PerimenopausePerimenopause/menopause /menopause

What is What is ••••••??

Hot flushesHot flushes Night sweatsNight sweats

DefinitionsDefinitions

Menopause: Menopause: ♠ last menstrual periodlast menstrual period♠ One complete year without a One complete year without a

menstrual cyclemenstrual cycle Perimenopause: Perimenopause:

♠ transition into menopause. It can last transition into menopause. It can last for 2 to 8 years prior to menopause for 2 to 8 years prior to menopause and includes the first year after and includes the first year after menopausemenopause

Three-stepThree-step

Pre-menopausePre-menopause Peri-menopausePeri-menopause Post-menopausePost-menopause

perimenopausal perimenopausal syndromesyndrome Definition: Definition:

♠ In about 2/3 of the women in In about 2/3 of the women in perimenopausal period ,there perimenopausal period ,there appear a series of symptoms due to appear a series of symptoms due to deficiency of sexual hormone. deficiency of sexual hormone.

♠ usually occurring in women ageing usually occurring in women ageing from 45 to 55.from 45 to 55.

Menopause affects the women who Menopause affects the women who suffer from it as well as their loved suffer from it as well as their loved

ones!ones!

Signs and SymptomsSigns and Symptoms

Vasomotor symptoms:hot flashes, Vasomotor symptoms:hot flashes, night sweatsnight sweats

Vaginal dryness:painful Vaginal dryness:painful intercourse,Vulvae pruritusintercourse,Vulvae pruritus

InsomniaInsomnia Weight gainWeight gain Sexual changesSexual changes Irregular mensesIrregular menses Moon changes: Irritability,depressionMoon changes: Irritability,depression

Menopause: EtiologyMenopause: Etiology

NaturalNatural Surgical Surgical

PrematurePremature

Post-chemotherapy/radiationPost-chemotherapy/radiation♠ cancercancer

♠cyst ,EMscyst ,EMs♠cancercancer

♠<40ys<40ys

Health Issues:Health Issues:

♠ OsteoporosisOsteoporosis♠ Cardiovascular riskCardiovascular risk♠ Breast DiseaseBreast Disease♠ Diet modificationDiet modification♠ ExerciseExercise♠ Calcium intake, Vitamin DCalcium intake, Vitamin D♠ Family historyFamily history

CommonlyCommonly––AskedAsked Questions Questions Is hormone replacement therapy Is hormone replacement therapy

(HRT) safe?(HRT) safe? What can I do about my lack of What can I do about my lack of

sex drive?sex drive?

What is HRT?What is HRT?

Combination of estrogen, progesterone and Combination of estrogen, progesterone and sometimes testosteronesometimes testosterone

Estrogen is given for relief of hot flashes, night sweats Estrogen is given for relief of hot flashes, night sweats and vaginal drynessand vaginal dryness

Other advantages of estrogen:Other advantages of estrogen:♠ Improvement of sexual functioningImprovement of sexual functioning♠ Improvement with sleepImprovement with sleep♠ Improvement with cognitionImprovement with cognition♠ Improvement of moodImprovement of mood♠ Prevents osteoporosisPrevents osteoporosis♠ Decreases risk of fracturesDecreases risk of fractures♠ Decreases risk of colon and rectal cancerDecreases risk of colon and rectal cancer♠ ? Improves skin? Improves skin

What is HRT?What is HRT?

Progesterone is given with Progesterone is given with estrogen to prevent cancer and estrogen to prevent cancer and hyperplasia (pre-cancer) of the hyperplasia (pre-cancer) of the lining in the uterus (endometrium)lining in the uterus (endometrium)

Estrogen alone is generally given Estrogen alone is generally given to those women who donto those women who don’’t have a t have a uterusuterus

Testosterone is given to improve Testosterone is given to improve sexual dysfunctionsexual dysfunction

Is HRT Safe?Is HRT Safe?

Disadvantages of estrogen - based on the Disadvantages of estrogen - based on the WHI study (WomenWHI study (Women’’s Health Initiative)s Health Initiative)♠ Coronary heart diseaseCoronary heart disease♠ StrokeStroke♠ Venous Thromboembolism - clotting that Venous Thromboembolism - clotting that

occurs in the deep veins (usually the legs, occurs in the deep veins (usually the legs, pelvis or lungs)pelvis or lungs)

♠ Breast cancerBreast cancer♠ Endometrial cancer and hyperplasia (known)Endometrial cancer and hyperplasia (known)

WHI StudyWHI Study

Mission: does Prempro (combo of Mission: does Prempro (combo of premarin and provera) or premarin and provera) or premarin alone reduce premarin alone reduce cardiovascular riskcardiovascular risk♠ (premarin is a conjugated estrogen (premarin is a conjugated estrogen

and provera is and provera is medroxyprogesterone acetate)medroxyprogesterone acetate)

