Infertility, PMS, perimenopause and menopause
In 1980 twelve-year-old Meredith Rosen was diagnosed with a strangulated ovary. A grapefruit-sized dermoid cyst on her left ovary was twisting her fallopian tube, resulting in a cutoff of the blood supply to the ovary and acute inflammation of the affected tissue. Meredith underwent emergency surgery with a complete ovariectomy—removal of her left ovary—as well as partial removal of her right ovary, where more cysts were found.
In 1989, at twenty-one years old, Meredith was back in the hospital for an other emergency surgery to remove another dermoid cyst that had developed on what was left of her right ovary. Aside from the fear of surgery, Meredith was terrified that she would lose the small piece of ovary she had left and never be able to have her own biological children. Her fears were justified. After the second surgery, Meredith was left with a mere remnant of ovarian tissue. Within a few weeks she began suffering from hot flashes. Her follicle-stimulating hormone (FSH) levels indicated she was in perimenopause.
When ovarian function begins to decline, preceding menopause, the pituitary gland secretes follicle stimulating hormone (FSH) in an attempt to stimulate the ovary to ovulate. If the ovary does not respond, the FSH levels will continue to rise. In a postmenopausal patient with unresponsive ovaries, levels of FSH will typically be above 60 to 80, while a fertile woman with regular menstrual cycles who ovulates monthly will have an FSH level of less than 20. Therefore, lower levels of FSH indicate ovulation, while very high levels of FSH suggest the ovaries are not responding. High levels of FSH can be seen in menopause or in premature ovarian failure.
For the next seven years, Meredith was under medical care for hormone maintenance of her estrogen levels. In 1996, at age twenty-eight, she married David, her high-school sweetheart. “Two years later, when I was thirty, David and I began discussing raising a family,” Meredith said. “I had never given up on having my own children. If I had a piece of ovarian tissue and I wasn't menopausal, then I was determined to find a way. I had faith that God would send me in the right direction. I believed that God would provide so that I could be a mother.” Meredith became singularly focused on ovulating. She also became “very aware of pregnant women, menstrual cycles, babies and anything else that had to do with having a baby.”
She went to an infertility clinic and shared her story with the specialist. “I was told that I had a zero percent chance of becoming pregnant. I would not listen to the doctor and insisted on starting fertility treatment.” Meredith began by using an estrogen patch to see if any ovarian follicles would develop as a result of increased estrogen. During the early follicular phase of a cycle, FSH stimulates the growth of ovarian follicles and increases luteinizing hormone (LH) receptors. Receptors are sites on all living cells that respond to a specific agent such as hormones, neurotransmitters or proteins. In other words, receptors are like the lock and the specific agent is the only key that will unlock the receptor. FSH and LH work synergistically to increase follicle size. As it grows, the follicle secretes estrogen. One follicle outgrows the others and becomes the dominant follicle destined for ovulation. About ten to twelve hours before ovulation LH and FSH secretions peak, causing the follicle to reach maximum size. The follicle releases the ovum (egg) into the fallopian tube. The follicle then decreases estrogen secretion.
Following ovulation, cells within the ruptured ovarian follicle undergo a process called luteinization, forming a small mass called a corpus luteum. The corpus luteum secretes progesterone, which is responsible for ripening the endometrial lining, preparing it for implantation of a fertilized egg. If conception does not occur, progesterone and estradiol (estrogen) levels decline, leading to the sloughing off of the thick and highly vascular endometrial lining of the uterus resulting in menstrual flow.
“I think the doctors at the fertility clinic were trying to show me—without making me spend all my money and waste my time and theirs—that if the patches did not cause a follicle to develop, then obviously there were no eggs on my ovary,” Meredith said. When the estrogen patch failed and Meredith did not get any encouragement from the doctors at that clinic, she began shopping for a new fertility doctor, but every doctor she saw attempted to discourage her.
Meredith finally managed to talk one doctor into prescribing Pergonal shots—synthetic high-dose estrogen—in the hopes of stimulating follicular development. It was expensive, time-consuming and painful. Two cycles on Pergonal produced no results. The doctor at the clinic advised Meredith to see a psychiatrist to deal with her denial and to see a gynecologist to receive hormone replacement maintenance to manage her menopausal symptoms. Although Meredith agreed to see a gynecologist, she did not give up. “If my FSH levels indicated that I was in perimenopause, not menopause [when the ovaries are completely depleted of follicles that can develop and release eggs], it meant that I had one egg in what was left of my ovary. One egg meant one baby, and nothing would stop me from finding that egg.”
The gynecologist Meredith went to see was sympathetic. “She told me that she thought it would be a rough road for me to get pregnant but it was certainly worth the effort. I thought, ‘Finally—a doctor who isn't throwing my hopes in the garbage. ’ It felt wonderful.” The doctor recommended Meredith try natural remedies to help with her perimenopausal symptoms. “I thought she was kind of nuts,” Meredith said. “She told me about Chinese herbal teas and acupuncture and referred me to a doctor of Chinese medicine. I thought, ‘This is the first time a doctor has really listened to me, ’ but at the same time I thought, ‘I'm not coming back here and I'm not going to any Chinese doctor. ’ But when I went home and told my husband, he said, ‘If you don't try, you may turn around someday and say, “What if Chinese medicine could have worked?” ’ I knew I would be eating myself alive for the rest of my life wondering.”
