By Harriet Beinfield, L.Ac., and Efram Korngold, L.Ac., OMD
Most gynecologists have a knee-jerk reaction: if it's menopause, it's
time for Premarin. While this may be right for some women, some of the
time, it is not for all women all of the time. Most women want to heed
their doctors - some seek to be educated about alternative points of
view. Although hormone supplementation may be useful and warranted,
conventional pharmaceuticals (like Premarin, Provera, Estraderm, Estrace)
are not the only or necessarily best choice. When combined, acupuncture,
herbal formulas, and natural hormone creams can be of enormous benefit.
Western and Chinese medical paradigms are quite parallel in the way they
describe the menopausal process. One speaks through the language of
hormones and their interaction with the reproductive organs, and the
other uses the vocabulary of Essence and its relationship with the
Kidney. Understanding hormone supplementation with the context of
Chinese medical thinking will maximize our ability to treat menopausal
women effectively. Translating from West to East, steroid hormones can
be regarded as Essence (jing) tonics.
The Western Vocabulary of Hormones
Derived from the Greek word 'hormon,' meaning to urge on, excite, or
stimulate, hormones are chemical messengers disseminated via the
bloodstream to regulate cell physiology. They interact with and
counterbalance each other. In the follicular phase, the ovaries secrete estradiol to produce eggs. After ovulation, the space once occupied by
the egg becomes the corpus luteum, which produces progesterone - about
20 mg/day. During pregnancy the uterus and placenta produce up to 400
mg/day of progesterone (pro-gestation). Progesterone can be considered a
precursor hormone, meaning that it occupies the headwaters from which
flow a stream of steroid hormones including cortisol, androstenedione,
testosterone, and the estrogens (estrone, estradiol, estriol). The
ovaries, along with the thyroid and adrenals, form an integral part of
the hypothalamic-pituitary axis responsible for the fundamental
regulatory processes of reproduction, growth, maturation, metabolism,
maintenance of temperature and pressure, red blood cell production, and
adaptation to stressors like infection, trauma, and other environmental
influences.
In spite of the recognized complexities of hormonal dynamics,
disturbances that occur in menopausal women are simplistically
attributed to the decline of ovarian function and the consequent
cessation of estradiol secretion. A complex chronological, biological,
and cultural event has been reduced to a single problem: estrogen
deficiency-with an apparently uncomplicated and obvious solution:
estrogen replacement.
The current medical wisdom is the product of an industrially
manufactured consciousness. In 1966, Searle, Upjohn, and Wyeth-Ayerst
pathologized the perception of menopause, transforming it from a
transitional life stage into a chronic disease process by hiring a
Brooklyn physician named Robert A. Wilson to write a book called
Feminine Forever, proclaiming that estrogen would protect a woman's
youth and save her from "living decay." The book injected fear by
insisting that without estrogen replacement therapy (ERT), bones would
dissolve, hearts clog, vaginas shrivel, breasts sag, skin crinkle, and
minds deteriorate.
Estrogen became perceived to be the miracle antidote to loss. The
marketing campaign worked. Menopause is now universally and virtually
unanimously treated with estrogen. Estrogen sales jumped from $17
million in 1966 to $83 million in 1976, and in 1990, sales swelled to
$460 million. This in spite of the NIH Consensus Conference on Estrogen
Use and Postmenopausal Women that concluded: "Given the current state of
knowledge, no general recommendation, applicable to all postmenopausal
women, can be made...(HRT is a) promising but unproven approach to
prevention."
The Chinese Vocabulary of Essence
While Western doctors define the problems associated with menopause as
stemming solely from estrogen deficiency, in Chinese medicine estrogen,
along with other hormones, is subsumed within the larger category of
internal secretions known as Essence (jing). Estrogen is a kind of
Essence, just like carrots are a kind of vegetable; but just as all
vegetables are not carrots, not all Essence is estrogen.
In John Lee, M.D.'s descriptive definition, it is striking how easily
the term Essence (jing) can be substituted for steroid: "Steroid
[hormones] stabilize, energize, nurture our cells and tissues, ensure
repair and replication of vital tissue, protect us against damage, and
foster the genesis and development of a new life to carry on our
species." The same functions performed by the hypothalamic-pituitary
axis - the capacity to grow, mature, reproduce, maintain stability,
generate blood and marrow, adapt to stress, repair body tissues - are
governed by the Kidney. Inherited and acquired Essence, pooled within
the reservoir of the Kidney, are stored and dispensed as needed. All
other organ systems live downstream from this inland sea, dependent on
its supply.
