Menopause is a season that marks the end of a person's reproductive years. It might be a joyful season if those years were filled with uncomfortable menstrual symptoms or a season of grief if the family you yearned for did not eventuate. 

Menopause is super rare in the animal kingdom, it occurs only in humans, two kinds of whales, and was recently discovered in some wild chimpanzees.  These are some of the longest-living female creatures alive today, with lifespans extending well beyond reproductive years. They are also, like humans, social creatures, living in groups, often related matrilineally.

There’s no scientific consensus as to why menopause occurs in these animals. One theory from evolutionary biology known as the ‘grandmother hypothesis’ posits that menopause preserves genetic lineage; rather than competing with younger descendants to reproduce, an elder can support the survival, well-being, and reproduction of their children (& grandchildren). In the human world, this extends beyond the conventional idea of ‘family’ out to society generally - where even people who are not parents can extend their value to future generations through experience and wisdom. 

Menopause is a one-day event, marked on the day twelve months following the final menstrual period. The lead-up to menopause, when characteristic symptoms may start to arise alongside continued menstrual cycles, is called perimenopause, and it can start well before menopause, like, I’m talking late 30s - early 40s.

I want to be clear about one thing, perimenopause (and menopause) is a season of life, a natural phenomenon, not a diagnosis and not a pathology. Hear me out… we do not take our child to the GP for a diagnosis of “first period” and we do not tell our friends and family “I’ve been diagnosed with pregnancy”… But I am seeing more and more people referring to their “perimenopause diagnosis” on chat groups, support pages and in the clinic too. Why are we being given pathological terminology to describe a natural transition?

I do not ask this question to diminish people’s symptomatic experiences, these are very real and require support and care, that’s part of why I am here, writing about it.

Each person experiences perimenopause differently; some glide through with no issues, and others experience life-altering symptoms. It’s called ‘the change’ for a reason. Things change, then as you get used to a particular symptom or way of feeling, they change again. Then those things change again.

It can be unpredictable, but it’s also a window of golden opportunity. 

A traditional perspective and philosophical approach to peri-menopause

In Chinese medicine, menopause is referred to as the 'Second Spring'. It represents the renewal of energy and opportunities as there is a shift from fertility and reproduction to conserving and nourishing one's self. The body is no longer focused on creating and nourishing a new life but can focus that energy inwardly.

As a Westerner, I don’t see value in commenting on East-Asian cultural views of aging and romanticising stereotypes.

There are some beautiful signs that we are starting to recognise ageism and shifting toward celebrating elder wisdom in our culture; when it comes to challenging cultural norms and standards, though, we have a way to go. 

As a doctor of Chinese Medicine, I will share some ancient wisdom that has passed through the ages. The Nei Jing, one of our seminal texts, did not pathologise menopause; instead, it quite logically explained the different life cycles for a woman (remember, this text is thousands of years old, so it speaks in binary of man/woman). The lifespan (of a woman) was mapped out in seven-year cycles, each seven-year segment described a shift in the state in the natural history of someone’s function. 

Here are some noteworthy ones:

• At two times seven (14 years old), ‘heavenly gui’ arrives (this is menarche, the first menstrual period)

And yes, this is happening earlier in modern times with a current age range starting at 9 years of age.

• At five times seven (35 years old), ‘yang ming’ (gut function) subtly weakens, peak condition begins to decline. As a result of this decline in gut function, there is a decline in the production of qi & blood (nourishment). The body, in its wisdom, begins to assess the allocation of energy toward the possibility of creating a pregnancy each month.

As a side note, I find it interesting that this segment of seven coincides with the Western concept of ‘Advanced Maternal Age’ (previously known as geriatric pregnancy - a term you will never again hear me say), and the idea that it becomes more difficult to conceive after the age of 35…

• At seven times seven (49 years old), the heavenly gui is exhausted and one can no longer bear children (this is menopause)

And yes, it is happening later in modern times with the average age of menopause being 51, but up to 55 is commonplace as well.

Reframing Menopause with acupuncture & Chinese medicine

For me, there is a sense of everything following its natural course, everything as it should be. And together with the ‘grandmother hypothesis’ we spoke about earlier, I have a real sense that menopause can be reframed as a positive experience. A golden opportunity.

Some people will have a positive experience of perimenopause. For others, it will be confusing and overwhelming and have a massive impact on the quality of their lives. There is no one-size-fits-all approach to this process. Your experience of perimenopause and the years that follow will be unique to you. 

And it is a process. And the process starts earlier than you might think.

Acupuncture & Chinese Herbal Medicine can help symptoms of peri-menopause

What better way to support someone going through an entirely personal experience than with a wholly personalised treatment approach? Individualised treatment is inherent to Chinese medicine.

Acupuncture has been shown in clinical trials to effectively reduce, ameliorate or manage numerous symptoms associated with perimenopause, including hot flushes, insomnia, palpitations, night sweats, depression & anxiety,  urogenital symptoms, osteoporosis and cognitive decline (1). 

Let’s take a brief look at each of these areas.

