Author: Rebekah Michaels
Chinese herbal medicine offers safe, effective, and customized treatment for many of the symptoms associated with menopause and andropause. With the debate about hormone replacement therapy (HRT) once more in the news with the rising interest in “bio-identical” hormones, and research casting doubt on the efficacy of such over-the-counter remedies as black cohosh/vitex (Douaud/Daniells), many people are looking for another approach. Chinese herbal medicine offers viable alternative treatment strategies with a documented history of use, safety, and efficacy that goes back 2000 years.
Menopause is defined as the complete and permanent cessation of menstruation. Andropause, the male analogue, is the gradual reduction of circulating testosterone. Both situations are a natural part of the life cycle and neither need to be treated medically unless the symptoms result in a reduction of quality of life. The symptoms of menopause and andropause are very similar, but the male version tends to be less dramatic and consequently may be less reported. About 70% of women will experience menopausal symptoms of some severity, whereas only 40% of men will report troubling symptoms related to andropause.
The time before the cessation of menses is called the “climacteric” or “peri-menopause” and is often when women experience the most distressing symptoms. The climacteric, and the symptoms associated with it, can start many years before menses actually end. The basic mechanism of menopause, from the Western medical perspective, is the gradual decline of viable ovarian follicles and the corresponding drop in estrogen production. Prior to birth the female fetus has about six million potential follicles; by menarche (the beginning of menstruation) this number has already dropped to 300,000; at menopause a mere 10,000 potential follicles remain. At a certain point the depletion of follicles corresponds to a drop in estrogen levels (estrogen is secreted by the maturing ovarian follicles). This drop in estrogen may precipitate a feedback loop in which the pituitary gland produces increased levels of follicle stimulating hormone (FSH) in an effort to trigger ovulation; if the remaining follicles are unable to cooperate, this increase in FSH level may generate heat (Maciocia). The classic “hot flash” is the body’s way of dissipating the excess heat to the exterior of the body by vasodilation. Although hot flashes are uncomfortable (especially when they happen twenty times a day!), they are not pathological in and of themselves.
The mean age for menopause is 51. About 25% of women slide though this transitional time with minimal symptoms, 50% experience symptoms that they characterize as mild to moderate, and 25% are truly miserable. Eighty-five percent of women going through menopause experience some degree of hot flashes, sometimes for a number of years (Weschler/Maciocia). Other symptoms that form part of the “menopausal syndrome,” but are harder to explain as a direct result of dropping estrogen levels, are: poor memory and concentration, sleep disturbances, depression/anxiety, mood swings, thinning of the skin, loss of bone density, and weight gain.
Between the ages of 45 and 60 there is a gradual decline in circulating testosterone (free available testosterone or FAT), there may also be a relative increase in available estrogen that binds with the same receptor sites, thus reducing even more the availability of testosterone to key cells (andrology.com). The symptoms that may accompany these changes parallel the experience of menopause, hence the term “male menopause.” Symptoms include: lethargy, depression, increased irritability, mood swings, hot flashes, insomnia, decreased libido, impotence, and loss of lean body mass and bone mass. Fifty-one percent of healthy men between the ages of 40 and 70 will experience some level of impotence/erectile dysfunction (ED). The symptoms associated with andropause often occur gradually and may go unreported as they seem to be less severe than the female version. The exception to this is ED, which has spawned an impressive amount of research and drug development. Men going through andropause or post andropause are still able to father children, since sperm continues to be produced throughout a man’s lifetime, but there is usually a decline in quality of sperm starting in the mid-40s.
Remember Dr. Strangelove and the precious bodily fluids? Chinese medicine considers that sexual activity resulting in ejaculation is potentially depleting of the Kidney essence (i.e., generative energy, which is the root of pretty much everything). Too much sex results in depletion, fatigue, and potential illness; not enough sex results in atrophy. How much sex is appropriate depends on age and health. Women in the Chinese model are not depleted by sexual activity, but rather by menses and childbirth. Sadly the reality is that interest in sex, and the ability to have sex, may peak at different times for men and women, a mismatch that leads to a host of social and marital frustrations!
HRT – Women
Hormone replacement of the Premerin/Prempro type offered an 80% to 90% reduction in symptoms of hot flashes and vaginal dryness (Daniells/Weschler), but often needed to be combined with other therapies to address the symptoms not directly related to estrogen levels. The Women’s Health Initiative was a group of studies launched in 1991, one of which looked at the long-term effects of estrogen or estrogen and progesterone supplementation on the health of post-menopausal women. The long-term followup of the study is due to end this year, but the publication of the initial results prompted a major change in use of, and prescription guidelines for, HRT. The consequences of this type of HRT administered to women in the age group of the study (50-79) were found to be substantial and the wholesale use of HRT to control menopausal symptoms stopped very quickly. The subject has recently come to the forefront again, with research into different formulations, delivery methods, and the significance of timing of intervention (The Estrogen Dilemma – Cynthia Gorney, New York Times Magazine, April 12, 2010).
