Menopause

Understanding Menopause and How It Affects Fertility

Menopause is the cessation of menstruation that usually occurs between the ages of 48-55. The menopause transition, and post-menopause itself, is a natural life change for every woman, not a disease state or a disorder. Perimenopause is the term describing the menopause transition years. In women who have a uterus, perimenopause describes the years both before and after the final period (although it is only possible to determine in retrospect which episode of flow was indeed the final period). During perimenopause, ovarian function slowly declines and there is a delayed response to gonadotropins. This delay results in a decrease in follicles that release estrogen to circulate in the body. The decrease in estrogen can lead to symptoms of hot flashes, irregular menstrual cycles, headaches, mood swings, insomnia, an inability to concentrate, weight gain, and vaginal dryness. Production of progesterone and testosterone also diminish and become more irregular. During the perimenopause years, fertility diminishes, but is not considered to reach zero until the official date of menopause is determined retroactively 12 months after the last menstrual cycle. The duration of perimenopause with noticeable bodily effects can be a few years, ten years or even longer. At least one year’s absence of menstruation signals a woman’s postmenopausal state. The conclusion of menopause can lead to an increased incidence of cardiovascular disease and osteoporosis due primarily to the decline of estrogen.

How Chinese Medicine and Acupuncture Treat Menopause

Chinese medicine views menopause as a natural physiological process that can be reflective of the state of the body’s internal climate and “essence” or prenatal constitution. The essence is intricately linked to reproduction, ovarian function and the state of the kidneys. Just as the follicular number of each woman is predetermined, so too is the quality of her essence. A woman’s lifestyle through puberty and her reproductive years greatly influences the ease through which she will move through menopause. Excessive work, stress, and a poor diet are extraordinary contributors to poor ovarian function and a difficult menopausal transition. Treatment may include either one or a combination of acupuncture, herbal medicine, massage, nutritional guidance, and/or specific exercises or lifestyle recommendations.

Acupuncture attempts to encourage the body’s endocrine system to adjust more quickly to fluctuating levels of estrogen and progesterone, thereby restoring equilibrium in a more gentle way with fewer side effects. It encourages the restructure of hypothalamus hormonal triggers, thus helping the body to acclimate to the rapid temperature changes associated with vasodilation and perspiration (hot flashes). Acupuncture also releases endorphins, hormones which can positively affect mood and sleep patterns.

Chinese herbs nourish the kidney and essence while calming an unquiet mind. Single herbs have documented cardiovascular effects helping to regulate vasodilation and constriction, ultimately having a positive effect in temperature regulation. A well composed formula will also contain herbs to stimulate the central nervous system, aiding in improved concentration and decreased anxiety.

Reproductive organ massage is a highly specialized form of therapeutic massage that manipulates the fascia of the pelvic cavity to improve the blood flow to these organs. This type of massage can greatly reduce stress levels, relax the body, and allow a woman to re-establish a relationship with her changing body. The massage focuses on an awareness of breath to open the abdominal space and to allow for the menopausal transition to move smoothly and efficiently.

Nutritional guidance emphasizes a balanced diet and an awareness of certain foods that can aggravate the symptoms of menopause. Moderating the use of caffeine, spicy food, red meat, dairy and alcohol can greatly diminish frustrating menopausal symptoms. Increasing calcium and vitamin D can help to strengthen bones, diminishing the risk of osteoporosis. Soy foods are natural sources of estrogen and can help treat hot flashes while protecting against heart disease. Avoiding stress and cigarette smoking will also reduce symptoms.

How Western Medicine Treats Menopause

Western treatments vary in intensity based on symptom severity and prevalence. Usually hormone replacement therapy (HRT) is prescribed which seeks to reintroduce estrogen into the body through synthetic or “natural” sources in an attempt to keep the levels of these hormones in the body much more consistent than they are naturally in perimenopause. In those women who have no uterus (usually due to a previous hysterectomy) estrogen alone is a suitable hormone therapy. Women who still have a uterus need to take progesterone in addition to estrogen, in order to ensure that the endometrium, the lining of the uterus, does not build up too much, which would be a risk for cancer of the endometrium.

Research and Related Articles on Menopause

Menopause (regulating endocrine perimenopausal women)
[Effects of electroacupuncture of Sanyinjiao (SP 6) on genito-endocrine in patients with perimenopausal syndrome]
Qin ZY, Ling H, Xia XH, Meng L, Wu ZJ.
Zhen Ci Yan Jiu. 2007 Aug;32(4):255-9. Chinese.
PMID: 17907389 [PubMed – indexed for MEDLINE]

Effects of acupuncture, applied relaxation, estrogens and placebo on hot flushes in postmenopausal women: an analysis of two prospective, parallel, randomized studies.
Zaborowska E, Brynhildsen J, Damberg S, Fredriksson M, Lindh-Astrand L, Nedstrand E, Wyon Y, Hammar M.
Climacteric. 2007 Feb;10(1):38-45.
PMID: 17364603 [PubMed – indexed for MEDLINE]

Nir Y, Huang MI, Schnyer R, Chen B, Manber R (April 2007). “Acupuncture for postmenopausal hot flashes”. Maturitas 56 (4): 383–95. doi:10.1016/j.maturitas.2006.11.001. PMID 17182200.

Cohen SM, Rousseau ME, Carey BL (2003). “Can acupuncture ease the symptoms of menopause?“. Holistic Nursing Practice 17 (6): 295–9. PMID 14650571. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0887-9311&volume=17&issue=6&spage=295.

The effect of acupuncture on postmenopausal symptoms and reproductive hormones: a sham controlled clinical trial
Acupuncture in Medicine. 2011 Mar;29(1):27-31. doi: 10.1136/aim.2010.003285.