A Comprehensive Program for Gynecologic Health
At one time or another, most women contend with some unpleasant physical symptoms, such as bloating, irritability, or pain, before or during their menstrual periods. These are not signs of illness but rather indicate that there is a degree of disharmony in the reproductive system. By following this comprehensive program, you can lessen or eliminate those unpleasant symptoms and restore harmony without resorting to over-the-counter medications or prescription drugs.
Before beginning this program, let’s review the Chinese and Western concepts of women’s reproductive system and the origins of disharmonies and disorders.
WOMEN’S HEALTH IN CHINESE MEDICINE
The monthly cycle depends on the harmonious functioning of the Stomach, Spleen, Liver, and Kidney systems and a balanced flow of Qi and Xue. Irregular periods, pain, bloating, mood swings, and cramps are signs that one or more of the governing Organ Systems and Qi and Xue are not in balance. It’s also possible that gynecological problems have a more complex origin in your emotional history that has caused damage along the Chong Mai (Penetrating Channel). (For more detail on the Chong Mai, see “The Chong Mai” on page 41.)
Such emotional and physical disharmonies can produce a combination of symptoms. The Kidney System controls the formation and release of the egg from the ovaries. If Kidney Qi, Yin, or Yang is weak, infertility may result. Kidney Deficiency can accompany a kind of chronic fearfulness that causes tension, irritability, or depression associated with the monthly cycle. The Liver Qi promotes the free flow of Qi in all areas of the body and triggers the release of Xue and the onset of the period. Therefore, menstrual problems, such as cramps before or during onset of the monthly period and mild premenstrual headache, are usually due to Stagnant Qi. If Liver Qi is not flowing smoothly, depression and anxiety may occur in the days before the period. Liver Excess can accompany generalized anger. Conversely, anger and emotional suppression can damage Liver Qi. Stagnant Liver Qi is associated with menstrual cramps and mild headaches that subside with onset of the period. Stagnant Liver Qi with Heat is associated with irritability, flashes of anger, a feeling of a hot sensation in the upper part of the body, and breast pain. When combined with Stomach Heat, you may experience acne, increased appetite, and breast pain.
When Stagnant Liver Qi leads to Stagnant Xue, there may be blood clots with severe headaches during the menstrual period. When Stagnant Xue is accompanied by Cold, you may experience a cold sensation in the abdomen, darker flow with dark clots, and cramps that are eased by the application of warmth.
Disharmony in the Spleen develops as either Deficient Spleen Qi or Spleen Deficient Qi with Dampness. These syndromes are associated with digestive disturbances, sugar cravings, and fluid retention. When Deficient Spleen leads to Deficient Xue, it is associated with lengthening of the cycle or missed periods and difficulty falling asleep.
THE MENSTRUAL CYCLE IN CHINESE MEDICINE
WOMEN’S HEALTH IN WESTERN MEDICINE
Women show considerable variation in the lengths of their menstrual cycles. Normal cycle length may vary between twenty-one and thirty-six days, but most sources use twenty-eight days as the average number for the total menstrual cycle.
Convention uses the onset of menstrual bleeding to mark the beginning of the cycle, so the first day of bleeding is called “Cycle Day One (CD1).” The menstrual cycle can be divided into several phases. Although the length of each phase varies widely from woman to woman and cycle to cycle, most references use the following average numbers.
MENSTRUAL CYCLE PHASES
|
NAME OF PHASE |
CYCLE DAYS |
|
Menstrual phase |
1 to 4 |
|
Follicular phase (also known as proliferative phase) |
4 to 14 |
|
Ovulation (not a phase, but an event dividing the phases) |
14 |
|
Luteal phase (also known as secretory phase) |
15 to 26 |
|
Ischemic phase (some sources group this with the secretory phase) |
27 to 28 |
The phases of the menstrual cycle are controlled by the interaction of three hormone-secreting organs: the hypothalamus, pituitary, and ovaries. They secrete gonadotropin-releasing hormone (GNRH), gonadotropin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and steroidal hormones (estrogen and progesterone).
