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Menopausal Syndrome
Menopausal Syndrome is the group of symptoms that sometimes appear in the time before, during and after the normal cessation of menstruation in women at the appropriate age (40–59 years of age being common). The Menopausal period is often associated with the period of time 5 years before and after the cessation of Menstruation.
Symptoms may include hot flushes, night sweats, anxiety, depression, mood swings, insomnia, lethargy and lack of sex drive. Some women may have various symptoms associated with this 'change in life', including Urinary dysfunction, digestive symptoms, palpitations, Joint pains, Headaches etc.
It is interesting to note that in all medicine traditions, a time for the cessation of menstruation was acknowledged, but there were never symptoms associated with it. The fact that many women from Traditional cultures tend to have either no symptoms or very mild symptoms would suggest that modern western diet and lifestyle is largely to blame. This is also evidenced by the fact that a primary formula for Menopause in TCM (Er Xian Tang) was written in the 1950's.
Differential Diagnosis:
1. Yin Deficiency:
Lower back and knee pain, dizziness, tinnitus, night sweats, hot flushes, feet hot at night, insomnia, dry mouth, nocturnal urination
Formulas:
–Cooling Pearl Powder (Diamargaritum)
–Liu Wei Di Huang Wan, standard for Yin deficiency, marked by sore and painful lower back and knees, nocturnal enuresis, dry mouth and mild sweating or flushes.
–Tian Wang Bu Xin Dan: Heart Yin deficiency with Insomnia, irritability, palpitation, poor memory, red and dry tongue with a thin and rapid pulse.
2. Yin and Yang Deficiency with Rising Heat
Sore and weak lower back and knees, dizziness, insomnia, sweating, hot flushes, nervousness or irritable, palpitations, depression, frequent urination
Formulas:
–Cooling Pearl Powder (Diamargaritum)
–Zhi Bai Di Huang Wan: for Yin deficiency with deficient Heat or rising Yang.
–Er Xian Tang: stronger to Warm the Yang while settling 'floating' heat or lowering rising (unsecured) Yang.
–Dan Zhi Xiao Yao San: supports Liver and Spleen, moves Qi and clears deficient Heat. Good for irritability, anger, headache and Liver-heat symptoms. It can be combined with Liu Wei Di Huang Wan or Zhi Bai Di Huang Wan.
–Da Bu Yin Wan: strong to Nourish Yin and clear deficient Heat. For more severe Yin deficiency.
Taiwanese database was studied for trends of Herbs and Formulas prescribed for Menopause throughout the nation (15486 subjects with 54456 prescriptions), the most commonly prescribed medicines were:
Symptoms may include hot flushes, night sweats, anxiety, depression, mood swings, insomnia, lethargy and lack of sex drive. Some women may have various symptoms associated with this 'change in life', including Urinary dysfunction, digestive symptoms, palpitations, Joint pains, Headaches etc.
It is interesting to note that in all medicine traditions, a time for the cessation of menstruation was acknowledged, but there were never symptoms associated with it. The fact that many women from Traditional cultures tend to have either no symptoms or very mild symptoms would suggest that modern western diet and lifestyle is largely to blame. This is also evidenced by the fact that a primary formula for Menopause in TCM (Er Xian Tang) was written in the 1950's.
Differential Diagnosis:
1. Yin Deficiency:
Lower back and knee pain, dizziness, tinnitus, night sweats, hot flushes, feet hot at night, insomnia, dry mouth, nocturnal urination
Formulas:
–Cooling Pearl Powder (Diamargaritum)
–Liu Wei Di Huang Wan, standard for Yin deficiency, marked by sore and painful lower back and knees, nocturnal enuresis, dry mouth and mild sweating or flushes.
–Tian Wang Bu Xin Dan: Heart Yin deficiency with Insomnia, irritability, palpitation, poor memory, red and dry tongue with a thin and rapid pulse.
2. Yin and Yang Deficiency with Rising Heat
Sore and weak lower back and knees, dizziness, insomnia, sweating, hot flushes, nervousness or irritable, palpitations, depression, frequent urination
Formulas:
–Cooling Pearl Powder (Diamargaritum)
–Zhi Bai Di Huang Wan: for Yin deficiency with deficient Heat or rising Yang.
