Women's Health Menopause: Philosophies of the East and West
by Eyton Shalom
This is part three of our Tao of Health series. In this article we will discuss alternatives to hormone replacement therapy (HRT).
Question: "I'm a successful attorney. I'm 46 years old and for the last six months I've suffered from terrible hot flashes. My whole head feels like it's burning and sometimes my hands too. I wake up at night and my bed is drenched in sweat. I'm constantly on edge, I get palpitations and feel basically depressed and fatigued much of the time. On the bright side, I haven't gotten my period for four months, but just when I thought it was safe, boom!, I got an exceptionally heavy flow. My doctor says I'm in perimenopause, the period before menopause, and that I should start taking estrogen tablets to control my symptoms, but I read recently in a book about the change of life called The Silent Passage by Gail Sheehy, that there are certain dangers such as increased risk of uterine and breast cancer associated with hormone replacement therapy (HRT). I'm scared, because my mother was on estrogen for twenty years from the age of 45 and she did develop a uterine malignancy. Are there any alternatives?"
Answer: This reader poses an important query. Currently HRT is heavily in the medical vogue and ads from the giant pharmaceutical companies can be seen in all the health magazines extolling the virtues of estrogen as a treatment for menopausal syndrome and as a preventative for the heart disease and osteoporosis to which post-menopausal western woman are at greater risk. Little mentioned, unfortunately, for a host of social, cultural, and economic reasons, are the potential risks of unopposed estrogen replacement. What is going on?
To begin, menopause (Greek for the ending of the month) is not a disease, but along with menarche and pregnancy, is one of the three great physical changes that are unique to being a woman. As a woman's ovaries age, they produce less and less estrogen, and as a result, less progesterone. This is part of the body's normal processes, and can result in certain vasomotor disturbances like hot flashes, night sweats, and headaches that are the result of imbalance between estrogen and the pituitary hormone FSH, that is its precursor. In addition, there can be a gradual effect on the secondary sexual characteristics. Interestingly, in cultures in which the aging process is viewed more favorably, women display far fewer "symptoms" of menopause. A person who focuses all their energy on beauty and youth may feel very depressed and frustrated by the aging process.
While aging is never easy, people who value other nonphysical attributes may welcome advancing age as a time for further personal development. This is a time when essence is reduced, but wisdom can be increased. In traditional cultures it was quite natural for people to pass through various stages of life and people were prepared physically and spiritually. The Chinese, a people with a culture that places harmony at a premium, have always used herbal medicine, acupuncture, and lifestyle modification to facilitate the smooth passage through menarche, pregnancy, and menopause. While it may appear that all women suffer badly during menopause, the truth is there is a tremendous range of experience based on differences in body chemistry, lifestyle, and stress levels. From the standpoint of Chinese Medicine our reader's symptoms, though common, are not necessary and are symptomatic of an imbalance in the body system that is readily remediable.
There are two basic reasons why doctors give estrogen hormones to their patients: the first is to treat symptoms of menopause such as hot flashes, and so forth, and the second is as an alleged preventative against osteoporosis and heart disease. However, like many "miracles" there is a catch. Research has shown that the effectiveness of estrogen in preventing osteoporosis and heart disease is dependent upon its long-term use; once you stop taking it, it stops helping you. The problem with long-term use is that it seriously increases one's risk for breast and uterine cancer, a risk that is already increased by the aging process itself. So while pharmaceutical companies which sell approximately a billion dollars worth of hormones per year are touting their preventative benefits, the truth is that very few woman can conscionably benefit from this quality without putting themselves at risk for cancer. Intelligent physicians will restrict long-term usage to those most at risk from osteoporosis and heart disease, those whose bone density levels have been measured and found to be low, and those with either a personal history or direct family history (a mother or sister who had symptoms before the age of 50) of heart disease or bone loss.
Are there any other ways to avoid heart disease and bone loss besides tampering with your body's endocrine chemistry? Of course! Weight-bearing exercise such as walking, stress reduction practices, and eating green, leafy vegetables like collard greens (1 cup cooked has 250 grams calcium versus 330 for a cup of milk), help support the body systems and increase bone strength and density. Vegetable-origin calcium has been shown to be more assimilable than dairy calcium. One can ingest all the supplemental calcium possible, but if it is not assimilated, then the only result will be calcium-enriched urine. In addition, avoidance of phosphorus-rich soft drinks that leach the calcium out of the bones, and avoidance of caffeine and cigarettes all reduce one's risk for osteoporosis. Progressive relaxation, a diet high in grains and vegetables, and a healthy lifestyle can further reduce one's heart disease risk.