For fertility to be robust, the luteal phase needs to be from twelve to fourteen days long. Menstruation itself runs one to seven days. Longer than seven days is considered abnormal. Disorders such as premenstrual syndrome (PMS) and endometriosis (an often painful disorder in which tissue that normally lines the inside of your uterus grows outside your uterus) are not entirely understood by current science. No one is sure of what triggers either condition.
THE CHINESE CYCLE AND THE WESTERN CYCLE
Although this is the “ideal” cycle, Chinese medicine considers any regular cycle to be a healthy cycle. One woman may have a period every twenty-one days, another every thirty-five. If they are both regular, no disharmony is indicated.
When PMS is diagnosed in Western medicine, recommendations typically include hormonal therapy, anti-prostaglandins and analgesics (pain medications such as NSAIDS), dietary changes such as avoiding caffeine, exercise, and psychotherapy. For endometriosis, the alternatives usually prescribed are surgery and potent but often difficult drug therapy with many side effects and mixed results.
Until recently, emotional components of gynecological disorders were dismissed or trivialized by Western physicians. A relatively new field in Western medicine is called psychoneuroimmunology (coined in 1975), the study of the interaction between psychological processes and the nervous and immune systems of the human body. Psychoneuroimmunology recognizes that emotional stressors can be related to disease development. In general, however, Western therapies offer few targeted treatments to ameliorate emotional disturbances and associated physical complaints.
BASIC FACTS
• The average age of menarche in North America is 12.47 years old.1
• The perimenopausal stage can last from two to ten years. In the beginning, there are usually shorter cycles—probably caused by the luteal phase becoming irregular. As menopause nears, menstrual periods generally come farther apart due to cessation of ovulation. The beginning and end of the fertility cycle are marked by long anovulatory cycles with progesterone deficiency.
• The average age for menopause is fifty-one.2 In the United States, smokers reach menopause earlier.3 (A recent study shows this may be a genetic variation in white women, but it’s not known for others.)
PART ONE: SELF-CARE FOR PREVENTION AND THERAPEUTIC TREATMENT
Except in severe life-threatening situations, I believe that self-care is 80 percent of all care. Your ability to take care of yourself often determines how well you will be and how much you can enjoy yourself—in the short term and also for your whole life. In this section, you will learn how to take care of yourself in a step-by-step method to create wellness and wholeness.
Step One: Adopt the Comprehensive Program for Strengthening Organ Qi and Protective Qi
A general, preventive health care routine that includes a balanced diet, regular exercise and meditation, self-massage, and other stress-reduction techniques is essential for reproductive health. That’s why the Comprehensive Program for Gynecologic Health integrates the Comprehensive Program for Basic Good Health and a Strong Immune System (see page 223), including preventive techniques tailored to suit the unique needs of women’s bodies.
If you suffer from specific complaints, such as PMS or menopausal symptoms, or who need fertility support, you will find targeted therapies at the end of this chapter to consider.
Step Two: Expand Your Daily Journal
When starting a Comprehensive Program for Gynecologic Health, the first step is to expand your daily journal to a monthly log. It should include information on your cycle and associated physical and emotional responses. You should develop a habit of making these notations every day for at least six months—even if you stop keeping your general journal after two weeks. In fact, this would be a good practice for a lifetime. If you have a well-balanced cycle, it will help alert you to the development of any disharmonies. If you are currently working to remedy an imbalance, it will alert you to triggers and help you track improvements.
The monthly log should include information on the following:
• Food cravings or times when you lose your appetite for specific foods or food in general
• Alcohol and caffeine consumption
• Energy levels and ability to exercise
• Times when sore breasts, overall heaviness, bloating, depression, or fatigue makes it difficult to exercise
• Emotional ups and downs—especially times when you are irritable, cry or feel like crying, get angry, or become depressed as well as when your emotions are positive
• Physical symptoms you suspect are associated with your cycle, such as headaches, blood sugar problems, insomnia, swollen ankles, tender breasts, swollen abdomen, cramps, acne, or lower back pain
• Information about the quality of your period itself: date of ovulation and feelings surrounding it, date of onset, and description of quality of flow, color, texture, intensity, and duration
A review of this information over the course of several months should reveal correlations between your monthly cycle, diet, exercise, emotions, and physical symptoms. This information indicates how you can control or eliminate some of the troubling symptoms associated with your cycle. You’ll see which times of the month you should be particularly vigilant about exercising, curtailing stress, and avoiding foods that exacerbate symptoms.
