Menopause Conundrum

Hello Tanya

great question ! I think this is where we sometimes make things to simplistic and we find problems when trying to compare Western and Chinese medicine.

Menopause is commonly both a kidney yin and yang deficiency which changes in a womans life. Each individual will have their own pattern.

According to Shiao Ting Jing's clinical pearls video:
http://chinesemedicinetools.com/multimedia/videos/shiao-ting...
she believes many of the heat symptoms relating to menopause are caused by liver Qi stagnation creating depressive heat.

Not sure if this answers your question or not but hopefully will put some fresh ideas into the mix.

Ryan

I am preparing a talk for the public in Vancouver with endocrinologist and author, Dr. Jerilynn Prior on Peri-menopause.

I will share a few studies that you can look into. And I also like the video Ryan put a link too. TCM practitioners often jump to KD Yin deficiency. This maybe the text book answer but clinically I see it more as a Liver issue. Check out Ryan`s link above to Shiao Ting Jing`s you tube video.

I will try to share more as I prepare and complete my own presentation. Here is some studies for now

http://www.ncbi.nlm.nih.gov/pubmed/19423996
http://ecam.oxfordjournals.org/cgi/content/full/nep001
http://www.cemcor.ubc.ca/taxonomy/term/7
http://www.acufinder.com/Acupuncture+News/Acupuncture+Reduce...

Lorne
www.acubalance.ca
www.prodseminars.com

Ignore the disease title estrogen dominace or estrogen deficiency and look at the signs and symptoms that come with the label estrogen dominance. It will help you re-frame the disease into a TCM patter(s)

It is more about the Yin Yang relative balance or in this case imbalance between estrogen and progesterone that lead to symptoms. And there are more than one kind of estrogen. So some forms are lacking and some forms are too much which leads to unwanted symptoms.

Lorne
www.acubalance.ca
www.prodseminars.com

I agree with Lorne that we as TCM practitioners should not fall into the trap of confusion because we can't reconcile hormonal values with the TCM pattern we expect to find and don't. The balance of yin and yang is dependent upon the transformative action of Qi. When Qi transformation is stuck due to Liver stagnation, it is at this point that we as TCM practitioners must determine whether pathogenic heat is depressive(transformative) due to Liv Qi stagnation or vacuity heat due to K Yin deficiency. Better to look at the tongue and pulse than Western lab results when determining treatment. That said, when trying to explain estrogen dominance to your patient, you can say that while estrogen values may be greater than progesterone, testosterone levels may be relatively higher due to the lack of Qi transforming testosterone into estrogen thereby creating or contributing to heat symptoms.

While we're on the subject, has anyone ever noticed when treating PCOS that many women with high testosterone also have Kidney Yang vacuity? 

The following comes from an article found at http://acupuncture.com/newsletters/m_feb09/menopause chinese medicine.htm

.....By reducing carbohydrate intake, one reduces the level of circulating insulin, enabling the cells to respond normally to thyroxin, progesterone, estrogen, testosterone, cortisol, and other hormones. This disturbed carbohydrate-insulin dynamic interferes with the liver's ability to detoxify excess estrogen: women with symptoms of Liver Qi and Blood stagnation are likely to be estrogen dominant. These women will benefit by restricting carbohydrate consumption (grains, cereal, bread, potatoes, pasta, fruit, or fruit juice) to one meal a day, preferably dinner. Digestive aids such as pancreatin and plant-based enzymes as well as friendly intestinal microflora (probiotics) will also help to normalize the function of the Stomach and Spleen.

Lorne
www.acubalance.ca
www.prodseminars.com

 I agree with some of the above thinking, in that it is not so easy to translate or compare a western concept into chinese theory. This whole idea of saying that Estrogen is yin comes from where??

Something can only be called yin in comparison to something that is in relationship to it. Ie. in talking about the light of day we can have daylight=bright=yang, compared to night=dark=yin. But if we compare night to a mountain, how can we say one is more yin the other? We cannot because they are not in relationship to one another.

Estrogen can only be called yin when compared to something else that is in relationship to it. So maybe in terms of function it is more yin than progesterone. But can we use the same concept of estrogen being yin to help explain the multitude of menopausal symptoms that a woman can manifest? I don't think so.

Estrogen dominance is very common in menopausal women, particularly overweight women whose adipose tissue around their waist has good aromatase activity (not all estrogen comes from the growing follicle). This is  actually one reason a menopausal woman may have periodic uterine spotting from time to time. 

I say it is much better and easier to stick to using Chinese medical theory as it is and diagnose a woman based on how she is presenting at the time. Otherwise one is bound to get very confused. As mentioned above, I see many menopausal women who have liver depression, QI stagnation, with depressive heat, and phlegm/ damp accumulation as their primary patterns. In these women I cannot use the blanket statement of "menopausal women are kidney yin deficient because of their declining estrogen." This statement is simply not true and is not based on any traditional concept that I can tell.

Remember that night sweating and hot flushing is not only from yin deficiency. Damp heat, QI level heat, and blood heat can all have these symptoms. I don't agree that just because a woman is menopausal, in a western sense, indicates that she has yin xu.

We have to treat what we see and use proper pattern discrimination, whether a person is five or fifty. The theory of declining kidney yin due to age may be applicable in some cases, but I don't think it will work for all. This is the difference between being either a good pattern detective or a just a theorist. 

As one of my mentors, Dr. Kingson Wu, encouraged, "Believe nothing that you read or hear,  prove it to yourself in clinic." So if kidney yin deficiency is the issue for all menopausal women, then the treatment results should speak for themselves.

Trevor Erikson, Dr TCM, FABORM

www.skin.health-info.org

www.acubalance.ca

Kimtaoyin

After reading the discussions I have checked out the link & video clip Shiao Ting Jing's clinical pearls video.  She talks about the prescription Chai Hu Long Gu Mu Li Tang.  Well this is not available in England becuase two of the herbs cannot be used Long Gu and Mu Li.  As I am still new in the world or Oriental Medicine has anyone replaced these two herbs in the prescription with similar functioning herbs.
 

Going through menopause and experiencing the night sweats & spontaneous sweating I would like to consider this prescription.

As many of the comments mention KI yin def and during my degree we looked at my symptoms and they show towards KI yin/Qi & Blood def. Kun Bao Wan worked for a while but I stop taking it to see how long it would take for the symptoms to come back.  It took 6 months.  Since then it has no affect.  I have also tried another type same herbs Gen Nian Pian.  That also does not really work.  For a while alternating Lui Wei Di Huang Wan and Jin Kui Shen Qi Wan one week then the other did work but then it stoped.

I look forward to your comments.