Menopause is defined as the permanent cessation of menses. While it is a normal process of aging, it may create a number of complications that require medical attention. such as vasomotor complaints ( hot flashes), psychosomatic complaints, genital atrophy, and osteoporosis. The issue of menopause is becoming increasingly important as life expectancy climbs to over 85 years. Since most baby-boomers approach menopause near age 50, they can expect to spend more than one-third of their life post-menopause. Therefore, adequate care is essential to ensure quality of life during the golden years. This update discusses optimal method of addressing the changes that occur during menopause, in both western and Traditional Chinese medicine.
Western Medical Perspective
While menopause is not a disease, it is normal process of that can be disturbing and discomforting. It may create conditions and complications that require medical intervention. Vasomotor complaints ( hot flashes), psychosomatic complaints, genital atrophy, and osteoporosis are the four main medical conditions associated with menopause that are discussed here.
Vasomotor complaints (hot flashes) may occur in 80% of menopausal women, and may last for up to five years. “Vasomotor flush” is the objective and visible flushing of blood affecting the thorax, neck and face, followed by an increase in body temperature and profuse sweating. Hot flashes are the subjective sensation of intense warmth in the upper body, typically lasting for 4 minutes. since vasomotor complaints ( hot flash) occur most frequently at night, it is not uncommon for women affected by them to experience insomnia, restlessness, irritability and emotional instability. Many women seek professional help when these changes begin to disturb their daily activities..
Genital atrophy may also occur in approximately 20% of postmenopausal women. Since many tissues in the genitourinary region are estrogen dependent, post-menopausal women may experience atrophy of the lower vaginal, labia, urethra, and bladder trigone. Genital atrophy may progress to vaginal dryness, painful coitus, diminished libido, increased vaginal ulceration, increased risk and frequency of infection, dysuria, urgency, painful urination, and stress incontinence. These imbalances may required therapeutic intervention by health care professionals.
Osteoporosis is characterized by reduction in bone mass. Osteoporosis is becoming one of the most common disorders in the West. as the large population over 50 continue to age and life expectancy continue to increase. Osteoporosis occurs mostly in individuals between 51 and years of age, and is six times more common in women than men. Menopause is the number one risk factor for osteoporosis, since women lose 1-2% of their bone mass density every year for 5 years after menopause. There are numbers other risk factors for osteoporosis, including but not limited to aging, dietary habits, lifestyle, family history , chronic use of drug and long term exposures to alcohol and tobacco. The clinical implications of osteoporosis include bone fracture after minimal trauma and prolonged recovery. Injuries often result from a (relatively low-impact) fall from standing height, subsequently leading to fractures of the vertebrae, wrists, hips, humerus, and tibia. With bone fracture, there is severe pain, discomfort, decreased mobility, and risk of infection, in the elderly, decreased mobility may lead to further health complications, further delaying recovery. Of the conditions associated with menopause, osteoporosis is considered by many to be the most severe and the most significant.
Many pharmaceuticals are available for prevention and treatment of menopause and related conditions. Listed below are some of the most commonly used therapies and /or drugs.
1. Hormone Replacement Therapy (HRT)
The purpose of hormone replacement therapy is to supply the body with an external source of hormones, including estrogen and/or progesterone. While there are numerous forms, premarin (conjugated estrogen) and Provera (medroxyprogesterone) remain the most popular brands. In fact in the year 2000-2001, Premarin is the number one most-frequently prescribed medications in the United States. This is an astounding statistic, considering menopausal women is the only individual for whom medication is prescribed. Estrogen is commonly prescribed for numerous purposes, including but not limited to menopausal signs and symptoms, osteoporosis and atrophic vaginitis. In addition to use of estrogen for menopause, some early studies have hinted that the use of estrogen may be associated with prevention of Alzheimer’s disease. However, more recent data concluded that the beneficial effects of estrogen are observable only for up to 16 weeks, after which no difference is observed between placebo and control groups.
Unfortunately, despite possible benefits, the use of estrogen replacement therapy has many potential conflicts and controversies. One of the biggest disadvantages is the staggering number of side effects associated with estrogen therapy, including but no limited to increased risk of breast cancer, uterine cancer, ovarian cancer, endometrial carcinoma, malignant neoplasm, gallbladder disease, thromoembolitic disease, and photosensitivity. Progesterine is prescribed in combination with estrogen to minimize the risk of endometrial cancer. However, it causes side effects such as increase in cholesterol levels, edema, weight gain, and bleeding. Due to these adverse effects, there are many who cannot, or will not take hormone replacement therapy.
