Eastern Overview:

In Traditional Chinese Medicine (TCM) theory, menopause is actually the body’s natural way to slow down the aging process by returning balance and nourishment to our bodies in our later years. According to modern Western medicine, natural menopause is described as the transitional phase of a woman’s life when menstrual function ceases due to age-related declining ovarian function. Around the end of the fourth or beginning of the fifth decade of life a woman’s ovaries cease producing estrogen and progesterone despite hormonal stimulation from the pituitary gland. The term “Peri-Menopause” encompasses the time during ovarian decline when ovulation becomes less and less frequent and eventually stops when estrogen blood levels fall below the point necessary to produce uterine bleeding so that the periods slowly cease and a woman enters menopause. The term “peri-menopause” means “around menopause”. Some sources refer to the time after the menopause as “post menopause” but that is redundant. Peri-menopause actually continues for the rest of a woman’s life again after menopause. It is a time when a woman’s body, mind and spirit can focus on a lot more than fertility and child bearing. Some call it a woman’s “Second Spring”.

In the Huangdi Neijing (**see below) the first classic of Chinese Medicine written over 2,000 years ago says that at 14 years of age the energetic orb known collectively as the “Kidneys” are mature. And when the Kidneys are mature, that two of the woman’s meridians, the ren mai and the chong mai are full and the tian qui (menstrual period) arrives. In other words a girl reaches puberty and menstruation begins. This is based on a Chinese medical theory which describes the physiological growth, maturation, and decline of reproductive function in women in terms of seven year cycles. Each 7 year segment describes a state in the natural history of an individual’s Kidney function which is the most important ‘energetic orb’ in Chinese medical physiology. It is said that at seven times seven years (i.e. at 49 years of age) the Kidney chi or ‘energy’ is debilitated and the tian qui is exhausted (the period stops). The stopping of the period is the body’s natural way of slowing down the aging process and returning balance and nourishment through the ren mai and chong mai channels to woman’s bodies in later years.

Menopause can be defined as the time in a woman’s life when she has not had a menstrual period for at least twelve consecutive months. Many women find menopause to be a relief from a majority of the discomforts they experience during “peri-menopause”, or the period of transition from regular, ovulatory menstrual cycles to the completion of menopause, and again after menopause. Menopause does not have to be seen as the beginning of old-age; but as the beginning of a new phase of life – and more 7 year cycles.

There are different ways of looking at the causes of hot flashes, night sweats, mood changes, insomnia, heavy menstrual bleeding, dryness, bladder changes, or other complaints that some women have during this time in their lives. Western medicine examines how hormones such as estrogen, progesterone, and others are fluctuating and changing during peri-menopause, and whether they need to be supplemented to reproductive or sub-reproductive levels to alleviate the symptoms some women experience.

Traditional Chinese Medicine sees menopause as a natural part of a woman’s life, and the discomforts of peri-menopause are seen as a reflection of her current state of Yin, Yang, Chi, and Blood, and especially how well her Chi (energy) and Blood are circulating in her body. The Traditional Chinese Medicine (TCM) concept of the peri-menopause and menopause phases doesn’t look at hormones; but rather imbalances in “Chi and Blood” or the “Yin and Yang”. Yang is body activity, movement, and metabolism. Heat results from this Yang activity. The body’s Yin is its fluids, its circulation, and consequent nourishment. Yin fluids are cleansing and cooling.

As these conditions vary, so do the symptoms of menopause. Hot flashes, night sweats, low libido, dryness, insomnia, fatigue, moodiness, neck and shoulder tension, depression, anxiety, and high blood pressure are among the most common symptoms.

The number, frequency, and duration of the discomforts of peri-menopause that a woman will experience are as numerous and varied as the women who display them. A majority of women have a relatively smooth transition into their menopausal years, with perhaps some minor periods of difficulty sleeping, or perhaps some heavier menses. But there are some women who experience some extreme discomforts that can last many years, perhaps even into the menopausal years. For some of these women, the goal may be to reduce symptoms to a more manageable level.

