Every woman, usually between the ages of 48-55, will reach menopause, which ends her menstrual cycle. Menopause is a natural process in a woman's life, and most will experience a variety of symptoms such as hot flashes and sweating, insomnia, migraines, mood swings (depression and anxiety), weight gain, blood lipids profile changes, pain, hair loss, vaginal dryness, decreased libido and, over the long term, osteoporosis and urinary incontinence. There is no uniformity in the duration or intensity of symptoms and they may persist for many years after the onset of menopause.
Let's talk about hot flashes
Hot flashes are the most "famous" and indeed most common symptom of menopause, occurring in about 75% of women, 30% of whom describe them as significant and as having an impact on quality of life. Hot flashes are manifested by a sudden feeling of heat and flushing, mainly in the head, face, neck and chest, accompanied by sweating and sometimes rapid heartbeats. The symptoms will usually disappear after 2-3 years but, in 25% of women can last up to 5 years.
The pathological source of hot flashes is a decline in the “fine tuning” of the body’s own thermostat which resides in the hypothalamus. This change occurs due to the decrease in the level of the hormone estrogen. As a result, the body activates “heat emission mechanisms” such as dilation of blood vessels in the skin and sweating.
How are hot flashes treated?
The most popular treatment is estrogen-based hormone replacement therapy (HRT). The benefit vs. risk of HRT differs significantly between early onset use and late onset use. In general HRT is not recommended for women who are at risk for cancer (especially breast cancer), heart attack, stroke, hypercoagulability and more. The treatment is usually given for up to 5 years and the results are rapid.
What about sleep problems and mood swings?
Between 33-55% of menopausal women suffer from insomnia (1) and up to 62% suffer from depression (2). As we age, there is a decrease in melatonin (sleep hormone) levels, as well as changes in its secretion cycle. As a result, there is a greater tendency to fall asleep early, accompanied by a tendency to awake early and an inability to go back to sleep.
Sleep problems and mood swings are most commonly treated with benzodiazepines, melatonin, or SSRIs (Cipralex, Seroxat and others). HRT is also prescribed for such issues. Sedatives and sleeping pills are also effective, but when used for a long time can cause depression, restlessness and difficulty in concentrating and memory. While anti-depressants are effective in improving depression, they will not always be helpful in improving sleep during menopause, as the sleep abnormality is largely related to hormonal changes.
Menopause according to Chinese medicine
According to Chinese medicine, menopausal women suffer from Yin loss which is a natural physiological process manifested in lack of estrogen and body fluids. As a result, there is relative excess of Yang energy presented in symptoms characteristic of this energy such as vaginal dryness, restlessness, thirst and hot flashes. Because Yin is associated with nighttime, a deficiency will cause symptoms such as insomnia and night sweats.
The biological process leading to menopause occurs throughout a woman's entire life, and the lifestyle and dietary habits from childhood onwards will affect what symptoms of menopause will occur later in life. A woman that works hard, lives a stressful life, sleeps very little, gives birth to many children and maintains an unbalanced diet, will consume the body essence (Jing) and Yin faster and will probably suffer more severe symptoms during postmenopausal years.
How does Chinese medicine treat the main symptoms of menopause?
There are women who choose to avoid HRT or for whom it is not suitable due to risk factors. Chinese medicine helps to significantly reduce the intensity of menopause-related symptoms with the help of a combination of acupuncture, improved nutrition, and herbs, many of which nourish the Yin.
A study comparing the use of acupuncture to a control group in 209 women showed that acupuncture reduced the frequency and intensity of hot flashes by 37%, and reduced the negative impact on daily functioning, improved the length and quality of sleep, and improved memory and anxiety (3).
Another study in 120 breast cancer patients who recovered following chemotherapy and radiation treatments but suffered from hot flashes compared true acupuncture, placebo acupuncture, gabapentin (a drug used to treat hot flashes) and a placebo pill. Those treated with real acupuncture experienced the most significant decrease in the amount of hot flashes, and this reduction was maintained for a longer time and without side effects (4). In addition, acupuncture improved sleep quality and length (1).
Regarding depression, a study comparing acupuncture to Cipralex in 221 menopausal women suffering from depression, showed that acupuncture was effective at a level similar to that of Cipralex, over the long term, but without side effects (2). This study is in addition to other studies that have shown that acupuncture improves the efficacy of SSRI antidepressants and even lowers the intensity of side effects from this group of drugs (5).
In addition to acupuncture, dietary change has also been shown to contribute to the reduction of menopause-related symptoms. For example, it is recommended to consume foods that contain isoflavones, which are actually phytoestrogens (= act similar to estrogen from a plant source). These include soy and soy products, legumes, flaxseed, sesame seeds, oats, alfalfa sprouts, berries and more (6). Herbs such as black cohosh, red clover, sage, licorice and more also contain a high amount of phytoestrogen and relieve symptoms such as hot flashes (6). The dietary plan should be made according to the overall health of the patient.
Menopause is a natural process, you can experience it calmly
Cong Fu et al. (2017) Sleep 40 (11) DOI: 10.1093/sleep/zsx153
Sheng Li et al. (2018) BioMed Research International DOI: 10.1155/2018/5351210
Avis N. et al. (2016) Menopause 23 (6): 626-37 DOI: 10.1097/GME.0000000000000597
Mao JJ et al (2015) J Clin Oncol 33 DOI: 10.1200/JCO.2015.60.9412
Bingcong Z. et al. (2019) J Psych Res 114: 24-33 DOI: 10.1016/j.jpsychires.2019.04.005
McGarry K. et al. (2018) Clinical Therap 40 (10): 1778-86 DOI: 10.1016/j.clinthera.2018.08.010