WHI StudyWHI Study

Results:Results:♠ Prempro trial was halted prematurely after Prempro trial was halted prematurely after

only 5.2 years due to the increased risk of only 5.2 years due to the increased risk of CHD, stroke, VTE, and breast cancerCHD, stroke, VTE, and breast cancer

♠ Premarin-alone trial was halted Premarin-alone trial was halted prematurely due to the increased risk of prematurely due to the increased risk of strokestroke

Due to these findings the number of Due to these findings the number of HRT prescriptions dropped by 50% HRT prescriptions dropped by 50% from 1995 to 2003 from 1995 to 2003

WHI StudyWHI Study

The HeadlinesThe Headlines♠ 41% increase in strokes41% increase in strokes♠ 29% increase in heart 29% increase in heart

attacksattacks♠ Greater than 100% Greater than 100%

increase in VTEincrease in VTE♠ 22% increase in total 22% increase in total

CVDCVD♠ 26% increase in breast 26% increase in breast

cancercancer

♠ 37% decrease in 37% decrease in colorectal cancercolorectal cancer

♠ 33% decrease in hip 33% decrease in hip fracturefracture

♠ 24% decrease in 24% decrease in total fracturestotal fractures

Not in the media about WHINot in the media about WHI♠ Average age was 63Average age was 63♠ Only 16% were within 5 years of their last Only 16% were within 5 years of their last

mensesmenses♠ Most were an average of 12 years after Most were an average of 12 years after

their last mensestheir last menses♠ Most already had silent CVDMost already had silent CVD♠ 50% current or former smokers50% current or former smokers♠ Average Body Mass Index 28.5, many Average Body Mass Index 28.5, many

obese obese ♠ Average participant was older, overweight Average participant was older, overweight

smokersmoker

Is HRT Safe?Is HRT Safe?

Take Home MessageTake Home Message

HRT is safer for younger menopausal womenHRT is safer for younger menopausal women HRT is intended for relief of vasomotor HRT is intended for relief of vasomotor

symptoms only (hot flashes, night sweats, symptoms only (hot flashes, night sweats, vaginal dryness)vaginal dryness)♠ Flushing is worse between the transition from pre-Flushing is worse between the transition from pre-

menopause to perimenopausemenopause to perimenopause♠ Vaginal dryness, sweating, insomnia is most Vaginal dryness, sweating, insomnia is most

prominent during the transition from prominent during the transition from perimenopause to post-menopauseperimenopause to post-menopause

WHI study tested only premarin and proveraWHI study tested only premarin and provera♠ Many other forms of estrogen and progesteroneMany other forms of estrogen and progesterone

What can I do about What can I do about my lack of sex drive?my lack of sex drive? Definition: Definition:

♠ decreased interest in sexual activity or lack decreased interest in sexual activity or lack of sexual satisfaction.of sexual satisfaction.

♠ 40% of women between ages 18 to 59 40% of women between ages 18 to 59 report some sort of sexual dysfunction.report some sort of sexual dysfunction.

Sexual functioning is a very important Sexual functioning is a very important part of a womanpart of a woman’’s relationship with her s relationship with her partner.partner.

Sexual dysfunction is very common Sexual dysfunction is very common during the perimenopausal and post-during the perimenopausal and post-menopausal years. menopausal years.

Sexual DysfunctionSexual Dysfunction

Causes:Causes:♠ Chronic diseaseChronic disease♠ MedicationsMedications♠ Psychological causesPsychological causes♠ Socio-cultural causesSocio-cultural causes♠ Loss of estrogenLoss of estrogen♠ Loss of testosteroneLoss of testosterone

Sexual DysfunctionSexual Dysfunction

Medical problems as a cause for Medical problems as a cause for decreased sexual activitydecreased sexual activity♠ Endocrine disorders Endocrine disorders –– diabetes, kidney diabetes, kidney

diseasedisease♠ Vascular diseasesVascular diseases♠ AtherosclerosisAtherosclerosis♠ Neurologic disorders or injuriesNeurologic disorders or injuries♠ Alcohol or substance abuseAlcohol or substance abuse♠ Removal of the ovariesRemoval of the ovaries

SnapshotSnapshot

The number of women aged 50 and above is The number of women aged 50 and above is increasing as life expectancy risesincreasing as life expectancy rises

Women can now expect to live greater portions of Women can now expect to live greater portions of their lives postmenopausaltheir lives postmenopausal

Proactively managing menopause is an opportunity for Proactively managing menopause is an opportunity for women to prevent disease and improve their long-women to prevent disease and improve their long-term health and quality of lifeterm health and quality of life

Menopause is a perfect time to evaluate your life and Menopause is a perfect time to evaluate your life and make changes to ensure that you stay fit and healthy make changes to ensure that you stay fit and healthy now and in the futurenow and in the future

MenopauseMenopause

Derived from the Greek words for Derived from the Greek words for ““monthmonth”” (men) and (men) and ““cessationcessation”” (pausis)(pausis)

A natural event in a woman's life - A natural event in a woman's life - this is a time of changethis is a time of change

What is menopause?What is menopause?