–Er Xian Tang: stronger to Warm the Yang while settling 'floating' heat or lowering rising (unsecured) Yang.
–Dan Zhi Xiao Yao San: supports Liver and Spleen, moves Qi and clears deficient Heat. Good for irritability, anger, headache and Liver-heat symptoms. It can be combined with Liu Wei Di Huang Wan or Zhi Bai Di Huang Wan.
–Da Bu Yin Wan: strong to Nourish Yin and clear deficient Heat. For more severe Yin deficiency.
Taiwanese database was studied for trends of Herbs and Formulas prescribed for Menopause throughout the nation (15486 subjects with 54456 prescriptions), the most commonly prescribed medicines were:
- Dan Zhi Xiao Yao San was the most commonly prescribed formula for Menopause.
- Er Zhi Wan (Eclipta Han Lian Cao and Ligustrum Nu Zhen Zi) were commonly prescribed.
- Dan Zhi Xiao Yao San was often combined with Er Zhi Wan or Salvia Dan Shen
- Zhi Bai Di Huang Wan was also commonly prescribed (usually with Dan Zhi Xiao Yao San)
Most Commonly used Chinese Herbs for Menopausal Syndrome
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Paeoniae Bai Shao
Dang Gui Dioscorea Shan Yao Rehmannia Di Huang |
Poria Fu Ling
Epimedium Yin Yang Huo Cornus Shan Zhu Yu Paeonia Mu Dan Pi |
Phellodendron Huang Bai
Anemarrhena Zhi Mu Zizyphus Semen Suan Zao Ren Salvia Dan Shen |
Herbs with Proven efficacy for Menopausal Syndrome
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Soy bean
Alfalfa Aniseed Fennel Nigella sativa Fenugreek |
Sage
Lemon balm Hypericum perforatum Agnus-castus Valerina Licorice |
Evening primrose
Ginkgo biloba Passion Flower Red clover Black cohosh |
Herbs with Proven efficacy for Hot Flushes
The Following Medicines have shown clinical efficacy in relieving Hot Flashes of Menopause (see research)
The Following Medicines have shown clinical efficacy in relieving Hot Flashes of Menopause (see research)
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Soy
Evening Primrose oil Flaxseed Saffron |
St. Johns wort
Aniseed Black Cohosh Licorice |
Red Clover
Sage Valerian |
Kun Bao Wan
Kun Bao Wan is a special medicine specifically for menopause and is produced by Beijing Tong Ren Tang:
Kun Bao Wan is a special medicine specifically for menopause and is produced by Beijing Tong Ren Tang:
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Paeoniae Bai Shao 8.25%;
Mother of Pearl shell 8.25% Spatholobus Ji Xue Teng 8.25%; Eclipta Han Lian Cao 5.5%; Ligustrum Nu Zhen Zi 4.13%; Paeonia Chi Shao 4.13%; Rehmannia Shu Di Huang 4.13%; Scutellaria Huang Qin 4.13%; Chrysanthemum Ju Hua 4.13%; Adenophonra Sha Shen 4.13%; Cynancumi Bai Wei 4.13%; Anemarrhena Zhi Mu 4.13%; |
Dendrobium Shi Hu 4.13%;
Lycium bark (Di Gu Pi) 4.13%; Raspberry fruit (Fu Pen Zi) 2.75%; Dang Gui 2.75%; Dodder seed (Tu Si Zi) 2.75%; Lycium Gou Qi Zi 2.75%; Mulberry leaf (Sang Ye) 2.75%; Polygonum He Shou Wu 2.75%; Ophiopogon Mai Men Dong 2.75% Turtle shell gelatin Gui Ban Jiao 2.06% Zizyphus seed (Suan Zao Ren) 1.38%; Honey 5.76% |
This formula (along with acupuncture) was as effective as Hormone Replacement Therapy in clinical studies.
