Menopause and Peri-Menopause from a Chinese Medicine Prospective

In every woman's life there are many transitions: menarche, pregnancy and menopause being the three most important ones from the Chinese Medicine perspective. In these instances we are given tools from the wisdom of our mothers, a set of do’s and don'ts that help us navigate through these transitions. From the Chinese medicine perspective there are three main concepts I want to draw attention to.

The first one is the concept of Jing or Essence. The idea is that we come to the world with a set of predisposed elements in our body and spirit. Our constitution is given to us by our ancestors, a mix of our mother and father's constitutions. You can think of it as genetics. In Chinese Medicine Jing or Essence is stored in our kidneys and manifests in the health of our bones, brain, teeth, reproductive organs and hormonal balance. When we are first born we are given a certain amount of this Essence, and as we go through our life we gradually keep using it till there is nothing left at the moment of our death.

The Yellow Emperor, the bible of Chinese Medicine from 200BC, opens up with the advice about preserving and managing our Essence from minister Qi Bo to the emperor: "In the past, people practiced the Tao, the Way of Life. They understood the principle of balance, of yin and yang, as represented by the transformation of the energies of the universe... They ate a balanced diet at regular times, arose and retired at regular hours, avoided over-stressing their bodies and minds, and refrained from overindulgence of all kinds. They maintained well-being of body and mind; thus it is not surprising that they lived well over one hundred years. Theses days, people have changed their way of life. They drink wine as thought it were water, indulge excessively at destructive activities, drain their Jing -the body's essence that is stored in their kidneys- and deplete their Qi. They do not know the secret of conserving their energy and vitality. Seeking emotional excitement and momentary pleasures, people disregard the natural rhythm and order of the universe. They fail to regulate their lifestyle and diet and sleep properly. So it is not surprising that they look old at fifty and die soon after." This advice from ancient China sounds familiar to our modern life style! Qi Bo continues his advices on how to preserve our Essence and cultivate Qi or energy, which became a foundational source for Chinese Medicinal theories and acupuncture as we practice today.

The second concept I want to focus on, since it relates to menopause, is the play of yin and yang. You might have seen the Tai Qi ball. The constant movement of give and take between the black and white colors. That is the duality at the core of life. Everything can be separated into two opposite elements that are constantly balancing one another. The Chinese character for yin is the shady side of the hill. Yin represents the female, the quietude, nourishment, the darkness, cold, heaviness, stillness, the moon. The character for yang is the sunny side of the hill. It represents the male, the noise, movement, energy, brightness, warmth, the sun. In the body yin and yang are constantly playing and balancing one another. In every part of body, every organ, or acupuncture channel, if there is not enough yin there is too much yang and vise versa.

The third principle is the natural cycles of the Essence in the body and how by adapting our behaviors to these cycles we can increase vitality and avoid illness. These are cycles of seven years for women and eight years for men. The first three cycles of our life is about expansion and growth. For women the first cycle is birth to age 7, the second one to age 14, and the third one to 21. The forth and fifth 7 year cycles are where the Essence plateaus and it's the best time for reproductive activity, so from 21 to 28 and then 35. After that the Essence gradually diminishes. This is my least favorite theory! But the truth is that by learning how to conduct a balanced life in each cycle, we can smoothly transition into the next level, avoid illnesses, and maintain or even increase our vitality. If I had maintained the life style of my 20's during my 30's I would have had a much harder time now that I'm in my 40's. So having access to the ancient Chinese wisdom helps us make the life choices that will lead to a more balanced and graceful aging process.

The average age of menopause in the US is 51 and women go through seven years of symptoms on the average. So around the sixth and seventh cycles, 42-48-54, is the time where the dance of yin and yang starts to get out of balance in our body, first by diminishing yin, and eventually diminishing both yin and yang in the older ages. So the recommendation is to start treatments for menopause at the fifth cycle, or age 35. That seems excessive in our modern day culture. However Chinese medicine is a cumulative holistic modality that needs time and repetition to create life changing patterns in the body, the result of which can reverberate in many years to come. You can translate diminishing yin to hormonal changes such as elevation of FSH and diminished estrogen and progesterone. But in Chinese medicine it is more complex than just reproductive hormones. Yin includes the state and function of our bone marrow and our brain, our bone density and fluidity of our joints, our blood quality and cardiovascular health, the depth of our sleep, and the health of our hair and teeth.

The dance of yin and yang in these years can be compared to a fire that is running out of coal. The intensity of the light and the warmth of the coal is increased. That is the rising yang due to the lack of yin to hold it down and ground it. In the body when there is rising yang, due to yin deficiency, one feels the rush of energy upwards. Thus the hot flushes, the palpitation, the sweating as a mechanism to expel the heat, dizziness, having hard time falling asleep at night, or waking up and staying awake in the middle of the night. All these can lead to anxiety and depression. The diminished Essence eventually causes other conditions such as osteoporosis, poor memory, and poor cardiovascular health.

During my practice as an acupuncturist I have seen many women going through this transition. I have also worked with a lot of cancer patients some of whom where experiencing early menopause due to surgery or as a result of chemotherapy and radiation. Using acupuncture and Chinese herbs can help balance the relation of yin and yang in the body and can help us feel more grounded and in touch with our body-mind-emotions as we go through this transition. Cooling and calming herbs are used, and acupuncture is great for clearing heat, calming the mind, improving the sleep, lowering the intensity and frequency of hot flashes, and one feels more energized with a balanced mood. This is a healing process that can start years before actually getting to menopause. Acupuncture helps balance the menstrual cycle throughout the woman's life. It offers her a smooth transition through pregnancy and breast feeding. So that when one is faced with menopause the symptoms are less intense and limiting, and one moves towards more vitality as one ages.