Step Three: Implementing a Dietary Program
In addition to the diet guidelines outlined in the Comprehensive Program for Basic Good Health and a Strong Immune System (see page 223), you may tailor your diet to remove Dampness and promote a balanced flow of Qi and Xue with the following recommendations:
• Eat a diet of warm, cooked foods. Be particularly careful not to eat cold, raw foods during your period, because it may increase cramping and discomfort.
• Avoid excess dairy products to decrease Dampness and strengthen the Spleen.
• Eliminate caffeine and drink a minimum of alcohol, which increases PMS symptoms and is linked to increased breast cancer risk. Artificial stimulants of all kinds amplify gynecological disharmonies, causing Stagnant Liver Qi along with Liver and Heart Fire.
• Eat an optimal fat diet. Too little or too much body fat affects estrogen production and can lead to various gynecological problems. Too fatty a diet, especially poor-quality fats, can also increase Stagnant Qi and Dampness, which is associated with depression and lack of energy. Too little fat can lead to Deficient Yin and Dryness.
• Increase fiber and include whole grains in your diet to avoid premenstrual constipation.
• Eliminate excess salt from your diet to ease water retention. Pure foods contribute enough salt to the diet to maintain health. Eating processed and packaged foods and adding salt to home-cooked meals is unnecessary, and it can be detrimental to your health. According to Five Phases diagnoses, excess salt injures the Kidney Water, counteracts Earth, and injures the Spleen.
• Once a week, you may enjoy a bowl of San Qi Chicken (see the recipe on page 121) to promote proper Xue movement.
• Eliminate any foods that your daily journal indicates are associated with PMS, cramps, irregularity, or any of the emotional and physical symptoms surrounding the progress of your cycle. You may try reintroducing them after a one-month break by using the First-Step Dietary Therapy Program (see page 113).
Step Four: Implementing an Exercise Plan
To regulate and move Qi and Xue so they flow smoothly, avoid excessive aerobic activities. If you’re trying to reestablish a regular, symptom-free cycle, the first step is to use Yoga, Qi Gong warm-up exercises (see page 182), and walking to stimulate balanced flow. Once a routine is established (daily for thirty minutes), you can expand your exercises to include aerobics such as jogging, cycling, and swimming. Walking 10,000 steps per day can meet the exercise goal. For example, if you walk a lot at work or to and from work, you may want to wear a pedometer (such as a Fitbit) to monitor your walking.
Guidelines from the Centers for Disease Control and Prevention (CDC) recommend that adults ages eighteen to sixty-four engage in at least two hours and thirty minutes (150 minutes) of moderate-intensity aerobic activity weekly (or an hour and fifteen minutes of vigorous activity), and also do muscle-strengthening activities that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms) such as push-ups or weight lifting, at least two days a week.4
Exercising five times a week, forty-five minutes a day will strengthen Qi, but you should avoid exercising to the point of exhaustion or you will deplete your Qi. Your optimal exercise time in a week should be about five to seven hours, including Yoga and/or Qi Gong, walking, and aerobics.
If you have any gynecological disharmony, do weight-lifting exercises only three days a week. The process of tearing down and building up muscle tissue may cause Spleen Deficiency in susceptible women, which could lead to Deficient Xue and increased menstrual problems.
Step Five: Implementing Meditation
Stress is both a trigger and a result of gynecological problems. Meditation can alleviate the stress and diminish associated symptoms, such as premenstrual depression and anxiety. Use the Lotus Blossom Meditation (see page 189) for a quick time-out from cycle-related discomfort and stress. Use the Buddha’s Breath exercise (see page 179) to help ease Stagnation. Regular practice of the longer Qi Meditation (see page 186) can produce constitutional improvements that will do much to restore harmony.
Step Six: Using Self-Massage and Moxibustion for Preventive Care
Massage and acupressure are extremely helpful in relieving gynecological problems. For example, Qi Gong abdominal massage (see page 194) is effective while you are having cramps. When used regularly throughout the month, it can dispel Stagnation and Dampness, relieving PMS and dysmenorrhea.
