menopause: a mellow and mild second spring

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 now refer to as menopause: At about 49 years, menstruation (Heavenly Dew) ceases, and conception is no longer possible. The vitality that was needed in the uterus (Baby Palace) now moves up to the heart, providing a deeper wisdom, a “second spring”. This is certainly a beautiful and poetic image.

For some women, however, the late-forties are a time of 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. Over one in ten women will have severe menopausal symptoms, and over 85% of menopausal women will experience hot flashes.

Western medicine explains the main cause of menopause as a decrease of the hormone estrogen, which occurs when the ovaries cease their function. In addition to the more common menopausal symptoms, lowered estrogen levels can also contribute to bone loss, resulting in back pain and the possibility of fractures.

Hormone replacement therapy (HRT) is the most common treatment that western pharmaceutical medicine offers menopausal women. HRT consists of either estrogen, or estrogen combined with progesterone. HRT can be an effective short-term remedy for acute menopausal symptoms of hot flashes, night sweats and vaginal dryness. There are side effects associated with HRT: uterine and breast cancer may occur in some women who are on HRT for a prolonged period. For this reason, HRT combining estrogen (for symptom relief) with progesterone (to prevent excessive uterine lining buildup) is probably the safest western pharmaceutical remedy.

Estriol, a simpler form of estrogen, is commonly prescribed in Europe. It is weaker and safer than the estrogen used in our country, and is reported to help shrink estrogen dependent tumors, protect against cancer, help maintain current bone levels, and has a protective effect on the heart. Since it is made from wild yam root, it cannot be patented, so it is not marketed to medical doctors here.

Women who take or took birth control pills may be predisposed to menopausal problems. In the '60's and 70's, some of those pills were 500 times as potent as these used today. Just because you are asymptomatic while taking "the Pill" doesn't mean that you are in the clear. Similar to PMS and menstrual problems that only show up at the period, problems associated with birth control pills often only show up at menopause.

Estrogen is not only found in medicines. Xenoestrogens (meaning "foreign"estrogens) come from break down of plastics and agricultural chemicals in the environment. These are then ingested through our water and food sources. They are becoming more common and abundant every day, and are especially plentiful in animal foods (meat, fowl, fish and dairy products). For this reason, it is highly advisable to eat organically produced foods, especially organic animal products.

From the Chinese medical point of view, there are several causes for menopause. The most common cause is a deficiency of yin, which is the fluid aspect of the body. Yin is, in some ways, similar to estrogen. Without sufficient yin, our fire aspect (yang ) flares up, producing the hot flashes, sweating, and vaginal dryness. Yin is produced from the food and drink we consume, and the air we breathe. In the west, where many women obsess on being thin, yin is often at a premium. If we don't eat enough, or think of coffee and donuts as a balanced source of nutrition, yin is then robbed from organs and tissues that would otherwise use it in day-to-day function. Alcohol, coffee and other strong stimulants, most recreational drugs and cigarettes are other yin plunderers. Chronic and low-grade, or sudden and intense physical or emotional stress also causes yin-deficiency.

Women do not only experience deficiency of yin at menopause. Pre- and peri-menopausal signs of yin-deficiency include insomnia; thirst; afternoon fever; hot and/or sweaty palms, soles and chest; nervousness and irritability; high blood pressure; scanty menstrual flow, or, in extreme cases, amenorrhea; back pain; and a whole list of other symptoms, too numerous to list. As a preventive approach, treatment of menopause is best begun before onset of symptoms. If you have one or several of these yin-deficient symptoms, consider seeking treatment or consultation.

Some menopausal women experience a decreased function of Yang , the fire aspect of our body, which manifests as fatigue, weight-gain, water retention, incontinence, depression and low libido. As with yin deficiency, these symptoms are not only experienced by women at menopause. If you have these symptoms pre-menopausal, it is likely that they will be heightened when menopause arrives. Often, there is a combination of mutual yin and yang deficiencies.

In both cases, proper nutrition is of utmost importance. Eating enough, but not too much, is always critical. There are numerous diets out there that tout their benefits, each one different from the other: some are high protein/low carb; some raw food based; some by blood type. Each one has its benefits, in the short term. However, traditional peoples in most of the world eat a universally similar diet. It is primarily based on some starch, usually grain: rice all over Asia, wheat in the Middle East, corn and potato in South and Central America. Along with the starch, some vegetables—cooked or pickled, a small amount of meat, fish or beans; and some broth or soup. This is a sound diet for optimal health. If you adhere to this as the basis of your meals, the occasional (not daily) coffee, candy, cake, wine, or even cigarette will do little if any harm.

Acupuncture and Chinese herbal medicine treatments have been used to successfully treat all types of menopausal problems for thousands of years. Each woman’s situation is unique, and Chinese medical diagnosis and treatment is precisely designed to meet those individual needs. Acupuncture points may be selected from anywhere on the body. There are combinations for treating hot flashes, depression, irritability, low libido, abnormal bleeding, hypertension, etc. Super-thin needles are inserted with little sensitivity into anywhere from 5 to 15 points. Once they are in, a very peaceful calm settles in, and the patient rests for 20-30 minutes. Treatments are usually once weekly, and, depending on the severity of the condition, are prescribed for one to three months. Some symptoms may resolve after one or two visits; chronic conditions require longer.

Chinese herbal medicine is prescribed in formulae made up of 4 to 20 individual herbs. The target for each formula varies according to symptoms and constitution (yin or yang balance). Usually the main symptoms are treated first, and then once they resolve, the focus is to work on maintaining normal or optimal function and preventing recurrence of symptoms. Herbal medicine is subtle, yet powerful. Like acupuncture, herbal therapy may take up to several months to be effective.

The ideal menopause outlined in the opening passage of this article is not always the most commonly experienced one. But it is one to strive for, and for many women, it is one that is easily within reach.