When Essence is plentiful, our ability to resist disease and adapt to
change is optimal. With age, fundamental resources ebb, and these
capacities decline. In youth it is possible to compensate for spending
more biological cash than is returned to our reserve Essence account,
but as this principal diminishes over time, we become less able to push
ourselves without receiving notice of insufficient funds. If throughout
our lives we run the body economy at a deficit, the dearth of resources
eventually catches up with us. Menopausal complaints are the outcome of
deficit spending: the debt can no longer be rolled over, because there's
no longer a cushion of funds from which to draw. Menopausal problems
result from the diminution of Essence and a consequent deficiency of Qi
and Blood.
Stored by the Kidney, Essence is the origin of all Yin (Blood and
Moisture) and Yang (Qi and Warmth). Loss of libido, stamina, hearing,
and vision, lower back pain, sore hips or knees, apathy, despair, dull
mindedness, memory problems, vaginal dryness and atrophy, thinning of
bones, and deterioration of teeth and gums are all symptoms of deficient
Essence.
When Essence becomes depleted, so do Blood and Qi, Yin and Yang. Lack of
Qi produces fatigue, weakness, dull thinking, melancholy, and decreased
motivation. Deficiency of Blood leads to weak vision, dizziness, night
sweats, irritability, and restless sleep. Lack of Blood deprives
muscles, tendons, and ligaments of sufficient nourishment and
suppleness, so they become tight and inflamed, leading to muscle cramps,
joint pain, and neck tension. The organism responds to this state of
scarcity with
Anxiety and lability, for lack of Blood disrupts the
smooth flow that preserves elasticity of tissue and emotional
flexibility. As Kidney Essence declines, a domino effect engenders down
line deficiencies that eventually impact the Liver, Heart, Spleen, and
Lung.
Hot flashes are a consequence of the inability of Yin to restrain Yang,
so heat flares upward uncontrollably. Yin deficiency of the Liver and
Heart can trigger hyperactivity that leads to rising Heat. But hot
flashes may also be a consequence of Kidney Yang deficiency, or weakened
Life Gate Fire. When Kidney Yang is weak, the Spleen becomes unable to
extract the necessary nutrients to generate adequate Moisture and Blood.
This results in Dryness (dry eyes, skin, hair, and vagina, brittle
nails, constipation, even cystitis). This in turn undermines shen-jing,
the unified relationship between Heart and Kidney, Mind and Essence.
Kidney Yang deficiency engenders Spleen weakness, causing symptoms such
as lethargy, weakness, easy bruising, poor concentration, fluid
retention, indigestion and bloating. It also leads to a weakening of the
Kidney's capacity to anchor the Qi, permitting True Yang to leave its
proper place in the Lower Burner and surge upward, producing agitation,
flushing and perspiration, followed by chilliness, weakness, and
fatigue.
In sum, labile emotions and unpredictable surges and lapses of physical
and mental energies result from the attrition of Yin and Yang Essences
of the Kidney, causing the Qi of the Liver, Heart, and Spleen to become
erratic and insufficient. Many women have signs of both Kidney Yin and
Yang depletion. But because hot flashes, sweating, agitation, and
dryness (Kidney Yin Deficient symptoms) are more attention-getting,
herbs that treat Kidney Yin deficiency are often overemphasized at the
expense of those that restore the true Yang of the Life Gate, an equally
important goal.
Diet and Menopause
Dietary changes can be profoundly helpful. Many menopausal women become
lactose intolerant and eliminating milk products can dramatically reduce
symptoms of indigestion like bloating and gas. In general, high
carbohydrate consumption can be problematic. Carbohydrates are broken
down into glucose, which triggers insulin production. Excessive
carbohydrates lead to excessive levels of insulin which reduces the
cell's ability to respond to hormone stimulation. While foods with a
sweet flavor tonify Qi and Blood and strengthen the Spleen, excess
sweetness will produce dampness and stagnation. This results in feelings
of heaviness, lethargy, distension, constipation, diarrhea, muscle
soreness, and puffiness. Spleen Qi stagnation leads to Liver Qi
stagnation, resulting in irritability, frustration, hypersensitivity,
cramps, swollen breasts, mood swings, and headaches.