Vasomotor Symptoms (VMS - aka hot flushes & night sweats) & Acupuncture

Hot flushes and night sweats are among the most commonly experienced issues, affecting up to 70% of menopausal people. A 2009 review (2) concluded that the majority of studies on acupuncture for VMS reported 50% reductions in hot flashes that lasted for up to six months. These results were supported by a 2015 meta-analysis (3) which found that acupuncture significantly reduced the frequency & severity of hot flashes. 

Mood & mental health (menopause-associated anxiety, depression) & Acupuncture

Irritability and mood disturbances can be driven by fluctuating hormone levels and/or sensitivity to hormones. Alongside anxiety & depression, anger and rage are super common during perimenopause. This may be at least in part thanks to the toll of the increased mental load, emotional labour and unpaid work that are typical features of being forty-something, this stage of life can be full of stressors. 

The authors of a 2013 review (4) including six trials with a total of 605 female subjects aged 18–71, concluded that acupuncture was “promising” as a therapy for menopausal women with depression. They went on to say: “At this time, it is reasonable to use acupuncture as an adjunctive therapy for treating depression in postmenopausal women who have vasomotor symptoms.”

An earlier 2007 review (5)  focused on acupuncture for anxiety. It included 12 controlled trials, 10 of which were RCTs. All of the trials reported positive outcomes.

Sleep (peri-menopause-associated insomnia, disturbed sleep) & Acupuncture

A 2015 review (6) included 12 studies on acupuncture for sleep disorders in post-menopausal females. The studies involved a wide range of treatment protocols, interventions, and durations. Overall, 75% reported improvements in sleep complaints following acupuncture treatment.

Cognitive decline in Perimenopause & Acupuncture

We often don’t consider it as such, but menopause is very much a neurological event. There is a change in the HPOA (hypothalamic-pituitary-ovarian axis) as ovarian hormone production begins to decline. I suspect we are going to start seeing some interesting details emerge in this area in the coming years.

The risk of cognitive decline, including Alzheimer’s disease, increases significantly following menopause. A 2019 systematic review and meta-analysis (7) found that acupuncture provided some benefits. It included 13 studies comparing acupuncture with medication alone. The results showed that acupuncture had positive effects and a high clinical efficacy rate.

A note on the research: acupuncture trials tend to be small (we don’t have access to big pharma budgets), and there is no sure way to compare to a placebo, as even touching the skin has therapeutic benefits. So, there is always a need for more, quality research to fill the evidence gaps.

Other areas where acupuncture might be able to help ease the transition through peri-menopause

Not yet supported by high enough quality modern evidence to claim efficacy, acupuncture might also be able to support changes in libido (for us, this is a yin yang thang), and urogenital symptoms like irregular periods, UTIs, prolapse, vulvodynia, and increased urinary frequency.

What to expect from my peri-menopause acupuncturist?

As a complimentary healthcare provider, we will always work collaboratively with your chosen care team, whether your GP, gynecologist, pelvic physio, hormone specialist, naturopath or whomever.

We will never judge your choices or persuade you to choose differently when it comes to menopausal hormonal therapy (MHT), which helps a lot of people. We will encourage informed decisions and second opinions if your primary care team isn’t adequately meeting your needs.

We will encourage lifestyle changes; during the perimenopausal transition, it becomes increasingly important to nourish yourself appropriately, to move appropriately, to manage and eliminate stress, to reduce or cut alcohol & smoking, to define & maintain personal boundaries, and to prioritise quality sleep.

And foot soaks. I will for sure encourage regular herbal foot soaks. More on that soon.

References

1. https://www.evidencebasedacupuncture.org/acupuncture-menopause/

2. Alfhaily F, Ewies AAA. Acupuncture in managing menopausal symptoms: hope or mirage?. Climacteric. 2007; 10(5): p. 371-380.

3. Chiu HY, Pan CH, Shyu YK, Han BC, Tsai PS. Effects of acupuncture on menopause-related symptoms and quality of life in women in natural menopause: a meta-analysis of randomized controlled trials. Menopause. 2015 Feb; 22(2): p. 234-244.

4. Sniezek DP, Siddiqui IJ. Acupuncture for Treating Anxiety and Depression in Women: A Clinical Systematic Review. Medical Acupuncture. 2013; 25(3): p.164-172.

5. Pilkington K, Kirkwood G, Rampes H, Cummings M, Richardson J. Acupuncture for anxiety and anxiety disorders – a systematic literature review. Acupuncture in Medicine. 2007; 25(1-2): p.1-10.

6. Bezerra AG, Pires GN, Andersen ML, Tufik S, Hachul H. Acupuncture to Treat Sleep Disorders in Postmenopausal Women: A Systematic Review. Evidence-Based Complementary and Alternative Medicine. 2015; 2015:563236.

7. Huang, Q., Luo, D., Chen, L. et al. Effectiveness of Acupuncture for Alzheimer’s Disease: An Updated Systematic Review and Meta-analysis. Current Medical Science. 2019; 39: p.500–511.