‘‘MenopauseMenopause’’ refers to the stage in a woman refers to the stage in a woman’’s life s life when her periods ceasewhen her periods cease

Menopause occurs when the ovaries stop Menopause occurs when the ovaries stop producing the hormones oestrogen and producing the hormones oestrogen and progesterone progesterone

Usually occurs between ages of 45 and 55 yearsUsually occurs between ages of 45 and 55 years

Symptoms such as hot flushes, mood swings, Symptoms such as hot flushes, mood swings, tiredness, loss of libido and irregular bleeding are tiredness, loss of libido and irregular bleeding are commoncommon

There are three stages of There are three stages of menopause that take place over menopause that take place over about a decadeabout a decade♠ Peri-menopausePeri-menopause

♠ MenopauseMenopause

♠ Post-menopausePost-menopause

Peri-menopausePeri-menopause♠ The years prior to menopause (when The years prior to menopause (when

symptoms commence) and also the symptoms commence) and also the first year after menopausefirst year after menopause

MenopauseMenopause

Permanent cessation of menstruation which occurs Permanent cessation of menstruation which occurs when the ovaries stop producing the hormones when the ovaries stop producing the hormones oestrogen and progesteroneoestrogen and progesterone

Natural menopause is recognised to have occurred Natural menopause is recognised to have occurred once a period of 12-months has lapsed after the last once a period of 12-months has lapsed after the last menstrual period, and for which there is no other menstrual period, and for which there is no other obvious causeobvious cause

No specific indication marks the beginning of No specific indication marks the beginning of menopause other than the onset of symptomsmenopause other than the onset of symptoms

Post-menopausePost-menopause

When one year has lapsed since the When one year has lapsed since the last menstrual periodlast menstrual period

Some women may still continue to Some women may still continue to experience menopausal symptoms for experience menopausal symptoms for several years following their last several years following their last periodperiod

Hot flushes!!Hot flushes!!

The hallmark and the most commonly associated The hallmark and the most commonly associated symptom with menopause. This is just one of several symptom with menopause. This is just one of several symptoms that may occur letting you know that symptoms that may occur letting you know that menopause is on its waymenopause is on its way

Though not welcomed, these symptoms tend to be Though not welcomed, these symptoms tend to be experienced by the majority of women and are due to experienced by the majority of women and are due to the declining level of oestrogen in the body which up the declining level of oestrogen in the body which up until now has maintained the until now has maintained the ‘‘hormonal balancehormonal balance’’ all all these yearsthese years

The body is now moving into a state of readjustment The body is now moving into a state of readjustment and learning to live without oestrogenand learning to live without oestrogen

Hot flushes and night sweatsHot flushes and night sweats

♠ Very commonVery common

♠ A sensation of heat spreads over your A sensation of heat spreads over your body, in particular your head, face body, in particular your head, face and chest and is often accompanied and chest and is often accompanied by flushing and sweating, followed by by flushing and sweating, followed by a chilla chill

Menopause Western Menopause Western OverviewOverview Differentiation: menopause: Differentiation: menopause:

natural (49 natural (49 –– 50 y/o), artificial 50 y/o), artificial (surgery, radiation), premature (< (surgery, radiation), premature (< 40 y/o, smoking, radiation, 40 y/o, smoking, radiation, chemo)chemo)

Diagnosis: cessation of Diagnosis: cessation of menses 1 yr, decreased menses 1 yr, decreased response to LH, FSH, shorter response to LH, FSH, shorter follicular phases, fewer follicular phases, fewer ovulations, less estrogen & ovulations, less estrogen & progesterone, rise of LH/FSHprogesterone, rise of LH/FSH

Symptoms: none; hot flashes, Symptoms: none; hot flashes, night sweats, fatigue, irritability, night sweats, fatigue, irritability, insomnia, nervousness, dizziness, insomnia, nervousness, dizziness, paresthesias, palpitations, paresthesias, palpitations, tachycardia, tachycardia, ‘‘cotton headcotton head’’, , cystitis, incontinence, vaginitis, cystitis, incontinence, vaginitis, arthralgia, myalgia, digestive arthralgia, myalgia, digestive complaints, increased risk for complaints, increased risk for osteoporosisosteoporosis

