Going through perimenopause
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Lee Sung-hun
By Lee Sung-hun
A lady in her mid 40s visited my clinic just several weeks ago with occasional hot flushes on her face as her main complaint.
When I enquired about her menstrual cycles, she responded that it had become irregular with very little menstrual bleeding.
Although she was still a little bit young, it was determined that her symptoms reflected that of perimenopause and treatments began accordingly.
According to the definition by the World Health Organization, perimenopause includes the period immediately before the menopause when the endocrinological, biological and clinical features of approaching menopause commence, and the first year after menopause.
This transitional period can last on average about four years, but varies greatly depending on the individual; so much so that some will experience it for only several months while others may go through it for several years.
It is not an illness but rather a natural progression of the body as the ovaries ages.
Generally, most women will experience her last period between the ages 48 and 52, and the average age of menopause for Korean women is 49.7 years old.
While going through perimenopause, a woman’s body experiences a variety of symptoms due to the hormonal changes.
Because of the individual susceptibility to hormones, some women experience a whole list of symptoms simultaneously while others notice very little discomfort.
Among the initial physical changes, the most noticeable one is the irregularity of the menstrual cycles during which the menstrual bleeding can decrease or increase.
Also due to the decrease of female hormones, other symptoms can appear, one of which is the hot flush _ a creeping feeling of intense warmth around the neck and facial areas.
The hot flush is a very common symptom of menopause, experienced by 50 percent of women going through menopause, and it can last anywhere between one and three minutes.
It can occur five to ten times per day on average, but some can experience it up to 30 times a day.
Due to its frequency, it is possibly the most discomforting symptoms and it can also accompany perspiration and a rapid pulse.
Other symptoms that a woman going through menopause experiences includes musculoskeletal ones such as shoulder pain, headaches, back and joint pain and psychoneurotic ones such as anxiety, insomnia and feeling helpless.
Also, dry skin and numbness in the extremities can be observed.
Low estrogen levels can also result in atrophy in the vagina and urinary tract which can be seen by vaginal dryness, dyspareunia, lack of sexual drive, frequent urination and incontinence.
Also, in a typical Korean family, when the woman experiences her menopause at around 50 is when the husband is still quite dedicated to his work and thus can spend more time away from home and family and when the children become more independent and prefer the time with their peers rather than their parents.
The mother then can become prone to feeling lonely and void, thinking that she is left alone in an empty house.
On top of the physical and hormonal changes, she can experience anxiety and depression.
In Oriental medicine, the physical transition of a female body is described in seven-year cycles.
According to “Internal Classic,” the oldest medical text in Oriental medicine, a woman begins her periods at age 14 and at age 49 her vessel for pregnancy declines, leading her to menopause and an inability to bear children anymore. In Oriental medicine, vessels refer to the conduits through which qi and blood pass.
This cycle is based on the fluctuations in kidney’s qi.
In Oriental medicine, the kidneys are the organs where the essence of all our internal organs gathers.
Thus, a woman’s period begins as the kidneys become energetic, and once they lose their vitality, the period accordingly stops.
Therefore, the principal treatment for perimenopausal syndrome in Oriental medicine focuses on replenishing vitality to the kidneys.
Hot flushes are considered to be the result of insufficient yin-qi in the kidneys that has resulted in its inability to control the yang-qi, whose heat has risen to the face.
Treatment then becomes two-pronged by replenishing the kidney and removing the heat from the upper body.
If the patient is easily surprised, and her heart beats quickly and she is unable to sleep soundly, it is deemed as an issue with the heart’s vitality, and so treatment aims to promote the qi flow between the heart and kidneys.
If the patient is psychologically tense, irascible and suffers from depression, the qi of the liver is deemed to be in congestion, which needs to be remedied.
Hormone replacement therapy (HRT) that involves estrogen and progestin have become a common option to manage perimenopausal symptoms, but the known risks associated with them prevent women with fibroid, liver and gallbladder disease, and thrombophlebitis from using such therapy.
HRT is also known to increase the probability of breast cancer and cardiovascular illnesses.
If a woman is in the known risk group for HRT or simply against it, Oriental treatment can be a viable and effective option.
Some of the foods known to assist in alleviating the symptoms include soybeans, pomegranates, kudzu plant, and black cohosh whose plant estrogens can mimic the functions of the female hormone.
Owing to the advance of modern medicine, average life expectancy has been extended, and so has life after menopause for a woman.
If left unaddressed, the symptoms and effects of decreasing female hormones can lead to osteoporosis or other cardiovascular diseases.
My advice to female readers is that you should pay close attention to the changes during perimenopausal years and respond accordingly so that during the years after menopause, you are healthy and fit to enjoy yourselves.
The writer practices Oriental medicine at the UN Oriental Medical Clinic in
Hannam-dong, Seoul.