On February 23, 1999, Meredith went to see Daoshing Ni, Lic. Ac., D.O.M., Ph.D. a thirty-eighth-generation Chinese doctor and cofounder of the Tao of Wellness clinic in Los Angeles. Dr. Dao specializes in gynecology and reproductive medicine, including infertility, pregnancy, postpartum issues, dysmenorrhea, endometriosis, pelvic pain, perimenopausal symptoms, postmenopausal symptoms, aging issues and other issues of women's health as well as male infertility.
Dr. Dao sees approximately three thousand infertility patients a year and estimates his overall success rate is as high as 60 percent when a patient follows the complete treatment protocol. He treats infertility patients with herbs, acupuncture, acupressure and massage. Chinese medicine has been shown to be helpful in the treatment of endometriosis, uterine fibroids, tubal blockage, premature menopause, male infertility, sperm antibody conditions, irregular ovulation, pituitary imbalances, hypothyroidism, recurrent spontaneous abortion, luteal phase defects and unexplained infertility. “Chinese medicine can work miracles with women who have become overly anxious about conceiv-ing,”Dr. Dao said. “Unfortunately, most women seek out Chinese medicine as a last resort, after years and many thousands of dollars spent in Western infertility clinics. When Meredith came to see me, she had not had a period in ten years and had been on hormone replacement therapy for almost that long. She had a history of ovarian tissue removal and had very little ovarian tissue left. She exhibited symptoms of menopause—hot flashes and night sweats.”
“After reading my medical file, Dr. Dao took my pulse,” Meredith said. “Then he asked me to show him my tongue. I remember his words exactly: ‘May I see your tongue, please? ’ I was completely perplexed. I thought, ‘Where's the lab? Doesn't he need some vials of blood to look at? ’ ”
“In Chinese medical terms, Meredith's pulse was thready, her tongue tip was red with a thin white coating,” Dr. Dao said. “She had Kidney Qi and Kidney Essence deficiency syndrome. Our goal was to replenish her Kidney Qi and Kidney Essence by utilizing acupuncture points that can nourish the Kidney system. From a Western point of view, the goal was to stimulate and facilitate her ovarian function.”
Meredith was skeptical but liked Dr. Dao's team mentality. “Meredith and I did not know whether or not she would ever get pregnant,” Dr. Dao said. “We set a very conservative goal—to resolve her menopausal symptoms and to get her off hormone replacement therapy.” Dr. Dao's plan of action was to put Meredith's body back in balance. This meant stimulating ovarian function to increase her own estrogen production, eliminate hot flashes and night sweats, and facilitate ovulation so that Meredith would begin menstruating again.
Meredith has a highly allergic, reactive and sensitive constitution. She had been hospitalized in the past for allergic reactions. She was worried about taking herbs. She and Dr. Dao mutually agreed not to introduce herbs at the beginning of her treatment and to first see how she responded to acupuncture treatments. Meredith went off the estrogen patch and began acupuncture treatments.
In the beginning, Meredith did not feel confident with acupuncture as a treatment for infertility. But she agreed to the treatments and went twice a week. “Acupuncture moves and draws in Qi,” Dr. Dao said. “In this case, Mere dith's hypersensitivity became a plus for her. The points that I used are very gentle but powerful. She felt the needle greatly, so the efficacy of acupuncture treatments became heightened. One often doesn't feel pain or discomfort from the acupuncture needles. Meredith responded very favorably to acupuncture treatments, and within the first few treatments her hot flashes decreased dramatically.”
After three months of treatment, on May 30, 1999, Meredith told Dr. Dao she was having discomfort where her ovary used to be. He needled her to minimize the discomfort but she still felt something in that area. “I had a funny feeling,” Meredith said. “I thought, what if my ovary remnant was actually being stimulated? I decided to get an ovulation test. As I was driving to the pharmacy I was laughing and crying at the same time. I thought, what am I doing? I'm going to buy an ovulation test? Who am I kidding?” Meredith's ovulation test showed a blue line indicating ovulation. Disbelieving, she tried another test and got the same result.
She had an appointment with Dr. Dao the next morning and showed him the test results. He suggested she go to her gynecologist to have a blood test to check her estrogen levels. “I could not control the tears when I got the results,” Meredith said. “I had ovulated. Not only were my estrogen levels good, they were great. They were completely normal. My blood levels indicated no sign of perimenopause at all!”
Acupuncture treatments had successfully stimulated Meredith's ovarian function, and she was ovulating. Given the scar tissue in her fallopian tube and other complications, Dr. Dao recommended she work with a Western infertility specialist. Meredith went home and began waiting for her period to start so that she could count the days until midcycle, when she would ovulate again and could begin working with an infertility specialist. When her period did not start, on a whim she purchased a pregnancy test. “Once again, I laughed and cried as I took the test. My heart started beating really fast. ‘Oh my God! ’ I yelled. There were two pink lines!” Meredith and David rushed to the lab in the morning. “The lab technicians all knew me and were also eager to find out if I was really pregnant. They drew my blood and told me they would call me by noon. That was it. It was the day I had been waiting for. I would find out if I was going to have a baby. I would find out if I was going to be a mommy.” The lab called at noon and connected Meredith with the doctor's office. The nurse said, “You have us all baffled here. Congratulations, Meredith, you are pregnant!” It was three months after Meredith began acupuncture treatments.
