Perimenopausal symptoms are a cause of distress for many women. Symptoms often begin during the mid to late 40s and continue through the cessation of menstruation in the late 40s or early 50s. Anxiety, in particular, is a common symptom that accompanies menstrual changes.
In addition to anxiety, common perimenopausal complaints include: insomnia, thinning hair, declining vision, vaginal dryness, mild urinary incontinence, reduced libido, weight gain, fatigue, memory loss, brittle nails, irregular menstruation and joint pains. These symptoms can be successfully treated with Chinese Medicine.
Chinese medicine has a unique perspective on the physiology of menstruation that allows for precise diagnosis and effective treatment of symptoms that arise in relation to the menstrual cycle. (For a short explanation on the phases of the menstrual cycle according to Western medicine, see The Phases of the Menstrual Cycle according to Western Medicine.)
I’ve written an in-depth article for those who are interested that looks at the phases of the menstrual cycle, and how the Classical Chinese medicine perspective of the menstrual cycle informs my approach to the treatment of perimenopausal symptoms. If you are interested specifically in information about treatment of perimenopausal anxiety, scroll down to that section below. (Or, call my office and we can discuss it one-on-one.)
The Phases of the Menstrual Cycle in Chinese Medicine
Similar to Western medicine’s explanation of the menstrual cycle, Chinese medicine identifies four phases of the menstrual cycle. The focus of the menstrual cycle in Chinese medicine, however, is on the function, movement, quality and quantity of Qi, Blood, Yin and Yang. These are the four fundamental substances of the body. They underlie the functioning of all systems in the body. Therefore, treatment of menstrual irregularities also can address the root cause of illness.
The menstrual phase. During the menstrual phase, which typically lasts 5 to 7 days, Qi, Blood, Yin and Yang are at their lowest. The natural movement of Qi and Blood in the body is down, and treatment during this time is to support an imbalance in this movement. This typically involves moving the Blood, and also addressing any related imbalances such as treating the root cause of excessive bleeding, pain, or any other symptoms.
The post-menstrual phase. During the post-menstrual phase, which begins at the end of menstruation and lasts until ovulation, Blood and Yin begin to grow. Treatment during this time is to nourish the Blood and Yin directly and through support of the Spleen, Liver and Kidneys. Blockages in the lower burner (lower abdomen) are also treated during this time. The Penetrating vessel (chong mai) fills with blood during the post-menstrual phase.
The inter-menstrual phase. During the inter-menstrual phase, which lasts for 1 to 2 days around ovulation, Yin is at its maximum and transforms into Yang, triggering ovulation. Yin and Blood are full, as are the Penetrating vessel (chong mai) and the Conception vessel (ren mai). Treatment during this time is to support the transformation of Yin into Yang, and address any stagnation in the lower burner (abdomen) and upper burner (chest).
The pre-menstrual phase. During the pre-menstrual phase, both Yin and Yang, along with QI and Blood, have reached their maximum fullness and begin to decline as menstruation nears. It is the drop in Yang which triggers menstruation. Treatment during this time is to supplement the Yin and Yang, and move the Qi.
The Movement of Yin and Yang / The Classical View of Jing-Essence in Chinese Medicine
These phases present the clinical mechanics of menstruation. However, there is a larger and more comprehensive picture that is presented in Classical Chinese Medicine.
The interpenetration of Yin and Yang produces Qi; it is this movement that defines life. When we are conceived, we receive prenatal Jing (essence) from our parents. This Jing is carried in Blood from the woman and Semen from the man. The Jing is stored in the Kidneys; specifically in the conceptual space between the Kidneys, in the lower abdomen, which is known as the lower dan tian, or lower field of elixir.
This Jing manifests first as Yang and Yin, which are stored in the Kidneys and represented respectively as the Governing vessel (Du mai) and the acupuncture point Governing vessel 4; and the Conception vessel (ren mai) and the acupuncture point Conception vessel 4. These two vessels, or meridians, are the first that are formed following conception. They are the primary vessels of the 8 extraordinary vessels, and represent the division into 8 segments of the body. This is the Chinese concept of developmental embryology. The 8 extraordinary vessels carry Jing through the life of the person. This Jing becomes usable as Yuan Qi, which manifests at the Yuan points on the acupuncture channels. (I will write more about the differentiation and categorization of acupuncture points in a future article).