You may also use reflexology on the hands and feet, particularly on the abdomen, womb, uterus, lower back, and brain points. (See the hand illustration on page 210.)
For reducing symptoms associated with Stagnant Liver Qi, you may perform acupressure on Liver 3. (See the acupressure illustration on page 206.)
In addition, perform a monthly breast self-exam, using the following procedure:
• All women over age twenty are encouraged to examine their breasts regularly for changes in texture, shape, and color of the skin and for evidence of discharge from the nipples.
• If you notice a change, such as the development of a lump or swelling, skin irritation or dimpling, nipple pain or retraction, redness, or scaliness of the nipple or breast skin, or a discharge other than breast milk (such as staining of your sheets or bra), you should see your health care provider as soon as possible.5
• In addition to the traditional Western self-exam, Western herbalist Susun Weed advocates an herbal massage, which is done in the bath.6 This is a less intimidating process, and it also combines the monthly checkup with stress reduction. To enjoy this therapeutic soak, follow these steps:
• Buy or make your own herbal oil by infusing olive or almond oil with fresh thyme, rosemary, basil, peppermint, or rose petals.
• Draw a warm bath.
• Pour herbal oil into the palm of your hand.
• Place both of your hands around one breast, with your thumbs pointing to the ceiling and your fingers cradling the breast from underneath.
• Touch the tips of your thumbs at the top of your breast and draw them down toward the nipple.
• Repeat this motion slowly, pressing down as hard as is comfortable, but spreading the thumbs apart 1/2 inch (1.3 cm).
• Repeat this motion until your thumbs are halfway down your breast on opposite sides.
• Add more oil at any time.
• Now use your fingers under you breast to draw up toward the nipple. Spread them farther and farther apart until you have massaged the whole breast.
As with the more traditional massage, if you repeat this at the same time in your cycle every month, you will become acquainted with the texture of your breasts and become alert to any variations that may require diagnostic testing by a Western doctor.
Perform self-moxa on Spleen 6 and Ren 6 once a week for three weeks, with a week off during your period.
Step Seven: Using Soaks, Saunas, and Compresses for Self-Healing
In general, warming compresses and brief soaks can ease some of the discomfort associated with cramps and lower back pain during the onset of your period. You have to tune into what temperature is best for you. If you are already feeling too hot or dizzy, keep water and sauna temperatures below 101°F (38°C). If you have Cold Dampness, hotter compress, soaks, and saunas can be beneficial.
Use Sleep Ease, a chamomile-based soak, to which you may also add valerian (see “Sleep Ease” on page 213). Enjoy this soak for up to a half hour. You can also prepare and use ginger soaks and Gingerly compresses (see “Gingerly” on page 217).
Step Eight: Taking Nutritional Supplements
All women should adopt a daily supplement program. Ask your practitioner for specific dosing recommendations, because individual needs are different for different women. Your regimen should include essential fatty acids, such as krill oil and flaxseed oil that are sources of omega-3 fatty acids. Vitamin D is prescribed from 2000 IU to 10,000 IU. It is best to dose this according to lab results, although 4000 to 6000 IU is the average dose I give to women. Antioxidants such as lycopenes are important. Also, if you can tolerate it without diarrhea, include 1 to 3 grams of vitamin C a day. Calcium is recommended daily; use from 500 to 1500 milligrams of calcium hydroxyapatite (prion free) or calcium citrate, which contains all of the substances needed to help absorb and build bone mass, including vitamin C, vitamin K, vitamin E, magnesium, and boron. A combination of vitamin B12/folic acid/vitamin B6 is another daily recommendation. The sublingual form is great for absorption. Daily Lactobacillus acidophilus can also be taken to protect against yeast infections and keep the digestive tract healthy. The Mayo Clinic recommends that “1 × 109 living L. acidophilus cells by mouth in divided doses daily is an adequate dose for most people.”7
PART TWO: ASSEMBLING THE TEAM
When it comes to gynecological health, you need to include both Western-trained and Eastern-trained practitioners to optimize your preventive health care plan. When you use practitioners of both types of medicine in concert, it will give you the opportunity to create an individualized comprehensive treatment plan, share diagnoses, reduce side effects, make better choices for treatments and self-care, and attain the best outcomes.