Menopause Western Menopause Western OverviewOverview Treatment: counseling, anti-Treatment: counseling, anti-

depressants, tranquilizers, ERT: depressants, tranquilizers, ERT: estrone (Ogen); 17-beta estradiol estrone (Ogen); 17-beta estradiol (oral: Estrace; transdermals: (oral: Estrace; transdermals: Estraderm, Climara; vaginal: Estring) Estraderm, Climara; vaginal: Estring) estriol: has to be compounded; estriol: has to be compounded; conjugated estrogen (Premarin, conjugated estrogen (Premarin, similar to 17-beta estradiol, may similar to 17-beta estradiol, may increase blood pressure)increase blood pressure)

Menopause Western Menopause Western OverviewOverview

Progesterone: acts on osteoblasts: Progesterone: acts on osteoblasts: medroxyprogesterone (Provera), medroxyprogesterone (Provera), progesterone USP (Prometrium, progesterone USP (Prometrium, Crinone); testosteroneCrinone); testosterone

Natural Treatment:Natural Treatment: natural OTC natural OTC estrogen & progesterone creams, bi-estrogen & progesterone creams, bi-est (estradiol/estriol mix), tri-est (80 % est (estradiol/estriol mix), tri-est (80 % estriol, 10 % estrone, 10 % estradiol), estriol, 10 % estrone, 10 % estradiol), DHEADHEA

Menopause Western Menopause Western OverviewOverview Lignans: cereals, fruits, Lignans: cereals, fruits,

vegetables, flax seedsvegetables, flax seeds Calcium: yoghurt, OJ, sardines, Calcium: yoghurt, OJ, sardines,

green leafy vegiesgreen leafy vegies Vitamin E: hot flashes, vaginal Vitamin E: hot flashes, vaginal

dryness also topicallydryness also topically

Life begins from the dance of the opposing forces of Yin & Yang, heaven & earth, day-time & night-time, heating & cooling, moistening & drying, contracting & relaxing.

Menopause Oriental Views

Yang

Yin

Menopause Western Menopause Western OverviewOverview

Lignans: cereals, fruits, Lignans: cereals, fruits, vegetables, flax seedsvegetables, flax seeds

Calcium: yoghurt, OJ, sardines, Calcium: yoghurt, OJ, sardines, green leafy vegiesgreen leafy vegies

Vitamin E: hot flashes, vaginal Vitamin E: hot flashes, vaginal dryness also topicallydryness also topically

Life begins from the dance of the opposing forces of Yin & Yang, heaven & earth, day-time & night-time, heating & cooling, moistening & drying, contracting & relaxing.

Menopause Oriental Views

Yang

Yin

Yin/Yang Theory Yin/Yang Theory YinFemaleColdMoistNightAutumn, WinterEarthStructureBloodInteriorSinews/BonesChronicSolidWeakSinking

YangMaleHotDryDaySpring, SummerSkyFunctionQiExteriorSkin/ Body HairAcuteHollowStrongRising Up

Yin Yang Theory 8 Pathologies

Health Pathology

Menopause Oriental Menopause Oriental ViewView

Yang Yin Qi

Examples

Blood

5-Phase Theory5-Phase Theory

H, SI,

P, SJ

SP, ST

LU, LI

LIV, GB

KID, BL

Menopause Oriental View

Insomnia, speech probl, memory, anxiety/joy

Digestive probl, prolapses, bleeding issues, worry

Respiratory, immunity -allergies, skin probl, grief/sadness

FBD, fibroids, menstrual probl anger/ depression

Urology, aging, fertility, brittle bones, hairloss, fear/fright

Collecting the information from the patient

Questioning (history), Inspection (visual, tongue), Listening & Smelling (voice, breathing, odors), Palpation (pulse, relevant)

Disease & their energetic imbalances are classified into an Oriental medical diagnostic pattern of disharmony (Bian Zheng Lun Zhi).

Treatment focuses on correcting patterns of disharmony by controlling and regulating the flow and balance of energy to create homeostasis.

Menopause Oriental Menopause Oriental ViewsViewsPatterns of DisharmonyPatterns of Disharmony

Disease Causes Disease MechanismsDisease Causes Disease Mechanisms Kidney Yin Deficiency:Kidney Yin Deficiency: Low back pain, chronic knee pain, Low back pain, chronic knee pain,

night sweats, hot flashes, night sweats, hot flashes, irritability, vaginal dryness, irritability, vaginal dryness, osteoporosis, decreased libido, osteoporosis, decreased libido, hairloss, fearful, urinary frequencyhairloss, fearful, urinary frequency

MenopauseMenopause Patterns of Patterns of DisharmonyDisharmony

Kidney Yang Deficiency:Kidney Yang Deficiency: Chills, cold extremities & knees, Chills, cold extremities & knees,

cold back, frequent profuse cold back, frequent profuse urination, low back pain, buckling urination, low back pain, buckling knees, chills after a hot flash, knees, chills after a hot flash, incontinence, decreased libidoincontinence, decreased libido

