Saturday, July 27, 2013

Chinese women and menopause


In the American culture, menopause — the time when a woman's menses gradually cease, normally between age 35 and 60 — is often accompanied by flushing or hot flashes, mood swings, depression, insomnia, and thinning of bones, skin, and vaginal walls. In Western medical practice, this plethora of symptoms is treated with "hormone replacement therapy" (HRT): a regimen of prescription synthetic hormones.

Yet in the Chinese culture, hot flashes are considered less common. Why? Because there were no studies on the matter, of because the culture, climate, or diet helps women better combat unpleasant menopausal symptoms?

Age of Menopause

A study conducted by the Chinese Menopause Society, Peking Union Medical College Hospital in Beijing, surveyed a total of 1850 women; a relatively small sample for research, but a huge breakthrough for medical research, since the topic of menopause until recently has not been considered as open for discussion and research.

A breakdown of the average participant ages shows Chinese women dealing with menopause at or just under the standard North American menopausal benchmark age of 51.
*Average age for natural menopause: 49.60 years old
*Average age for entering menopause transition: 46.22 years old
*Average age for onset of menopausal symptoms 46.28 years old

Spiritual transition

According to traditional Chinese medicine, during menopause there is a natural decline in what's known as "Precious Essence" — which is a "yin," or passive, feminine energy. But while Precious Essence declines, Chinese medicine also sees a corresponding increase in "yang" energy, or active, masculine energy. That increase is an important part of the change that's happening.

So menopause can be a time of life when many women move from being passive to setting boundaries and becoming more goal oriented. Many women learn to speak their minds more easily. Women change. Their personalities change, their outlook on life changes. This is part of the process. This can be a rich time, and deep inward direction can come out of it.

In the Chinese view, Precious Essence is prenatal energy, stored in the kidney, that conveys the gifts of fertility, libido, regeneration of the body, and tissue elasticity and strength. The term Precious Essence stems from the idea that this energy is worth guarding, because its function is to maintain youth, and there is only so much of it.

Precious Essence is of two kinds: Pre-Heaven, representing inherited characteristics, and Post-Heaven, representing energy accumulated or lost through the way we live our lives. Pre-Heaven essence is not easily renewed, but it may be replenished through breathing and meditation exercises. Post-Heaven Essence can easily be renewed through lifestyle changes — exercise, balanced activities, and the intake of proper food, air, and water.

According to the Chinese, those who wisely protect their Precious Essence may live long without wrinkles and maintain a youthful appearance. From a lifetime of balance, it is even possible to achieve an excess of Precious Essence.

Menopausal symptoms and Chinese women

During the survey, the Chinese women were asked about their menopausal symptoms. Not surprisingly, Chinese women tended to report the same symptoms as their North American or Western sisters. Insomnia was reported by 60% of the women, followed by hot flashes (51%), joint and muscle aches (18%), and exhaustion (16%). It appears no matter where women live in the world, they share many of the same menopausal symptoms.

Still, overall Chinese women experience menopause symptoms with higher ease than their Western colleagues. While we don't know the precise reason for this, there are some scientific suggestions offering the support for the factual data:

    * American women tend to have higher estrogen levels than Chinese women.
    * Many researchers suspect that difficulties with menopause are caused by the degree that estrogen levels fall. In other words, if estrogen levels are not so high to begin with, their fall is far shorter, leading to fewer symptoms. Meat, chicken, and dairy products contain foreign estrogens that are fed to animals to increase weight and production, but they also lead to higher estrogen levels.
    * Diets rich in vegetables, particularly whole grains and legumes, provide magnesium and vitamin B6, both of which appear to reduce symptoms of PMS, and possibly, of menopause.
    * Many plant foods, such as soy products, contain phytoestrogens (plant estrogens) such as genistein, which bind to estrogen receptors in the breast or endometrium, "locking out" the "bad" estrogens associated with cancer. In addition, these phytoestrogens provide a natural and gentle source of estrogen as women's levels drop during menopause. Researchers hypothesize that the high intake of soy products in Asia - tofu, soybean juice, miso - may be partly responsible for easing the Asian women's way through this mid-life passage.

