Menopause: A Comprehensive Guide for Practitioners - eBook format
The first of its kind, this book provides a comprehensive guide to menopause and the years that follow, bringing together modern biomedical research and ancient wisdom to provide practitioners with an integrated approach to treatment.
The text is largely based on the teachings of renowned and highly-experienced traditional Chinese and East Asian medicine practitioners (TCEAM), including Suzanne Cochrane, Brian Grosam, Honora Lee Wolfe, Giovanni Maciocia, Rebecca Avern, Peter Deadman, Anastacïa White, Julian Scott, and Bob Flaws. It includes information provided by experts in related fields, such as Professor Bruce Robinson M.D. and naturopathic nutritionist Susan Kath.
We discuss the physiology of menopause from both eastern and western perspectives, pattern differentiation and treatment frameworks for some of the most common menopausal symptoms, and in-depth lifestyle and self care advice. We also cover a variety of conditions that frequently affect women following menopause.
Watch video for more information: https://www.treatingwomen.com/Menopause_Book
Purchase the webinar 'Sex, Drugs and Menopause' which was presented by Katherine Berry and Natalie Chandra Saunders for the launch of this eBook on World Menopause Day: Buy the webinar here
Menopause: A Comprehensive Guide for Practitioners
Katherine Berry and Natalie Chandra Saunders
With Suzanne Cochrane and Brian Grosam
Foreword by Honora Lee Wolfe
"This textbook, the first of its kind, is an ‘encyclopaedia’ of everything we need to know about menopause. It demonstrates the immense value of Traditional Chinese and East Asian Medicine (TCEAM) for menopausal health and includes diagnosis, treatment and self-care. It is a comprehensive book that will fully equip every practitioner to treat. It is likely to become a classic".
Angela Hicks, Author and Founder of the College of Integrated Chinese Medicine, United Kingdom
"The textbook practitioners of Traditional Chinese and East Asian Medicine have been waiting for – a comprehensive, evidence-based guide on treating menopause. With not only chapters that give detailed information for western medical background, Traditional Chinese and East Asian Medicine perspectives and practical clinical applications for diagnosis and treatment, but also information on diet, self-care, and a menopause “toolkit”. TCEAM has a valuable contribution to make in women’s health care and this text allows practitioners the opportunity to be fully informed and offer treatment with confidence".
Debra Betts (PhD), Author and Director of Postgraduate Programmes, New Zealand School of Acupuncture and Traditional Chinese Medicine, Wellington NZ
1.2. Introduction: Your Role as a Clinician
1.3. Definitions and Terminology
The Biology of Menopause
2.1. Female Anatomy and Physiology
2.2. Female Reproductive Hormones
2.3. Menopausal Hormone Therapy
2.4. Genetics and Epigenetics
2.5. Medical and Surgical Menopause
2.6. Premature Ovarian Insufficiency
2.7 Breast Health
Menopause in Chinese and East Asian Medicine
3.1. Traditional Chinese and East Asian Medicine Perspectives
3.2. Jing (Essence) and Menopause
3.3. The Gates of Life
3.4. Body Type
3.5. Complexion, Skin, and Hair
3.6. Five Elements, Five Phases
Symptoms and Treatment
4.1. Vasomotor Symptoms
4.2. Mood Disorders
4.3. Insomnia and Sleep Disorders
4.4. Urogenital Symptoms
4.5. Uterine Bleeding
4.6. Libido and Sexual Dysfunction
4.7. Musculoskeletal Pain
4.8. Osteopenia, Osteoporosis, and Hyperkyphosis
4.9. Metabolic Syndrome, Diabetes, and Cardiovascular Disease
4.10. Cognitive Decline
5.1. Metabolism, Weight Management, and Exercise
5.2. Stress, Trauma, and Stress Resistance
5.3. Sleep, Energy, and Fatigue
5.4. Sexual Activity
5.5. Alcohol, Tobacco, and Other Drugs
Diet and Nutrition
6.1. Factors Influencing Digestion, Absorption, and Elimination
6.2. Vitamins, Minerals, and Micronutrients
6.3. Diet, Lifestyle, and Disease Prevention
6.4. Herbs and Botanicals
7.1. Yang Sheng: The Ancient Art of Self-Care
7.2. Tea and Infusions
7.3. Foot Soaks
8.1 Appendix 1. Menopause Toolkit
8.2 Appendix 2. Evidence Based Acupuncture Menopausal Symptoms Evidence Summary
8.3 Acupuncture Protocols
84 Appendix 3. TCEAM Formulas
8.5 Appendix 4. Glossary of Traditional Chinese Medicine Terms
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The vasomotor system includes the nerves and the structures from which they arise (e.g., the medulla oblongata or spinal cord) that regulate blood flow to specific organs or body parts by controlling the blood vessels’ internal diameter.
Vasomotor symptoms (VMS) are synonymous with menopause, including hot flushes and night sweats. They affect the majority of individuals to some extent during the climacteric period. Vasomotor symptoms can be defined as periodic episodes of intense heat accompanied by sweating or flushing.
They usually affect the head, neck, chest, and upper back, lasting 3–10 minutes, and may occur multiple times each day. In some cases, vasomotor symptoms may be accompanied by feelings of anxiety and palpitations.
