Menopause is a time of transition, a crossing from one state to another. The key in all transitions is to find safe passage across what can be rough waters. From the point of view of traditional Chinese medicine, a key year in this transition lies in the 48-49 year range. When confronted with menopausal or peri-menopausal symptoms, there are three main paths that a woman can take:
▪ Conservative. This views menopause as a natural transition where treatment should be minimal. In my practice, women who choose this path use classical homeopathy and perhaps some nutritional and dietary therapy to manage symptoms.
▪ Energy Imbalance Perspective. This point of view reflects the understanding of Chinese medicine (TCM). From the point of TCM, hot flashes and other menopausal symptoms arise out of an energy imbalance that can easily occur at mid-life. The energy of the kidneys, which create cooling vital fluids, declines at menopause, and thus fall out of balance with the fire energy of the body. The water-fire balance tips in favor of heat and leads to hot flashes. In addition, when women stop menstruating, they may load extra toxicity which formerly was excreted through menstruation. If the body does not find a new balance, illness may develop. Women who choose the energy balance path can use herbal therapy to replenish their lost vital essence, and often hold this balance through the transition and beyond. They may or may not use classical homeopathy along with this approach.
▪ Hormonal Imbalance perspective. This is viewpoint of a segment of western doctors, particularly those involved in anti-aging medicine, and has been popularized by Suzanne Somers. In this view, the decline of hormones in mid-life leads to symptoms. To manage the symptoms, this view advocates replenishing the lost hormones with bio-identical hormones. The agreement among all doctors who work at the forefront of this field is that estradiol (estrogen) should not be taken orally. Doctors mainly prescribe transdermal (applied to skin) application for both estradiol and progesterone replacement, although many advocate taking the progesterone orally if there is insomnia. Within this group of doctors, there are many individual variations, but two main groups you should be aware of:
⁃ -Cyclers: This sub-group, whose chief proponent is Susie Wiley, maintains that women should take hormones in a way that mimics the hormonal rhythms of a younger, menstruating women. In this method of hormone replacement, the first half of the cycle is an estrogen phase and the second half is a progesterone phase. When hormones are cycled in this way it will promote a menstrual period. The Wiley Protocol is the most extreme of the cycler group, because it advocates returning a woman to the higher hormonal levels of a young woman, attempting to exactly mimic the rhythm of young adulthood.
-Non-cyclers: This group usually gives static (i.e. the same dose each day) daily doses of hormones. If a diagnosis of “estrogen dominant” is given, then there will be a daily dose of progesterone alone. Other situations may call for giving both estradiol and progesterone. Some doctors always give a combination of estradiol and progesterone each day.
In reference, to the above three approaches, here is the approach of my practice:
1) If I had to choose only one therapy from the above three, I would choose classical homeopathy. The reason is that this treatment is so deep that it can manage most health problems. With a good homeopathic prescription, a woman feels better than using either Chinese herbal medicine or bio-identical hormone replacement alone, or together. I find that using bio-identical hormone replacement can be limited in cases where the health of the woman is not that good.
2) Treating with classical homeopathy and then supplementing with Chinese herbals to fine-tune and build the vital essence of the body is an excellent way to proceed.
3) Using all three approaches together. This has slowly been evolving into my treatment of choice. First I like to begin with classical homeopathy and see how things balance out. From there, if signs of deficiency exist, I will restore the balance with herbals. I find that then adding in bio-identical hormones optimizes how a woman feels, allowing her to move into a new and higher state of well-being.
4) Although I recognize arguments for both Cyclers and Non-Cyclers, my prescribing sides more with the Cyclers. Before prescribing a cycling regimen, though, a woman needs to be OK with the likelihood of menstruating beyond normal menopausal age. If you give bio-identical estrogen in the first half of the cycle, followed by progesterone in the second half, a woman will build up a uterine lining (assuming she has a uterus). When the progesterone is stopped at the end of the cycle, bleeding will occur. All doctors using bio-identical replacement therapy agree that taking some bio-identical hormones is healthier than not, even when given in a low-dose static way. I agree, however, with the Cyclers who argue that a static dose of hormones tends to “clog” the receptors, inhibiting them from regenerating.
5) Although I have seen no evidence, either in practice or in the literature, that bio-identical hormone replacement promotes cancer or any other disease, I have seen evidence that giving too much of either estradiol or progesterone can create toxicity. Thus, I do not want to say that bio-identical hormone replacement is without risks. It is important to tune in to how you feel when you start taking bio-identical hormones. If you do not feel better, you either need to change the regimen or stop them. When bio-identical hormone replacement works, this is reflected both in measurements (e.g. the Digimeridian I use) and in how you feel.
The above is a brief summary of an evolving field. Use it as general guidelines, asking questions to find answers that suit your individual needs and outlook. Trust that, for those in the know, there are profound interventions that can make the menopausal years healthy and joyful.
