Menopause & Hot Flashes | Chiyu Acupuncture

"Menopause” is defined as the permanent cessation of menstruation and is diagnosed when a woman has had no menstruation for 12 consecutive months. It is due to the primary dysfunction of the ovaries’ production of hormones, estrogen and progesterone. This is a normal aging process for all women. The average age of menopause in Canadian women is 51 years old but it usually occurs at an age ranging from 45 to 55. However, women going though the change-of-life will experience many symptoms with fluctuation and decline in the levels of estrogen and progesterone with elevated FSH (follicle-stimulating hormone) for some years before and after “menopause” actually hits – this period is called “perimenopause” and lasts for 2-8 years.

The up-and-down of the hormones causes a variety of symptoms:

Change in menstruation - irregular (shortened or prolonged) cycles; heavy or scanty periods; bleeding/spotting between periods, etc.

Vasomotor symptoms - hot flashes, night sweats, chills, palpitations, pseudo-hypertension (hypertension related to stress and emotional attack).

Psycho-physiological symptoms - headaches, dizziness, insomnia, fatigue, anxiety, nervousness, mood swings, depression, poor memory; low libido; joint pain, muscle pain etc.

Atrophic changes - vaginal dryness; urethritis (difficult and/or frequent urination with pain or uncomfortable sensation); sensitive skin, itchy skin, wrinkles; hair loss; dry eyes, etc.

Some women experience mild symptoms, however, some suffer from severe symptoms that affect their daily activities of life. In addition to these subjective symptoms, this hormonal change brings menopausal women osteoporosis and high cholesterol that could lead to fracture and cardiovascular diseases (e.g. high blood pressure, heart attack) in the future.

What treatment for menopause is right for you?

Conventional hormone replacement therapy (HRT) with synthetic hormones is considered the standard treatment for menopause and related conditions in Western Medicine. It may alleviate symptoms, but will also have many significant side effects with the increased risk of breast, ovarian and uterine cancer. Although it is well known that taking estrogen with progesterone avoids this risk, the risk still remains.

Recently, bio-identical hormone replacement therapy (BHRT) with hormones derived from plants such as yams and soy is becoming more popular, and is considered as safe alternatives to conventional HRT. However, some of you may have heard the recent news on BHRT say that it may also increase the risk of cancers like HRT; the BHRT creams, which are hand-mixed by pharmacists, are untested and unregulated by Health Canada, and therefore women on BHRT can’t be sure of the levels of hormones they are absorbing.

Traditional Chinese Medicine (TCM) (acupuncture and Chinese herbal medicine) is right for you if you are looking for a natural way to regulate the hormones to relieve your perimenopausal/menopausal symptoms.

There are many studies that prove that acupuncture is effective to reduce hot flashes and accompanying symptoms (click here to see "studies")

Chinese herbal medicine has a long history in treating gynecological diseases including menopause, and offers a gentle yet effective way to reduce menopausal symptoms. When prescribed by a qualified herbalist, Chinese herbal medicine is very safe and is without serious side effects.

The combination of acupuncture and Chinese herbs are very effective to reduce hot flashes, night sweats and other accompanying symptoms by regulating the body and correcting imbalances naturally.

I would recommend acupuncture treatment twice per week to start (gradually reduced to once a week upon improvement) along with taking Chinese herbs. You will notice an improvement in hot flashes, sleep, emotions and overall health within 1-2 months. The higher the frequency of treatment, the faster results will be obtained.

Self-care for Menopause

1) Regular exercise

Regular exercise can help manage many of the uncomfortable menopausal symptoms as well as the related health issues, such as heart disease and osteoporosis.

In TCM theory, exercise helps our qi/energy and blood flow freely throughout the body, which is very important to fight against sickness and maintain health because all diseases start from the imbalance of qi/energy and blood! In other words, stress, emotions and over-thinking are the main causes of imbalance of the body in TCM, and exercise can help you release stress and cope with emotions.

2) Diet

Avoid spicy foods, coffee and alcohol -- they are "warm" in nature and aggravate hot flashes.

Avoid or cut back on drinks and foods that contain caffeine such as coffee, soda, colas, cocoa, chocolate etc. -- this is because caffeinated drinks, especially carbonated beverages, can leech calcium from your bones, and speeds elimination of many minerals and vitamins that are essential to health by its diuretic effect. Black tea and green tea contain about half the amount of caffeine that coffee does (tea 50 mg/cup, coffee 100 mg/cup).

Avoid (or cut back) on sweets, sugar, greasy foods including dairy products, and raw foods, and cold foods. When they are over-consumed they can weaken your spleen, which results in not producing enough qi/energy and blood and generating pathogenic water called dampness. As a result, fatigue, insomnia, digestive problems, and/or joint & muscle problems may occur. Note: when it comes to dairy foods, it can be a little controversial because they are a good source of calcium (see blow).

Eat calcium-rich foods -- these include dairy products (yogurt, milk, ice cream, cottage cheese, Romano cheese, Parmesan cheese, cheddar cheese, Swiss cheese, mozzarella cheese etc.), soy products (tofu, soy milk, soy yogurt etc.), and green vegetable (broccoli, collard greens, spinach, kale, and beans etc.).