By reducing carbohydrate intake, one reduces the level of circulating
insulin, enabling the cells to respond normally to thyroxin,
progesterone, estrogen, testosterone, cortisol, and other hormones. This
disturbed carbohydrate-insulin dynamic interferes with the liver's
ability to detoxify excess estrogen: women with symptoms of Liver Qi and
Blood stagnation are likely to be estrogen dominant. These women will
benefit by restricting carbohydrate consumption (grains, cereal, bread,
potatoes, pasta, fruit, or fruit juice) to one meal a day, preferably
dinner. Digestive aids such as pancreatin and plant-based enzymes as
well as friendly intestinal microflora (probiotics) will also help to
normalize the function of the Stomach and Spleen.
The Yin and Yang of Estrogen and Progesterone
The life process demands the capacity for proliferation and restraint,
growth and its regulation - both are necessary for conception,
gestation, birth, and development. Ordinarily estrogen is considered to
be a Yin-promoting agent because it relieves conditions of Yin
deficiency (hot flashes, dryness) as well as producing conditions of Yin
excess (Dampness, Blood stasis). Progesterone could easily be considered
a Yang agent because of its ability to enhance fat metabolism and
thyroid function, as well as improving circulation of Blood and
distribution of fluids.
However, in the context of developmental cycles, estrogen acts like a
Yang agent because it promotes cell division and rapid growth; whereas
progesterone acts like a Yin agent because it moderates growth by
promoting cell differentiation and maturation. Pregnancy requires cell
proliferation, differentiation, and maturation - both Yin and Yang
functions. The dynamic of estrogen and progesterone can be compared to
that of the sheng (engendering) and ke (controlling) sequence. In later
life we are not supposed to continue to proliferate tissue at a rapid
rate, grow, and accumulate mass, but rather to mature.
Because of Western medical education and research, we are aware of the
benefits of estrogen and uninformed about the value of progesterone.
Whereas estrogen levels decline by 50 per cent at menopause,
progesterone levels can drop nearly to zero. Even though the ovaries
cease producing estradiol, estriol continues to be made by the adrenal
glands and in fat cells. Canadian endocrinologist Jerilynn Prior has
found that athletes with low progesterone levels but high estrogen
showed signs of osteoporosis, provoking her to speculate that it is
perhaps progesterone deficiency, not estrogen depletion, that is the
true culprit. It is also not widely known that lifelong exposure to
xenoestrogens (estrogen-like compounds found in petrochemicals) destroys
follicular function, preventing the development of the corpus luteum,
resulting in massive estrogen dominance and profound progesterone
deficiency. Excess estrogen, whether endogenous (produced by the body)
or exogenous (from outside the body), creates Qi and Blood stagnation,
particularly affecting the Liver and Spleen.
Phytosterols
There is no direct evidence that plants contain compounds that are the
same as estrogens. Norman Farnsworth, an internationally renowned
pharmacognosist, states that because plants have been used successfully
to induce ovulation and increase fertility, it's logical but not
necessarily correct to infer that it must be because they contain
substances that are equivalent to human and animal hormones. Yet a great
variety of plant constituents are similar in their molecular structure
to human steroid hormones. The implications of this are still under
investigation in an attempt to explain the mechanism by which herbs
affect hormones. It is speculated that herbal agents: stimulate
endogenous hormone production; sensitize and/or increase hormone
receptors; inhibit steroid degradation by altering the rate of
catabolism in the liver (producing the net effect of more circulating
hormones in the blood stream). Also, we now know that compounds such as
genistein in soy and red clover occupy estrogen receptor sites,
compounds in licorice can occupy receptors for cortisol, and dang gui
appears to contain compounds that occupy progesterone receptors.
Herbs are complex biological substances with incompletely understood
mechanisms of action, sometimes producing paradoxical, normalizing
effects. Genistein simultaneously acts as a weak estrogen,
anti-estrogen, angiogenesis inhibitor, and anti-oxidant. Perhaps
Japanese women do not complain of hot flashes because their soy-based
diet contains high levels of genistein, which buffers the loss of
estrogen by binding to the same receptor sites on cells, easing the
panic of the hypothalamus in response to declining estrogen. It is
curious that Asian women have lower levels of estrogen and a lower
incidence of estrogen-deficiency symptoms. According to Subhuti
Dharmananda, Ph.D., licorice not only mimics cortisol, but also acts as
a modulator of estrogen activity, inhibiting or enhancing its effects.