Paraesthesia or odd skin sensations

One interesting symptom reported by a whopping 45% of the women was paraesthesia which refers to a skin sensation like pricking, burning, itching, or tingling that seems to have no real cause. This symptom is not usually high on the list of complaints for North American menopausal women but it is likely that many readers have experienced a feeling that their skin is ‘crawling’ or that skin is more sensitive than in the past. Some menopausal women find that their skin reacts to long favorite products including perfumes, skin lotions, and laundry detergents leading women to believe that they have developed allergies.

Chinese women and Japanese women

This study of Chinese women reveals that former beliefs of a homogeneous Asian culture are completely false. Compared to Japanese women, Chinese women report symptoms more familiar to North American, European and Australian women. Japanese women complain less about hot flashes and night sweats than do Chinese women. Researchers point to the large intake of soy typical in most Japanese diets; soy intake in China is relatively lower and more along the lines of a Western diet. With further research, scientists will be able to compare menopausal symptoms and between the similarities and differences, learn more about treatments.

Diet recommendations

To ease menopause symptoms, women should eat lots of whole grains — rice, spelt, oats, and so on, but not bread or flour products — and lots of leafy green vegetables and seaweed. Add plenty of cooked vegetables to the diet and choose foods that are high in vitamin and mineral content.

Fruit and fruit juices should be eaten only in moderation, prepared according to season: raw in the summer and cooked during the cooler months.

Also, traditional Chinese Medicine recommends eating fruits and vegetables that are grown locally and are in season. Eating the local foods of each season is part of living in harmony with nature.

Meat and fish should be eaten in small quantities, although the total amount of protein we need varies. Someone who is very active — for example, a gardener who is moving plants and rocks all day — will need more protein than an office worker. Dairy products also can be eaten, but again, in small quantities.

Chinese herbal medicine

Most women in China are evaluated by a traditional Chinese medicine practitioner well before they reach menopause. In Chinese medicine theory, women with certain deficiencies or imbalances of the body are at risk to develop severe menopausal symptoms in the future. If a practitioner saw a younger woman who showed signs of Kidney Yin Deficiency, for example, he would project that she would be likely to have a difficult time at menopause unless the deficiency was corrected. Many of the most valuable Chinese herbal formulas are designed to be tonics for Chi, Blood, Yang, or Yin, and can be used on a regular basis with no adverse side effects. A woman who displayed symptoms of Yin Deficiency, such as insomnia or heart palpitations, would be recommended to take a Yin tonic formula. The practitioner can tell by the signs of which internal organ is most affected by the deficiency, and will recommend a tonic which is formulated specifically for that organ. A time-tested formula for Kidney Yin Deficiency, often given to menopausal and pre-menopausal women is Kidney Yin Tonic (Rheumania Six Formula).

Exercises

Physical exercises such as Chi Kung (or Qi Gong) or Yoga are extremely helpful for menopause. They are energy-moving, and can strengthen the body. These are disciplines that can regulate the body and bring about rejuvenation. The deeply meditative exercises that have this effect are not normally taught, so you may have to search for a teacher who can help with this.

Tolerance and forgiveness extended toward the self and others restores the Essence, as does the practice of devotion and honor. This is the path of the Tao, of walking energetically between Heaven and Earth. Practices that lead to the Way restore the body's vital energies.

Chi Kung and Yoga are best learned from a qualified teacher. Both methods of exercise nourish the chi through breathing exercises, and they strengthen the body through the movement of energy. These are exercises that stimulate the endocrine system and lungs. Yoga and Chi Kung improve longevity while increasing the sense of harmony within one's self in relation to the world.

It takes years to truly cultivate the significance of these practices, but even beginners will develop a sensation of wellbeing and peace of mind.