Western Medicine
The American Cancer Society recommends that every woman have a Pap smear every three years from age twenty-one to twenty-nine, then every five years along with HPV testing until age sixty-five.87 The American Cancer Society recommends mammograms yearly starting at age forty as long as a woman is in good health. Yearly screening for sexually transmitted disease, including HIV, is essential for sexually active women.
Eastern Medicine
Chinese medicine is particularly effective for treating the powerful confluences of emotional and physical forces that influence the harmony of a woman’s cycle. For information on Chinese medicine therapies for PMS, menopausal symptoms, and fertility support, see the specific treatment plans that follow the general gynecologic health plan.
Step One: Obtaining a Western Baseline
It’s important to use Western screening techniques to rule out sexually transmitted diseases and cancer as the cause of any gynecological irregularities or discomfort. Western doctors may also be able to offer quick therapies for some other problems. If you opt for Western treatments, take your baseline diagnosis and information on the treatment to a Chinese medicine practitioner. Always tell your Western doctor that you are seeking Chinese medicine therapy as there may be interactions with Western treatment. Also, if you are not using the medicine the Western physician prescribed and you have gotten better, any caring doctor will want to know this information.
Telling doctors what is actually working for you is a major way that Western physicians and practitioners learn that Chinese medicine can help their patients and make recommendations. By seeing a Chinese medicine doctor, you can receive treatment that will ease any negative side effects of Western treatment, and you can benefit from the balancing powers of acupuncture, herbs, and other Chinese medicine therapies.
IRENE’S STORY
“At forty-six, I was diagnosed with fibroid tumors, which caused prolonged bleeding, sometimes for a month at a time,” Irene said. “My gynecologist recommended that I take Provera [a drug that stops abnormal uterine bleeding]. My blood pressure was up to 140/90, and I was feeling pretty bad.” Irene had a hard time taking Provera, which made her vision blurry, moods manic, and body bloated. She decided to try acupuncture for the bleeding.
“After a few treatments, the bleeding stopped. I went back to my gynecologist and he told me that my blood pressure was also down—to 130/88. I didn’t immediately see the connection. But after a few months, I could tell that it was the acupuncture treatments. The treatments had taken care of the bleeding and my high blood pressure. Today at fifty-three, my blood pressure is 110/70, and I have acupuncture treatments twice a month for a half hour. The treatments also kept my condition under control for five years.
“One more thing: After observing my success with acupuncture, my seventy-seven-year-old mother tried it for arthritis and neck pain and has continued treatment for three years now,” Irene said. “She drives an hour each way to receive treatments she considers life prolonging.”
Step Two: Obtaining a Chinese Medicine Diagnosis and Treatment
To ascertain your gynecological health, a Chinese medicine practitioner does not do a direct examination of your reproductive organs. This is not part of the scope of practice of acupuncturists and Chinese medicine doctors in the United States. A Chinese medicine doctor will read the reports from the Western physician for this information. Rather, using the Four Examinations (see page 76), the practitioner conducts an interview to determine what disharmonies are present and to find out what symptoms are troubling you. Using this set of traditional diagnostic techniques, the practitioner is able to design a course of treatment that will restore harmony to your Organ Systems and Essential Substances and, as a consequence, alleviate your gynecological problems.
ACUPUNCTURE AND MOXIBUSTION
The inclusion of Qi and Xue harmonizing treatments once a month will promote gynecological harmony. They are effective in influencing the Spleen, Liver, and Kidney at appropriate stages of the cycle to preserve or restore regularity and harmony. Acupuncture can also be used to impact the Channels that are particularly important in maintaining a harmonious reproductive cycle. The four Extraordinary Channels that govern the cycle are the Chong Mai (Penetrating Channel), Dai Mai (Belt Channel), Ren Mai (Conception Channel), and Du Mai (Governing Channel).
The Chong Mai is known as the Sea of Qi and Xue. It is the root of the other Extraordinary Channels.
The Ren Mai is related to all of the Yin Organs and Channels and is in charge of transporting the Jing, Xue, and Jin-Ye. As conduit of the Xue—which is a Yin Substance, the Ren Mai plays a large part in the woman’s cycle. It also supports Qi, Xue, and Jin-Ye for supply to the fetus. If Ren Mai is weak, women may miss periods, become infertile, or have difficulty with pregnancy or labor.
