Menopausal Support and HRT Alternatives

Kit Li

A month ago, a female patient at 54 years-old who had been using Hormones Replacement Therapy (HRT) (1) patches for over 5 years to manage menopausal symptoms.  She consulted me seeking a Traditional Chinese Medicine (TCM) approach due to persistent symptoms, including breast tenderness, night sweats, constipation, and emotional discomfort.

HRT is  a medical treatment designed to relieve menopause symptoms, such as hot flushes, night sweats, mood swings, vaginal dryness, low libido;  also prescribed for women experiencing  premature menopause or early ovarian insufficiency.  It is claimed to help protect bones and prevent osteoporosis in postmenopausal women.  It works by replacing hormones that the body produces less of during menopause, primarily oestrogen, and sometimes progesterone or testosterone, depending on the individual's needs.

There are three common types of HRT:

• Oestrogen-only HRT: for women who have had a hysterectomy
• Combined HRT (oestrogen + progesterone): for women with an intact uterus, to reduce the risk of endometrial cancer.
• Testosterone therapy: sometimes prescribed to improve libido, energy, and cognitive function.

However, the risk factors are:

• Slightly increased risk of breast cancer (mainly with combined HRT)
• Slightly increased risk of blood clots or stroke (especially if started later in life)
• Not suitable for women with a history of certain cancers, blood clots, or liver disease

Following a thorough consultation, I prescribed a modified Geng Nian Kang (更年康) (2) to help alleviate her symptoms and gently support the body's transition throughout the menopausal, this herbal formula addresses common menopausal symptoms (3) and also work synergistically to: 

• Nourish Yin and Blood
• Tonify Qi in the Spleen and Lung
• Invigorate the Kidney and Liver
• Calm the Shen (spirit)
• Clear internal heat

After four weeks of treatment, her condition has significantly improved.  She now sleeps better, no longer experiences night sweats, and reports feeling noticeably calmer and more balanced.

From a TCM perspective, menopausal symptoms are primarily associated with imbalances in the Kidney, but also involve the Liver, Heart, Spleen, and sometimes the Lung. These imbalances are often categorized into distinct patterns:

1) Liver and Kidney-yin deficiency: 'The Liver and Kidney share the same source' (肝肾同源).  When Kidney-yin deficiency, it often affects Liver-yin, leading to: dry eyes, blurry vision,  dizziness, irritability, insomnia, menstrual irregularities or infertility in women.

2) Heart and Kidney disharmonized (心肾不交): Kidney-yin helps anchor the Heart-Yang and calm the spirit (Shen), if Kidney-yin is weak, Heart-yin may also become deficient, leading to palpitations, anxiety, insomnia with vivid dreams, and poor memory or concentration.

3) Lung and Kidney-yin deficiency: 'Kidney grasps the Qi'  (肺肾阴虚), especially in respiratory issues,  they  work together to regulate fluid metabolism and breathing, deficiency in both leads to dry cough or chronic dry throat, shortness of breath and wheezing, scanty or sticky sputum, tendency toward yin-type asthma or chronic respiratory issues.

4) Spleen-yin or -qi deficiency (脾气或脾阴虚): chronic Spleen-deficiency (especially Spleen-yin or qi) can eventually affect Kidney-yin through exhaustion of postnatal energy sources.  In reverse, Kidney-yin deficiency may dry fluids, affecting digestion and leading to constipation or dry stools.  

Chinese Herbal Medicines offer a gentle, tailored approach that works in harmony with the body's natural rhythms.  Used under proper guidance, it may serve as a preventive and supportive therapy, particularly for women seeking non-hormonal options or looking to transition off HRT safely.

References: 

1) Hormones Replacement Treatment (HRT)  

Study provides new estimates of breast cancer risks associated with HRT (Oct 2020)

 https://bmjgroup.com/study-provides-new-estimates-of-breast-cancer-risks-associated-with-hrt/#:~:text=A%20new%20study%20published%20by%20The%20BMJ%20today,risks%20of%20breast%20cancer%2C%20particularly%20for%20older%20women.

HRT, menopause and breast cancer Tiphaine Boulin, Isla Whitcroft, Hannah Moody Peer reviewed by two members of Breast Cancer UK independent Science Panel (Feb 2024)

https://cdn.breastcanceruk.org.uk/uploads/2024/02/Breast-Cancer-UK_HRT-and-Breast-Cancer-Review-2024.pdf

2) Modified Geng Nian Kang (更年康):

Shudihuang (Radix Rehmanniae Preparata): nourishing yin and blood

ShanYao (Chinese Yam): tonifies qi in Lung and Spleen

Zhimu (Anemarrhena asphodeloides Bunge): expels heat

Danggui (Chinese Angelica Root): nourishing blood

etc....

3) What is menopause?

https://cdn.breastcanceruk.org.uk/uploads/2024/02/Breast-Cancer-UK_HRT-and-Breast-Cancer-Review-2024.pdf (Page2)