Many herbs are adaptogenic, enhancing the body's self-regulatory
capacities. They can affect not only the quantity of hormones
circulating in the blood, but also the body's ability to respond to
those hormones. A term for describing how estrogen receptors respond to
exogenous and endogenous compounds is selective estrogen receptor
modulator (SERM).
Natural Progesterone Cream
Natural progesterone differs significantly from Provera (medroxyprogesterone
acetate), properly referred to as a progestin, not progesterone. What is
meant by a natural hormone is a substance that precisely matches in
molecular configuration what the body itself produces. Natural has less
to do with where it comes from, and everything to do with its
biochemical structure. The naturally occurring plant sterol diosgenin
from Mexican yams can be converted through a simple laboratory process
called hydrolyzation into a steroid compound molecularly identical to
human progesterone. Transdermal (topically applied) natural progesterone
creams, gels, and patches do not have the side effects associated with
Provera and other progestins. Possible side effects of Provera include
fluid retention, weight gain, depression, fatigue, nausea, acne,
migraine, breast tenderness, and spotting between periods. Unusual but
possible side effects include: liver toxicity, thrombophlebitis,
pulmonary embolism, stroke, or retinal thrombosis.
Hormones taken orally enter the bloodstream from the small intestine,
and go directly to the liver. Because the liver is not accustomed to
receiving large amounts of hormones, it begins to break them down,
leaving only a small percentage of the ingested hormone available to
cells. Transdermal delivery circumvents the digestive system -- cells
absorb hormones more efficiently, rapidly dispersing them into the blood
via capillary beds in skin and muscle. Martha Howard, M.D. says, "oral
pharmaceuticals can be harmful to the liver and gall bladder. Oral
administration is outmoded. Plant-derived creams fit better in the
body's receptors. I prefer transdermal delivery systems-it's safer and
more natural."
Progesterone has a broad spectrum of action, relieving symptoms of Qi,
Blood, and Essence deficiency-normalizing estrogen levels (Yin) and
thyroid function (Yang)-without causing stagnation. When progesterone
supplementation is inadequate in relieving hot flashes, sweating, and
vaginal dryness, herbs that tonify Yin, dispel Heat, and astringe
Moisture should be used. Another option is to use a transdermal
preparation marketed as a phytoestrogen cream (containing extracts of
ginseng, dang gui, chaste tree berry, red clover, black cohosh,
pomegranate, black walnut, borage and grape seed) that may help to
relieve hot flashes and vaginal dryness.
Women concerned about or diagnosed with breast cancer wonder whether
they should use natural progesterone cream. A Johns Hopkins study
published in 1981 found that women with low progesterone levels had a
5.4 times greater incidence of breast cancer and a 10 times greater
incidence of general malignancy. This makes sense since progesterone
encourages cell differentiation and malignancy is a phenomenon in which
undifferentiated cells multiply. One study showed that transdermal
progesterone reduced the risk of breast cancer by decreasing the rate of
division of breast epithelial cells, and inhibited the estrogen-induced
proliferative response in cancerous cell lines. It has also been
reported that women whose breast tumor surgeries were performed in the
early luteal phase (the early part of the last half of the cycle) had
better outcomes. This is when progesterone is dominant and estrogen
levels are relatively lower.
If hormones and Essence are virtual synonyms, then hormones can be used
in the same manner as Essence-replenishing herbs. In the spirit of
integrative medicine, Chinese medicine can expand its thinking and
practice to include natural hormone therapy as a complementary modality.
Harriet Beinfeld, L.Ac., and Efram Korngold, L.Ac., OMD are co-authors
of "Between Heaven and Earth: A Guide to Chinese Medicine", the "Chinese
Modular Solutions Handbook for Health Professionals", the pamphlet
"Chinese Medicine: How It Works" and many articles. For 25 years, they
have been engaged in the active practice of acupuncture and Chinese
herbal medicine and were among the first to become licensed by the State
of California in 1976. Currently on the faculty of the American College
of Traditional Chinese Medicine, they have taught and lectured at
medical schools, hospitals, acupuncture colleges and conferences.
Harriet Beinfeld is also the author of "Chinese Modular Solutions;
Handbook for Health Professionals", "Chinese Medicine, How It Works" and
"Simple Solutions for Stress."
Website:
http://www.chinese-medicine-works.com/index.html
She can be contacted at