What about the first reason for using estrogen replacement therapy (ERT) to treat the symptoms of menopause such as hot flashes, night sweats, depression, inability to focus, and a generalized sensation of discomfort in one's body? Why not give estrogen supplements from another species (in this case pregnant mare's urine, the source for Premarin, the most common estrogen supplement) if the symptoms are due to decreased production of estrogen in the ovaries? The problem with this treatment is that the intake of ERT stimulates the estrogen-driven buildup of the uterine lining, the endometrium; however, since the body is not making the estrogen, the cycle is incomplete and the lining remains intact and accumulates. Normally, the body's own estrogen would lead to progesterone production and the onset of menses or the normal sloughing off of the lining. Therefore, women taking estrogen (Premarin) also have had to take synthetic progestins, usually in the form of Provera. The difficulty with Provera is its draconian side-effects, causing women to experience extreme forms of PMS including cramps, depression, muscle tension, migraines, and insomnia.
This leads to the obvious next question. Are there any other ways to remedy the situation, to address the wild fluctuations in hormonal levels that women experience through this passageway?
Chinese Medicine has recognized the body's cycling since ancient times. In the ancient classic, the Nei Jing (circa 200 B.C.), it was stated that the "Kidney Qi" starts to decline around age 49 when, due to normal physiological processes, the body's "Jing" or essence begins to decline. This can lead to an imbalance in the Kidney Yin (moistening cooling property) and the Kidney Yang (warming activating property) which in turn can influence other organ systems such as the Liver Yin and the Spleen and Heart Blood. The treatment principle in these cases, depending on the conformation, is to use acupuncture and herbal medicine to lower fire by nourishing the Yin, to warm the Kidneys and reinforce the Yang, and to tonify the Spleen and Heart. In most American women, we find the syndrome complicated by what we call Liver Qi Stagnation and depressive heat. These women can and should be treated with Chinese Medicine which is without side effects, and can effectively address the entire range of menopausal symptoms.
In the very rare cases in which the patient requires additional therapy modalities besides acupuncture and herbal medicine for complete treatment, there are several new products that have been developed by pharmacists and progressive medical doctors working together. These are plant-derived hormones, estrogen and progestins, developed from mountain yam, soya, and licorice. Much research is being done on these products, which include the oral micronized progesterone. It has been found that their chemical structure is closer to that of humans and therefore better tolerated. Although these plant-derived hormones are extracts, they still are much less concentrated than the synthetic progestins found in Provera and the animal extract Premarin.
If you must use hormones for whatever reason, ask your doctor how long you should take them. Short-term use to get through the initial imbalance with a gradual tapering off after a year or two seems unreasonable. Ask your doctor about new forms of ERT that may not require progestin opposition. Lastly, discuss the need for regular testing of the uterine lining for abnormal cell growth. Early testing saves lives.
These are your bodies — mothers, daughters, sisters, and wives — know what you are doing to them and ask questions. You only get one chance.
This continues our ongoing series, The Tao of Health by Eyton Shalom. In subsequent issues, Eyton will focus on various aspects of Oriental medicine. If you have a question or concern about Oriental medicine, please send all letters in care of Jade Dragon Online, P.O. Box 23744, San Diego, CA 92193-3744, or call Eyton at (619) 595-0709.
Eyton Shalom, M.T.O.M., L.Ac., has been working in the holistic health field since 1973, including two and one-half years teaching and traveling in the Far East. He began his study of Chinese Medicine in 1983 in the Acupuncture department at Colombo South General Hospital, Colombo, Sri Lanka. An herbal consultant to the California Acupuncture Licensing Exam, Eyton practices Acupuncture, Herbal, and Nutritional Medicine at Oriental Medical Associates just north of downtown San Diego, CA. He is available for consultation at (619) 595-0709.
Part one in our continuing series: Tao of Health Chinese Herbal Medicine Cabinet
Part two in our continuing series: Tao of Health Living with the Seasons Winter
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