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Western Tradition
Simples
Compounds
Cordial Decoction Styptic Decoction Syrup of Dried Roses Simple Syrup of Hops Syrup of Water Lillies Syrup of Agnus Castus Syrup of Mugwort Compound Tincture of Balm Tincture of Dried Rose Tincture of Sage Sugar Penids Sugar Penids with Spices Powder for Spermatorrhea New Rose Powder (Rosata Nouvelle) (Nicholas) Abbots Confect of Rose (Diarrhodon Abbatis) (Nicholas) Aromatic Rose Compound (Aromaticum Rosatum) Cooling Pearl Powder (Diamargariton Frigidum) Cooling Powder of Gems Conserve of Rose Troches of Agnus Castus Electuary of Orchid (Diasatyrion) Rolled Turquoise 13 (Gyu dri 13) (Tibetan) Yin Deficiency Cooling Pearl Powder (Diamargariton Frigidum) Tragacanth Cooling Powder (Diatragacanth Frigidum) Electuary to Restore Humidity (Arnold de Villa Nova) Yang Deficiency Gelatin of Deer Horn Tincture of Cinnamon Electuary of Orchid (Diasatyrion) Yin and Yang Deficiency Restorative of Nicholas (Pleres Arconticon) Yin Deficient Heat Syrup of Hops Tincture of Dried Rose New Rose Powder (Rosata Nouvelle) (Nicholas) Conserve of Rose Troches of Sandalwood (Mesue) Aromatic Rose Compound (Aromaticum Rosatum) Cooling Pearl Powder (Diamargariton Frigidum) |
TCM Classification
Qi Stagnation with Heat
early stages of Menopause, recently ceased menstruation, maybe spotting, depressed, emotional, flushing when irritable Dan Zhi Xiao Yao San Yin Deficiency hot flushes, dizziness, tinnitus, night sweats, palms and soles feel hot, back pain, dry mouth, dry skin, constipation. Liu Wei Di Huang Wan Zhi Bai Di Huang Wan Zuo Gui Yin Yang Deficiency hot flushes with cold hands and feet, night sweats, pale face, back pain, depression, feels cold, edema. Li Zhong Wan You Gui Wan Shen Qi Wan (Jin Gui Shen Qi Wan) (Rehmannia 8) Yin and Yang Deficiency hot flushes, back pain, night sweats, frequent pale urination, irritable, feels cold, dry throat, dizziness, tinnitus. Er Xian Tang Shen Qi Wan (Jin Gui Shen Qi Wan) (Rehmannia 8) Yin Deficient Heat Flushes, night sweats, fever or feels hot especially at night, red cheeks, dry mouth, cracked lips, cracked tongue, irritable, insomnia Dang Gui Liu Huang Tang Zhi Bai Di Huang Wan Kidney and Heart not Balanced hot flushes, palpitations, nigh sweats, anxiety, restlessness, dizziness, tinnitus, excess worry, insomnia Gan Mai Da Zao Tang Tian Wan Bu Xin Wan Liu Wei Di Huang Wan Zhi Bai Di Huang Wan Blood Stagnation flushes, history of painful periods with dark clotted blood, abdominal pain, dull or cyanotic finger nails and lips, dull or dark complexion, choppy pulse Dang Gui Shao Yao San Shao Fu Zhu Yu Tang |
Special Formulas:
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1. Tribulus, Ginger, Saffron, Cinnamon (proven effect, see research below)
2. Er Xian Tang and Zhi Bai Di Huang Wan 3. Geng Nian Qin Capsule Lycium Gou Qi Zi Turtle shell Gui Ban Epimedium Yin Yang Huo Dang Gui Zizyphus semen Suan Zao Ren Paeonia Bai Shao Paeonia Moutan Mu Dan Pi Anemarrhena Zhi Mu Coptis Huang Lian Phellodendron Huang Bai This has been stuided and found effective in reducing symptoms. |
4. Geng Nian Le formula
Pearl Zhen Zhu Mui 15 grams Zizyphus semen Suan Zao Ren 8 grams Patycadaus Bai Zi Ren 12 grams Polygala Yuan Zhi 10 grams Albizzia He Huan Pi 8 grams Astragalus Huang Qi 15 grams Salvia Dang Shen 10 grams Dioscorea Shan Yao 15 grams Cuscuta Tu Si Zi 15 grams Ligustrum Nu Zhen Zi 10 grams |
Research:
1. Estrogenic Plants: to Prevent Neurodegeneration and Memory Loss and Other Symptoms in Women After Menopause
2. Menopause: a review of botanical dietary supplements.
2. Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials.