Meredith had a perfect pregnancy with no morning sickness. On January 25, 2000, Hannah Danielle, seven pounds, eight ounces, was born by cesarian section. It appeared that Meredith had been correct in her quest for the one egg that would produce one baby. After the follicle had matured and produced that egg, the remaining shred of ovarian tissue left from Meredith's two surgeries had been absorbed by her body—when Meredith's abdomen was opened, the surgeon could not find a trace of ovarian tissue.
“The Chinese medical approach to infertility is similar to Western medicine's in that we try to stimulate and increase the probability of conception before a woman's eggs get too old,”Dr. Dao said. “Age plays a role. Eggs act as if they have an expiration date on them. We try to improve the quality of the follicles. Success has a lot to do with the woman's family history of fertility and how well she has taken care of her body. In some instances, conception requires stimulation to the reproductive system. So you push it a little bit, but sometimes you have to be realistic and careful not to push a woman's body toward perimenopause. We don't want to exhaust the body when there are few or no more eggs to squeeze out.”
Dr. Dao often works closely with Western infertility doctors when women choose to use Western infertility drugs. “I advocate the integrative approach,” he said,“combining both Chinese and Western medicines to enhance the likelihood of conception. But if a woman comes in who I don't think needs artificial reproductive technologies [ART] to conceive, I will advise her to delay for a few months and to try Chinese medicine alone. If a woman doesn't want to wait, I will refer her to a reproductive endocrinologist and we will work together with her. There are other women who come to my office and I actually think they need ART right away. In that case I will tell them that Chinese medicine might help, but it would take too long.
“I ask that women have a fertility workup to see if there are problems that can be repaired by Chinese medicine. I use Chinese medicine for three months or longer to prepare the woman's body before she takes infertility drugs. A woman needs to be judicial when she uses infertility drugs. She needs to have a plan before she enters into treatment to decide what kind of drug protocol she will do and how many cycles. During her treatment with Western drugs, I watch her responses, monitor her for side effects and adjust my treatment accordingly. Some of the adverse reactions to infertility drugs are low energy, moodiness, depression, bloating, puffiness, breast pains, cramps and headaches.”
From Dr. Dao's point of view, Meredith's positive attitude played a role in her success. “Obviously, when you are positive, you can frequently elicit positive outcomes from your body,” Dr. Dao said. “We should never underestimate the power and importance of our mind and our spirit, and what they can do for our body. Mental attitude plays a huge role in the success of fertility treatments.”
In a woman's fertile years, estrogen is produced by her follicles, peaking at ovulation. Estrogen helps to build up the endometrial lining of the uterus. Progesterone is produced by the ovaries after ovulation. Progesterone is responsible for ripening the endometrial lining, preparing it for implantation of a fertilized egg. If no pregnancy occurs, estrogen and progesterone levels drop, causing the lining to be sloughed off (menses). A woman can begin to experience PMS during the last two weeks of her cycle. When a woman does not ovulate every month, she does not have the level of progesterone her body needs. Without adequate progesterone, there is too much estrogen left unchecked, which results in symptoms of PMS such as bloating, breast tenderness, crying jags, decreased tolerance to pain, difficulty coping with life, food and stimulant cravings, headaches, irritability and rage. Symptoms of PMS usually stop abruptly with the onset of menstrual flow.
From a Chinese medicine point of view, females have a different Energetic pattern than males. Women possess a special type of Kidney Jing, called Tian Kui (pronounced tea-en kway). Due to the cyclical pattern of menstruation, once a female reaches puberty, her Kidney Energy and Blood fluctuate, creating a unique tendency toward certain imbalances. For example, menstruation, although part of the normal physiology of females, also produces a cyclical loss of Yin and Blood. Consequently, females have a tendency to develop Liver Blood and Kidney Yin deficiencies—which result in PMS symptoms. There is a saying in Chinese medicine, “Women tend to lack in Yin and therefore are unable to counterbalance Yang, causing relative excess in Yang.” This phrase plays a strategic role in determining treatment for women, which tends to almost always emphasize protecting, supporting and nourishing Yin and harmonizing Liver.
When treating women, Chinese doctors are usually cautious in using herbs that can be overly drying and Warming, to prevent drying out the already deficient Yin Essence. Since Blood is part of Yin, the cyclical loss of Blood obviously tends toward a relative Yin deficiency. Since Yin is Cooling, the relative Yang excess further dries the Yin, causing a certain pattern of internal Heat within a woman's constitution. This is true during a woman's menstruating years.
From a Chinese medicine point of view, PMS symptoms are also tied to Liver Qi stagnation—blood flow is slowed to the pelvic cavity. Reproductive organs depend on blood supply. Herbs, acupuncture, nutritional changes and massage are all used to treat PMS-related Liver Qi stagnation. If Liver Qi stagnation is left untreated, more serious disorders, such as endometriosis and uterine fibroids can develop.
Chinese medicine herbal therapy addresses the individual's unique constitution, medical history and current condition. The treatment may not be the same, even with the same diagnosis of endometriosis. Dr. Dao treats endometriosis with herbs and acupuncture to release the stagnation and circulate Qi.
During perimenopause and menopause, Tian Kui—the special Kidney Jing—diminishes. Women will therefore develop some acute Kidney Yin deficiency. The loss of the Cooling effects of Yin creates a relative excess of Yang, which leads to hot flashes, emotional fluctuations and insomnia. Normally when one sleeps, Yang is submerged into Yin, Yin thereby having a somewhat more dominant role. Upon awakening and throughout the day, Yang emerges out of Yin and takes a somewhat more dominant role. This is part of the normal perpetual dance between Yin and Yang. In perimenopause or menopause, because of an acute deficiency of Yin, Yin is unable to adequately engage Yang and hold the Yang submerged. As a result, Yang has a tendency to flare up and float toward the top, leading to menopausal symptoms, including insomnia.