Western/Clinical Overview:

The signs and symptoms associated with menopause occur over a period of time, called perimenopause, which literally means ‘around menopause.’ For many women, the first sign of peri-menopause is an erratic menstrual cycle — skipped, lighter or shorter periods. The hallmark of this countdown to menopause is a fluctuating level of the female sex hormones, estrogen and progesterone. Estrogen highs can bring on PMS-like symptoms, including mood swings, fluid retention and headaches. Estrogen lows promise hot flashes, vaginal dryness and forgetfulness.

A woman is considered to have reached menopause when a year has passed since her last period. Although it can vary, the average age a woman hits menopause is 51. But not all women experience uncomfortable symptoms associated with peri-menopause. Although research is lacking in this area, there are a few factors that may increase the risk for suffering one or more of the symptoms of peri-menopause. Clients will respond to the following questions:

• Are you in your mid to late 40s?
• Did your mother experience any peri-menopausal symptoms?
• Do you suffer from premenstrual symptoms, especially mood swings?
• Do you eat a diet that’s high in animal fat and lacking fruits, vegetables and fiber?
• Do you drink too much alcohol and coffee?
• Is your life full of stress and tension?
• Do you lack adequate sleep on a regular basis?
• Do you lack regular exercise?

Today, more and more women are seeking alternative approaches to HRT. While the list below is not all-encompassing, it highlights a few important strategies that can help ease peri-menopausal symptoms.

Trigger Foods. Eliminate foods in the diet that can worsen hot flashes, insomnia or mood swings. Caffeine-containing foods and beverages like coffee, tea, dark chocolate, colas, certain orange sodas and root beers trigger hot flashes and can affect the quality of your sleep. Start by avoiding caffeine in the afternoon. Replace these beverages with caffeine-free or decaffeinated beverages like herbal tea, mineral water, fruit and vegetable juice or decaf coffee. Medications such as Midol, Excedrin and Anacin also provide a fair amount of caffeine.

Reduce alcohol intake to no more than one drink a day, preferably none if you are experiencing hot flashes or you are under stress. Drinking alcoholic beverages can bring on a hot flash, interrupt sleep and affect mood. To lessen the effect of alcohol, drink alcohol only with a meal. One drink is equivalent to 5 ounces of wine, 12 ounces of beer, 10 ounces of wine cooler or 1.5 ounces of liquor.

If you are experiencing hot flashes, avoid spicy foods. Many women complain that certain spices can trigger a hot flash.

Soy Foods and Isoflavones. A well-controlled, but over 12 year old study, found that soy foods can modestly ease hot flashes, and that may explain why women living in China and Japan have a 20 percent incidence of hot flashes compared with women in Western countries who have an 85 percent incidence. Soybeans contain naturally occurring compounds called isoflavones, a type of phyto (plant) estrogen. Genistein and daidzein are the most active soy isoflavones and have been the focus of much research. Isoflavones have a similar structure to the hormone estrogen and, as a result, they have a weak estrogenic effect in the body. Even though isoflavones in soy are about 50 times less potent than estrogen, they are able to offer women a source of estrogen. When a woman’s estrogen levels are low during peri-menopause, fermented soy foods such as tempeh and miso are better tolerated and do not have the negative goitrogen side effects that unfermented soy products or isoflavone supplements can have.

Experts believe that a daily intake of 40 to 80 milligrams of phytoestrogens is required to help alleviate hot flashes and reduce other health risks. Here is their recommendation for soy isoflavones from food sources:

Soy Food	Serving Size	Isoflavone Content
Roasted soy nuts	1/4 cup (60 ml)	40-50 mg
Green soybeans, uncooked	1/2 cup (125 ml)	70 mg
Tempeh, uncooked	3 oz (90 g)	38 mg
Soy flour	1/4 cup (60 ml)	37 mg
Tofu, firm	1/2 cup (125 ml)	27 mg
TVP, dry	1/2 cup (125 ml)	30-120mg
Soy milk	1 cup (250 ml)	24 mg
Soy protein powder	1 oz (28 g)	28 mg
Soy sauce	none
Soya oil	none
Yves Veggie Dog	1 (52 g)	12-19 mg

USDA: Iowa State University Database on the Isoflavone Content of Foods, 1999.

