By Xianmin Yu, Registered Acupuncturist

What is perimenopause?

Perimenopause refers to a period around menopause, which marks a transition period of female’s sexual function from maturity to decline or to the end of reproductive time. This transition period usually starts in the mid-40s, but some females might even start this process as early as their late-30s. Perimenopause is actually a normal process for females to have some physiological changes. Due to body constitution differences, and social and psychological factors, females who could not adapt to this physiological transition smoothly, would develop perimenopausal syndrome accordingly.

Perimenopause involves a series of clinical symptoms caused by endocrine (i.e., reproductive endocrine and neuroendocrine) disorders and autonomic dysfunction which are triggered by decreased estrogen level. As ovarian function declines to complete loss, both blood estrogen and progesterone levels drop, which breaks up the balance of hypothalamus-pituitary-ovarian axis, and thus leads to autonomic dysfunction.

Typical symptoms are irregular periods (i.e., the coming period is unpredictable as the length of time between two periods varies dramatically).

Popular clinical symptoms include sleep disorders (i.e., insomnia, shallow sleep, easy to wake up, dreaminess), sweating after hot flashes, fatigue, palpitation, dizziness, ear ringing, irritability, depression, anxiety, joints pain (osteoarthritis), low back sore, and heel pain.

Other common clinical symptoms include forgetful, breast fullness, abnormal skin sensations, knee weakness, decreased sexual desire, intercourse pain, etc.

Thee symptoms vary in severity, and may show up partially or entirely in some severe cases.

How is Perimenopause discussed in Traditional Chinese medicine (TCM)?

According to TCM theory, degeneration of kidney’s function is the fundamental pathogenesis. Deficiency of conception vessel and penetrating vessel leads to disharmony between qi and blood, yin and yang. It is also related to heart, liver and spleen function. There are a few typical patterns listed here:

1. Liver and kidney yin deficiency, which is characterized by irregular periods with less but very red blood, dizziness, ear ringing, sweating after hot flashes, irritability, low back sore and knee weakness.

2. Spleen and kidney yang deficiency, which is characterized by irregular periods with less but light red blood, fatigue, lack of appetite, forgetful, nocturnal enuresis and decreased sexual desire.

3. Disharmony between heart and kidney, which is characterized by irregular periods, insomnia, palpitation, dizziness, ear ringing, sweating after hot flashes, irritability and anxiety.

4. Both kidney yin and yang deficiency, which could have included all the symptoms mentioned above.

How could acupuncture help with Perimenopause?

Acupuncture could be used to regulate hormone level, to enhance immune function, to rebalance autonomic disorders, to postpone the aging process of cells, and to reduce blood total cholesterol (TC) level and low-density lipoprotein cholesterol (LDL-C) (which are potential cardiovascular risk factors) according to a few clinical studies 1-12. Two out of these ten studies further suggested acupuncture could have an effect on rebalancing hypothalamus-pituitary-ovarian axis 7-8.

Acupuncture method is slightly different between early to middle perimenopause stage and late perimenopause stage. During early to middle stage, acupoints used to sooth liver and calm mind were selected as key points, adding up one or two acupoints focusing on reinforcing kidney. In the late stage, acupoints focusing mainly on reinforcing kidney yin and/or yang were selected. Besides, it is also quite common that many females may have blood stasis inside the bodies. Thus, one or two additional acupoints for activating blood circulation may be added upon to the existing acupuncture formula.

What is the best time to start acupuncture treatment?

It is strongly recommended to start acupuncture intervention in the early stage of perimenopause (i.e., as soon as period starts to become irregular and/or a few symptoms are observed frequently), as the acupuncture could maximize its therapeutic effect (i.e., reduce symptoms frequency and severity, and thus improve quality of life).

Could acupuncture work with other therapeutic methods?

It is highly recommended to start a cocktail treatment plan, which include acupuncture, herbs and ear pellets. The comprehensive method is expected to achieve a better therapeutic effect than one method alone, and to preserve this effect longer, in order to help our clients get through this period more smoothly. The acupuncturist is collaborating with the naturopathic doctors in the clinic to offer the most suitable and highly individualized treatment plans for every client.

