Menopause and Perimenopause in Chinese Medicine: Thumbs Up for Our Approach

Menopause Is a Transition, Not a Disease

Menopause is a normal stage of life. As hormone levels change, the body has to adjust.

In Chinese medicine, this transition is closely associated with changes in the Kidneys, particularly Kidney Yin, Kidney Yang, and Jing, or Essence.

Don't take the word "Kidney" too literally here. In TCM, the Kidney system includes much more than the physical kidneys. It is associated with growth, reproduction, aging, bones, sexual function, fluid balance, and the body's deeper reserves of energy.

As we age, these reserves naturally decline. That does not mean something has gone terribly wrong. It simply means the body may need a little more support and a little less abuse.

Pulling all-nighters at 25 is one thing. At 55, your body may send you a formal written complaint, one that you will notice.

Hot Flashes and Night Sweats

One of the most common TCM patterns associated with hot flashes and night sweats is Kidney Yin Deficiency.

Yin is the cooling, nourishing, moistening side of the body. When Yin becomes deficient, Yang may appear relatively stronger, producing sensations of heat.

Typical signs may include:

• Hot flashes
• Night sweats
• Dry mouth or throat
• Trouble sleeping
• Warm palms and soles
• Irritability
• Vaginal dryness
• A feeling of heat later in the day or at night

The goal of treatment is not simply to "cool the body." A practitioner may instead work on nourishing Yin so the body's cooling and moistening functions are better supported.

Feeling Cold, Tired, and Drained

Not every woman becomes hot during menopause.

Some feel cold, tired, weak, or unmotivated. They may experience low libido, frequent urination, swelling, back weakness, or cold hands and feet.

Chinese medicine may view this as a pattern involving Kidney Yang Deficiency.

Yang provides warmth, movement, and metabolic activity. If Yang is weak, the body may feel as though someone turned the thermostat down and then hid the controls.

This is an important example of why treating menopause with one universal herbal formula makes little sense. One woman may need cooling and nourishing herbs, while another may need warming and strengthening herbs.

Those are nearly opposite treatments.

Insomnia and a Busy Mind

Sleep often changes during perimenopause.

Sometimes night sweats wake a person up. In other cases, the problem is more emotional: worrying, thinking, waking at 3:00 a.m., or feeling exhausted while the mind insists on holding a committee meeting.

Several TCM patterns can contribute to insomnia.

Heart Blood Deficiency may be associated with poor sleep, anxiety, palpitations, forgetfulness, and feeling easily unsettled.

Heart and Kidney disharmony may produce insomnia together with heat, night sweats, anxiety, and palpitations.

Liver Qi Stagnation may be more likely when stress, frustration, irritability, or mood swings are prominent.

Again, the symptom "insomnia" does not tell us which herbal formula to use. The pattern underneath the insomnia matters.

Irritability, Anxiety, and Mood Changes

Hormonal transitions can affect mood, but Chinese medicine also pays close attention to the Liver.

The Liver is responsible for helping Qi move smoothly throughout the body. Emotional stress, frustration, lack of exercise, overwork, and poor sleep can interfere with this movement.

When Liver Qi becomes constrained, a person may experience:

• Irritability
• Mood swings
• Anxiety
• Chest or rib-side tension
• Headaches
• Digestive changes
• A feeling of being emotionally "stuck"

Some people become more irritable during menopause. Others become tearful or anxious. Still others feel emotionally flat.

These are not necessarily the same TCM pattern and would not automatically receive the same herbs.

Brain Fog and Memory

Many women complain that menopause has suddenly turned familiar names into crossword-puzzle clues.

"What's her name? You know—the woman who lives three doors down with the little dog."

Chinese medicine may associate poor concentration and memory with several patterns, including deficiencies of Kidney Essence, Blood, or Qi.

Sleep deprivation can obviously make matters worse. So can stress, depression, thyroid problems, medications, and many other medical conditions.

Persistent or significant memory problems should therefore be medically evaluated rather than simply blamed on menopause.

Vaginal Dryness and Low Libido

Vaginal dryness is commonly associated in TCM with declining Yin and Essence, especially when accompanied by heat or night sweats.

Low libido can have many causes. Kidney deficiency may be involved, but stress, fatigue, relationship issues, medication effects, hormonal changes, depression, and physical discomfort can all contribute.

This is another area where Chinese medicine should not be reduced to "take a Kidney tonic."

A tonic is useful only when the person actually needs tonifying.

Weight Gain and Digestive Changes

Some women notice that their metabolism, appetite, or body composition changes during menopause.

Chinese medicine may look at the Spleen and digestive system in addition to the Kidneys.

A pattern known as Spleen Qi Deficiency may include:

• Fatigue
• Bloating
• Loose stools
• Cravings
• Heaviness
• Fluid retention
• Difficulty maintaining energy

Chinese medicine generally approaches these symptoms by trying to improve the body's overall function rather than relying on harsh purging, extreme dieting, or so-called detoxification.

Joint and Muscle Aches

Aches and stiffness are also common during midlife.

In TCM, these may involve deficiencies of Liver Blood, Kidney Essence, Qi, or Blood circulation. Some cases may also involve what Chinese medicine calls Bi syndrome, in which pain and stiffness are associated with impaired circulation of Qi and Blood through the channels.

The correct approach depends on whether the pain is fixed or moving, better or worse with heat, accompanied by weakness, or associated with other symptoms.

There Is No Single "Menopause Formula"

This is probably the most important point.

Traditional Chinese Medicine does not have one formula that is right for every woman going through menopause.

Consider three women:

One has severe hot flashes, dry mouth, and night sweats.

Another is exhausted, cold, and experiencing low libido.

A third is mainly anxious, irritable, and unable to sleep.

All three are menopausal.

From a TCM perspective, however, they may have three very different patterns and require three very different treatments.

That is why proper diagnosis matters.

Chinese Herbs and Acupuncture

Chinese herbal medicine may be used to address the individual's underlying TCM pattern rather than simply chasing each symptom separately.

A practitioner may choose herbs intended to nourish Yin, strengthen Yang, build Blood, support Qi, calm the Spirit, regulate the Liver, or improve circulation depending on the presentation.

Acupuncture is also commonly used during perimenopause and menopause, particularly for symptoms such as stress, sleep disturbance, discomfort, and hot flashes.

Responses vary, and neither herbs nor acupuncture should be presented as a guaranteed replacement for conventional medical care.

Don't Assume Every Symptom Is Menopause

This deserves special attention.

Fatigue, abnormal bleeding, palpitations, depression, major changes in weight, severe insomnia, or new pain may occur around the same age as menopause without actually being caused by menopause.

Thyroid disease, anemia, heart conditions, medication effects, sleep disorders, and many other medical problems can produce similar symptoms.

Unexpected vaginal bleeding after menopause should always be medically evaluated.

The TCM View in a Nutshell

Menopause is not one pattern and it is not one disease.

Chinese medicine looks at the whole picture: whether you are hot or cold, dry or swollen, tired or restless, anxious or irritable, sleeping too little or waking drenched in sweat.

That is what makes the TCM approach useful.

Two people can have the same Western diagnosis and still need completely different treatment.

The goal is not to fight menopause.

The goal is to help the body move through the transition as comfortably and smoothly as possible.