3. A review of effective herbal medicines in controlling menopausal symptoms.
4. Menopause-related symptoms: traditional Chinese medicine vs hormone therapy.
5. Systematic Review and Meta-analysis: Changes of Gut Microbiota before and after Menopause.
6. Chinese herbal medicine for menopausal symptoms.
7. The treatment of menopausal symptoms by traditional Chinese medicine in Asian countries.
'8. Chinese medicine for menopausal syndrome: current status, problems and strategies.
Individual Herbs
1. Dang Gui:
–A randomized, double-blind, placebo-controlled study of the effect of a Chinese herbal medicine preparation (Dang Gui Buxue Tang) on menopausal symptoms in Hong Kong Chinese women.
–Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial.
–Danggui Buxue Tang (Astragali Radix and Angelicae Sinensis Radix) for menopausal symptoms: A review.
2. Sage:
–The Effect of Salvia Officinalis on Hot Flashes in Postmenopausal Women: A Systematic Review and Meta-Analysis.
–Effectiveness of Menosan® Salvia officinalis in the treatment of a wide spectrum of menopausal complaints. A double-blind, randomized, placebo-controlled, clinical trial.
–Salvia officinalis for hot flushes: towards determination of mechanism of activity and active principles.
–Effect of Salvia officinalis scent on postmenopausal women's sexual function and satisfaction: a randomized controlled trial.
3. Elaegnus
–The effects of Elaeagnus angustifolia L. whole fruit on the sex hormone profile in menopausal women: A double-blind, randomized, placebo-controlled study.
–The effects of Elaeagnus angustifolia L. on lipid and glycaemic profiles and cardiovascular function in menopausal women: A double-blind, randomized, placebo-controlled study.
–The Effects of Elaeagnus angustifolia L. on the Thyroid-Stimulating Hormone, Dehydroepiandrosterone-Sulfate, Prolactin and Cortisol Levels in Post-Menopausal Women: A Double-Blind, Randomized, and Placebo-Controlled Study.
4. Pomegranate:
–Pomegranate (Punica granatum) Seed Oil for Treating Menopausal Symptoms: An Individually Controlled Cohort Study.
–Effects of pomegranate supplement on menopausal symptoms and quality of life in menopausal women: A double-blind randomized placebo-controlled trial.
5. Soy: :Utilization of Isoflavones in Soybeans for Women with Menopausal Syndrome: An Overview.
6. Black Cohosh: Review & meta-analysis: isopropanolic black cohosh extract iCR for menopausal symptoms - an update on the evidence.
7. Silybum: Evaluation of the effect of Silybum marianum extract on menopausal symptoms: A randomized, double-blind placebo-controlled trial.
8. Nettle: Urtica dioica in comparison with placebo and acupuncture: A new possibility for menopausal hot flashes: A randomized clinical trial.
9. Tribulus: Effect of Tribulus terrestris, ginger, saffron, and Cinnamomum on menopausal symptoms: a randomised, placebo-controlled clinical trial.
10. Saffron: Efficacy of Crocus sativus (saffron) in treatment of major depressive disorder associated with post-menopausal hot flashes: a double-blind, randomized, placebo-controlled trial.
11. Solanum xanthocarpum Effect of aqueous extract of Solanum xanthocarpum Schrad. & Wendl. on postmenopausal syndrome in ovariectomized rats.
12. Manasika: An assessment of Manasika Bhavas in menopausal syndrome and its management.
Combinations:
1. Clinical evaluation of Ashokarishta, Ashwagandha Churna and Praval Pishti in the management of menopausal syndrome.
2. A randomized, double-blind, multiple-dose escalation study of a Chinese herbal medicine preparation (Dang Gui Buxue Tang) for moderate to severe menopausal symptoms and quality of life in postmenopausal women.
