Menopause and Perimenopause

Perimenopause means “around menopause” and refers to the time during which your body makes the natural transition to menopause, marking the end of the reproductive years. Perimenopause is also called the menopausal transition.

Women start perimenopause at different ages. 

Traditional Chinese Medicine is very effective for treating menopausal symptoms including hot flashes, night sweats, vaginal dryness, heart palpitations, anxiety, and insomnia. Along with Chinese herbs, acupuncture offers a safe and natural solution to the hormonal fluctuations all women experience.

Throughout the menopausal transition, some subtle — and some not-so-subtle — changes in your body may take place. You might experience:

  • Irregular periods. As ovulation becomes more unpredictable, the length of time between periods may be longer or shorter, your flow may be light to heavy, and you may skip some periods. If you have a persistent change of seven days or more in the length of your menstrual cycle, you may be in early perimenopause. If you have a space of 60 days or more between periods, you’re likely in late perimenopause.
  • Hot flashes and sleep problems. Hot flashes are common during perimenopause. The intensity, length and frequency vary. Sleep problems are often due to hot flashes or night sweats, but sometimes sleep becomes unpredictable even without them.
  • Mood changes. Mood swings, irritability or increased risk of depression may happen during perimenopause. The cause of these symptoms may be sleep disruption associated with hot flashes. Mood changes may also be caused by factors not related to the hormonal changes of perimenopause.
  • Vaginal and bladder problems. When estrogen levels diminish, your vaginal tissues may lose lubrication and elasticity, making intercourse painful. Low estrogen may also leave you more vulnerable to urinary or vaginal infections. Loss of tissue tone may contribute to urinary incontinence.
  • Decreasing fertility. As ovulation becomes irregular, your ability to conceive decreases. However, as long as you’re having periods, pregnancy is still possible. If you wish to avoid pregnancy, use birth control until you’ve had no periods for 12 months.
  • Changes in sexual function. During perimenopause, sexual arousal and desire may change. But if you had satisfactory sexual intimacy before menopause, this will likely continue through perimenopause and beyond.
  • Loss of bone. With declining estrogen levels, you start to lose bone more quickly than you replace it, increasing your risk of osteoporosis — a disease that causes fragile bones.
  • Changing cholesterol levels. Declining estrogen levels may lead to unfavorable changes in your blood cholesterol levels, including an increase in low-density lipoprotein (LDL) cholesterol — the “bad” cholesterol — which contributes to an increased risk of heart disease. At the same time, high-density lipoprotein (HDL) cholesterol — the “good” cholesterol — decreases in many women as they age, which also increases the risk of heart disease.

TCM treatment for hot flushes

Approximately 60–80% of menopausal women experience hot flushes and sweating and the peak stage of onset occurs during the late menopausal transition and early menopause. It is believed in TCM that hot flushes are mainly caused by kidney Yin deficiency, resulting in excessive kidney fire and Yin deficiency in the liver and kidney, and ascendant hyperactivity of liver Yang. Hence, TCM methods for menopausal hot flushes mainly consist of nourishing Yin and clearing heat in order to regulate neuroendocrine functions.

The Chinese-patented medicine, Heyan Kuntai capsule (HYKT), is widely used to treat menopausal syndrome. A dual-center, randomized, double-blind, double-dummy, parallel-controlled study was conducted for 3 months in which 147 women were enrolled and 123 completed the trial. Menopausal women were randomly divided into groups receiving either the Kuntai capsule or estradiol valerate. The modified Kupperman index, serum estradiol, and vaginal epithelial cell index were assessed as primary outcomes for evaluating treatment efficacy, and adverse events, such as vaginal bleeding and mastalgia, were also recorded. After treatment, both drugs reduced hot flushes in 92.3% and 96.5% of women, respectively, which was not significantly different (p > 0.05), suggesting that both HYKT and estradiol valerate were effective in alleviating hot flushes.

Another randomized, double-blind, placebo-controlled study was conducted on 31 postmenopausal women in the Netherlands, in which the Chinese medicine Zhibai Dihuang was administered for 12 weeks followed by 4 weeks of treatment discontinuation. At follow-up, researchers evaluated the effect of this treatment on vasomotor symptoms, including hot flushes and night sweating, and found that Zhibai Dihuang significantly improved symptoms compared to a placebo (p < 0.01).