The Du Mai is the master of all Yang energy, and with the Ren Mai it regulates the balance of Yin/Yang, which in turn regulates Qi and Xue and keeps the functions of the uterus normal. The lack of Yang due to a Du Mai disturbance might lead to spotting accompanied by vaginal discharge.
Another Channel that is important is the Dai Mai, which is closely associated with the Liver and Gallbladder. If the Liver is not moving Qi correctly, it cannot absorb female hormones as it should. Headaches associated with the menstrual period may occur.
MOXIBUSTION
For general gynecological health, maintenance centers on Ren 4, Ren 6 (see page 40), Spleen 6 (see page 163), and Zi Gong (Uterus) (see page 206), plus back points along the Urinary Bladder—Urinary Bladder 20 and 23 (see page 166)—and the sacrum or lower back.
HERBAL TREATMENTS
Most herbal formulas are designed to treat specific disharmonies and are not appropriate for preventive care. However, some herbal soups can help regulate the flow of Qi and Xue and as such offer general herbal support for gynecological health. (For herbal treatments for specific gynecologic complaints, see the sections that follow on PMS, menopausal and premenopausal symptoms, and fertility support.)
HERBS FOR GENERAL GYNECOLOGICAL HARMONY
|
HERB SOUP |
HERBAL CONTENT |
CHINESE THERAPEUTIC INDICATIONS |
|
Dang Gui Chicken Soup (page 121) |
Dang Gui (Angelica sinensis) |
Eat once to four times per month to strengthen Spleen and tonify Xue. |
|
San Qi Chicken Soup (page 121) |
San Qi (pseudoginseng) |
Eat once to four times per month to strengthen Spleen and circulate Xue. |
PART THREE: BRING IN OTHER MODALITIES
Your treatment plan can be expanded in several ways. To increase Shen harmony and to reduce irritability, mood swings, stress, and/or depression, you may want to include other forms of Eastern meditations, biofeedback, hypnosis, or psychotherapy. To alleviate digestive problems associated with the cycle, some women adopt an Ayurvedic diet or other diets such as Paleo to dispel the imbalances. Japanese abdominal massage can also ease digestive problems and alleviate pain associated with the period.
FREEING THE QI: THE COMPREHENSIVE PROGRAM FOR PMS MANAGEMENT
To ease PMS symptoms, you will expand the Comprehensive Program for Gynecologic Health to include targeted therapies.
PMS is a loose collection of symptoms triggered by hormonal shifts that afflict an estimated 80 percent of all women during the last week or two of their menstrual cycles. The symptoms include increased appetite and sugar cravings, fatigue, headaches, dizziness, palpitations, depression, weight gain, breast tenderness, emotional volatility, vaginal infections, constipation, worsening of allergies, and acne or skin eruptions. For 10 to 20 percent of women, the syndrome is incapacitating.
In Chinese medicine, these symptoms are associated with various disharmonies: Stagnant Liver Qi, Depressive Liver Fire, Heart Fire, Deficient Heart and Liver Xue, Stomach Heat, and Deficient Spleen Qi with Dampness.
To eliminate debilitating symptoms and restore harmony to the Organ Systems, Essential Substances, and Channels, follow the Comprehensive Program for Gynecologic Health (see page 249), plus the following steps.
Step One: Additional Dietary Guidelines
In addition to the general gynecologic guidelines given earlier, women with PMS should eliminate all refined sugars from the diet; eliminate decaffeinated coffee, chocolate, and dark sodas; reduce the fat content of their diet to 25 percent of daily calories; avoid over-the-counter diuretics and instead adjust diet to eliminate excess salt; increase grains and fiber; and drink 48 ounces (1.4 L) of filtered or spring water a day.
Step Two: Additional Nutritional Supplements
Do not take nutritional supplements before talking to your Western doctor and/or Chinese practitioner because there may be contraindications you don’t know about.