Eat more foods rich in phyto-estrogens and progesterones: soy beans, red clover sprouts, yams, and flaxseed.

Eat more tryptophan-rich foods such as meat (red or lean meat, beef, mutton, chicken, especially turkey), seafood (fish, shrimps, scallops, seaweed etc.), dairy products (milk, cheese, yorgurt etc.), soy products, eggs, rice, nuts & seeds (hazelnuts, peanuts, sesame seeds, sunflower seeds), legumes (beans, split peas, lentils, etc.), and some fruits (bananas, figs, and dates, etc.). Tryptophan, an essential amino acid (which can't synthesized in the body and must be obtained from dietary sources), is the precursor to serotonin. Serotonin regulates the moods and may help sleep, and any imbalance in serotonin levels can lead to depression.

3) Supplements

B-complex with folic acid 400 mcg daily

Coenzyme Q10 (CoQ10) 60-120 mg daily

Calcium 1200-1500mg/daily + Vitamin D 600 IU/daily - they are essential to prevent bone loss. Vitamine D helps to fight some forms of cancer and assists in reducing inflammation.

Magnesium 500mg daily - it is known as 'nature's tranquilizer'. It also an important mineral for bone.

Omega-3 1000mg daily - it protects against blood clots, controls lipid levels, strengthens cell membranes and makes red blood cells.

Zinc 15-25g daily (with calcium) - it may protect against dementia and depression.

Vitamin E 800-1200 IU daily - it is an antioxidant and protects against cancer. It may decrease the risk of heart disease and stroke, and may improve memory.

L-glutamine 500mg daily (before meals) - It stabilizes blood sugar levels and protects from insulin spikes. It works in conjunction with calcium to curb sugar cravings.

4) Absolutely do not smoke! 

Smoking is considered to give your body heat, which aggravates hot flashes and night sweats. More than that, smoking does not do anything but harm your body.

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If you are interested in modern clinical research on menopause and acupuncture/herbal medicine, please click here.

If you are interested in the Chinese Medicine theory on menopause, please read on.

How Traditional Chinese Medicine views menopause?

I would like to give you a little lecture of some basic theories about aging in Traditional Chinese Medicine (TCM) first. In TCM, we have the five important organs in the body, which are the Liver, Heart, Spleen, Lungs, and Kidneys. They are very different from the anatomical organs in Western Medicine (WM). The Kidneys are the organs responsible for growth, development including sexual maturation, reproduction and aging (unlike the anatomical kidneys). The Kidneys store the essence, which is inherited from our parents (called prenatal essence; equivalent to genes or hereditary in WM) and acquired from food and drinks (called postnatal essence), and decline of the Kidney-essence is directly related to aging. The Kidneys are also the root of the other organs and the whole body. They are the root of everything of the body and have two important aspects; one is the Kidney-yang that is the root of the fire of the body, keeps our organs and body warm and provides energy (qi) for all physical activities, and the other the Kidney-yin that is the root of water of the body that reserves nutrients including the blood and moisture and fuel for all physiological activities. The Kidney-essence also has some more functions; first, it produces the marrow. The marrow produces the bone marrow and fills the brain and spinal cord. Therefore as the Kidney-essence declines, our bones become fragile and our memory becomes poor (dementia, Alzheimer’s disease if severe). In TCM, teeth are considered as extension of bone, and therefore we start losing teeth when we become old. Second, it nourishes the head hair with the blood – the essence and the blood have the same source and transform into each other, so if either of them becomes deficient, the other is also affected, resulting in hair loss. Therefore, deficiency of the Kidney-essence causes fall-out and/or graying of the hair. In addition, the Kidneys open into the ear, and therefore, we lose hearing with aging. These are how TCM explains general aging.

Back to menopause: now we know that aging is attributed to Kidney disorders. The Kidney-essence is the basis of the Kidney-yin & yang, and therefore as the Kidney-essence declines with aging, both of the Kidney-yin and yang decline. The Kidney-yin & yang control each other to keep them in balance, but as they decline, they get out of balance, which causes a various symptoms – this is how menopause is explained in TCM. Most symptoms come from a combination of both yin & yang deficiency, however, yin deficiency usually predominates since women lose the blood (that belongs to the yin) monthly and are prone to blood deficiency.

As mentioned earlier, the Kidney-yin is the root of water and controls the kidney-yang, the fire of the body. If you don’t have enough water to control the fire, the fire goes up and causes hot flashes and sweating. Night is the yin time when the yin prevails, and therefore sweating occurs more at night (night sweats). Deficiency of the yin also causes dryness in many parts of the body such as vaginal dryness, skin dryness etc.

The kidney-yang is the root of fire and provides energy for all physical activities. If it is deficiency, you may suffer from fatigue, a feeling of cold of the body and limbs.

