Menopause: A Woman’s Cycle

Ladies, we are in good company. There are few female mammals who can expect to live a substantial period of their lives in a post-reproductive state. Humans are one of these mammals along with killer whales, short-finned pilot whales, narwhals and beluga whales. ⁽¹⁾ Menopause is an unusual trait. Being unable to reproduce seems to be counter to the prime directive of all species, which is to continue the genetic code through offspring. The benefits of having an older female around center around knowing migratory patterns, food sources, and care for the young. ⁽²⁾ With menopause, human females can live up to fifty years beyond natural reproduction.

For millions of years, pregnancy and childbirth have been a hazardous undertaking. Those who survived would surely have beneficial knowledge. Without pregnancy and children, a woman could be freer innovate and problem-solve for the group. Given the long term evolutionary overview, this benefits the survival of the species. The triple goddess theme found in many cultures and reflects the three phases of a woman’s life: maiden, mother and crone. Crone being post-menopausal. Webster’s Dictionary defines a crone as a woman who is venerated for experience, judgment, and wisdom. Perhaps our first bipedal ancestor was an old granny who was able to stand upright to check for lions in the tall grass. Far from being a state of lost youth, menopause is an ingenious life extender. According to World Health Organization 2019 statistics, women outlive men worldwide.

Menopause is a consequence of ovarian decline. This results in low circulating estrogen and progesterone. It is not the first time these hormones have taken a dramatic dive. If the woman breastfed this same condition occurred. Peri-menopause symptoms start in middle age and 70% of women experience some of them. They include irregular periods, excessive bleeding, hot flashes, night sweats, mood swings, loss of libido, and vaginal dryness. As Estrogen continues to drop the body compensates and stores estrogen in the form of fat. Existing fat deposits are redistributed to the breasts, abdomen, and hips. New fat appears in these areas. Additionally, there can be a reduction of muscle mass in the upper arms. Menopause officially starts after menstruation completely ceases. At this time, lower hormone levels can bring on additional symptoms: anxiety, depression, irregular heartbeat, insomnia, digestive problems, constipation, headache, and/or incontinence. It’s probably easier to be a menopausal whale. Hot flashes are not a problem in the cool ocean and whales are built to carry estrogen storing fat.

It’s not all about ovaries. During menopause, the female body undergoes a transformative dance that shifts from one system of hormones to another. It switches from ovaries to adrenals. These little bean-shaped organs that perch atop the kidneys have been waiting their whole lives to be the stars of the show. The two hormones once produced by the ovaries, progesterone, and estrogen, can be produced by the adrenals. Progesterone is directly produced. Estrogen is made through secreted androstenedione. Androstenedione combined with aromatase from adipose tissue (remember fat that seemed to appear out of nowhere?), converts into estradiol, the most potent estrogen. A little pudge softens menopausal symptoms. Androstenedione is also converted into testosterone. Testosterone also converts into estradiol with the help of aromatase. Until menopause, the adrenal’s role to produce female sex hormones is minimal. However, sometimes they are working too hard at their regular job.

Throughout our lives, the adrenals have been secreting cortisol, aldosterone, and adrenaline, along with other hormones. Adrenal secretions help the body to adapt to stressors by regulating blood sugar, metabolism, circulation, and electrolyte levels. All this contributes to health and wellness while navigating the day today. When the day to day is overloaded by stressors, the adrenals become fatigued and can no longer produce the needed levels of hormones.

You see where this is going, right? Healthy adrenals are the keys to a comfortable transition into menopause and beyond. Traditional Chinese Medicine (TCM) sees adrenal function as part of Kidney function. Based thousands of years of empirical knowledge, the protocol for most menopause symptoms is to treat Kidney Qi. This includes Kidney Yin, Yang, and Jing depending on the presentation. Menopause is seen as the natural/inevitable waning of Kidney Qi starting with Kidney Yin. Yin is the cooling and calm component. Without Yin to hold him down and balance his heat, Yang will rise up and cause symptoms. These include feelings of heat in the face, hot flashes, night sweats, anxiety, insomnia, and palpitations. If Yang wanes this adds cold symptoms to the mix like cold feet, fatigue, and difficulty concentrating. When there is too much exhaustion from overwork Jing is damaged and all symptoms become more acute as both Yin and Yang depend on Jing for renewal. ( Hmmm sounds like the relationship between the adrenals and progesterone and estrogen.) Let’s look at formulas and how they have helped with menopause for, in some cases, thousands of years.⁽³⁾⁽⁴⁾

Lui Wan Di Huang Wan

Six Flavor Pill with Rehmannia

This lovely formula hails from 1119 C.E. Originally composed for children who did not thrive due to Kidney deficiencies, it is currently a popular anti-aging tonic in China. Liu Wei Di Huang Wan treats all the Yin organs without being cold or cloying. Balance within the formula is achieved by using the six flavors: bitter, sour, sweet, salty, acrid, and bland. The focus is primarily on Kidney Yin and Essence, which makes it a good candidate for balancing the symptoms of menopause. The symptoms that indicate use are hot flashes, night sweats, insomnia, sore knees, and lower back. This a particularly appropriate formula when there is exhaustion from overwork. Overwork hurts the Kidneys and can damage Kidney Essence. Kidney Essence is the stuff of life. It controls birth, puberty, menopause, and death. It is the material basis for Kidney Yin and Yang. Good stuff to hang onto, when it’s used up life is over. Shu Di Huang enriches Essence, Shan Zhu Yu prevents its leakage, Shan Yao supports the Spleen to stabilize Essence.^(3)(4)(5)
Caution: weak digestion