MenopauseMenopause Patterns of Patterns of Disharmony Disharmony

Liver Depression, Qi Stagnation:Liver Depression, Qi Stagnation: Depression, anger, PMS, fibrocystic Depression, anger, PMS, fibrocystic

breasts, fibroids, polycystic ovarian breasts, fibroids, polycystic ovarian disease - PCOS, clots, dysmenorrhea, disease - PCOS, clots, dysmenorrhea, dark blood (purple) menstrual blood, dark blood (purple) menstrual blood, menstrual irregularity, possible menstrual irregularity, possible diagnosis of endomitriosis for patients diagnosis of endomitriosis for patients with Blood Stasiswith Blood Stasis

Menopause Menopause Patterns of DisharmonyPatterns of Disharmony

Spleen Qi Deficiency:Spleen Qi Deficiency: Fatigue, irritable bowel syndrome Fatigue, irritable bowel syndrome

(IBS), loose stools, or loose stools (IBS), loose stools, or loose stools alternating with constipation, alternating with constipation, prolapses (hemorrhoids, uterine), prolapses (hemorrhoids, uterine), increased menstrual bleeding or increased menstrual bleeding or spotting in between, pale menstrual spotting in between, pale menstrual blood, frequent worrying or over-blood, frequent worrying or over-thinkingthinking

Menopause Menopause Patterns of Patterns of DisharmonyDisharmony

Heart Yin Deficiency:Heart Yin Deficiency: Insomnia, nightmares, anxiety, Insomnia, nightmares, anxiety,

sleepwalking, difficulty speaking, sleepwalking, difficulty speaking, memory loss, memory loss, ““cotton headcotton head””, , palpitations, rapid heart beat, in palpitations, rapid heart beat, in severe cases severe cases ‘‘night terrorsnight terrors’’

Treating Menopause Treating Menopause 80 % of menopausal women present 80 % of menopausal women present

with symptoms of all of the previously with symptoms of all of the previously mentioned patterns of disharmony mentioned patterns of disharmony

Helpful tips:Helpful tips: Bone soup: osteoporosis (make your Bone soup: osteoporosis (make your

own gelatin from beef or lamb bones)own gelatin from beef or lamb bones) Support adrenalsSupport adrenals Oriental medicine can be very helpful in Oriental medicine can be very helpful in

alleviating the symptoms of menopause alleviating the symptoms of menopause but treatment has to be individualizedbut treatment has to be individualized

Menopausal StateMenopausal State

Causes of MorbidityCauses of Morbidity♠ Cardiovascular diseaseCardiovascular disease♠ OsteoporosisOsteoporosis♠ Cancer : Lung, breast, ovarian, Cancer : Lung, breast, ovarian,

colon, cervical and uterinecolon, cervical and uterine♠ Sexual Function changesSexual Function changes

PostmenopausePostmenopause

Issues for primary care physicians and Issues for primary care physicians and gynecologists:gynecologists:♠ Hormonal changesHormonal changes♠ Cardiovascular diseaseCardiovascular disease♠ OsteoporosisOsteoporosis♠ Post menopausal bleeding (PMB)Post menopausal bleeding (PMB)♠ Abnormal PAPAbnormal PAP’’ss♠ Sexual FunctionSexual Function♠ DepressionDepression♠ Cancer screening and preventionCancer screening and prevention♠ Lifestyle and habitsLifestyle and habits

HRT&TCMHRT&TCM

However, we now know that However, we now know that hormone replacement therapy hormone replacement therapy carries significant risks, so many carries significant risks, so many women and their families need women and their families need safe, long-term strategies to treat safe, long-term strategies to treat menopausal symptoms. Traditional menopausal symptoms. Traditional Chinese medicine has kept women Chinese medicine has kept women healthy for centuries and provides healthy for centuries and provides a viable solution to this problem. a viable solution to this problem.

Health challenges can emerge as a Health challenges can emerge as a woman transitions into the second half woman transitions into the second half of life. Since her body is no longer of life. Since her body is no longer preparing for pregnancy each month, preparing for pregnancy each month, her overall hormone production ramps her overall hormone production ramps down. This shift in endocrine function down. This shift in endocrine function can bring on the symptoms associated can bring on the symptoms associated with menopause: hot flashes and night with menopause: hot flashes and night sweats, dryness, changes in bone sweats, dryness, changes in bone density, low libido, headaches, weight density, low libido, headaches, weight gain, and sleep difficulties.gain, and sleep difficulties.

