An Integrative Approach to Sex Hormone Decline with Functional Medicine and TCM

Featured Speaker: I lyas Hamid DAOM

On April 14th, a 54-year-old woman came into the clinic seeking treatment for insomnia, hot flashes, stress, and she was postmenopausal for 3 years, and since then, she had gained about 25 pounds. Her sleep routine involved going to bed around 10 pm, but she consistently woke up in full alert between 1-4 am and would not be able to fall back asleep. She would turn on the television to try to tire her mind to fall back asleep. She described herself as being in a constant state of anxiety all day and night that she could not turn off. She was regularly and randomly having hot flashes all day and night. She had achilles pain that was taken care of in the past but seemed to have been reactivated with menopause. It had become chronic for 3 years. Her energy levels were low. She felt as though she always needed sleep, and she felt unmotivated. Digestion-related, she always felt bloated. She had constipation that had been going on since her 20s. She would have bowel movements one to two times per week and sometimes would go a week without a bowel movement. The stools were very hard and dry. She would do detox teas to help her bowels move when she was severely constipated. To make herself regular, she would do colon cleanses one to two times a month for about 5 months, but this approach was unsustainable. Her diet included 2-3 meals per day. She would often miss breakfast, which seemed to have made her more stressed at work. She relied mostly on sandwiches and starches and included a lot of vegetables in her diet. Some foods that were regularly included in her diet were peanut butter and jelly sandwiches for lunch, pretzels for snacks, pasta for dinner, and cereal with fruit or toast with avocado and eggs. She loves coffee and has been drinking 2 large cups a day since she was in her 20s. She has also gone vegan at times. She perspired often, especially when having hot flashes. Some of her other symptoms include dry phlegm in the nose at night, and swelling and tightness all over her body,

As she was sharing her symptoms, I was navigating the possible pattern differentiations I could diagnose her with, just like many Chinese Medicine Practitioners do. When it comes to menopause, most practitioners will consider some form of Yin Deficiency. With her hot flashes and constipation, one may consider heat signs. But when I looked at her tongue, I was surprised to find that she had a very thick, greasy tongue coat, and a pale tongue that was slightly redder at the tip. The tongue coating was not just centralized but was also on the sides of the tongue which would be considered the Liver area. Her pulse was overall slippery and wiry on the right and left sides respectively. This was the first time I had experienced menopause in this way. I diagnosed this as a Damp Phlegm Accumulation trapping Empty Heat.

I approached this by first treating the excess using formulas to treat Damp Phlegm accumulation. Er Chen Tang was the base formula. I used this formula for one month and a half, making modifications as I went along. The herbal approach did not affect any of her symptoms. However, the Acupuncture treatments helped calm her mind and temporarily relieved her anxiety and stress.

The most challenging part of this experience was being able to assuage the patient's eagerness to get well. I am certain this is a challenge that many acupuncturists experience. In these situations, I have found that having a diversified toolbox of therapies comes in handy.

This is the point where Functional Medicine became a pivotal tool in managing the patient's care. There is an overlap in diagnostics between Functional Medicine and Chinese medicine. So as the patient was sharing her symptoms with me, I was also evaluating her symptoms from Functional Medicine ideologies. Her menopausal symptoms, of course, are hormonal-related. Her constipation and her diet had a clear overlap, making it easier to ascertain that the amount of gluten in her diet left her with increased intestinal permeability, which is what was creating her digestive symptoms. Hormones and toxins will continue to re-circulate through the body if the intestines cannot detoxify through bowel movements. The Liver and Small Intestine regulate this process, and the biomarker involved is beta- glucuronidase.  The Chinese Medicine understanding of the Liver regulating the smooth flow of qi throughout the body was quintessential in analyzing this situation. Her signs showed phlegm in the areas of the tongue that pertained to the Liver, and her symptoms of stress and anxiety could be attributed to Liver qi stagnation. At this point, it seemed that her new pattern was Liver qi stagnation with Damp Phlegm accumulation trapping empty heat.

My new approach involved removing gluten from her diet. As each week went by, her bowels started to regulate, but she still had all the negative menopausal symptoms. The next step involved detoxifying her Liver and boosting her gastrointestinal immune system from a Functional Medicine standpoint. To navigate her conditioned sleeping imbalances, we used ear seeds on Shen Men and Sympathetic points for her to press into when she wakes up at night. With one month of therapy, she slept 7-8 hours per night with unbroken sleep. She stopped having hot flashes. Her stress and anxiety were eliminated. She was having regular, formed, and brown bowel movements 2-3 times per day. Her tongue coat became thin, with a few spots of phlegm on the sides and at the base of the tongue. The color became pale pink and the redness at the tip diminished to a pink color.  Later, she noticed that when she traveled, her hot flashes would come back. This was due to her diet of eating high amounts of gluten and traveling to different time zones. At this point, we focused on supplementing with DHEA and anti-inflammator supplements for maintenance. This approach worked well, and she stated that she noticed a significant difference in mood when she stopped taking these supplements.

Ongoing maintenance involves Acupuncture once every two months and ongoing maintenance with supplements that focus on anti-inflammation and probiotics.