2. Biphosphonates for Osteoporosis
Biphosphonates is a class of drugs that includes alendronate (Fosamax), etidronate (Didronel), Pamidronate (Aredia), tiludronate (Slelid), and risedronate (Actonel). These substances treat osteoporosis primary by blocking the loose of bone mass. Biphophonates such as alendronate (Fosamax) may increase bone density by 5-10 percent, if taken daily, continuously for 3 years. Side effects of these drugs include nausea, diarrhea, esophageal irritation, and esophagitis. Furthermore, in laboratory studies, the use of biphosphonates is associated with the development of cancer (thyroid adenoma and adrenal pheochromocytoma) and fertility impairment (inhibition of ovulation in women, and testicular and epididymal atrophy in men.
is the abbreviation for “selective estrogen receptor modulator”. Currently, SERM (Evista) is the only medication approved in this class. It works by facilitating the utilization of calcium for proper bone maintenance, and is therefore used for prevention and treatment of osteoporosis. Unfortunately, the use of this medication is associated with increased risk of venous thromboembolism and increased severity and incidence of hot flashes. It is also contraindicated in patients with liver problems, as raloxifene is metabolized hepatically.
Clonidine (Catapress) is another option of the relief of hot flashes. It stabilizes the blood vessels by binding the alpha-adrenergic receptors. It rarely prescribed because it has significant side effects such as postural dizziness, blurred vision, first-dose syncope and withdrawal hypertension.
Overall, there are numerous pharmaceutical options available for treatment of menopause and related conditions. Unfortunately, there is no consensus on how menopause should be treated in western medicine. Despite much contemporary clinical and laboratory research, medical doctors cannot agree on when and under what circumstances treatment of menopause should be started. Some propose to begin treatment during premenopausal years, some prefer to initiate treatment only after menopausal signs and symptoms have begun, and still others discourage the use of drugs, pointing out that the risk outweigh the benefits. Until more authoritative information is available, the best conclusion that can be drawn at this time is that treatment should be initialized, and both patients and doctors must have complete understanding of the goals to be accomplished and the risk involved in each course of action.
TRADITIONAL CHINESE HERBAL MEDICINE PERSPECTIVE
According to traditional Chinese medicine, the Kidney is the organ responsible for growth, maturation and aging. Therefore, the fundamental changes that occur during menopause can be attributed to Kidney deficiency, and Kidney deficiency is the universal diagnosis among all women with menopause. This is extremely important to keep in mind: women may reach menopause of different ages and under different circumstances. For example, those who are pre-menopausal may have only mild symptoms. Those who are peri- or post-menopausal may experience moderate symptoms, and those who had artificial menopause (such as hysteretomy) show immediate and severe symptoms. Therefore, Kidney tonic herbs are absolutely essential for the success of the treatment regardless of whether the patients are acutely symptomatic.
Menopause patients may have one or more of the following diagnosis. Kidney Yin deficiency, Kidney Yang deficiency, Kidney Jing (essence) deficiency, Liver qi stagnation, blood deficiency, and rising deficiency heat. In response to these differentiations. treatment of menopause using Chinese herbal medicine is divided into primary and supplementary treatment.
1. Yin Deficiency: Nourish is one of the most commonly used and the most effective formulas for menopause. It has marked effectiveness to treat the cause (estrogen deficiency) and the symptoms of menopause (hot flashes, perspiration, insomnia, emotional instability, etc). The foundation of Nourish is based on the classic formula that has excellent functions to tonify Kidney yin and treat the underlying cause of the disorder. From the western pharmacological perspective, this formula has a remarkable effect on the endocrine system. The first tree tonic herbs in Nourish stimulate the glands to produce more hormones, while the other three sedating herbs provide negative feed-back inhibition to stop the production and release of these hormones. The harmonious blend of stimulation (with tonic herbs) and inhibition (with sedating herbs) is absolutely essential in treating patients with delicate imbalance of endocrine system. It is also interesting to note that the pharmaceutical companies have long acknowledged the therapeutic effect of Kidney tonic herbs. In fact, hormones such as synthetic estrogens and progesterones are originally derived from natural products such as Shan Yao. In short, Nourish treats menopause primarily by tonifying Kidney yin, with a secondary effect of controlling deficient heat. For women over forty, it is also a safe anti-aging tonic for long-term use.