Other:
1. The effects of yoga on quality of life among postmenopausal women: A systematic review study.
2. Menopause: a review of botanical dietary supplements.
2. Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials.
3. A review of effective herbal medicines in controlling menopausal symptoms.
4. Menopause-related symptoms: traditional Chinese medicine vs hormone therapy.
5. Systematic Review and Meta-analysis: Changes of Gut Microbiota before and after Menopause.
6. Chinese herbal medicine for menopausal symptoms.
7. The treatment of menopausal symptoms by traditional Chinese medicine in Asian countries.
'8. Chinese medicine for menopausal syndrome: current status, problems and strategies.
Individual Herbs
1. Dang Gui:
–A randomized, double-blind, placebo-controlled study of the effect of a Chinese herbal medicine preparation (Dang Gui Buxue Tang) on menopausal symptoms in Hong Kong Chinese women.
–Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial.
–Danggui Buxue Tang (Astragali Radix and Angelicae Sinensis Radix) for menopausal symptoms: A review.
2. Sage:
–The Effect of Salvia Officinalis on Hot Flashes in Postmenopausal Women: A Systematic Review and Meta-Analysis.
–Effectiveness of Menosan® Salvia officinalis in the treatment of a wide spectrum of menopausal complaints. A double-blind, randomized, placebo-controlled, clinical trial.
–Salvia officinalis for hot flushes: towards determination of mechanism of activity and active principles.
–Effect of Salvia officinalis scent on postmenopausal women's sexual function and satisfaction: a randomized controlled trial.
3. Elaegnus
–The effects of Elaeagnus angustifolia L. whole fruit on the sex hormone profile in menopausal women: A double-blind, randomized, placebo-controlled study.
–The effects of Elaeagnus angustifolia L. on lipid and glycaemic profiles and cardiovascular function in menopausal women: A double-blind, randomized, placebo-controlled study.
–The Effects of Elaeagnus angustifolia L. on the Thyroid-Stimulating Hormone, Dehydroepiandrosterone-Sulfate, Prolactin and Cortisol Levels in Post-Menopausal Women: A Double-Blind, Randomized, and Placebo-Controlled Study.
4. Pomegranate:
–Pomegranate (Punica granatum) Seed Oil for Treating Menopausal Symptoms: An Individually Controlled Cohort Study.
–Effects of pomegranate supplement on menopausal symptoms and quality of life in menopausal women: A double-blind randomized placebo-controlled trial.
5. Soy: :Utilization of Isoflavones in Soybeans for Women with Menopausal Syndrome: An Overview.
6. Black Cohosh: Review & meta-analysis: isopropanolic black cohosh extract iCR for menopausal symptoms - an update on the evidence.
7. Silybum: Evaluation of the effect of Silybum marianum extract on menopausal symptoms: A randomized, double-blind placebo-controlled trial.
8. Nettle: Urtica dioica in comparison with placebo and acupuncture: A new possibility for menopausal hot flashes: A randomized clinical trial.
9. Tribulus: Effect of Tribulus terrestris, ginger, saffron, and Cinnamomum on menopausal symptoms: a randomised, placebo-controlled clinical trial.
10. Saffron: Efficacy of Crocus sativus (saffron) in treatment of major depressive disorder associated with post-menopausal hot flashes: a double-blind, randomized, placebo-controlled trial.
11. Solanum xanthocarpum Effect of aqueous extract of Solanum xanthocarpum Schrad. & Wendl. on postmenopausal syndrome in ovariectomized rats.
12. Manasika: An assessment of Manasika Bhavas in menopausal syndrome and its management.
Combinations:
1. Clinical evaluation of Ashokarishta, Ashwagandha Churna and Praval Pishti in the management of menopausal syndrome.
2. A randomized, double-blind, multiple-dose escalation study of a Chinese herbal medicine preparation (Dang Gui Buxue Tang) for moderate to severe menopausal symptoms and quality of life in postmenopausal women.
Other:
1. The effects of yoga on quality of life among postmenopausal women: A systematic review study.