What is perimenopause?

Perimenopause affects many women in the years leading up to menopause. It’s a transitional phase of life when periods are still occurring but ovarian function declines and changes in cycles from month to month can occur. Most women begin to experience perimenopause in their 40s, but can start as early as the 30s and as late as the early 50s.  According to the Cleveland Clinic, perimenopause can start 8-10 years before menopause.

Symptoms

Some women experience only mild symptoms during perimenopause, while others notice significant physical, emotional and psychological changes as their body begins to feel the effects of estrogen withdrawal and mini-surges back to normal levels, as well as swings with testosterone and progesterone.  Periods often become irregular and menstrual cycles shorter. Vasomotor symptoms such as hot flashes, skin flushing and night sweats can begin years before the onset of menopause. Mood changes, sleep disturbances and cognitive impairment are common, as are fatigue, weight gain, hair loss and vaginal dryness.

Acupuncture and Traditional Chinese Medicine (TCM) can provide significant relief for some of the most problematic symptoms of perimenopause, without the potential side effects of pharmaceutical drugs. 

According to TCM, the body’s hormonal cycles are closely related to the energy of the Liver and Kidney systems. The Liver is the storehouse of the blood and is responsible for the smooth unfolding of the body’s cyclical process, including menstruation.

PLEASE NOTE: I am NOT anti-HRT (Hormone Replacement Therapy). In fact, acupuncture can help HRT to work better, as well as help women transition to lower doses of HRT if they wish when they feel like their symptoms are under control. I believe each individual needs to make informed choices about the options they are given, and I refer to Western doctors that also are seeking what is best for their patients.

Acupuncture helps ease the perimenopausal transition by mitigating symptoms and restoring balance. Here are five science-backed ways acupuncture can help:

1. Hot flashes

Hot flashes are one of the most common symptoms of menopause and perimenopause. Hot flashes occur when the body’s cooling (yin) energy declines, resulting in a relative excess of the body’s yang energy. Yang ascends to the upper body, causing heat sensations and red flushing of the skin of the face, neck and chest. Yin is naturally dominant at night, but if the body’s yin energy isn’t sufficient to anchor the yang, yang will become dominant, causing night sweats. The TCM approach is to boost the body’s yin energy so it keeps the yang in check, while clearing out excess heat. 

Physiologically, acupuncture can help cool you down by promoting blood vessel dilation, stimulating the release of endorphins, and regulating the hypothalamus, your body’s internal thermostat. A recent study at Wake Forest University found that acupuncture reduced hot flashes and night sweats by 47%, and for a smaller group, the benefit was almost double. Another study found that 80% of women receiving acupuncture for hot flashes and other menopausal symptoms felt that the sessions had helped them after six weeks of treatment. 

2. Mood Stabilization

Irritability, anxiety, depression, even perimenopausal rage—the hormonal changes of perimenopause can have a significant impact on your mood. Estrogen affects the production of neurotransmitters like dopamine and serotonin that boost feelings of happiness. Less estrogen = lower neurotransmitter levels = more mood instability. One study found that irritability is the primary mood complaint for up to 70% of women during perimenopause. 

According to TCM theory, the Liver system is at the root of perimenopausal mood disturbances. When the Liver system is out of balance, you’ll have greater fluctuations in your hormone levels. Additionally, each of the organ systems in TCM has an associated emotion, and the emotion of the Liver is…no surprises here…anger. So a Liver system gone haywire means erratic hormone levels and flares of anger.

The good news is that acupuncture is incredibly effective at balancing the Liver system (in Western medicine speak: stabilizing the mood).  In addition to treating irritability and excessive anger, acupuncture has a proven track record in benefiting depression and anxiety, which can also increase during the perimenopausal transition.

3. Brain Fog and Mental Focus

Having difficulty with memory and mental focus? You’re not alone. Studies have shown that up to 70% of peri- and post-menopausal women experience problems with memory and cognition. Another study found that women don’t learn as well during perimenopause. Estrogen affects brain function by promoting neuronal growth and survival, and supporting cognitive function of the prefrontal cortex. When estrogen declines during perimenopause, the brain feels the effects. Other perimenopausal symptoms such as hot flashes, insomnia and depression can also cause impairments in cognitive function. 

The brain is supported by the Jing (essence)of the Kidneys and nourished by the blood, which is made by the Spleen, stored in the Liver, circulated by the Heart and oxygenated by the Lungs. In essence, all of your organ systems play a role in supporting your cognitive function and when any of them are out of balance, brain performance suffers. Both animal studies and human studies have demonstrated a positive effect of acupuncture on cognitive impairment.

4. Fatigue

Tired all the time? Fatigue during perimenopause can be caused by a combination of factors, including fluctuating hormone levels and sleep disturbances. 

When treating fatigue, an acupuncturist will usually focus on the digestive system (Spleen and Stomach in Traditional Chinese Medicine) and the Kidneys. When the digestive system is weak, we have to dip into our reserve of Pre-Heaven Essence, or jing, which is stored in the Kidneys. Jing naturally declines as we age, and unlike like nutrients from the food we eat, jing can’t be replenished. So a healthy digestive system not only improves energy, it also prevents premature aging. Studies have shown that acupuncture can help boost energy levels and treat chronic fatigue. It also treats sleep disturbances, a common issue in perimenopause and a cause of low energy levels during the day. 

 5. Menstrual Cycle Changes

Menstrual cycle changes are often an early indicator of perimenopause. Skipped periods, shorter cycles, and heavier or lighter periods are all common. Although there’s no escaping the day when you’ll officially be in menopause—defined as one year without a period—acupuncture can help make your periods more bearable by increasing circulation to the ovaries and uterus and regulating the hypothalamic-pituitary-ovarian (HPO) axis, the feedback loop that governs the unfolding of the cycle.

Acupuncture helps with a host of other perimenopausal issues, including insomnia, changes to the skin such as acne and dryness, decreased libido, vaginal dryness, hair loss, and breast tenderness. I am becoming less and less surprised  as I go through this phase of life myself when I discover a new symptom I’ve heard from a client or experienced myself and can be caused by perimenopause. 

Perimenopause is a natural part of life but it doesn’t have to be miserable! Acupuncture is a proven, effective treatment to manage the transition from perimenopause to post-menopausal years and keep you as close to your badass self as possible.

And, lastly, when you have crossed over that rainbow bridge to no more Aunt Flo… 

Menopause

After your periods inevitably stop for over one year, you are “officially” in menopause.  That being said, I’ve seen women get to the year mark and then (surprise!) get another cycle.  Regardless, perimenopausal symptoms listed above can continue into the postmenopausal years.  The sooner the better as far as starting with acupuncture and herbal treatments to help alleviate symptoms, but women who are well into their menopausal years can still be assisted by both.  Some women choose to take HRT of some form to help alleviate their symptoms, and acupuncture can help those medicines work more effectively. I do not believe in an Eastern vs. Western approach, but one in which they complement each other in order to provide the best outcome for each individual person.