Zhi Bai Di Huang Wan

Anemarrhena, Phellodendron and Rehmannia Formula

If you can’t stand the heat take some Zhi Bai Di Huang Wan. This formula is Lui Wei Di Huang Wan with two herbs to help with fire flaring upward: Zhi Mu and Huang Bai. Indications for Zhi Bai Di Huang Wan include those of the previous formula, however, symptoms are more acute and worse at night. The insomnia is characterized by being able to fall asleep easily but waking several times during the night and waking early in the morning. Other key symptoms are red cheeks, mental restlessness, anxiety, dark urine, and constipation. The tongue is red and peeled, possibly with cracks. ⁽⁴⁾⁽⁵⁾
Caution: weak digestion or Yang deficiency.

Tian Wan Bu Xing Dan

Emperor of Heaven’s Special Pill to Tonify the Heart

This formula addresses the same issues of Kidney Yin with fire flaring as Zhi Bai Di Huang Wan, but with a different twist. Tian Wan Bu Xing Dan treats some of the cognitive issues that ride in on the menopause train. This is one of the older formulas, dating back to the Ming Dynasty (16th C.E.) from a book called “Fine Formulas for Women”. Previous to being recorded the formula was storied to have been given to an exhausted Buddhist monk by the gods in a dream. Its effect in treating exhaustion from too much thinking is near magical. ⁽⁵⁾ The herbal actions of Tian Wan Bu Xing Dan are to enrich the Yin, nourish the Blood, clear Heat and calm Spirit. The chief herb nourishes Kidney Yin making this a natural for menopause symptoms. Nourishing the Blood nourishes the Heart, the home of the Shen or “Mind”. If the Heart is deficient the Shen will be disturbed. This results in dull or slow thinking. In terms of cognition, the Kidneys play a part by being home to the Zhi. Zhi translates as “memory” or “will power”. Zhi gives the ability to memorize and store data. A lack of Zhi/Will Power causes chronic depression as well as cognitive difficulties. Indications for use of Tian Wan Bu Xing Dan are irritability, anxiety, palpations, fatigue, insomnia with very restless sleep, inability to think or concentrate for even short periods of time, forgetfulness, dry stools. Additional indications can be mouth and tongue sores, low-grade fever, and night sweats.⁽⁵⁾
Caution: Careful with weak digestion.

Yuo Gui Wan (Yang) / Zuo Gui Wan (Yin)

Restoring the Right Kidney / Restoring the Left Kidney

Most menopause symptoms result from a deficiency of Kidney Yin, however, sometimes Kidney Yang can be more deficient. In such a case hot flashes will be accompanied by cold hands and feet. Night sweats happen in the early morning hours. The woman would be depressed, chilly, and pale. As with all Kidney deficiencies, there is backache and this time it is paired with edema of the ankles. The tongue is pale. The correct herb formula is Yuo Gui Wan. Since it is rare that menopause is solely a Kidney Yang deficiency adding in Yin using Zuo Gui Wan is easily done and appropriate. To balance a Yang deficiency take a full serving of Yuo Gui Wan ( Yang ) in the morning ( Yang time ) and one third to one half serving Zuo Gui Wan ( Yin ) in the evening ( Yin time ). Ideally, evening serving should be taken with slightly salted warm water. Salt nourishes the Kidney Yin and benefits the adrenals. If there is more Yin deficiency take more Zuo Gui Wan in the evening and less Yuo Gui Wan in the morning.⁽³⁾⁽⁴⁾

Er Xian Tang (Wan)

Two Immortal Decoction

Composed by Shanghai physician, Zhang Bo-Na, in 1950 Er Xian Tang is considered a modern formula. It was designed to treat hypertension in menopausal women. It is an example of using traditional therapeutic strategies for bio-medically defined diagnoses. The TCM diagnosis for Er Xian Tang is a deficiency of Kidney Yin and Yang with fire flaring at the Gate of Vitality (AKA Ming Men). Without sufficient Kidney Yin and Yang the Ming Men fire, which powers all the internal organs is not contained and flares upward. This is precious fire and vital to life, it needs to be preserved. Symptoms of this condition will appear mixed hot and cold. Hot symptoms from Yin deficiency are irregular menstruation, amenorrhea, hot flashes, sweating, nervousness. Cold symptoms from Yang deficiency are fatigue, lassitude, depression, frequent clear urination, cold feet, and muscular flaccidity. Symptoms of fire flaring upward are irritability, insomnia, palpitations. The tongue can be either pale or red without a coat. With the correct presentation, this formula is used for the following bio-medical conditions: peri-menopausal syndrome, essential hypertension, chronic glomerulonephritis, chronic pyelonephritis, polycystic kidneys, renal vascular disease, hyperthyroidism, urinary tract infection, and hypofunction of the anterior pituitary. ⁽⁵⁾ A rat study proved Er Xian Tang to be both osteoprotective and boosts the bones self-renewal capacity.⁽⁶⁾ Another study of 108 peri-menopausal women showed after three months greatly reduced hot flashes and improved quality of life in terms of menopausal symptoms. Interestingly there was no change in serum hormone levels. ⁽⁷⁾

Three Immortals from Health Concerns is a related formula. It is Er Xian Tang plus Er Zhi Wan (Two Solstice pill) and Gan Mai Da Zao Tang.

