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Menopause and Hot Flushes - A Chinese Medicine Perspective

by Dr Danny T. Siegenthaler
(MSc. (TCM), BSc. (Hons.), Dip. TCM; Dip. Ac.)

What is Menopause

This article reviews menopause and describes how this condition is understood in both Western medicine (WM) and traditional Chinese medicine (TCM). It further identifies the key diagnostic indicators for menopause in both medical systems and explains how these indicators reflect the disease pathogenesis. Furthermore, it will provide a generalised overview of WM and TCM treatment protocols and outcomes for the menopausal syndrome (MPS).

Menopauseal syndrome is arguably not a disorder, rather it is a natural process every woman’s body goes through during her late 40’s or early/mid 50’s [1,2].

World-wide, in 1998, there were over 470 million menopausal women [3] and it is estimated that in 2010, 171 million women, in Western countries alone, will suffer from MPS [4].

Menopause and Hot Flushes

Menopausal symptoms can vary in variety and severity, and may last for several years. Menopause usually begins with the perimenopausal phase and ends following the postmenopausal phase [5]. However, in the biomedical model there are considerable gaps in the knowledge and understanding of perimenopause and menopause related pathophysiology as well as treatment approaches, and little scientific investigation has focused on menopausal transition and early post-menopause [6,7,8].

WM utilises hormone replacement therapy (HRT) as the primary treatment for MPS, by replacing the naturally declining hormones with HRT. However, increasingly, women are moving away form HRT [9], as it is associated with increased risks of heart disease, breast cancer and other health problems [10,13,6,3,34].

TCM on the other hand, has a well-developed, individualised diagnostic approach to symptoms associated (in WM) with menopause. It does not focus on the hormonal changes that occur; rather its focus is on assessing the individual according to classic diagnostic principles and once a diagnosis is made, treatment principles are developed from which a treatment regime is derived and implemented [20,31].

Typically Signs & Symptoms of Menopause include:

  • Irregular periods
  • Vaginal dryness
  • Hot flashes
  • Chills
  • Night sweats
  • Sleep problems
  • Mood changes
  • Weight gain and slowed metabolism
  • Thinning hair and dry skin
  • Loss of breast fullness
  • and others

How Does Traditional Chinese Medicine (TCM) view Menopause

Chinese Medicine Patters involved in Menopausal Syndrome

According to Maciocia [2] symptoms associated with Menopause are due to a decline of the Kidney Essence, and the primary TCM patterns associated with Menopause involve the Kidneys, Liver, Heart and Stagnation of Blood (Xue). This is reiterated by Lyttleton [25], who states: “…every menstrual cycle in which an ovulation occurs requires contribution from the Jing (Kidney Essence). It is when no more Jing contributions can be made (i.e. there are no more viable eggs) that menstrual cycles cease and menopause has arrived”.

Thus, as Kidney Jing weakens, Kidney Yin and/or Yang may become deficient. This in turn may lead to more complex TCM patterns involving either the Liver (e.g., Kidney- and Liver-Yin deficiency with Liver-Yang rising) or Heart (e.g., Kidneys and Heart not harmonising). Alternatively, Kidney deficiencies may lead to stagnation of Qi and/or Blood, or accumulation of Phlegm and stagnation of Qi.

Buy Wait – There’s More

Typical pattern differentiation and their respective treatments are outlined by Maciocia [2]. However, there is at least one commonly seen pattern that is not frequently outlined or discussed. Liver & Heart Xue Xu (deficiency of the liver & heart blood’s energy).

In the author’s experience, problems associated with menopause begin during a difficult birth, where there is an excessive loss of blood followed by an inadequate recovery period. The birthing process is draining enough without the excessive loss of blood. Both Kidney Yin and Yang energies are lost during the birthing process not to mention the Kidney Essence (Jing).

In today’s western society, there is typically little time for a mother to recover from the trauma and energy expenditure of birth. The family structure of yesteryear, where grandmothers, sisters and other family members where close at hand to help the new mother with her baby, is no longer common place. Instead, most new mothers have to continue their duties plus look after the newborn baby. This is draining her of further energies, which will lead to potential problems at the time of menopause.

Patients usually present with anxiety, palpitations, floaters before the eyes and blurring of vision, especially when tired, and other typically xue (blood-energy) deficient signs and symptoms. In addition, they also present with mild night sweats, or a sensation of getting hot then cold at night, they tend to have a malar flush, however, the otherwise typical yin xu symptoms are not present or if present are only mild in nature (Blood nourishes Yin).