How many sessions are needed?

Sessions could be varied from person to person based on your body constitution and the Perimenopause stage when you come to resort to the practitioner. In general, it is recommended once a week for eight weeks or twice a week for four weeks, and then the practitioner will reassess the client’s body constitution to discuss the next step. Usually a few more follow-ups will be advised with longer Intervals between two sessions (i.e., once every two weeks, or once every month to once every two months). As the practitioner will acquire your feedback on each follow-up session, more details will be discussed then.

What are the precautions when trying acupuncture?

As always, please do not come for acupuncture with either a complete empty stomach or a complete full stomach, as the former condition could trigger dizziness while the latter condition would trigger nausea or even vomit. Drinking alcohol is also not encouraged before your acupuncture appointment.

 

References:

  1. Avis, N. E., Coeytaux, R. R., Isom, S., Prevette, K., & Morgan, T. (2016). Acupuncture in Menopause (AIM) study: a pragmatic, randomized controlled trial. Menopause, 23(6), 626-637.
  2. Avis, N. E., Legault, C., Coeytaux, R. R., Pian-Smith, M., Shifren, J. L., Chen, W., & Valaskatgis, P. (2008). A randomized, controlled pilot study of acupuncture treatment for menopausal hot flashes. Menopause, 15(6), 1070-1078.
  3. Chiu, H. Y., Pan, C. H., Shyu, Y. K., Han, B. C., & Tsai, P. S. (2015). Effects of acupuncture on menopause-related symptoms and quality of life in women in natural menopause: a meta-analysis of randomized controlled trials. Menopause, 22(2), 234-244.
  4. Fang, Y. R., Wang, L. J., & Zhou, X. (2004). The changes of serum sex hormone levels, free radicals, and lipid content in perimenopausal women. Shiyong Fuchanke Zazhi, 20(3), 151-152.
  5. Kim, K. H., Kang, K. W., Kim, D. I., Kim, H. J., Yoon, H. M., Lee, J. M., … & Choi, S. M. (2010). Effects of acupuncture on hot flashes in perimenopausal and postmenopausal women-a multicenter randomized clinical trial. Menopause, 17(2), 269-280.
  6. Kim, T. H., Lee, M. S., & Alraek, T. (2017). Acupuncture for the management of menopausal and perimenopausal symptoms: Current clinical evidence and perspectives for future research.
  7. Li, G. A., & Yu, Y. (2002). Research on acupuncture treatment of female climacteric syndrome. Shang Hai Zhen Jiu Za Zhi, 21(3), 6-8.
  8. Painovich, J. M., Shufelt, C. L., Azziz, R., Yang, Y., Goodarzi, M. O., Braunstein, G. D., … & Merz, C. N. B. (2012). A pilot randomized, single blind, placebo-controlled trial of traditional acupuncture for vasomotor symptoms and mechanistic pathways of menopause. Menopause (New York, NY), 19(1), 54.
  9. Porzio, G., Trapasso, T., Martelli, S., Sallusti, E., Piccone, C., Mattei, A., … & Marchetti, P. (2002). Acupuncture in the treatment of menopause-related symptoms in women taking tamoxifen. Tumori, 88(2), 128-130.
  10. Sunay, D., Ozdiken, M., Arslan, H., Seven, A., & Aral, Y. (2011). The effect of acupuncture on postmenopausal symptoms and reproductive hormones: a sham controlled clinical trial. Acupuncture in Medicine, 29(1), 27-31.
  11. Wyon, Y., Lindgren, R., Lundeberg, T., & Hammar, M. (1995). Effects of acupuncture on climacteric vasomotor symptoms, quality of life, and urinary excretion of neuropeptides among postmenopausal women. Menopause: The Journal of the North American Menopause, 2(1), 3-12.
  12. Xu, T. S. (2004). Research on auricular acupuncture combined with body acupuncture for menopausal syndrome. Xiandai Zhongxiyi Jiehe Zazhi, 13(17), 2269-2270.