The severity of vasomotor symptoms usually peaks between late perimenopause and early post-menopause. However, they may occur much earlier, even before the onset of menstrual irregularities, and persist into a person’s 60s or 70s. For this reason, it is essential that practitioners learn how to treat hot flushes and night sweats to alleviate their patients' suffering.
As women approach menopause, their ‘thermoregulatory zone’ narrows, meaning the range within which normal body temperature is maintained reduces. Thus, even small fluctuations in the external temperature can trigger a homeostatic response, including peripheral vasodilation and perspiration.
The exact physiological mechanism underlying vasomotor symptoms is unclear. However, they appear to be the result of multiple central and peripheral systems interacting abnormally due to fluctuating oestrogen and FSH levels. The fact that oestrogen replacement therapy reduces vasomotor symptoms suggests that reduced oestrogen levels are a critical factor.
The serotonergic, noradrenergic, autonomic, and vascular systems may all play a role in the development of vasomotor symptoms. There is also some inconsistent evidence suggesting the involvement of the endogenous opioid system. One theory suggests that decreased oestrogen levels increase noradrenaline release, upregulating hypothalamic serotonin receptors, which play a role in temperature control.
Although vasomotor symptoms are extremely common, the following risk factors can predict more severe, more frequent, and longer-lasting problems:
According to the large-scale Study of Women's Health Across the Nation (SWAN) study, the ethnic group most likely to be severely affected by vasomotor symptoms is African-Americans. The least likely groups to suffer are Chinese and Japanese women, while Caucasian and Hispanic women report similar rates of vasomotor symptoms.
The reason for these differences is unclear. In the past, it has been suggested that East Asian women suffer fewer vasomotor symptoms due to a higher soy intake. However, this does not appear to be the case. Other possible explanations are cultural differences in the way menopause is interpreted, experienced, and reported to health professionals, particularly in cultures where doctors are mostly male.
Women with a higher body mass index, especially those carrying excess abdominal fat, have a higher risk of experiencing severe vasomotor symptoms. This could be due to increased endocrine dysregulation or the additional insulation of adipose tissue. However, the precise reasoning is not fully understood.
Both active and passive smoking may increase the risk of severe vasomotor symptoms. Many of the chemicals in cigarette smoke have anti-oestrogenic properties.
Women who suffer from anxiety or depression tend to experience more severe vasomotor symptoms. There also appears to be a connection with childhood abuse or neglect and lower socioeconomic status (see chapter 5.2 Stress, Trauma, and Stress Resistance).
Diet and Exercise
The direct link between diet, physical activity, and vasomotor symptoms has not been confirmed. However, eating a balanced, calorie-controlled diet and engaging in regular physical activity can contribute to a healthy body mass index, which in turn could reduce the risk of vasomotor symptoms.
Traditionally, VMS (and menopause in general) have been associated with Kidney deficiency, especially Kidney yin deficiency. In reality, the aetiology of this symptom is usually far more complex.
While Kidney deficiency is common among older patients, either Kidney yin or Kidney yang deficiency may predominate. However, it is rare to see one without at least some degree of the other. Furthermore, other zangfu are frequently involved, as are qi and Blood deficiency or stasis.
In TCEAM terms, VMS may be seen as a form of tidal heat effusion, or chaore. There are several different patterns of disharmony that may underlie tidal heat effusion, which we will discuss below. These may occur in combination with a variety of other underlying patterns.
- Predominance of Kidney yin deficiency
- Predominance of Kidney yang deficiency
- Kidney and Liver yin deficiency with Liver yang rising
- Kidney and Heart not harmonised
- Yin and Blood deficiency
- Spleen and Stomach qi deficiency
- Yangming repletion
- Summer-heat invasion
- Blood stasis
Rebellious Qi in the Penetrating Vessel (Chongmai)
Around menopause, the qi of the chongmai can become destabilised, causing symptoms such as hot flushes and anxiety. This is not a clinical pattern in itself, but may occur alongside other patterns, including cold, heat, stagnation, and phlegm.
The chongmai has two branches originating from Yinhui REN-1. One branch descends to the feet while the other ascends to the face. Around the time of menopause, qi in the chongmai may become destabilised causing it to rebel upward and fail to descend. This can occur as a result of various excess or deficiency factors, including heat, cold, stagnation, etc.
Feelings of heat in face, cold feet, headache, feeling of a lump in the throat, breast distension/pain, flutter in the chest or above the stomach, palpitations, slight breathlessness, sighing, chest tightness/oppression, abdominal fullness/distension/pain, irregular/painful/heavy periods, hypogastric fullness/distension/pain.
To make a diagnosis, at least three symptoms must be present at different physical levels (i.e. hot face, cold feet, and abdominal symptoms), in combination with anxiety.
Pulse: Firm and beating straight up and down in all three positions, from chi to cun, being most pronounced in the middle (guan) position. However, the precise quality will vary depending on coexisting excess and deficiency patterns, meaning that patients may present with a wide variety of pulses.
Tongue: Variable, depending on coexisting excess and deficiency patterns.
Harmonise the chongmai, subdue rebellious qi.
For cold: Wu Zhu Yu Tang
For heat stagnation: Zuo Jin Wan
For phlegm: Wen Dan Tang
For food stagnation: Bao He Wan
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