Due to the intimate relationship between Kidney Energy and the bones, the Kidney Energy imbalance during perimenopause and menopause significantly increases the risk of osteoporosis in postmenopausal women. The relative lack of Yin Energy and its Cooling and moistening properties also explains why postmenopausal women have a tendency toward dry skin and vaginal dryness.
From a Western point of view, women begin to experience symptoms when ovarian function (estrogen, progesterone and testosterone) declines and sex hormones fluctuate during perimenopause. The cardiovascular system, bones, skin and certain cognitive functions begin to deteriorate. Perimenopause begins when your ovaries are no longer secreting adequate amounts of progesterone because you are no longer ovulating every month. Regular or irregular menstrual cycles may have heavier flow.
Some Perimenopausal Symptoms Due to Declining Ovarian Function
Hot flashes and night sweats
Sleep disturbances
Fatigue
Spontaneous crying jags
Irritability
Headaches
Foggy-headedness
Rage
When a woman has not had a period for one year she is considered in menopause. The mean age for menopause is 51.2 years. A woman's ovaries are now only producing very low levels of estrogen. As her ovaries are no longer releasing eggs, there is no progesterone. Testosterone production also declines.
Some Menopausal Symptoms Due to Decreased Ovarian Function
| Acne | Hot flashes | Memory loss |
| Breast tenderness | Inability to have | Night sweats |
| Brittle/ridged nails | orgasm | Night obsessions |
| Constipation | Incontinence | Numbness and |
| Decreased sex drive | Increased facial hair | tingling |
| Degenerative diseases | Increased/decreased | Pain with intercourse |
| Dry skin | breast size | Reduced sex |
| Fibrocystic breasts | Insomnia | drive |
| Fleeting joint pain | Intolerance to | Vaginal dryness |
| Fluid retention | cold/heat | Weakness and fatigue |
| Hair loss | Loss of body hair | Weight gain/loss |
Also, bone loss may accelerate. See pages 212–213 for information on osteoporosis.
Using Chinese herbs to alleviate perimenopausal and menopausal symptoms
“In treating perimenopause, the goal is to boost and maintain ovarian func-tion,”Dr. Dao said. “However, ovarian and other reproductive functions decline naturally in menopause. In menopause the objective is to try to balance the body and slow down the aging process. We use acupuncture and herbs and other traditional Chinese medicine modalities such as Qigong, meditation, massage and acupressure to relieve menopausal symptoms.”
From a Chinese medicine point of view, menopausal symptoms are the body's panic reaction to the sudden decrease of Tian Kui. A woman can use Chinese herbs and acupuncture to stimulate the ovaries in a controlled fashion so that sex hormones decline gently over a period of time. This allows the body's withdrawal symptoms from sex hormones to diminish gradually over a period of time without as much discomfort. In the meantime, additional herbs are used to support and protect your heart and bones. Many symptoms can be resolved without bringing up and maintaining the high level of sex hormones. “Some women are concerned that they will have to take herbs for life,” Dr. Dao said. “But most women feel better within a couple of weeks of using herbs and acupuncture. Some women take two or three months to feel balanced and vital. Using hormone replacement is a personal choice that we do not try to discourage women from if that is what they need or if that is their personal choice. Of course, the earlier a woman addresses her symptoms, the more successful the outcome of the treatment. If a woman requires a complete hysterectomy, it's difficult to be without hormone replacement therapy. Whenever possible, I encourage women to request that at least a portion of one ovary be left in when having a hysterectomy.”
Hormone replacement
Some women will choose to take Chinese herbs when they experience the symptoms of perimenopause and menopause. Others will use Chinese herbs along with hormone replacement therapy (HRT) and a third group will use only HRT.
Increasingly, over the past fifty years, the stress of eating processed and refined foods, ingesting stimulants and drugs and being exposed to environmental toxins and other poisons has affected women's ovarian function, often leading to sex hormone imbalances (estrogen, progesterone and testosterone). From a Western perspective, the goal is to maintain ovarian function to preserve hormone balance by focusing on nutrition and lifestyle. Once you have done everything you can to balance your hormones and you still feel symptomatic, it may be time to consider hormone replacement therapy.
Some women do not feel symptomatic during menopause. A lack of symptoms, however, does not mean that a woman will not develop a degenerative disease such as cardiovascular disease or osteoporosis due to a lack of hormones.
Herbs and acupuncture can stimulate your ovaries to produce more hormones as well as support your system so that they work better to alleviate symptoms. Taking herbs is not replacement therapy. No matter how well you do at balancing your nutrition and lifestyle, and no matter how many herbs you take to stimulate your ovaries, there is going to come a point where your ovaries are not going to produce any more hormones.
Premarin, PremPro, PremPhase and Prempac-C are estrogen drugs made from the urine of pregnant mares. These drugs are not bioidentical to naturally R occurring estrogen in the human body and therefore cannot be called hormone replacement therapy. They are FDA approved only to alleviate hot flashes and to prevent osteoporosis—not as hormone replacement. Synthetic progesterone, called Provera, is made only in part with natural progesterone. Since a natural substance cannot be patented, manufacturers have changed the molecular configuration so that it is unlike anything found in nature. Methyltestosterone is a synthetic drug that has created a bad reputation for testosterone replacement because it can cause hair growth in unwanted places, high cholesterol and aggressiveness.
