By Uma Saema
“I am falling to pieces, I have a horrible, flat, feeling. Am I going mad?”
A lot of women only understand menopause and perimenopause after the event. Studies suggest that most women feel unprepared for menopause, don’t know what to expect or how to react to optimise their health when they find themselves undergoing the transition.
This is hardly surprising. There are a bewildering variety of symptoms and these are often experienced very differently from person to person and from culture to culture.
Thankfully in recent years the topic has become a lot less taboo and there have been major public campaigns towards greater awareness and support for women going through this significant and natural change in our lives.
Today, there are commonly agreed four menopausal stages:
- Pre-menopause: i.e. the period before your body starts making changes towards menopause. You will have a normal period cycle and no symptoms.
- Peri-menopause: i.e. the transitional period. You will observe changes in your normal period cycle, quantity or quality and menopausal symptoms start appearing. Pregnancy is still possible.
- Menopause: i.e. the end of menstruation. You will have no period for 12 consecutive months. Symptoms may still present, but pregnancy is no longer possible
- Post-menopause: i.e. You will have had no period for longer than 12 consecutive months, but symptoms may still be present.
While peri-menopause and menopause usually occur between the ages of 45 and 55 they can also happen earlier; either naturally, or as a result of medical interventions such as surgery or cancer treatment.
In a typical menopause, women can start their symptoms up to 10 years before and some still experience symptoms strongly as long as 10 years afterwards.
This is a very long time to have your life disrupted, and so unsurprisingly a lot of women feel they have reached the end of the road and fear they will never feel great again.
Treatments for menopause
There are a number of ways to help smooth the menopausal process. Hormone replacement therapy or HRT which has been the primary treatment for menopausal symptoms under the NHS is gaining more acceptance and has helped many women. Otherwise, alternatives to deal with specific symptoms such as clonidine or gabapentin for hot flushes, or antidepressants may be offered. Lifestyle and dietary adjustments along with regular exercise can also make a big difference.
Some look towards complementary medicine. This generally falls into two categories- firstly food supplements and herbal medicine, secondly mind-body practices such as yoga, cognitive behavioural therapy, hypnotherapy, etc, including the subject of this piece, acupuncture.
Acupuncture is increasingly popular for women who cannot or choose not to take hormone therapy- either because of lack of access to HRT, unsatisfactory outcomes or to manage or avoid side effects of the treatment. Recent randomised control trials and systematic reviews also support the idea that acupuncture can help with reducing the severity of hot flushes and improving mental health during menopause.
My Approach to Acupuncture
Good health to me doesn’t mean that everything has to work at full capacity at all times. If we can imagine our body as an orchestra, good health is where each instrument knows its role within the whole and which plays harmoniously as one ensemble. If instead, you were to have all the instruments play at full volume and without listening to each other, it would be a complete cacophony!
Most of the time your body conducts this music itself very well. A life change is like a new piece of music that our body needs to learn. As an acupuncturist my role is like a guest conductor who steps in to guide the ensemble to a new and more cohesive interpretation.
The needles in acupuncture are used to send messages through your body’s internal communication and feedback systems to let your body know how to make adjustments to play harmoniously and with focus.
How I treat menopause
Chinese medicine always views body changes such as menopause as a gradual, continuous process of transformation. While certain signs indicate shifts, such as the arrival or cessation of periods, overall changes like this are not abrupt and a following a process of adjustment to these transitions in our lives is very important.
I am also wary of seeing menopause- a multidimensional and natural experience- as a collection of independent negative symptoms to be treated independently, and this view is supported by a growing number of health experts who voice concerns that by seeing the menopause experience simply as a ‘hormone deficiency’ we risk seeing menopause as a pathology, and of over medicalising any treatment.
For me, menopause is like a new piece of music for the body to learn and learning a new piece of music takes time and effort. Menopause is a natural transitional process that happens within your overall health and wellbeing and when I treat you, I do not separately identify what is, and what isn’t menopausal.
Through listening to and observing you in the treatment room, I use this to inform me of the reaction patterns your body is undergoing. And I sometimes use a Chinese 5 elements system of categorisation to help me understand this.
Five Elements or Wu Xing is an ancient Taoist system for grouping aspects of nature that are deemed to share certain characteristics under the categories of Wood, Earth Fire, Metal and Water. This framework can be used to categorise different systems in our body and physiological processes that results from the interplay between the elements. It can also be used to indicate an individual’s constitutional predispositions.
As a very rough example, menopause conditions showing muscle spasms & pain, high blood pressure and high levels of frustration might indicate a wood type. Anxiety, nervous exhaustion, profuse sweating, hot flushes, rashes and insomnia might suggest a fire type. Being someone with a lot of worries, digestive symptoms, lethargy and water retention, might suggest an earth type. Chills, loss of libido, backaches and arterial problems may be categorised as indicating a water type. Stiff joints and muscles, dry skin and hair, breathing problems might point towards metal and so on.
This would indicate a rough guide to the areas of body for which work might be needed. I will then investigate further into the area associated with the type and using Chinese medicine system of diagnosis to find out which organ functions is involved, and whether this suggests excess or deficiency, ‘hot’ or ‘cold’, what level is effected, qi, blood, nutrients and so on. It is also normal for a person to present a mixture of types and for symptoms in one element to have originated from a glitch in a different element altogether.
Summary
A path to manage the menopause transition appropriate to you.
Five elements is just one pattern identification method and I will always do my best to come to a diagnosis and work with you to steer your transformation through path that is appropriate to you. I always strive to do this without bias on my part. Going back to the orchestra analogy, sometimes problems may not just be about communication, sometimes the instruments themselves need to go back to the workshop- sometimes medication does need to be part of the answer.
Underpinning all this I believe very strongly that if the different aspects of the body are communicating well are and working in harmony (i.e. they are ‘conducted’ well) then at least half of the battle is already won. And I have seen how acupuncture in conjunction with lifestyle adjustments can make a major difference in helping manage the menopause transition for many women.