Acupuncture

Acupuncture balances energies, adding energy where it is needed, dissipating energy when it is too concentrated, moving energy that is stagnant. And it works directly on whatever organ you target. So acupuncture can work directly on the kidney and liver problems that are associated with menopausal symptoms.

As we said, it is the kidney that stores Precious Essence, and the kidney is the only organ that is both yin and yang. It rules the teeth, bones, hair, ears, reproductive functions, and growth or development of the body. An imbalance of kidney energy might be determined outwardly from thin, dry hair, poor teeth, and a recent development of worry and paranoia.

Because acupuncture can help to balance energy, it is significantly helpful for symptoms of menopause. Acupuncture helps tremendously with hot flashes and can control or eliminate them.


Sources and Additional Information:


Wednesday, July 3, 2013

Indian women and menopause


It is not a secret that the common perception is that Western cultures treats older women as if they were less valuable members of society. You may not feel such change in societal attitude, but nevertheless it exists. Yes, the processes in our society obviously move the people’s attitude in a favorable direction, however, the shift in minds is gradual and slow. But in other cultures, menopause is considered as honorable, useful, and spiritual time in their lives. There are also cultures and countries, where the menopause is still considered as untouchable topic for discussion.

Thus, we will review the different aspects of the Menopause, associated with international cultures, customs, and beliefs worldwide. Our first review in the series is devoted to India.


While menopausal women in India experience the similar emotional and physiological problems, it is almost officially unheard of in public circles. India has traditionally ignored women’s health issues including menopause, and only the latest societal trends are attempting to break the outdated attitudes towards women.


Menopause attitudes in India

Women in India are no different in terms of attitudes towards menopause; some women dread and fear menopause while other women embrace or at least accept menopause. The fear and dread of menopause stem from being seen as no longer useful or productive in society. For the most part, life for Indian women centers on home and family while accepting secondary citizen status in this male dominated culture. Women’s issues including health and menopause are almost never discussed.

The flip side notes the relief women feel about the end of having menstrual periods. Although women always remain subservient to men, older women in India do enjoy a measure of respect as the senior member of the family. Unfortunately this enhanced status does not make it easier for women to talk about or seek help for menopause.

Bangalore Study (Institute for Social and Economic Change)

* For the study, researchers of ISEC used data from the National Family Health Survey, conducted in 1988 and 1999, which examined about 90,000 married women ages 15 to 49 across 26 Indian states.

* The study found that 3.1% of women living in India became menopausal between ages 30 and 34, 8% of women experienced menopause by age 39 and 19% of were menopausal by age 41. The average menopausal age in India is 44.3 years.

* The study found that premature menopause was most common in rural areas, as well as among agricultural workers, women who were illiterate and women who had a low body mass index. According to the researchers, malnutrition and poverty are believed to be contributing factors to premature menopause; however, the study did not address these factors.


Indian Menopause Society Report

Menopause symptoms vary from woman to woman in India as is the case for women elsewhere. The Indian Menopause Society’s (IMS) 2008 Consensus Statement contains important statistics about menopausal symptoms and recommendations to improve healthcare for Indian women. Some of the IMS research findings show:

*The average age of menopause in India is 47.5 years, which is higher than posted in the previous research, but is still slightly lower than the average age of 51 for North American and European women. However, the premature menopause cases are on the rise in India due to a combination of environmental and genetic reasons.

*Indian women living in rural areas (72% of the population) and urban areas both cite having urogenital symptoms and general body aches and pains. Interestingly, women in urban areas complain more about having hot flashes, mood swings, psychological problems, and intercourse challenges. Like their Western counterparts, urban-based Indian women are subjected to more demanding and fast-paced lifestyles which may explain the differences in symptom reporting.

*Osteoporosis is a serious risk for Indian women. Osteopenia, or low bone mineral density (BMD) usually means a greater chance of developing osteoporosis. Approximately 35-40% of Indian women aged 40-65 suffer from osteopenia. Indian women tend to have low bone density due to a lack of both sufficient calcium intake and adequate exercise.