Estrogen, progesterone and testosterone must be replaced with a hormone that fits into that receptor to mimic what the ovaries once supplied. Bioidentical hormones are hormones that fit into your body's hormone receptors. By using bioidentical hormones in appropriate doses, most symptoms can be relieved without side effects. Problems and side effects do not occur if you use physiological doses of bioidentical estrogen, progesterone and testosterone—in other words, when you replace what the woman is lacking and no more. The goal is to find balance in all hormone levels.
Ways to preserve or restore ovarian function
Avoid Processed and Refined Foods: These foods contain toxic chemicals, pesticides, hormones and damaged fats that lead to cellular damage, decreased ovarian function and premature aging. Likewise, women can maintain healthier ovarian function longer by not using stimulants such as caffeine, nicotine, alcohol and Ma Huang. Recent research has demonstrated that smoking may also lead to premature decline of ovarian function.
Please see chapter 21 for recipes for women's health. Avoid Exposure to Toxins: Exposure to toxins results in earlier ovarian function decline. See more about toxins on pages 166–172.
Reduce the Amount of Prescription and Over-the-Counter Drugs You Are Taking: Discuss the necessity of your prescription drugs with your doctor to determine if you are taking any drugs that you can safely eliminate. Instead of automatically reaching for over-the-counter drugs, consider taking herbs and having acupuncture as alternatives.
Choose Herbs and Acupuncture to Alleviate Symptoms—or Take Hor-mone Replacement Therapy: If you are experiencing symptoms of ovarian function decline, a health care professional can work with you and follow your healing progress. If you suffer from PMS, herbs and acupuncture can balance ovarian function, or you can begin herb and acupuncture treatments or begin using an over-the-counter progesterone cream with the supervision of your health care practitioner. When symptoms of menopause increase, you can choose acupuncture and herbs to alleviate your symptoms, or you can see a hormone replacement expert for bioidentical progesterone, estrogen and testosterone replacement therapy.
Chinese Herbs and Western Supplements: When you do not provide your body with adequate vitamins and minerals, your body—including your ovaries—will age more rapidly. You can take Chinese herbal formulas and Western supplements specifically formulated for women's health.
For women, the Chinese herb Deer Velvet Antler has been shown to be effective in treating gynecological problems due to hormonal imbalances, particularly low estrogen, excessive menstrual bleeding or amenorrhea (lack of menstrual period), as well as excessive vaginal discharge due to depressed ovarian function. See page 290 for more on Deer Velvet Antler. Deer Velvet Antler should be taken under the supervision of an herbalist.
Routinely, take the immune-modulating formula described on pages 103–104.
Female infertility is defined as the inability to conceive with a normal sex life without using contraceptives for two years. Statistically, in relationships where the male has a normal sperm count and no other abnormalities, 60 percent of women become pregnant within six months without using contraceptives, 80 percent within nine months, up to 90 percent within a year.
Female infertility can be generally divided into two categories: structural and functional. Structural problems include (1) blocked fallopian tube(s) resulting from severe scarring from past pelvic inflammatory disease (PID), endometriosis, extensive surgery, obstruction from tumor or congenital abnormality, (2) completely blocked cervix, (3) destruction of the linings of the fallopian tube(s) or uterus and (4) congenitally deformed or nonexistent uterus or ovaries.
Functional problems include (1) obesity, (2) certain hormonal imbalances, (3) inflammation of the pelvis, uterus or vagina, (4) certain immune disorders such as antibodies against sperm protein and antibodies to certain hormone receptor sites and (5) fallopian tubes kinked or blocked by mucus.
Infertility in Chinese medicine can generally be divided into two classes: deficiency primarily involving Kidney Energy, which is roughly equivalent to hormonal imbalances, and stagnation primarily involving Liver Energy, which is often equivalent to a functional blockage in the Western sense, such as decreased libido and hormone imbalance resulting in decreased ovarian function. Some structural problems obviously cannot be resolved by Chinese medicine.
The main therapeutic goals in treating infertility are to balance and support Kidney Energy and Jing, resolve stagnation, especially Liver Energy stagnation, and build Blood.
Avoid overwork
Overwork depletes Kidney Yin, which is the basis for menstruation and the health of your ovaries and uterus. Excess physical work or exercise in adolescence injures Kidney and Spleen Energies, which are required for the development and continuation of the menstrual cycle. This can create a fundamental weakness or imbalance in these Energies (which carry hormone cycles) by undermining the ovarian function before it is mature. Adequate rest nourishes Yin.
Avoid long-term use of contraceptives
Such use can interfere with your normal hormonal balance and ovarian function.
Practice safe sex
Unsafe sexual practices can result in sexually transmitted diseases (STDs), which weaken Kidney Energy. Abortions also weaken Kidney Energy.
Avoid extreme cold
Avoid exposure of your body to extreme Cold and Dampness. The uterus is sensitive to Cold, which affects the flow of Energy. This is especially true during the menses. Exposure to Cold and Dampness usually occurs during exercise or through sports activities.
Avoid excess intake of Cold, iced foods and drinks to prevent Cold invasion of the uterus. Excess sugar, processed foods, fried foods and dairy can lead to Damp stagnation, which can affect ovarian function and even result in ovarian cysts and blockage of fallopian tubes.