The efficacy of acupuncture in the treatment of hot flushes has been verified by extensive data provided by Chinese and international studies. A prospective and multicenter cohort study using acupuncture to treat 175 patients with hot flushes found that, within 24 h, more than 62% of subjects in the acupuncture group reported improvements in symptoms, whereas only 27% of subjects in the control group reported an improvement.

Among menopausal symptoms, depression and anxiety are the main characteristics of non-specific psychological syndrome and are considered menopausal mood disorders. The morbidity of mood disorders is higher in menopausal women than in their healthy counterparts in whom regular menstruation occurs during the childbearing age. Modern medicine posits that the cause of mood disorders may be related to a decline in ovarian function and a subsequent reduction in serum estradiol levels, which result in the elevation of serum monoamine oxidase levels. This can further cause increased degradation and metabolic inactivation of dopamine, norepinephrine, and serotonin, as well as the down-regulation of monoamine neurotransmitter activity. Currently, treatment mainly involves antidepressants; however, many studies have reported that hormonal replacement therapy improves mood and cognitive function in women.

Menopausal mood disorders belong to the TCM disease categories of ‘Lily disease’, ‘hysteria’, and ‘depression’. TCM believes that the pathogenesis of this disease is due to the gradual decline in kidney Qi, thereby resulting in kidney Yin deficiency and liver depression that progresses into liver fire, thus further excessive burning Yin fluid. Together, these conditions manifest as hot flushes, sweating, chest tightness, irritability, and insomnia. Moreover, heart Yin is damaged over time and reduces interactions between the kidney and heart, which aggravates depression and anxiety.

Saikosaponin, the active ingredient of the radix bupleuri in Xiangshao granules, has anti-inflammatory and anti-convulsion effects and can extend sleep duration. It has demonstrated good therapeutic efficacy against anxiety and depression, possibly by affecting serotonin activity in the central nervous system. Wang observed that Xiangshao granules regulated serum neurotransmitter levels, including serotonin, norepinephrine, and epinephrine, thereby indicating that Xiangshao granules may improve menopausal depression through balancing the neuroendocrine system.

A study observing the effects of bilateral acupuncture at the FeishuXinshuGanshuPishuShenshu and Geshu points on patients with menopausal depression found that the Hamilton Depression Scale scores at the 6th week of treatment were comparable between the acupuncture group and the fluoxetine hydrochloride group. Notably, acupuncture exhibited better outcomes (p < 0.05) at weeks 2 and 4.

TCM treatment for sleep disorders during menopause

TCM posits that the pathogenesis of sleep disorders in women during menopause is mainly due to kidney deficiency; reduced interaction between the kidney and heart; lack of Qiblood and Yin essence; and disharmony of Yin–Yang. Accordingly, treatments, such as enriching the kidney, nourishing Yin, and soothing the mind have an improved therapeutic efficacy.

A systematic review consisting of six randomized, controlled studies with a total of 510 patients comparing the efficacy and safety of JiaWeiSuanZaoRen soup and sleeping pills in the treatment of menopausal insomnia showed that JiaWeiSuanZaoRen soup showed comparable effects to diazepam and alprazolam tablets, whereas JiaWeiSuanZaoRen soup treatment showed better efficacy than estazolam (p < 0.05). Additionally, JiaWeiSuanZaoRen soup improved the quality of sleep, as indicated by the Pittsburgh Sleep Quality Index, when compared with alprazolam (p < 0.05). More adverse events were reported in the group receiving sleeping pills than in the JiaWeiSuanZaoRen soup group (p < 0.05, χ2 = 4.9246). In addition, a randomized, double-blind, placebo-controlled, small-sample study found that the sleep quality index was improved significantly after menopausal women (n = 18) received acupuncture therapy, and polysomnography indicated that the duration of deep sleep increased after treatment.

Reference: Q.Yu (2018). Traditional Chinese medicine: perspectives on and treatment of menopausal symptoms. vol.21. Climacteric. pp. 93-95.