HRT & RISKSHRT & RISKS

Western doctors traditionally prescribed Western doctors traditionally prescribed hormones to replace a womanhormones to replace a woman’’s own s own diminishing production. Since the Womendiminishing production. Since the Women ’’s s Health Initiative ended early in 2002, Health Initiative ended early in 2002, however, research has shown that this however, research has shown that this strategy is fraught with side effects. This strategy is fraught with side effects. This major long-term study on hormone major long-term study on hormone replacement therapy found that health risks replacement therapy found that health risks include greater incidence of ovarian cancer, include greater incidence of ovarian cancer, stroke, and breast cancer ratesstroke, and breast cancer rates——especially especially for women who take hormones for 15 years for women who take hormones for 15 years or more. or more.

As the risks and benefits of As the risks and benefits of hormone replacement therapy hormone replacement therapy come to light, collaboration with come to light, collaboration with providers of complementary providers of complementary approaches like traditional approaches like traditional Chinese medicine becomes ever Chinese medicine becomes ever more valuable.more valuable.

TCM AND MENOPAUSETCM AND MENOPAUSE

Traditional Chinese medicine Traditional Chinese medicine creates equilibrium in a womancreates equilibrium in a woman’’s s system while her body naturally system while her body naturally adjusts to a different hormone adjusts to a different hormone balance. Success rates are balance. Success rates are impressiveimpressive——Chinese medicine has Chinese medicine has reduced hot flashes, decreased reduced hot flashes, decreased night sweats, and helped balance night sweats, and helped balance emotional wellbeing for centuries. emotional wellbeing for centuries.

DiagnosisDiagnosis

Western medicine focuses more on Western medicine focuses more on structure component ( nervous structure component ( nervous system, musculoskeletal system ) system, musculoskeletal system )

Chinese medicine concentrated on Chinese medicine concentrated on identifying body functions and identifying body functions and

( physical, emotional ) clarifying ( physical, emotional ) clarifying their relationships to each other. their relationships to each other.

TreatmentTreatment

Western researchers focus onWestern researchers focus on identification of external agentsidentification of external agents of disease and developing of disease and developing weapons against them. weapons against them. Chinese medicine act with the Chinese medicine act with the

bodybody’’s defenses. They stimulate s defenses. They stimulate the immune system by increasing the immune system by increasing

related cellular activity and related cellular activity and efficiency. efficiency.

Although treatment originates Although treatment originates from outside, healing comes from from outside, healing comes from within in Chinese medicine.within in Chinese medicine.

The human body exists in a state of relative balance described by the yin and yang paradigm. This balance relates to the individual’s constitution, stress level, emotional change, or illness, factors that vary as widely as fingerprints do.

Pathogenesis:Pathogenesis:

decline of kidney Qidecline of kidney Qi near exhaustion of reproductive substance(Tiangui)near exhaustion of reproductive substance(Tiangui) deficiency of the thoroughfare and conception vesselsdeficiency of the thoroughfare and conception vessels insufficiency of essence and blood before and after menopauseinsufficiency of essence and blood before and after menopause asthenia of kidney Yangasthenia of kidney Yang malnutrition of meridians and vesselsmalnutrition of meridians and vessels frequent asthenia of bloodfrequent asthenia of blood multiparity and excessive sexual lifemultiparity and excessive sexual life serious disease and prolonged illnessserious disease and prolonged illness severe asthenia of kidney Yin that lead to failure of Yang to severe asthenia of kidney Yin that lead to failure of Yang to

keep in latency as well as asthenia of yin and hyperactivity of keep in latency as well as asthenia of yin and hyperactivity of YangYang

deficiency of kidney yin that fail to nourish heart and liver, deficiency of kidney yin that fail to nourish heart and liver, leading to hyperactivity of heart and liver fireleading to hyperactivity of heart and liver fire

frequent asthenia of Yang and excessive intake of cold foods frequent asthenia of Yang and excessive intake of cold foods consuming kidney Yang. consuming kidney Yang.

Key points of Key points of diagnosis:diagnosis: symptoms: symptoms:

♠ flushed cheeks, tidal fever, sweating, aversion flushed cheeks, tidal fever, sweating, aversion to cold after sweating, palpitation and chest to cold after sweating, palpitation and chest oppression, dizziness and tinnitus ,headache oppression, dizziness and tinnitus ,headache and insomnia ,or pain in the waist, back and and insomnia ,or pain in the waist, back and joist, dry and itching skin as well as emotional joist, dry and itching skin as well as emotional changes like depression ,anxiety ,susceptibility changes like depression ,anxiety ,susceptibility to irritability and even emotional disorders in to irritability and even emotional disorders in climacterium or after removal of ovary climacterium or after removal of ovary followed by disorder of menstruation or followed by disorder of menstruation or menopause.menopause.