Jing manifests as Yin and Yang. Yin and Yang interpenetrate and create Qi, and life occurs. Yang Qi is the basis for the energy of life. Yin Qi is the basis for its substance. The strong movement of Yang Qi in the Kidneys is what causes changes in physiology and life cycles. This can be observed for example during teething, puberty, and menopause / andropause.
Prenatal Jing cannot be replenished; it is finite in quantity. Jing is wasted through lack of rest, overuse of drugs and stimulants, poor diet, menstruation, childbirth, and ejaculation.
Prenatal Jing is like a retirement account: it should be saved and preserved until it is really needed.
We are able to make postnatal Jing. The Spleen and Lungs extract respectively the clear essence of food and air, and from this Qi and Blood are made in the Lungs and Heart. We use this Qi and Blood on a daily basis to live, and any conceptual excess is stored as postnatal Jing. That is to say, if we spend less than we make, we have extra to store.
Postnatal Jing is like a savings account that we can replenish, but also utilize when needed, during times of excess activity, stress, or need. If prenatal Jing is a retirement account and postnatal Jing is a savings account, then Qi is like a paycheck. With good diet and lifestyle, we can make enough Qi to live and any surplus is stored as postnatal Jing.
In life and health, we have a surplus of Qi and Blood, Yang and Yin. The movement and interpenetration of Yin and Yang take place through the acupuncture channels of the body, and in this case most specifically the Penetrating vessel (chong mai).
As we age and use the physical and energetic substrate of our bodies, these begin to decline. Yin and Yang diminish and gradually begin to separate. Yang, being hot, rises. Yin, being cold, sinks. This also takes place through the Penetrating vessel. The resultant dynamic is that as we age, we get hot, dry, and excessive above and inside; cold, wet and deficient below and inside. When Yin and Yang fully separate, Qi is not generated and life is no longer supported.
Perimenopausal Anxiety in Chinese Medicine
Each month, a woman loses prenatal essence, or Jing, through menstruation. At approximately 49 years of age, as Yin and Yang, Qi and Blood have declined to the point where childbearing is no longer physiologically tenable, menstruation ceases. During this time, prenatal essence, or Jing, begins to rise through the Penetrating vessel through the Spleen, and up to the Heart. In the process, it is rarified and transformed into Shen, or Spirit. Jing from the Kidneys, Qi from the Spleen, and Shen from the Heart are referred to as the 3 Treasures.
The cessation of menstruation does not occur all at once. It is a gradual process, and in the West we refer to this process and phase as perimenopause. During perimenopause, women frequently experience symptoms that arise from declining Qi, Blood, Yang and Yin, and the physiological imbalances that result.
As the Yang Qi becomes unrooted from the Yin Qi, it begins to rise and flicker. This is similar to how a candle flame begins to flicker when the wax becomes low. It is the rising of Yang Qi into the upper burner and Heart that produces perimenopausal anxiety. Heat disturbs the Heart and Spirit (Shen), giving rise to restlessness, agitation, insomnia, and generalized anxiety.
This “imbalance”, while problematic when it produces symptoms, should not be interpreted negatively.
Perimenopause and menopause represent a transition time in the life of a woman. While our physical bodies are changing and declining, there is transformation. Life experiences are integrated, unresolved emotions are resolved, and traumas are healed.
The negative emotion of the Kidneys, which is fear, is transformed into its virtue, which is wisdom. The spirit of the Kidneys, which is the “will”, manifests as stillness and peace. This process can manifest as anxiety, particularly when it is becomes stuck or obstructed.
In a culture that values youth over age, production over tranquility, and where understanding of this transformation is lacking, the manifestation of symptoms is even more prevalent. The treatment of perimenopausal anxiety in Chinese medicine is not only to ease the symptoms, but to facilitate the process of transformation.
The Treatment of Perimenopausal Anxiety in Chinese Medicine
Perimenopausal anxiety is treated differently than anxiety that occurs at other times of life.
As we age, and Yin and Yang decline and separate, there is a need to address the resultant imbalances with acupuncture and Chinese herbs. In acupuncture, this means treating the extraordinary vessels; particularly the Penetrating vessel and Conception vessel. With Chinese herbal medicine, this means supplementing the Kidneys and restoring the Yang Qi to the lower burner. This is accomplished through the use of specific herbal formulae that are utilized in Classical Chinese Medicine.
With proper treatment, relevant dietary and lifestyle changes, and time, perimenopausal anxiety can be successfully treated using acupuncture, herbs, and Chinese medicine.