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Perimenopause
Perimenopause is the interval between the last regular
menstruation and menopause. Irregular cycles with decreased
frequency, quantity and duration of flow can last from 2-7
years.
An estimated 75-98% women develop symptoms (hypoestrogenism)
and for 15-25% they are severe and disruptive enough to
require medical assistance.
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The definition according to Traditional Chinese Medicine (TCM)
is a bit more complex... symptoms are grouped into "zang
fu" syndromes. These syndromes are defined by groups of the
wide range of perimenopause symptoms.
Perimenopausal Symptoms
Menopausal symptoms fall into a number of categories:
- Menstrual: irregular menses, changes in bleeding pattern,
pain, PMS changes, duration, severity, breast distention
- Temperature: hot flashes, perspiration
- Psychological: cognitive changes, memory loss, concentration,
mood changes, anxiety, depression, irritability, insomnia, sensitivity,
instability, agitation, suspiciousness
- Digestive: indigestion, diarrhea, gas, constipation,
bloating, weight gain, nausea, loss of appetite, loose stool
- Pain: myalgias and arthralgia, headaches and brain
buzz
- Head: dizziness, vertigo, hot flashes, flushed cheeks,
tinnitus (ear ringing)
- Heart: palpitations, chest oppression
- Skin: formications, dryness, rashes, itching prickly
skin
- Urinary: frequent urination and incontinence
- Body Fluids: muscosal changes, bitter taste, dry mouth,
bad breath, dry nostrils, eyes, vaginal dryness, edema of face
and lower limbs
- Sexual: libido loss, energy loss
What Else Could Those Symptoms Mean?
It is important to consider what other diseases or conditions
might be confused for perimenopause. After all, we don't want
to treat the wrong thing! The differential diagnosis includes:
- Dysthymia or cyclothymia
- Insomnia
- The full range of endocrine disease, for example:
- anterior hypothalamus disease
- hypothyroidism or hyperthyroidism
- diabetes
- hypoadrenalism or hyperadrenalism
- Anemia
- Anorexia nervosa
- Metabolic disorders
- Chronic fatigue syndrome
- MS
- Lupus
- Early hepatitis C or D
This is exactly why we need primary care doctors. Someone needs
to consider your symptoms, and then order the relevant labs tests
to make sure of the cause. In California, acupuncturists can order
lab tests and can be your primary care physician.
Regardless, it's best to have a health care team at your disposal-
MD/DO, L.Ac., D.C., Massage therapist, etc. Whatever your pocketbook
and coverage will allow
Types of Perimenopause
I'd like to present 4 general ways that perimenopause can show
up. I'll go into detail about each one in further articles. The
4 types are:
- Early Perimenopausal
Syndrome, Physiological Type
- Early Perimenopausal Syndrome, Psychological Type
- Later Perimenopausal Syndrome, Hormonal Imbalance with
both Physiological & Psychological Presentation
- The Traditional Menopausal Syndrome
In future articles, I will cover each of these types. As they
are finished, you will be able to click above for more info.
For TCM Practitioners, here are the zang-fu patterns, distinctive
symptoms, and recommended herbal formulas for these 4 types:
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Type
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Zang Fu Patterns
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Distinctive Symptoms
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Herbal Formula and Vitamins
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| 1. Early Perimenopausal Syndrome, Physiological
Type |
Liver qi stagnation, general qi and blood
stagnation, with damp phlegm accumulation due to underlying
Sp qi deficiency |
- Epigastric distention, gas, abdominal
bloating
- Headaches usually with a muzzy or heavy
quality
- Fibrocystic breasts
- Tongue: lateral redness, body may be
pale, possible dusky purplish, may be swollen with a thick
coating
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Minor Bupleurum Formula
- Carth Persic Comb
Vitamins & Minerals:
- Vitamin E 400-800IU daily at bedtime
- Pyridoxine (B6) promotes
- Folic acid 5 mg daily
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| 2. Early Perimenopausal Syndrome, Psychological
Type |
Liver Qi Stagnation leading to Fire Flaring
to Heart and Deficiency Kidney qi and yang. |
- Anxiety, instability, tension, uncertainty,
angry, depression, irritability, lability, uncontrolled
crying, inability to manage stress,
- Migraine headache, tension headache
- Swelling, water retention in extremeties,
great fluctuation in weight
- Tongue: Red, yellowish coating
- Pulse: rapid
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OB-GYN PMS Formula
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| 3. Later Perimenopausal Syndrome, Hormonal
Imbalance with both Physical & Psychological Presentation |
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- Occurs later in perimenopause
- Combination of the physiologic and psychological
symptoms above
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Hormonal Balance Formula
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| 4. Traditional Menopausal Syndrome |
Kidney Yin and Qi Xu with Rising Liver Yang. |
- Libido loss, energy loss, insomnia, cognitive changes,
memory loss, concentration, etc.
- Irregular menses, changes is bleeding pattern
- Muscosal changes-bitter taste, dry mouth, bad breath,
dry nostrils, eyes, vaginal dryness
- Mood changes-anxiety, depression, irritability, headaches
and brain buzz, dizziness
- Constipation, bloating
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Menopause Formula
Variations:
- Rehmannia Six Formula
- Anem-Phello & Rehmannia Formula
- Lycium & Rehmannia Formula
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Obviously, there is some overlap in the symptoms... diagnosis
of zang fu patterns for herbal treatment is very complex and requires
years of education and practice. Your Chinese Medicine (CM) practitioner
will also take your pulse, examine your tongue, and may conduct
other physical examinations to verify your diagnosis.
If you don't have a CM practitioner, read the Pulse article,
"Finding an Acupuncturist."
More detail on these 4 types and the herbal formulas next time!
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Lynda Harvey, OMD, LAc, PhD(c) is a doctor of oriental
medicine, licensed acupuncturist, chinese herbalist, clinical
nutritionist, and Ph.D. candidate in clinical psychology
and with over 18 years experience in women's health.
You can reach her at in the San Diego area at 619-322-9200.
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