Chinese herbs and Western supplements
You can use Chinese medicinal herbs in recipes to improve your overall health. See chapter 21 for recipes. You can also take Chinese herbal formulas designed to address mild cases of functional problems. For more information, log on to ancientherbsmodernmedicine.com.
Fibroids are knots of muscle tissue typically found in smooth muscle such as the muscle of the uterus. While they are never cancerous, fibroids are sometimes called fibroid tumors because of their shape. Fibroids cause problems simply due to their size and their physical compression of other pelvic organs. If they penetrate into the endometrial cavity of the uterus, they can cause irregular and heavy bleeding; this is a common reason for women seeking treatment for their fibroids. They can sometimes cause infertility. Studies have shown that up to one-third of all women have at least some small fibroids in their uterus at the time of death. Most are completely asymptomatic. When fibroids grow and begin to cause either pain or irregular bleeding, they may require treatment. Fibroids can be removed while leaving the uterus intact in a myomectomy, but this is usually only a temporary treatment, as the likelihood that the fibroids will grow back is quite high. Therefore, myomectomy is generally reserved only for those women who are trying to conceive and give birth. The only definitive treatment for fibroids is a hysterectomy. Occasionally, medications such as Lupron (synthetic progesterone) can be used to shrink fibroids. This again is typically only a temporary measure and is used in preparation for surgery to make the procedure easier and safer; on occasion, the medication can shrink the fibroids prior to conception.
From a Chinese medicine point of view, fibroids are a type of stagnation that can involve Qi, Blood and Dampness. R 1L
If you are experiencing symptoms of PMS and you have fibroids, you may benefit from bioidentical progesterone replacement therapy.
Focus on your emotional health
See a therapist to resolve emotional strain, especially repressed anger, frustration, hatred and resentment. Negative emotions stagnate Qi; left unresolved, they can result in stagnation of the Blood.
Avoid estrogen-stimulating herbs
Fibroids are stimulated by estrogen. Herbs such as Dang Gui, Lu Rong, Ren Shen and Black Cohosh can stimulate estrogen production and should be avoided.
Manage habits that lead to high insulin secretion
High insulin secretion—which is a growth factor—will contribute to the development of uterine fibroids. Factors that raise insulin levels include eating a low-fat, high-carbohydrate diet, stress, dieting, caffeine, alcohol, aspartame (an artificial sweetener), tobacco, steroids, stimulants and other recreational drugs, lack of exercise, excessive or unnecessary thyroid replacement therapy and all over-the-counter and prescription drugs. Once you have fibroids these factors will stimulate their growth. From a Chinese medicine point of view, these factors create Heat, Damp and stagnation.
Modify your diet
Excess consumption of raw, cold foods or drink results in stagnation of Qi. Irregular eating habits such as skipping meals and poor diet upset Spleen and Liver Energy, which also leads to Qi stagnation. Avoid fried foods, dairy, sugar and processed foods, which create Damp and Phlegm accumulation. Do not eat chicken skin, which contains xenoestrogens—molecules that exert an estrogenic influence on your body. Avoid commercial chicken broth, which is processed with chicken skin. Be aware that restaurants often use chicken broth, and order accordingly.
Overwork, overexercise and lack of rest leads to Qi deficiency. All abdominal masses involve Qi deficiency.
Chinese herbs and Western supplements
You can use Chinese medicinal herbs in recipes to strengthen your Qi. See chapter 21 for recipes. You can take Chinese herbs and Western supplements to strengthen Qi.
Surgery
Hysterectomy is surgery in which the uterus is removed. In a total abdominal hysterectomy, the entire uterus including the cervix is removed. A subtotal hysterectomy is sometimes performed, in which the cervix is left behind but the rest of the uterus is removed. The subtotal hysterectomy is a much easier surgery, and is performed when a shorter surgery is optimal. It is also performed in a laparascopic procedure when removing the cervix would simply be too difficult. A major drawback in the subtotal hysterectomy is that leaving behind the cervix leaves the woman at risk for cervical cancer. One of the benefits of a hysterectomy is the removal of tissue that commonly develops cancerous cells. Leaving behind a nonuseful organ fragment that can develop cancer is not thought optimal by many experts in the field.
There are three methods currently used for performing a hysterectomy. The first and most common is a transabdominal hysterectomy. This surgery in volves taking the uterus out through an abdominal incision. The gynecologist will try to use a bikini incision if possible, but many factors play a role in making the decision of where and how to perform the operation. The second and often preferred method is a vaginal hysterectomy. This method involves taking the uterus out through the vagina. This method is technically more difficult and requires an experienced surgeon but is generally preferred when possible, as the recovery time and discomfort are significantly less than with the abdominal procedure. It also does not have the drawbacks of leaving visible scars. Thevaginal hysterectomy is a dying art in this country, and there are too few physicians experienced in this procedure due to its technical and dexterity requirements. The last method for hysterectomy is called laparoscopic surgery, a newer technique that involves performing surgery with the use of tube-shaped cameras and instruments that are inserted through small incisions in the abdominal wall of the anesthetized patient. This surgery commonly takes much longer than the previously mentioned methods but offers the benefits of much smaller incisions and in some cases faster recovery. While techniques are rapidly changing, it is clear that the future of surgery in all specialties will be the minimally invasive surgical laparoscopic techniques. Currently, however, the laparoscopic approach should be reserved for cases where it is deemed appropriate. Using this type of procedure in the wrong type of surgical candidate can lead to a much more difficult and potentially dangerous surgery.