This role of soy foods in breast cancer risk is currently under investigation by scientists in Canada and the United States. In the meantime, most experts agree that eating soy foods three times per week does not pose a risk for women at high risk for breast cancer. However, some experts do recommend that plant estrogens from any source can pose a risk and therefore advise patients to avoid soy all together. In the end, it becomes a personal decision until we have more research to guide us. But one recommendation is universal – women at high risk for breast cancer should avoid large doses of isoflavones in powders or pills.

Soy isoflavones may have different effects depending on the dose and the time in a woman’s life when she consumes them. For example, in a premenopausal woman with estrogen, soy isoflavones may act like anti-Estrogen and prevent the binding of estrogen to breast cells. On the other had, in a postmenopausal woman who is deficient in estrogen, soy isoflavones may have an estrogenic effect.

Vitamins and Minerals

Vitamin B12. Many studies have found that vitamin B12 promotes sleep, especially in people with sleep disorders. B12 is thought to restore sleep by working with melatonin, a hormone that’s involved in maintaining the body’s internal clock. A deficiency of vitamin B12 may cause disturbances in melatonin release.

The recommended dietary intake for vitamin B12 for healthy women is 2.4 micrograms. Vitamin B12 is found in all animal foods: meat, poultry, fish, eggs and dairy products. If you’re eating these foods every day, chances are you are meeting your B12 needs. Foods fortified with the vitamin include soy beverages, rice beverages and breakfast cereals (but check labels to be sure).

Strict vegetarians, women who take acid-blocking medication and women over the age of 50 must get B12 from foods fortified with the vitamin or by taking a supplement. Vitamin B12 supplements come in 500 or 1000 microgram strengths. B complex supplements provide 25 to 100 micrograms of B12 along with the family of B vitamins.

Iron. If you’re experiencing heavy menstrual flow, it’s extremely important to eat an iron-rich diet. Iron is used by red blood cells to form hemoglobin, the molecule that transports oxygen from your lungs to your cells. If your diet falls short of iron, or if your body loses iron faster than your diet can replace it, red blood cell levels drop and less oxygen is delivered to your tissues. Symptoms of iron deficiency include weakness, lethargy and fatigue on exertion. Iron deficiency is a progressive condition. Even if your iron stores aren’t low enough to diagnose anemia, symptoms of iron deficiency can still be felt.

Women who are menstruating require 18 milligrams of iron per day. Postmenopausal women need 8 milligrams. The best iron sources are lean beef, tofu, legumes, enriched breakfast cereals, whole-grain breads, raisins, dried apricots, prune juice, spinach and peas. Iron in food comes in two forms: heme iron in animal foods and non-heme iron in plant foods.

Heme iron is present in the hemoglobin and myoglobin in the blood. That is why heme iron is found in red meat where it represents approximately 40 % of total iron. Non-heme iron is in every other food: vegetables, eggs and dairy products. A classical omnivore diet provides approximately 15 % of heme iron while a vegetarian diet is 100 % non-heme iron. The iron found in the vegetable world is not as well absorbed as heme iron, so pre-menopausal vegetarians are at risks of deficiencies.

A whole food multivitamin and mineral supplement is recommended for women with higher iron requirements. Most formulas provide 10 milligrams, but you can find some that provide up to 18 milligrams. If you’re experiencing persistent heavy bleeding, the recommended daily intake might not be enough to meet your needs. Sometimes supplemental iron is recommended to rebuild your iron stores. After menopause, when a woman is no longer loosing menstrual blood iron supplementation is rarely needed. Too much iron in the blood can lead to heart and joint problems. Donating blood several times a year is also beneficial for men and women to reduce excess iron in the blood.

Herbal Remedies

Black Cohosh for Hot Flashes. Based on clinical experience and findings from controlled scientific studies, black cohosh is often called one of the most promising herbal remedy for treating hot flashes. A number of randomized controlled trials have found black cohosh to be as effective as estrogen therapy at relieving flashes. Black cohosh does not cause the uncomfortable side effects associated with hormone therapy. And unlike estrogen, laboratory research has found that black cohosh inhibits the growth of breast cancer cells. If a woman has kidney deficiency heat however, black cohosh alone may not be the solution and a Chinese herbal Kidney tonic may be indicated. (*see note below)

The recommended dose of Black Cohosh is 40 milligrams twice daily. It is best to look for a product standardized to contain 2.5 percent triterpene glycosides. The specific black cohosh evaluated in much of the scientific research is sold under the name Remifemin. This product is sold as a 20 milligram tablet, since a recent study showing that a lower dose of the herb is equally effective. Once you start black cohosh, it may take up to four weeks to notice an effect. Mild stomach upset and headache may occur.