The Liv/Ht. Xue Deficiency is characterised in menopause by pale tongue, malar flush, insomnia – usually problems with falling asleep (Ht Xue Xu) but may also wake up during the night (Ht Yin Xu), poor memory or forgetfulness, but may also have symptoms such as brittle nails, lusterless hair, vaginal dryness, etc.

Treatment Is Specific and Individualised

Treatment protocols in Chinese medicine are highly individualised and specific to each woman. They generally take an approach of combining acupuncture with Chinese herbal formulae, as well as a lifestyle and dietary review.

Research has shown acupuncture to be highly effective, safe and producing fewer side effects for the treatment of menopausal associated symptoms such as hot flushes, etc. [35,36,37].

At Kurrajong Natural Medicine Centre our highly qualified and experienced team of practitioners are happy to develop a personalised treatment programme with you. Simply call (02)4573 0784

What You Can Do to Help Yourself If You Suffer From Menopause

Hot flushes may be keeping you up at night, keep your bedroom cooler and try drinking small amounts of cool water before bed. Layer your bedding so it can be adjusted as needed. Some women find a bed fan helpful. Other lifestyle changes that may help:

Maintain a healthy lifestyle:

  • Eat a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Limit your intake of processed foods, caffeine, and spicy foods, as they can trigger hot flashes and other symptoms.
  • Stay hydrated by drinking plenty of water throughout the day.
  • Engage in regular physical activity such as walking, jogging, yoga, or swimming to help manage weight, improve mood, and reduce symptoms.
  • Dress in layers, which can be removed at the start of a hot flash.
  • Carry a portable fan to use when a hot flush strikes.
  • Avoid alcohol, spicy foods, and caffeine, as these can make menopausal symptoms worse.
  • Try to maintain a healthy weight. Women who are overweight or obese may experience more frequent and severe hot flushes.
Manage stress:
 
  • Practice stress-reduction techniques such as deep breathing exercises, meditation, yoga, or tai chi.
  • Engage in activities that you find relaxing and enjoyable, such as reading, listening to music, or spending time in nature.
  • Prioritise self-care and make time for activities that bring you joy and help you unwind.
  • Try mind-body practices like yoga or other self-calming techniques. Early-stage research has shown that mindfulness meditation, yoga, and tai chi may help improve menopausal symptoms.
 
Seek relief for hot flashes and night sweats:
 
  • Dress in layers, use breathable fabrics, and keep your environment cool.
  • Use a fan or air conditioner to help cool down during hot flashes.
  • Avoid triggers such as spicy foods, caffeine, alcohol, and hot beverages.
  • Consider natural remedies like herbal supplements (e.g., black cohosh, soy), but consult a healthcare professional before using them.
 

Improve sleep quality:

  • Create a conducive sleep environment by keeping your bedroom dark, quiet, and cool.
  • Establish a consistent bedtime routine and ensure you have a comfortable mattress and pillows.
  • Limit electronic device usage before bed to minimize disruption to sleep patterns.
 
Stay connected and seek support:
 
  • Share your experiences and concerns with trusted friends, family, or support groups.
  • Educate yourself about menopause through reliable sources to better understand and manage your symptoms.
  • Consult a healthcare professional to discuss treatment options and address any specific concerns you may have.

References & Bibliography

  1. Kwee, S. H., Tan, H. H., Marsman, A., & Wauters, C. (2007). The effect of Chinese herbal medicines (CHM) on menopausal symptoms compared to hormone replacement therapy (HRT) and placebo. [doi: DOI: 10.1016/j.maturitas.2007.06.005]. Maturitas, 58(1), 83-90.
  2. Maciocia, G. (1998). Obstetircs and Gynecology in Chinese Medicine. Edinburgh: Elsevier Churchill Livingstone.
  3. Sze, S. C. W., Tong, Y., Zhang, Y. B., Zhang, Z. J., Lau, A. S. L., Wong, H. K., et al. (2009). A novel mechanism: Erxian Decoction, a Chinese medicine formula, for relieving menopausal syndrome. [doi: DOI: 10.1016/j.jep.2009.02.034]. Journal of Ethnopharmacology, 123(1), 27-33.
  4. Tan, L. H., Rampp, T., Zhang, L., Sun, Z., Klose, P., Musial, F., et al. (2008). Westliche und TCM-diagnostische Kriterien der Menopause bei deutschen und chinesischen Frauen: Eine transkulturelle multizentrische Vergleichsstudie. [doi: DOI: 10.1016/j.dza.2008.10.003]. Deutsche Zeitschrift für Akupunktur, 51(4), 20-25.
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