Whether or not the ovaries are taken out during a hysterectomy is a complicated decision. The conservative approach is to remove the ovaries at the time of hysterectomy if the risk of cancer is thought to outweigh the benefits of leaving them. Today women are more informed, engage in more research before surgery and are more involved in decision making than in the past. More women are opting to have their ovaries or part of one ovary as well as their cervix left in place when having a hysterectomy. Since every woman's case is different, this decision is best made with the advice of your doctor.
In addition to healthy ovarian function, healthy thyroid function is crucial for health and well-being. Hypothyroidism, or low thyroid function, affects as many as 40 percent of the population, though many people go undiagnosed— and it can affect you at any age. The thyroid is a small, butterfly-shaped endocrine gland located just below your Adam's apple. Every cell, tissue and organ of your body is affected by the actions of your thyroid gland. The thyroid controls your metabolism, regulates your body's thermostat, helps maintain your circulatory system and blood volume, heightens the sensitivity of your nerves and is necessary for building and maintaining lean body mass (muscle and bones).
Some symptoms of hypothyroidisim and menopause are similar, so the two can often become confused. A patient may have one and be labeled as having the other. There can also be multiple interactions between hormonal disorders, further complicating the situation. Patients with menopausal symptoms will sometimes benefit from screening for thyroid disorders.
Secreted by the thyroid gland, T4 is converted into T3 in the liver, heart and kidneys. Thyroid-stimulating hormone (TSH) stimulates the thyroid gland when it is not making enough thyroid hormone. When a thyroid blood test shows an elevated TSH, hypothyroidism is indicated even if T3 and T4 levels are normal.
Symptoms of Low Thyroid Function
| Bruising easily | Increased susceptibility to colds |
| Coarse hair or hair loss | and other viruses |
| Constipation | Infertility |
| Dry, coarse, leathery or pale skin | Lethargy |
| Emotional instability with | Loss of appetite |
| crying jags | Mental sluggishness |
| Feeling cold all the time, | Migraine headaches |
| particularly hands and feet | Mood swings |
| Fluid retention | Weakness |
| Impaired memory |
In a hypothyroid individual, body temperature falls below normal. You can easily check your thyroid function at home by using a basal (mercury) thermometer. Shake the thermometer down before you go to bed and leave it at your bedside, within reach. Immediately upon awakening in the morning take your temperature. Reach for the thermometer and put it under your tongue. Do not get up to use the bathroom, and avoid movement. Remain still for ten minutes. If your temperature reads below 97.8 degrees, you may well be suffering from hypothyroidism.
From a Chinese medicine point of view, those suffering from hypothyroidism manifest classic Yang deficiency.
See a hormone expert
If you are experiencing symptoms of hypothyroidism, you may benefit from thyroid hormone replacement therapy.
Focus on your emotional health
Focus on resolving emotional strain, especially anxiety and fear. Anxiety and fear injure the Yang. Think of the expression “frozen with fear.” When Yang Energy is deficient, the body turns Cold.
Avoid overconsumption of Cold, iced or raw foods. Eat a diet that is generally Warm. See pages 310–326 for the Energetic temperature of foods. Eat a whole-food diet, which does not create Dampness. Regulate your weight within ideal limits. Obesity is usually a reflection of Damp stagnation and Spleen deficiency.
Chinese herbs
Chinese medicine does not use a substance to replace the functions of thyroid hormones, but rather works to stimulate thyroid function. Mild to moderate hypothyroid function can be restored by using Chinese medicine to regulate Kidney Yang deficiency. You can purchase Chinese herbal formulas to stimulate thyroid function at a Chinese herbal clinic or online at ancientherbsmodern medicine.com. You can also use Chinese medicinal herbs in recipes to stimulate thyroid function. See chapter 21 for recipes.
Uterine pain and cramping during the menstrual period is called dysmenorrhea. Dysmenorrhea is extremely common and can vary in women from hardly noticeable to severe and disabling. Extreme pain is not normal and is usually associated with an underlying medical condition. There are a variety of gynecologic conditions that can lead to disabling pain before and during menses. Pain present since a woman's first period or pain that develops early in the teen years is considered primary dysmenorrhea and is usually caused by excess prostaglandin production. This type of menstrual pain is characterized by onset prior to menstrual bleeding and can be treated with nonsteroidal antiinflammatory drugs such as ibuprofen (Motrin, Advil) or naproxen (Aleve).
Pain that begins with bleeding or after bleeding has begun is usually considered secondary dysmenorrhea and is usually associated with an underlying anatomical problem such as endometriosis or adenomyosis (benign invasive growth of the endometrium into the muscular layer of the uterus). Treatment of this condition is more complex and diverse and ranges from hormonal therapies to hysterectomy.
In Chinese medicine, menstrual cramps can be of five different origins, depending on the nature of the imbalance. It can be caused by excess or deficiency, and is commonly associated with the stagnation of the Liver and Kidney Energy systems.
Focus on your emotional health
Repressed anger, frustration and hatred constrain Liver Qi. Negative, unresolved emotions stagnate Qi, which can lead to menstrual cramping.
Modify your diet
Alcohol, sugar, caffeine, dairy and oily foods create stagnation. Avoid physically and Energetically Cold foods and drink.
Avoid overuse of drugs
Unnecessary over-the-counter and prescription drugs or recreational drug use upsets your body's balance and can create stagnation.