Vitamin B6 may provide some relief in doses between 250 and 500 milligrams a day. The proof that it works is anecdotal at this point.9
The American Journal of Epidemiology reports that women with PMS may benefit from taking zinc10 as well as non-heme iron (plant-based iron not the iron found in red meat). However, only take supplements under the direction of your practitioner. The highest limit of zinc that should be consumed without a physician recommendation is 40 milligrams per day. Higher doses may interfere with copper and iron metabolism, leading to a negative impact on serum lipids (fat in the blood) and immune function. Non-heme iron should only be consumed up to a maximum 45 milligrams per day in menstruating women unless a physician prescribes it.11 High potassium levels may increase PMS symptoms because it can increase fluid retention, causing symptoms of PMS like extremity swelling and bloating.
Calcium (best as hydroxyapatite or citrate) and magnesium should be considered. Chocolate cravings associated with PMS may in fact result from magnesium deficiency because chocolate is relatively high in magnesium. So, if you eat chocolate (best in small amounts), you are getting some extra magnesium. Magnesium deficiency can lead to symptoms such as leg muscle cramps, especially at night. Daily consumption of 200 milligrams of magnesium (best is citrate or hydroxyapatite) can alleviate mild symptoms of PMS-related fluid retention.12 And calcium is important for general gynecologic health plus as a preventive measure against osteoporosis, the brittle bone syndrome that afflicts so many women after menopause.
Step Three: Additional Herbal Treatments
Several Chinese herbal formulas are designed to treat disharmonies associated with symptoms of PMS. It is advised that you do not take herbs without a practitioner’s direction and prescription because you may take the wrong formula, which at the least may not work and at the most may be harmful. A licensed practitioner should do a thorough diagnostic examination and then prescribe appropriate herbal therapy. Many formulas are associated with PMS symptoms. Your practitioner may recommend some of the formulas in the following table or other herbal formulas, depending on your diagnosis.
EXAMPLES OF CHINESE HERBAL FORMULAS FOR PMS
|
FORMULA |
CHINESE FUNCTION |
INDICATIONS |
|
Xiao Yao San (Rambling Powder) |
Spread Liver Qi, relieve Stagnation, tonify Spleen, nourish Xue |
Irritability, depression, moodiness, fatigue, headache, dizziness, breast distention, irregular menstruation, menstrual pain |
|
Woman’s Balance |
Regulate Qi, nourish Liver Xue and Yin, strengthen Spleen Qi, harmonize Liver and Spleen |
Menstrual disorders, PMS, swollen breasts, depression, menstrual pain, irregular periods, abdominal bloating |
Step Four: Bringing in Additional Modalities
Some practitioners—especially naturopathic physicians (N.D.s) and some natural medicine M.D.s—use natural progesterone topical creams to combat PMS.
A common theory about PMS is that is stems from elevated levels of estrogen. But another view holds that it is the relative lack of progesterone in relation to the amount of estrogen that causes PMS. Western science and many physicians prescribe synthetic progestin to counter menopausal symptoms, but this chemical is not a satisfactory replica of natural progesterone. In fact, progestin has been posited by some researchers to actually inhibit the body’s natural synthesis of progesterone, and it may worsen symptoms.
WARNING
Never use natural progesterone cream without a practitioner’s supervision and never in conjunction with other hormones or medicines without consulting both your Chinese and your Western doctors.
SUPPORTING THE YIN: THE COMPREHENSIVE PROGRAM FOR MENOPAUSAL SYMPTOMS
To ease menopausal symptoms, you will expand the Comprehensive Program for Gynecologic Health to include targeted therapies.
In Chinese medicine, the symptoms of menopause—hot flashes, palpitations, emotionality, depression, vaginal dryness, change in libido, urinary problems, and changes in skin texture—are associated with Deficient Kidney Yin, Deficient Liver Xue, Deficient Kidney Yang, and Deficient Yin and Yang of Kidney. It is important to emphasize that menopause is not a disease or a disorder. Menopause is part of the natural progress of a woman’s life. Any physical or emotional discomfort associated with menopause can be eased or eliminated.
To relieve your symptoms, implement the guidelines in the general gynecologic program plus the suggestions that follow here.
Step One: Expanding the Daily Journal
Along with your daily journal of your cycle, symptoms, diet, sleep patterns, exercise, stress, and emotions, record the following information:
• Changes in length of cycle (shortening or lengthening) and how long your period lasts
• The quality of menstrual blood, including color, heaviness of flow (light or heavy), and clotting (small, large, color)
• How you feel during mid-cycle: Is there mid-cycle bleeding or spotting? Is there mittelschmerz (pain at mid-cycle)? What about emotional changes?