Lab:Lab:♠ FSH and LH obviously increased , E2 FSH and LH obviously increased , E2

decreased decreased

Differential DiagnosisDifferential Diagnosis

Angina pectoris,Angina pectoris, primary hypertension,primary hypertension, perimenopausl psychosisperimenopausl psychosis benign and malignant tumor of benign and malignant tumor of

genitaliagenitalia urethrocystitisurethrocystitis

Differentiation of Differentiation of SyndromesSyndromes Chinese medicine emphasizes Chinese medicine emphasizes

the differentiation of syndromes; the differentiation of syndromes; that means that even within the that means that even within the same same ““disease,disease,”” different stage different stage (e.g. pre-menopause, (e.g. pre-menopause, menopause, post-menopause) will menopause, post-menopause) will have a different treatment and have a different treatment and with a lot of individual variation.with a lot of individual variation.

Balance of Yin and Yang

Yin Pathogenic Factor

Preponderance of Yin Consumes Yang. (Shi-Cold Syndrome)

Preponderance of Yang Consumes Yin. (Shi-Heat Syndrome)

Weakness of Yang Leads to Preponderance of Yin(Xu-Cold Syndrome)

Weakness of Yin Leads to Preponderance of Yang

(Xu-Heat Syndrome)

Yang Pathogenic Factor

Ginseng, there are more than fifty different chemicals in it.

When a traditional Chinese Doctor prescribes a specificherb, he is not depending onactive Chemical ingredients And attempting to correct a chemical abnormality, He based on a complex Set of rule which govern balance in the human body and trying

restore the harmonious flow of Qi., It developed 2500 years ago, Before chemistry as we know it was described

Syndrome Syndrome differentiation and differentiation and treatment:treatment: Kidney asthenia is the root cause Kidney asthenia is the root cause

of this syndrome which is usually of this syndrome which is usually of asthenia, even if the syndrome of asthenia, even if the syndrome is of sthenia, it is often mingled is of sthenia, it is often mingled with asthenia. with asthenia.

Yin asthenia syndrome Yin asthenia syndrome of the liver and kidneyof the liver and kidney Main symptoms: Main symptoms:

♠ Dizziness and tinnitus, flushed cheeks and high Dizziness and tinnitus, flushed cheeks and high fever, occasional sweating, +symptoms of Yin fever, occasional sweating, +symptoms of Yin asthenia syndrome of the liver and kidney asthenia syndrome of the liver and kidney (feverish sensation over the palms, soles and (feverish sensation over the palms, soles and chest, insomnia and dreaminess, aching and chest, insomnia and dreaminess, aching and weak sensation in the loins and knees, dryness weak sensation in the loins and knees, dryness and pruritus of skin, dry mouth and retention of and pruritus of skin, dry mouth and retention of feces, scanty and yellowish urine, or scanty feces, scanty and yellowish urine, or scanty menstruation with red menses, )+ disturbance of menstruation with red menses, )+ disturbance of menstrual disorder, alternate sudden profuse menstrual disorder, alternate sudden profuse uterine bleeding and dripping uterine bleeding. uterine bleeding and dripping uterine bleeding.

♠ Tongue : red tongue with scanty furTongue : red tongue with scanty fur♠ Pulse: thin pulse. Pulse: thin pulse.

Therapeutic methods:Therapeutic methods:♠ Nourishing the liver and kidney, fostering Nourishing the liver and kidney, fostering

Yin and suppressing YangYin and suppressing Yang Prescription and drugs:Prescription and drugs:

♠ Modified Zuogui WanModified Zuogui Wan

Shengdi10 Shoudi10 Gouqi10Shengdi10 Shoudi10 Gouqi10

Shanzhuyu10 Shanyao20 Fuling10 Shanzhuyu10 Shanyao20 Fuling10

Mudanpi10 Guiban10 Longgu15Mudanpi10 Guiban10 Longgu15

Nvzhengzi15 Hanliancao15Nvzhengzi15 Hanliancao15

Yang-deficiency Yang-deficiency syndromesyndrome Main symptoms: Main symptoms:

♠ Before or after menopauseBefore or after menopause♠ grayish complexion, dispiritedness, grayish complexion, dispiritedness, ♠ symptoms of ( puffy face, edema of limbs, symptoms of ( puffy face, edema of limbs,

chilly body and aversion to cold, anorexia chilly body and aversion to cold, anorexia and abdominal distention, loose stool, and abdominal distention, loose stool, frequent and profuse urine, irregular frequent and profuse urine, irregular menstruation, or sudden profuse uterine menstruation, or sudden profuse uterine bleeding, whitish and thin leucorrhea. )bleeding, whitish and thin leucorrhea. )

♠ Tongue: bulgy tongue with tooth print and Tongue: bulgy tongue with tooth print and whitish thin fur whitish thin fur