Valerian for Insomnia. A number of European studies have shown that valerian makes getting to sleep easier and that it increases deep sleep. Unlike popular prescribed sleeping pills, valerian does not lead to dependence or addiction. Nor does it cause a morning drug hangover. Scientists have learned that valerian promotes sleep by binding weakly to two brain receptors, GABA receptors and benzodiazepine receptors.

The recommended dose is 400 to 900 milligrams, taken 30 minutes to one hour before bedtime. Buy a product that is standardized to contain at least 0.5 percent essential oils or 0.8 percent valerenic acid. If you wake up feeling groggy, reduce the dose. The herb is most effective when used over a period. Do not take valerian with alcohol or sedative medications. The herb is not recommended for use during pregnancy and breastfeeding.

*Black Cohosh is a Chinese herb often found in herbal products used for menopause. Though it is effective in reducing the “heat” of hot flashes, etc., it is often misused for this purpose. Black cohosh is best used for short periods to reduce excess heat; that is, measurable fevers from illness, etc. Long term use of this herb is not recommended.

The “heat” experienced from hot flashes, night sweats, etc. is long term in nature and is known as deficiency heat (or false Yang). It is different from the “excess heat” of fevers. Deficiency heat is caused by a weak cooling system (the Yin). This heat is experienced but not measurable. There are several other Chinese herbs that support the Yin such as Dong Quai, Anamarrhena, Vitex (Chaste Tree Berry); Eleuthero and Rehmannia.

About the Author: Margo Jordan Parker, OMD

Margo Jordan Parker has had a Doctorate in Oriental Medicine (OMD) since 1985. She had a ‘celebrity’ practice in Hollywood, California for many years and was featured in LIFE Magazine as one of the top people who “Keep the Stars Shining”. She had invented a technique for facial rejuvenation using micro current therapy in 1982; and later developed a device that could be used at home for facial rejuvenation. She was on the faculty of Sierra Tucson, an addiction treatment hospital in Tucson, Arizona and also founded the Acupuncture and Oriental Medicine department at Canyon Ranch Spa and Resort in Tucson, Arizona.

In 1990 Dr. Parker helped to develop the curriculum for the Program in Integrative Medicine (PIM) at the University of Arizona, College of Medicine. PIM is a 2-year Post Doctoral Fellowship for MD’s. Dr. Parker was part of the original faculty of the Program in Integrative Medicine and she received an appointment to the University of Arizona, College of Medicine. Dr. Parker is also a member of Dr. Andrew Weil’s team of subject matter experts in the field of Traditional Chinese Medicine.

Dr. Parker founded MJP Botanicals, Inc., DBA: HERBAL FORTRESS, in 1999. She formulated the product line and is still currently the CEO of the company. Dr. Parker continues to formulate products for her own and other nutritional supplement and skin care companies. Dr. Parker has helped design programs and products for the Spa and Wellness Industry, as well as training for therapists and health care providers in Natural Health, Prevention, Longevity and Healthy Aging. She has been nationally recognized as one of the leaders in the field for the past 24 years. She is currently developing a Nutrition Certification Program and a Health Coach Certification Program for the Integrated Nutrition & Healthy Aging Institute.

Huangdi Neijing (simplified Chinese: 黄帝内经; traditional Chinese: 黃帝內經; pinyin: Huángdì Nèijīng), also known as The Inner Canon of Huangdi or Yellow Emperor’s Inner Canon, is an ancient Chinese medical text that has been treated as the fundamental doctrinal source for Chinese medicine for more than two millennia and until today. It is comparable in importance to the Hippocratic Corpus in Greek medicine or the works of Galen in Islamic and medieval European medicine. The work is composed of two texts each of eighty-one chapters or treatises in a question-and-answer format between the mythical Huangdi (Yellow Emperor or more correctly Yellow Thearch) and six of his equally legendary ministers.