*Cardiovascular disease is quickly becoming one of the leading causes of death in women and Indian women are no exception. Higher HDL/LDL cholesterol and triglyceride levels, increased high blood pressure occurrences, and obesity rates among menopausal Indian women (and women of all ages) translate into increased risks for heart attacks and strokes. Diabetes rates are also on the rise for women in India.

*Cancer rates for Indian women between the ages of 35 – 64 are steadily growing. Breast, cervical, ovarian, and endometrial cancers account for between 29.4 and 72.5% of all cancers in women. Cancer rates vary between India’s geographic regions; healthcare access, education, and lifestyle are different throughout the country.

Surgical menopause (hysterectomy) is performed widely in India and both doctors and patients view a hysterectomy as a preferred option in menopause treatment. Compare this to North America and Europe where hysterectomies are no longer considered the best option for women. But with limited menopause treatment options, the fear of developing hormonal related cancers pushes many women to request a hysterectomy and doctors are all too willing to perform this controversial procedure.


Unneeded Sterilization

In one of the discussions, Dr. Veena Shatrugna, former president and now executive member of the Anveshi Research Center for Women's Studies, pointed out that in the rush to meet family planning targets, women in India are often sterilized immediately after giving birth, when their bodies are still vulnerable.

"Medically speaking, operations like these are to be carried out when all her parameters are normal," she said. "But then family planning doesn't care about the health of women. It's all about cutting the tubes. So at the second level, when they have problems arising from side effects of sterilizations, doctors suggest women finish the problem by removing the uterus. So menopause also occurs at an early age."

The state's introduction in 2007 of an insurance program for families below the poverty line that compensated doctors for conducting hysterectomies appears to have intensified the problem among low-income marginalized women.

In 2011 the state government--after studies found that a majority of the surgeries conducted in private hospitals approved by the health department were unnecessary--revised its guidelines and banned participating private hospitals from conducting hysterectomies and claiming the insurance money.

But women are still being actively pushed towards unneeded hysterectomies, said Dr. S.V. Kameswari, a leading gynecologist."There are not enough women doctors in rural medical facilities who can give proper advice. So, private rural medical practitioners in the villages take advantage of these women's ignorance and reluctance to access proper health services for reasons that include availability, distance, cost and quality."

She added that women who undergo early hysterectomies often have little or no education, don't understand the surgery or its side effects and are pushed toward it by gynecological complaints stemming from conditions such as early marriage, poor nutrition and spousal relations.

"Instead of treating these morbidities ethically, unscrupulous doctors recommend hysterectomy, which is unnecessary," said Kameswari. "They are rarely counseled about the consequences of the surgery . . . They don't know if their ovaries will also be removed along with the uterus, or that menopause will be an immediate consequence. We don't recommend the removal of ovaries as it increases the woman's overall risk of death by 40 percent."

Some husbands have also pushed wives to have a hysterectomy, said Kameswari. "They opine that women are susceptible to illness and it was better to opt for a 'permanent solution.' The only way to change their minds is greater gender sensitivity and awareness on this issue."

Cultural barriers

There are cultural barriers along with fears, concerns, and myths about the side effects of hormones in general. Improper compliance of patients on advice of life style changes and medication is another problem.

The high cost and non-availability of full range of therapy through the country make tailoring of treatment for individual women difficult at times. Moreover, there is lack of availability of diagnostic facilities for screening and monitoring of menopausal women including those on therapy. Many times, Indian symptomatic menopausal women are subjected to hormone replacement therapy based on Western experiences. Discontinuation rate is very high among Indian women due to myths and misconceptions.

The future for Indian women and menopause

The IMS is working to help improve awareness about women’s health issues and educating doctors and patients about menopause. This is an enormous project in India where the huge population and wide range of literacy and education levels make it difficult to effect positive change for women in society. The IMS seeks to improve living, dietary, and physical conditions of women.

Changes in India are slowly happening and though it may take several decades, talking about and seeking help for menopause will help to improve the lives of women in India.



Sources and Additional Information:


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