Menopause


Diagnosis

+/- 49 years young, menses stop. Around this time symptoms & signs start to appear. Cycle becomes irregular, dizziness, blurred vision, tinnitus, hot flashes, red complexion coming & going in waves, very emotional (anger, irritated, sadness, anxiety, etc.), edema, low back & knee weakness / pain, digestive problems, cold limbs, & urinary disorders. These do not come all at once, some women only get a few & some women encounter many. This may last for weeks to years in some cases. In U.S.A. The average age at menopause onset is approximately 51. [Soule MR, Bremmer WJ. The menopause and climacteric: Endocrinologic basis and associated sypmtomatology.1

TCM diagnosis can be divided into 3;

  1. menstrual cycle gets very irregular, bleed a lot, may be serious hemorrhage. Then may experience very occasional menses until they cease completely. May lose hair from blood ↓.
  2. ↓ Yang symptoms → Yang rises due to Yin ↓ (relative Yang ↑). WM says this is due to blood vessels contraction. Sudden heat → break sweat (hot flashes), dizziness, palpitations & rapid pulse.
  1. emotional imbalances → easy to anger, sadness etc. Manic behavior, depressed, abnormal, violence, & insomnia are all common. A blood test may show high FSH meaning ovary function has ceased.

 

Etiology

  1. KI Yin ↓ - pregnancy, menses, breastfeeding & abortions consume Essence & Tian Gui (hormones), Chong & Ren cannot be nourished. This creates hyper Yang rising.
  2. KI Yang ↓ - use of a lot of KI Qi for pregnancy, menses, breastfeeding & abortion consume the Ming Men Fire → KI Yang is ↓ & you see cold signs.

 

 

Pathogenesis Differentiation & Treatment

1. KI Yin ↓

  • occasional menses → scanty → cease completely. Vaginal dryness & itchiness (ph is not regulated properly anymore).
  • Plus – Yin ↓< sym. dizzy, tinnitus, insomnia, night sweats, afternoon heat feelings, back/knee pain/weakness, hot flashes w/ sweating, whole body itchiness. T- red w/ scanty coat P- thin rapid
  • P/T – nourish KI Yin
  • Rx – Zou Gui Wan (essence) or …
    Liu Wei Di Huang Wan + Huang Bai, Zhi Mu
    = Zhi Bai Di Huang Wan
    + E Jiao, Gui Ban, Bie Jia, He Shou Wu, Nu Zhen Zi
  • Rx – BL 23 & KI 3, SP 6, Ren 3, HT 7, Si Shen Cong
  • irritable- MH 7

2. KI Yang ↓

  • HEAVY periods, irregular uterine bleeding, then gradually finish menses completely, T- pale P- deep thin
  • Plus – Yang ↓ sym. cold, soft stools, ↑ frequency of urine, incontinence, low back/knee weakness/pain, Edema of lower limbs &/or face.
  • P/T – warm KI Yang – strengthen SP
  • Rx – You Gui Wan + Li Zhong Wan
  • Rx – BL 23, Ren 4, Du 4, with moxa, BL 15, SP 6
    • poor digestion- BL 20, ST 36
    • insomnia- HT 7

 

3. Combined KI Yin and Yang Presentation

  • P/T – nourish KI Yin & Yang
  • Rx – Er Xian Tang  (this may be taken long term)

 

Emergency Hemorrhage

  • Rx – Shen Fu Tang
    + stop bleeding herbs (Xian He Cao, Ai Ye Cao, Bai Ji, Han Lian Cao)
    → MOXA Du 20

Alternative Treatment Methods

  • auricular- endocrine, aubcortex, internal repro. organs, *KI, HT, Shenmen, sympathetic, LR

References

1. Soule MR, Bremmer WJ. The menopause and climacteric: Endocrinologic basis and associated sypmtomatology. J Am Geriatr Soc 1982;30:547 - 561.