Avoid overexertion
Overwork or overexercise can create Qi and Blood deficiency so Liver and Kidney Energies are undernourished and do not have the force to move the menstrual blood, which stagnates and creates pain.
Chinese herbs and Western supplements
You can use Chinese medicinal herbs in recipes to ease menstrual cramping. See chapter 21 for recipes. You can also take Chinese herbal formulas to relieve menstrual cramping. Herbal formulas can be purchased online at ancientherbs modernmedicine.com.
Urinary tract infections are extremely common in women due to the relatively short length of the urethra (the tube draining the bladder). The short urethra in women allows bacteria to more easily swim upstream and infect the bladder. Many additional factors increase the risk of infection, including sexual activity, pregnancy, and dehydration or decreased bladder drainage. Treatment includes aggressive hydration to flush out the bacteria, antibiotics and acidifying the urine with acidic foods such as cranberry juice.
In Chinese medicine, acute bladder infection, or urinary tract infection (UTI), is usually considered to result from Heat and Dampness, which disrupts normal bladder functions, creating discomfort and irritation. Chronic or recurrent bladder infection often results from Kidney or Spleen deficiencies or Liver Energy imbalance.
Modify your diet
Avoid sugar, dairy, fried foods and processed foods, which create internal Dampness and Heat and make the bladder vulnerable to infection. Excessive Cold such as iced foods and drink, especially ice cream, can create Dampness, precipitating Damp/Heat.
Avoid unnecessary drug use
Unnecessary over-the-counter and prescription drugs (especially antibiotics) or recreational drug use interferes with your body's balance and can result in Heat and Dampness, making the bladder vulnerable to infection.
Focus on your emotional health
Constrained emotions, particularly jealousy and suspicion or paranoia, can transfer to the bladder via Heart and Small Intestine Energy.
Keep cool
Exposure to Damp and Heat can arise from your living situation. To avoid Dampness, take care to stay cool and dry if you live in a tropical environment.
Be responsible in your sexual activity
So-called “honeymooner's syndrome” results from sustained sexual intercourse, or intercourse that is unsanitary (anal and genital during the same encounter).
Chinese herbs and Western supplements
You can use Chinese medicinal herbs in recipes to ease the symptoms of a bladder infection. See chapter 21 for recipes. You can also take Chinese herbal formulas to treat bladder infections. For more information log on to ancient herbsmodernmedicine.com.
Vaginal yeast infections are caused by Candida albicans, an organism that is normally present in relatively small numbers in the vagina. A yeast infection occurs when yeast multiplies rapidly. This can be due to a change in the vaginal environment, injury, sexual transmission or HIV. Common environmental disruptions that favor yeast include increased pH, increased heat and moisture, allergic reactions, elevated sugar levels, hormone fluctuations and reductions in the populations of bacteria that are normally present to counterbalance the yeast. Symptoms include intense itching, a burning sensation in the vagina and vulva, a yellowish-white cheesy discharge and a yeasty odor.
Primarily classified in Chinese medicine as Dampness, vaginal candida also involves the External Causes Wind and Heat.
Ways to address vaginal candida
Modify Your Diet: Reduce the consumption of fried foods, dairy, sugar and refined white flour products, which create Dampness that can manifest as candida. Skipping meals or eating too much (even if it is a well-balanced diet) can create Dampness. After menstruation or childbirth, women are susceptible to Damp invasion, which often combines with Heat in the vagina. It is crucial to eat a well-balanced diet of whole foods at these times.
Avoid Unnecessary Drug Use: Contraceptive pills and steroids can encourage yeast infections. Excessive use of antibiotics and antibacterial soaps can result in Dampness that can manifest as candida. Antibiotic soaps kill unwanted bacteria but can also kill good bacteria, upsetting the balance in your vaginal tract and allowing yeast to take over.
Wear Cotton: Wear unbleached, undyed cotton underwear and breathable clothing. Synthetic fabrics, tight or soiled underclothing trap heat and moisture. Do not sleep in underwear. 1L
Practice Safe Sex: Candida can be sexually transmitted. Women with compromised immune systems due to HIV or Lyme disease are prone to yeast infections. Maintain scrupulous hygiene and practice safe sex.
Avoid Perfumes and Dyes: Chemicals, such as those in inks, dyes and perfumes, can upset vaginal balance and/or trigger allergic reactions that lead to yeast infections. Commercial douches damage mucous membranes. Perfumed toilet paper, bubble baths, bath salts, scented tampons or sanitary pads, feminine deodorant sprays, detergents and fabric softeners contain allergenic dyes and perfumes. Use environmentally safe, fragrance-free products that can be purchased at your health food store.
Condoms are packaged with a lubricant that contains nonoxynol-9, a spermicide that may kill HIV. Several recent studies have shown that nonoxynol-9 is linked to yeast infections.
Injury to vaginal membranes from lack of lubrication during sexual intercourse can lead to a yeast infection.
Focus on Emotional Healing: Worry, anger, frustration and resentment all can imbalance Liver Qi, which can further compromise Spleen Energy's ability to digest properly, resulting in the accumulation of Dampness in the intestine and causing Damp vaginal conditions.
Chinese Herbs, Western Medications and Supplements: Effective over-the-counter FDA-approved medications to treat vaginal candida can be purchased at any pharmacy. You can use Chinese medicinal herbs in recipes to treat vaginal candida. See chapter 21 for recipes. You can also take Chinese herbal formulas to address vaginal candida. Formulas can be found online at ancient herbsmodernmedicine.com.