Menopause

Menopause is a natural stage of life, signifying the end of the reproductive years – but not signifying the end of life! For most women, menstruation commences a few years either side of the average age of 13 or 14, persisting until an average age of about 50. For many women, it just stops. For some, there is some irregularity in the period before it finally stops.

Unfortunately for many, there are distressing symptoms of varying severity, such as hot flushes, night sweating, insomnia, anxiety or depression. These and similar symptoms are generally well treated using Chinese herbal medicine and acupuncture, which have been shown in trials to regulate hormonal imbalance and brain activity affecting the emotions.

Many women also suffer severe menstrual disturbances referred to as DUB (dysfunctional uterine bleeding), heavy periods, shortened cycles, and sometimes bleeding with heavy gushes followed by days or weeks of trickling. In Chinese medicine this is aptly called Beng Lou, or “Flooding and trickling”. It is well-recognised and effectively treated by Chinese medicine.

The first paper on what was often called “the change of life” was written in 1774, and the word “menopause” was coined in 1812. The first books for women written on the subject in the early 1800s proved to be best sellers. .

A long history of clinical observation has demonstrated the efficacy of Chinese medicine in treating the various problems encountered in the period surrounding menopause. More specifically, clinical trials have also shown certain herbs, and certain treatment protocols to regulate the hormones which are in flux at that time, and which, if too far out of balance, can cause the problems commonly experienced by many women. Interestingly, some women suffer from hot flushes but the cause is not hormonal – because the science of Chinese medicine is not based on the Western concept of hormonal imbalance, it takes a different approach and often gets lasting results where other methods fail, or get temporary results only.

The Huang Di Nei Jing was written over 2000 years ago – and in the first chapter it outlines human growth and development, as well as the waning of health in later years. In relation to women, it describes seven-year stages, explaining, for instance, how at the end of the third seven-year period (ie 21 years of age), the woman has reached maturity and the wisdom teeth grow, and how at the end of the fourth seven-year period (28 years of age), the muscles and bones are strong, the hair is luxuriant and the body robust.  It then proceeds to explain that at 35 years the complexion starts to become dull and the hair starts to thin, and at 42 years of age signs of aging appear on the face, and the hair starts to turn white.  Finally, it says that at the end of the seventh seven-year period when the woman is 49 years of age, there is no menstruation and she is unable to bear children.

Menopause is defined as the cessation of menstruation and in effect the end of the child-bearing years.  The mean age for menopause is 50-52 with a range of 45-57 being considered within the norm.  Less commonly, it can occur as early as 35 or as late as 65 years.  Early menopause can be brought on by ovarian dysfunction, removal of the ovaries, and some drugs cause an artificial menopause.

Perimenopause refers to years either side of the actual cessation of menstruation: In the five years or so leading up to menopause, when hormones are waning, there can be anovulatory cycles and menstrual irregularities. In the years following the cessation of menstruation (anything from 2 to 10 years), many women suffer hot flushes, night sweats (vasomotor disturbances), and other symptoms caused by the withdrawal of hormones such as forgetfulness, anxiety, depression, etc. It is estimated that approximately 70% of women experience some difficulty with hot flushes or other symptoms such as vaginal dryness and some 40% suffer memory loss or depression, anxiety, palpitations and so forth.  Some 20% of women find the symptoms sufficiently distressing to seek medical assistance.

Dysfunctional uterine bleeding:  Although hot flushes often receive top billing in the list of unpleasant symptoms, in clinical practice, a high number of many women present with heavy or dysfunctional uterine bleeding (DUB), which can cause anaemia, iron deficiency and extreme fatigue. Menstrual irregularities include irregular cycles, missed periods, heavy or prolonged bleeding, bleeding outside the cycle and stop and start bleeding with heavy gushes followed by trickling.

Atrophy of oestrogen dependent tissues:  Other changes include: atrophy of oestrogen-dependent tissues such as breasts and genitalia, thinning and drying of the skin and hair, diminishing vaginal secretions and the loss of elastin and collagen, causing loss of skin and muscle tone, increased skin wrinkling and also an increased tendency to suffer stress incontinence and prolapse.

Osteoporosis: Bone density is influenced both by oestrogen which slows osteoclasia (the break-down of bone) and also by progesterone which supports osteogenesis (the build-up og bone).  When these hormones decline, osteoporosis becomes a significant problem for some women.

Cardiac implications:  Menopause also increases the risk of ischaemic heart disease, in part due to the loss of natural progesterone.

Anxiety, mental vagueness and depression:  Apart from physical changes, many women suffer mental vagueness or memory loss, anxiety, depression or periodic irritability.  These are well understood and treated in Chinese medicine. Depression and anxiety may be the result of, or exacerbated by, long-term physical and mental strain in addition to the withdrawal of hormones, and may also be the product of ‘empty nest syndrome’.

Menopausal symptoms in Australian women: In a random survey of 2000 Australian women, it was found that women with better general health, lower levels of stress, absence of PMS, non-smokers, exercisers at least once a week, and those with a positive attitude to ageing and menopause had significantly fewer symptoms. [Ref: Dennerstein, L., Smith, A. M., Morse, C., Burger, H., Green, A., Hopper, J., and Ryan, M  1993 Med J Aust 159;4:232-6]

HORMONAL PICTURE

Contemporary medicine explains menopausal symptoms in terms of the decrease or fluctuation in hormones, in particular focusing on the decline in oestrogen production due to FSH resistance of the ovarian follicles. Western medicine treatment is by supplementing hormone levels with hormone replacement therapy (HRT), Unopposed oestrogen therapy has adverse effects, however, some practitioners also have reservations about the synthetic progestins in HRT, because their chemical structure is different to that of natural progesterone and their physiological effects also differ significantly.

Natural progesterone has been shown to protect women for coronary artery disease, osteoporosis and cancer and synthetic progestins are now included in HRT therapy precisely because it is acknowledged that unopposed oestrogen can cause bleeding problems and also pose a cancer risk.  Contemporary medicine certainly confirms that progesterone is effective in treating DUB, which parallels the use in Chinese medicine of moxibustion and Yang tonics like Xu Duan to control bleeding from Yang deficiency.  During the reproductive years, progesterone regulates oestrogen receptors, thus exerting a protective effect from excess oestrogen which can feed mammary tumours and cause endometrial hyperplasia.  Although simple hyperplasia is not a cause for concern, 40% of atypical cases progress to adenocarcinoma.

LIFESTYLE FACTORS AFFECTING THE MENOPAUSAL SYNDROME

Menopause is a natural stage in life.  In fact, the cessation of menstrual bleeding and child-bearing means there is less of a drain on health.  It is not an illness and not all women suffer unpleasant symptoms at menopause.  Chinese medicine views a healthy lifestyle and good diet as being of paramount importance, and research has shown that women with better general health, lower levels of stress, absence of PMS, non-smokers, exercisers at least once a week, and those with a positive attitude to ageing and menopause had significantly fewer symptoms.