HRT – Men
Testosterone supplementation has many of the same issues as estrogen/estrogen & progesterone supplementation. The key questions are when, how much, and what form is best. The main concern is the potential for negative long-term effects on health. The deciding factor for many men may be that while testosterone supplementation often restores libido, it does not seem to help with most cases of erectile dysfunction (which looks more like an issue with blood supply and circulation), which is often the most distressing symptom of andropause.
Chinese Herbal Medicine
Western medicine looks at menopause and andropause, sees the falling hormone levels, and intervenes to replace the declining hormones, essentially fooling the body into thinking that it is younger. In contrast, Traditional Chinese Medicine (TCM) looks at the changes occurring at this time as a natural progression and works to help establish a comfortable balance within the new parameters. In this model the Kidney, which is home to the ancestral energy or Jing, the life force, and the ability to reproduce, is the key player. The Kidney essence, which incorporates both the yin and the yang, has declined. Often the decline of the yin and the yang are not equal; the dynamic balance between the two primary energies is disturbed and symptoms result. The classic textbook example is that the yin (the cool, moistening, nourishing, containing aspect) has been relatively more exhausted by a lifetime of stress, lack of sleep, childbirth, menses, too much sex (guys), and bad lifestyle choices – excessive drinking, smoking. In its depleted state, the yin is unable to contain and balance its partner the yang (the warming, moving, protective, active aspect). Consequently the yang seems to flair out of control, producing heat symptoms, harassing the heart (anxiety/irritability) and disturbing the sleep. The treatment for such a situation is two-fold: 1) address the symptoms that arise because of the imbalance (hot flashes, night sweats, insomnia, irritability …), and 2) address the imbalance itself by tonifying the yin aspect, thus allowing the system to re-balance. Another strategy is to look at the factors which prevent the body from re-balancing itself – most commonly stagnation of energy and blood (contributing causes for ED?) – and to address this factor to create a better environment for the yin and yang to re-balance organically.
Prescription of Chinese herbal medicine is based on pattern differentiation, thus each prescription is tailored to the individual’s specific situation. The average formula might contain anywhere from six to twenty different herbs selected to work synergistically to maximize results, while at the same time minimizing unwanted side effects. While two women might present with a main complaint of menopausal symptoms, each would be experiencing a different constellation of specific symptoms with different levels of severity depending on many factors including constitutional tendencies, lifestyle, and other concurrent health challenges. Because each menopause or andropause experience is unique, the treatment must be individualized and must evolve as the body transitions through this phase.
Although it is true that some herbs in the Chinese pharmacopoeia contain plant hormones, or in rare cases animal hormones (historically endangered animals that are no longer used), the selection of herbs is rarely based on the presence of hormones, and the treatment strategies are very different from medical hormone replacement. Chinese herbal medicine has a highly developed theoretical basis and is, in my opinion, more sophisticated than Western herbalism as represented in the over-the-counter remedies that you can buy at your local health food store. Black cohosh for example, sheng ma in Chinese herbal medicine, would never be used as a single herb, but rather as part of a prescription possibly for diarrhea, toxicity, or prolapse, but is not part of classic TCM strategy for hot flashes or night sweats.
There are very few silver bullets when it comes to health, and unfortunately treating menopause or andropause with Chinese herbal medicine is not a quick fix. Even though hormone replacement produces quick results it is a long-term medication commitment. Many people who use hormone replacement and then stop treatment will experience a renewal of symptoms. From the TCM perspective, tonifying any aspect of the Kidney is a long-term proposition and clearing out years of stagnation and constraint doesn’t happen overnight. Although some level of relief from symptoms may occur in a matter of days or a couple of weeks, to achieve lasting, sustainable results is more likely to be a question of months or even years. The good news is that since a Chinese herbal prescription is based on your particular presentation, rather then a generic approach, many issues can be addressed simultaneously. And because the prescription is internally balanced, there are unlikely to be unwanted side effects. Furthermore, since the treatment will necessarily evolve as your situation changes, it is unlikely that you would develop resistance or become unresponsive to Chinese herbal medicine. All told, Chinese herbal medicine offers a good choice for many people seeking relief from the symptoms of menopause or andropause.
Danniells, Stephen; Questions raised over HRT alternatives; Decisions News Media; 4/9/2006
Department of Health and Human Services/ National Institute of Health; Women’s Health Initiative Website
Douand, Clarisse; Health Canada issue Black Cohosh advisor; Decisions News Media; 8/23/2006
Gorney, Cynthia; The Estrogen Dilemma, New York Times Magazine; 4/12/2010
Harvard Health Letter, Hormone Replacement, the Male Version; 5/2004
Maciocia, Giovanni: Obstetrics & Gynecology in Chinese Medicine; Churchill Livingstone; 1998
Weschler, Toni; Taking Charge of Your Fertility; 2002