♠ Pulse: deep and thinPulse: deep and thin

Therapeutic methods:Therapeutic methods:♠ Warming the kidney and supporting Yang, Warming the kidney and supporting Yang,

strengthening the spleen and assisting strengthening the spleen and assisting transportationtransportation

Prescription and drugs: Prescription and drugs: ♠ Modified YouguiwanModified Youguiwan Lujiaojiao10 Dangshen15 Baishu10 Lujiaojiao10 Dangshen15 Baishu10 Buguzhi10 Xianmao10 Buguzhi10 Xianmao10

Xianlingpi10 Shanyao15 Shanzhuyu10 Xianlingpi10 Shanyao15 Shanzhuyu10 Duzhong10 Tusizi10 Duzhong10 Tusizi10

Liver depression Liver depression syndromesyndrome Main symptoms: Main symptoms:

♠ Before or after menopauseBefore or after menopause♠ mental depression, anxiety ,sentimentality, mental depression, anxiety ,sentimentality,

irritability, chest oppression , susceptibility irritability, chest oppression , susceptibility to sighing ,distending pain in to sighing ,distending pain in hypochondria ,feverish sweating, hypochondria ,feverish sweating, disturbance of menstruation, profuse disturbance of menstruation, profuse menorrhea in the late stage with dark red menorrhea in the late stage with dark red color; color;

♠ Tongue: red tongue with thin and white or Tongue: red tongue with thin and white or yellow fur yellow fur

♠ Pulse: tautPulse: taut

Therapeutic methods:Therapeutic methods:♠ Soothing the liver to relieve Soothing the liver to relieve

depression and regulating Qi to depression and regulating Qi to nourish Yinnourish Yin

Prescription and drugs: Prescription and drugs: ♠ Modified XiaoyaosanModified Xiaoyaosan

Baishao10 Dangui10 Caihu5 Baishao10 Dangui10 Caihu5 Shengdi10 Fuling10 Yujin10 Shengdi10 Fuling10 Yujin10 Shanyao15 Chenpi6Shanyao15 Chenpi6

Syndrome of Syndrome of simultaneous asthenia of simultaneous asthenia of heart and spleenheart and spleen Main symptoms: Main symptoms:

♠ Before or after menopauseBefore or after menopause♠ feverish sweating ,palpitation and feverish sweating ,palpitation and

shortness of breath, amnesia and shortness of breath, amnesia and insomnia ,sallow complexion, facial dropsy, insomnia ,sallow complexion, facial dropsy, lassitude ,epigastric and abdominal lassitude ,epigastric and abdominal distension ,anorexia and loose stool, distension ,anorexia and loose stool, disturbance of menstruation, or sudden disturbance of menstruation, or sudden profuse vaginal bleeding or dripping vaginal profuse vaginal bleeding or dripping vaginal bleeding with light color and thin texture . bleeding with light color and thin texture .

♠ Tongue :light colored tongue with whitish Tongue :light colored tongue with whitish thin fur thin fur

♠ Pulse: thin and weakPulse: thin and weak

Therapeutic methods:Therapeutic methods:♠ Strengthening the spleen and nourishing Strengthening the spleen and nourishing

Qi , nourishing heart and tranquilizing Qi , nourishing heart and tranquilizing mindmind

Prescription and drugs: Prescription and drugs: ♠ Modified GuipitangModified Guipitang

Huangqi10 Dangshen10 Baishu10 Huangqi10 Dangshen10 Baishu10

Danggui10 Fusheng10 Yuanzhi6 Danggui10 Fusheng10 Yuanzhi6 Suanzaoren10 Chenpi10 Muxiang10 Suanzaoren10 Chenpi10 Muxiang10 Gancao5 Dazao10Gancao5 Dazao10

DIET AND LIFESTYLEDIET AND LIFESTYLE

Moreover, key diet and lifestyle changes figure Moreover, key diet and lifestyle changes figure importantly in long-term menopause importantly in long-term menopause management. Specific exercises and relaxation management. Specific exercises and relaxation practices help reduce symptoms both in the practices help reduce symptoms both in the short- and long-term. Personalized dietary plans short- and long-term. Personalized dietary plans present another effective tool, especially when present another effective tool, especially when created by a health professional who created by a health professional who understands your particular medical history and understands your particular medical history and symptom picture. Point in fact: those cultures symptom picture. Point in fact: those cultures with vegetable and fish-based diets like the with vegetable and fish-based diets like the Japanese do not technically have a word for Japanese do not technically have a word for menopause, because the incidence of symptoms menopause, because the incidence of symptoms is so low. is so low.

This isnThis isn’’t a t a ‘‘one size fits allone size fits all’’ situation!situation!

All women are different and will All women are different and will need different ways to manage need different ways to manage their menopausetheir menopause