Furthermore, the Kidneys are not only the organ affected because all the five organs have a relationship with each other; the Kidneys are the mother of the Liver, and if the Liver is affected, you may have irritability, mood swings or depression since the Liver controls emotions. The Kidneys have a special relationship with the Heart; Kidney-water and Heart-fire need to be in balance. If there is not enough Kidney-water (Kidney-yin), the Heart-fire flares up causing palpitations, insomnia etc. The Kidney-yin is the root of all the yin of the other organs, so Kidney-yin deficiency may cause Liver and/or Heart-yin deficiency, which result in more symptoms.

The Kidney-yang is the root of all the yang of the other organs, and it often fails to provides the yang to the Spleen (Spleen-yang deficiency). Since the Spleen has the important functions of generating the qi (energy) & blood by digesting food and drinks, and the Spleen-yang deficiency also causes digestive problems (diarrhea etc.), fatigue and so on. This is how TCM explains for menopausal changes.

How TCM can treat menopause?

The main principals for treatment for perimenopause or menopause is to make the yin & yang balanced by supplementing them. However, that is not enough. If there is yin deficiency causing fire flaring up in the body, the fire needs to be cleared. If there is yang deficiency causing cold accumulation in the body, the cold needs to be removed by warming the body. If there is deficiency of any of the essence, yin, yang, qi or blood, it needs to be replenished. If there is any of excessive heat, cold or pathogenic water, it should be eliminated. If there is stagnant of the qi and blood, they need to be moved. Any kind of imbalance needs to be corrected. If the mind is not calm, it has to be settled down. This is how TCM treat menopausal conditions. Everyone has a different menopausal condition and therefore different symptoms. We TCM practitioners find out what conditions are causing your menopausal symptoms, and set up a tailor-made treatment for you.

Acupuncture is very good at calming the mind and making the qi & blood flow smoothly and get balanced; however, the best way to treat menopause is in combination with Chinese herbs, which are more powerful in moving, eliminating and supplementing.

Studies on Menopause

A pilot randomized, single-blind, placebo-controlled trial of traditional acupuncture for vasomotor symptoms and mechanistic pathways of menopause. Painovich JM et al. Menopause. 2012 Jan;19(1):54-61: "Both TA (traditional acupuncture) and SA (sham acupuncture) reduce VMS (menopause-related vasomotor symptoms) frequency and severity and improve VMS-related quality of life compared with WC (waiting control); however, TA alone may impact the hypothalamic-pituitary-adrenal axis."

Menopause-related Symptoms: Traditional Chinese Medicine vs Hormone Therapy. Azizi H et al.Altern Ther Health Med. 2011 Jul-Aug;17(4):48-53: "Conclusion application of the combination of Chinese herbal medicine and acupuncture proved as effective as hormone therapy in the treatment of menopause-related symptoms, and it achieved better outcomes than herbal medicine alone."

Effects of acupuncture on hot flashes in perimenopausal and postmenopausal women--a multicenter randomized clinical trial. Kim KH et al. Menopause. 2010 Mar;17(2):269-80: "Our results suggest that acupuncture in addition to usual care is associated with marked clinical improvement in hot flashes and menopause-related symptoms in perimenopausal or postmenopausal women."

The Acupuncture on Hot Flashes Among Menopausal Women study: observational follow-up results at 6 and 12 months. Borud EK et al. Menopause. 2010 Mar;17(2):262-8: "The statistically significant differences between the study groups found at 12 weeks were no longer present at 6 and 12 months. Acupuncture can contribute to a more rapid reduction in vasomotor symptoms and increase in health-related quality of life in postmenopausal women but probably has no long-term effects."

Norwegian group have published several papers on their study on acupuncture treatment for hot flashes/menopause called "ACUFLASH".

Depression in postmenopause: a study on a subsample of the Acupuncture on Hot Flushes Among Menopausal Women (ACUFLASH) study.Dørmænen A et al. Menopause. 2011 May;18(5):525-30.

The effect of acupuncture on postmenopausal symptoms and reproductive hormones: a sham controlled clinical trial. Sunay D et. Acupunct Med. 2011 Mar;29(1):27-31.

The acupuncture treatment for postmenopausal hot flushes (Acuflash) study: traditional Chinese medicine diagnoses and acupuncture points used, and their relation to the treatment response. Borud EK et al. Acupunct Med. 2009 Sep;27(3):101-8. "CONCLUSIONS: factors other than the TCM syndrome diagnoses and the point selection may be of importance regarding the outcome of the treatment."

The Acupuncture on Hot Flushes Among Menopausal Women (ACUFLASH) study, a randomized controlled trial. Borud EK et al. Menopause. 2009 May-Jun;16(3):484-93. "Hot flash frequency decreased by 5.8 per 24 hours in the acupuncture group (n = 134) and 3.7 per 24 hours in the control group (n = 133), a difference of 2.1 (P < 0.001). Hot flash intensity decreased by 3.2 units in the acupuncture group and 1.8 units in the control group, a difference of 1.4 (P < 0.001). The acupuncture group experienced statistically significant improvements in the vasomotor, sleep, and somatic symptoms dimensions of the Women's Health Questionnaire compared with the control group. Urine calcitonin gene-related peptide excretion remained unchanged from baseline to week 12.