2. Deficient heat rising: Balance (Heat) is another formula that is extremely effective for menopause. Its main focus is to address menopausal symptoms characterized by deficient heat: severe hot flashes, night sweating, insomnia, steaming-bones sensations, irritability, dizziness, nervousness, and emotional disturbances. The therapeutic actions of the formula are to clear deficiency heat, nourish yin, calm the shen (spirit) and stop perspiration. In short, Balance (Heat) treats menopause mainly by controlling deficient heat symptoms.
3. Kidney jing (essence) deficiency: Osteo 8 is the formula of choice for prevention and treatment of osteoporosis. It contains herbs that increase the utilization of calcium, strengthen the bones, prevent fractures, and promote healing. From the traditional Chinese medicine perspective, osteoporosis is equivalent to Kidney jing (essence) deficiency. Diagnostic symptoms and signs are weakness and soreness of the lower back and legs, inability to stand for a prolonged period of time, and decreased bone mass density. From the western medicine perspective, these herbs are rich in calcium, and function to increase absorption of calcium into bone, and promote growth and healing of bones. According to a clinical study conducted in Taiwan, the use of the herbs in Osteo 8 has been found to increase bone mass density by an average of 3.4% in one year. In addition to herbs, adequate amounts of calcium and vitamin D should be taken on a daily basis to ensure proper integrity of bones.
Differential Diagnosis and Treatment
In addition to Nourish, Balance (Heat), and Osteo 8, other formulas are sometimes necessary to control other conditions associated with menopause.
- For emotional instability, irritability, and mood swings, combine with Calm.
- For severe disturbance of the shen (spirit) combine with Calm ES.
- For patients with decreased libido, add Venus.
- For insomnia, combine with Schisandra ZZZ.
- For fibrocystic reproductive organ disorders, use Resolve (Lower).
- For benign breast tumors, mastitis and fibroids/nodules, use Resolve (Upper).
- For hair loss, combine with Polygonum 14.
Lifestyle and Dietary Instructions
Menopause patients are encouraged to consume a diet with a high content of raw foods, fruits and vegetables to stabilize blood sugar. Some foods may promote hot flashes or aggravate mood swings and should be avoided, such as dairy products, red meats, alcohol, sugar, spicy foods, and caffeine. Cigarette smoking or exposure to second-hand smoke should be avoided as smoking consumes yin and body fluids. Lastly, stress, tension and anxiety should be avoided as much as possible.
Though menopausal signs and symptoms are disturbing, they are self-limiting and are not life threatening. Such signs and symptoms may be prominent for a few years, but they gradually lessen in severity and eventually disappear. Osteoporosis, on the other hand, continues to advance with age and can be life-threatening. It is a disorder that requires active intervention and treatment.
Hormone replacement therapy is considered the standard allopathic treatment for menopause and related conditions. However, there is not a consensus as to when and how to prescribe these medications. While they may alleviate hot flashes and prevent osteoporosis, they also increase the risk of breast cancer, ovarian cancer, and uterine cancer, and they have a number of significant side effects. The bottom line is: synthetic hormones can never effectively replace endogenous hormones. There, no matter when or how they are prescribed, the potential for adverse reactions will always be present.
Traditional Chinese medicine, on the other hands, offers a gentle yet effective way to address menopause and related conditions. Chinese herbs have demonstrated via numerous in vivo and in vitro studies to have a marked effect on the endocrine system to alleviate hot flashes, vasomotor instability, loss of bone mass, and other conditions associated with menopause. Most importantly, herbs are much gentler on the body and safer than current allopathic options.
In conclusion, while western medicine claims that more time is necessary to determine how menopause can be treated, Chinese herbal medicine that has already been time-tested for over 3000 years prevails to ensure optimal quality of life in those who are reaching the golden years of their lives.
All information above comes from following source: Chen, John, Pharm.D., Ph.D., O.M.D., L.Ac. “Treatment of Menopause Using Chinese Herbs.” Lotus Inistitute Of Integrative Medicine (n.d.): n. pag. Print.