleep, 40(11), p.zsx153.
(12) Chiu, H.Y., Hsieh, Y.J. and Tsai, P.S., 2016. Acupuncture to reduce sleep disturbances in perimenopausal and postmenopausal women: a systematic review and meta-analysis. Obstetrics & Gynecology, 127(3), pp.507-515.