Er Zhi Wan is just two herbs as the translation implies, Nu Zhen Zi and Mo Han Lian. It is first found in a book dating from1534 called “Essential Formulas to Support Longevity”. Optimally the Nu Zhen Zi is picked during the Winter Solstice and Mo Han Lian during the Summer Solstice. The source text says this formula will “Make hair black like a crow, strengthen the back, knees and insufficient yin.” Currently, this formula is widely used in China to clear Heat and nourish Liver and Kidney Yin. All patterns that come with menopause. The third formula in Three Immortals is Gan Mai Da Zao Tang. The four herbs in this unassuming formula seem more at home in the kitchen than the apothecary, but be not deceived. This formula is highly effective for brain fog, sadness, crying, depression, and restless sleep. Research shows it protects the brain from the effects of stress.⁽⁸⁾ It would be a good addition to any herbal menopause protocol where symptoms are worse with stress. All together Three Immortals take on the physical, cognitive and emotional repercussions of menopause when both Yin and Yang are deficient. Symptoms addressed include headaches or migraines‚ hot flashes‚ night sweats‚ irritability‚ vertigo‚ digestive difficulties‚ lower back pain‚ insomnia‚ depression‚ tinnitus‚ reduced sex drive‚ heart palpitations‚ graying hair‚ and bleeding gums.

Serving size: For all the formulas mentioned in this article consume according to label directions or instructions from your knowledgeable healthcare practitioner.

Wherever you are in the menopause timeline, herbal treatments should be based on your presenting symptoms. These may change over time. It is beneficial to review long term herbal treatment periodically. Acupuncture treatments will compliment any herbal strategy. Get your Qi tuned up!

Disclaimer: Use herbs wisely. If you have questions or special considerations, work with your practitioner. If symptoms worsen or you have concerns, contact a knowledgeable practitioner. These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease.

References

1 Samuel Ellis, Daniel W. Franks, Stuart Nattrass, Thomas E. Currie, Michael A. Cant, Deborah Giles, Kenneth C. Balcomb & Darren P. Croft, Analyses of ovarian activity reveal repeated evolution of post-reproductive lifespans in toothed whales, Scientific Reports, volume 8, Article number: 12833 (2018)
https://www.nature.com/articles/s41598-018-31047-8

2 Ricki Pollycove, Frederick Naftolin, James A. Simon, Menopause, The evolutionary origin and significance of Menopause, PMC 2012 Sep 4.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3433273/

3 Maciocia, G., Obstetrics & Gynecology, Churchill Livingstone, 1998

4 Maciocia, G., The Foundations of Chinese Medicine, Churchill Livingstone, 1989

5 Scheid, Bensky, Ellis, Barolet, Chinese Herbal Medicine Formulas & Strategies 2nd Edition, Eastland Press, 1990

6 Shufen Liu, Jianhua Huang, Jing Wang, Yongjian Zhao, Sheng Lu, Yongjun Wang, Qin Bian, Er-Xian Decoction Stimulates Osteoblastic Differentiation of Bone Mesenchymal Stem Cells in Ovariectomized Mice and Its Gene Profile Analysis, Hindawi Publishing Corporation Stem Cells International. Volume 2016, Article ID 4079210
http://dx.doi.org/10.1155/2016/4079210
https://www.semanticscholar.org/paper/Er-Xian-Decoction-Stimulates-Osteoblastic-of-Bone-Liu-Huang/467eba9b813518433f2d273243a2cc79f9337183

7 Linda Zhong, Grace Tang, Yao Tong, Zhang-Jin Zhang, A randomized, double-blind, controlled trial of a Chinese herbal formula (Er-Xian decoction) for menopausal symptoms in Hong Kong perimenopausal women, Menopause (New York, N.Y.) July 2013 20(7):767-76
https://www.researchgate.net/publication/241693399_A_randomized_double-blind_controlled_trial_of_a_Chinese_herbal_formula_Er-Xian_decoction_for_menopausal_symptoms_in_Hong_Kong_perimenopausal_women

8 Jian-Shu Lou, Chang-Yu Li, Xiao-Chun Yang, Jie Fang, Yuan-Xiao Yang & Jian-You Guo, Protective effect of gan mai da zao decoction in unpredictable chronic mild stress-induced behavioral and biochemical alterations, Journal of Pharmaceutical Biology, Vol. 48, 2010, Issue 12
https://www.tandfonline.com/doi/full/10.3109/13880201003789440