To HRT or not to HRT?
“There is no more creative force in the world than the menopausal woman with zest.” Margaret Mead
Change is a universal constant, from the cosmic to the microscopic. The natural rhythm of life is the ebb and flow of activity. While we all experience change in form, function, and spirit from birth till death, as we evolve along the road of life, it is only the mid-life transition for the woman that is dubiously called “The Change.” There is more to this mid-life transformation than “raging hormones.” Research into physiological changes taking place in the menopausal transition reveals that in addition to the end of childbearing and hormonal shifts, there are intricate changes to our nervous systems. Our brains are being rewired, changing how we think and respond to the status quo. Free from childcare responsibilities and caring for aging parents this time of life presents a world filled with possibilities. It is a developmental stage that holds promise for new directions, careers, and purpose. It is a time of life that the wisdom of Chinese medicine refers to as ‘the Second Spring’.
Menopause is not a disease or an event, but a normal physiological transition occurring between the age 48 – 55 years (average age in Australia is 51), marked by a shift in the hormonal environment, a decline of ovarian function, and the end of menstrual cycles. The hormones responsible for supporting fertility, oestrogen & progesterone decline, while follicle-stimulating hormone (FSH) and luteinizing hormone (LH) rise in an attempt to stimulate the ovaries to respond. The ovaries are the main source for the production of oestrogen and progesterone. The body produces various oestrogens, oestradiol (E2) is the most abundant during the childbearing years and is produced exclusively by the ovaries. After menopause, estrone (E1) is the dominant circulating estrogen, derived from fatty tissue with help in the conversion process from the adrenal glands. During this transitional process, 90% of the women observe menstrual cycle changes and erratic ovulation patterns over a 4-8 year period of time. The menstrual period may become heavier or lighter and cycles may be delayed or more frequent. Whatever it is, people tend to know it is not their usual pattern and change is underway. Menopause is said to have occurred when a period has been absent for 12 consecutive cycles. Menopause can also occur at any age if the ovaries have been surgically removed or damaged through disease or toxic agents.
This period of hormonal reorganisation can create some temporary internal disturbances from time to time. The most common uncomfortable symptom for almost 85% of Western women (Asian women significantly less or not at all) is hot flashes. Hot flashes are episodic, vasomotor events where there is an increase in the core temperature. In an attempt to cool the body, surface blood vessels dilate, especially in the area of the chest, neck, and head, perspiration ensues, followed by chills. The hypothalamus, our thermo-regulating center is adjusting to the hormonal shifts. Some sources say 45% of women experience hot flashes for longer than 5 years. Night sweats are nocturnal hot flashes, that contribute to insomnia, accompanied by fatigue the next day, feeling foggy-headed, forgetful, irritable, anxious, headachey and depressed. Not to mention vaginal dryness and low libido. About 20% of all women experience no symptoms at all. In some cultures, it is reported that women do not experience any of these symptoms.
Medical management of menopause for many years relied on hormone replacement therapy (HRT). It was thought that a combination of oestrogen and progesterone or unopposed oestrogen would not only improve the symptoms women were experiencing, but also provide protection against coronary heart disease, breast cancer, and osteoporosis in postmenopausal women. It wasn’t until a long-term 9-year study initiated by the National Institute of Health funded the Women’s Health Initiative to conduct randomised control trials to evaluate the benefits of HRT on decreasing the risks of the leading causes of disease and death in women ages 50-79. 160,000 subjects were recruited to be followed over a 9-year period. The study was halted when evidence revealed that HRT actually increased the risk for coronary heart disease, stroke, pulmonary emboli, and breast cancer, with only a slight benefit to osteoporosis. It was concluded that the risks of HRT outweighed the identified benefits. Recent studies indicate that a brief course of HRT early in menopause is safe and may provide some lasting relief of symptoms.
Currently, doctors are finding some success in symptom relief with the use of antidepressants such as Paxil, Prozac, and Lexapro. Low-dose transdermal patches of Clonidine a blood pressure medication to reduce hot flashes.
Most of the patients I see at Yin Studio are looking for a safer, more holistic approach to managing their menopause symptoms. The Chinese medical view of menopause is that it is the natural decline of Qi, Blood, and Jing. I focus on the root cause, balancing the Yin and Yang of the body through the energetic system of the Kidney to alleviate the uncomfortable symptoms. According to traditional Chinese medicine, the Kidney is not only the centre of the body’s Yin and Yang but also the foundation for the body’s reproduction and development. Disharmony in the Kidney will affect other organs such as the Liver and Heart systems. As we age, the Essence or Jing (your constitutional strength, drive, energy) stored in the Kidney since birth declines, disrupting the dynamic equilibrium between Yin and Yang. This leads to a Yin deficiency (Yin aspect is cool, moist, quiet, feminine) creating a relative excess of Yang (hot, bright, active, masculine) causing a hyperactive state of Yang leading to hot sensations, red face, headaches, sweating, ringing in ears, dizziness, loss of natural lubrication, constipation and other symptoms.
Acupuncture, herbal remedies, dietary adjustments, exercise, massage, and meditation are the tools that are very useful when addressing menopausal symptoms. I take into consideration the whole person, knowing that every aspect of a woman’s life can be impacted by this challenging and exciting time. Herbal remedies act as take-home treatments as they solidify the therapeutic goals established in the treatment room. Many of the herbs prescribed have been studied extensively, proving to be both safe and effective. I would encourage anyone to visit a registered TCM acupuncture practitioner for the best treatment outcome.
If you’re interested in reading more about menopause, here are some suggested readings:
Discover Your Menopause Type – Dr. Joseph Collins, ND
What Your Doctor May Not Tell You About Menopause – Dr. John Lee
If you would like to know more about menopause and natural approaches to deal with it, you can book a free 15 minute discovery call with Cathy Bell.