• How you feel during the week prior to the onset of your period: Is there increased depression, bloating, or breast tenderness?
• Any increase in skin dryness and vaginal dryness and changes in secretions
• Fluctuations in your body temperature: Are you hotter or colder, less tolerant to changes in external temperature? Do you have hot flashes or sweating? How often? What time of day or night?
Step Two: Additional Dietary Guidelines
Some foods contain isoflavones that are biochemically similar to estrogens. These are sometimes called phytoestrogens because they are plant foods that contain estrogen-mimicking substances.
Eating foods that contain isoflavones may help ease the symptoms of menopause that are associated with lowered estrogen. In some societies, up to half the dietary intake contains foods that have isoflavones, but in the United States less than 10 percent of the diet comes from such sources.
Isoflavone-containing foods include soy and foods made from soy—such as tofu, tempeh, edamame, and miso—as well as flaxseed, red clover, oats, barley, and beans.
Two of the primary isoflavones, genistein and diadzen, can act similarly to estrogen in the body. However, they have a very small fraction of the potency of the estrogen produced and circulating in women’s bodies.
While isoflavones may act like estrogens, because they have much lower potency, they also are considered to have anti-estrogenic properties. This means that isoflavones potentially could block natural estrogens from binding to the estrogen receptors in tissues in the breasts and uterus, which could potentially lower the risk for these types of cancers.
Isoflavones are also thought to stop the formation of estrogens in fat tissue and stimulate production of a protein that binds estrogen in the blood (to make it less able to bind to the receptor). In addition, isoflavone-containing foods have antioxidants and are anti-inflammatory.
Studies conducted in Asian women have found a lower risk of breast cancer with eating more soy products. However, studies in the United States have tended to not find any association between how much soy a woman consumes and her risk of breast cancer. However, in general, women in the United States have a much lower soy intake overall than women in other countries do.13
Foods high in calcium and magnesium are recommended as well, although dairy products, especially those that are not organic, are generally discouraged in high quantities. Nondairy, high-calcium–containing foods include tahini, sesame seeds, curly kale, sardines, kidney beans, figs, and many types of nuts.14
Dietary fat (especially animal fats) should be kept relatively low, especially during perimenopause, when estrogen levels are unopposed by progesterone.
Step Three: Additional Exercise Guidelines
Weight-bearing exercise is an important part of any perimenopausal or menopausal program. It is associated with increased calcium uptake and increased bone density. It’s important to work both the lower and the upper body. Doing weight-bearing exercises on only one part of the skeleton will not spread the benefit throughout the body. You should only do weight-lifting exercises three times a week to avoid damaging the Spleen Qi and thus cause Deficient Xue.
Aerobic exercise is recommended for women who find they gain weight through menopause or who are at higher risk for heart disease. Remember, heart disease is the major killer of women older than age fifty.
Step Four: Additional Soaks
For hot flashes, cooling soaks such as Peppermint Cooler are recommended (see page 214).
Step Five: Additional Self-Massage
Ear massage: For general menopausal symptoms, try additional ear massage every day using the following points: Uterus, Endocrine, Ovaries, Sympathetic point, Shenmen, and Kidney. (See page 203 for the locations of the points.)
Acupressure: Rub the following points once a day for about ten minutes: Spleen 6, Kidney 3, and Stomach 36. For hot flashes, massage Heart 6, Kidney 7, Liver 2, and Kidney 6. (See pages 163 through 167for the locations of the points.)
Moxibustion: If you are having hot flashes, only use moxa after consulting a practitioner. However, moxa can be soothing for fatigue and vaginal dryness. Moxa Stomach 36, Spleen 6, and Ren 6.
Step Six: Assembling the Team
When it comes time to bring in a Western doctor, Chinese practitioner, and others who offer health care and healing, you want to remember the following:
• Menopause is not a disease. Avoid practitioners who treat you as though it were.
• Perimenopausal and menopausal women should be vigilant about having regular mammograms, Pap smears (even after the period has stopped), and cardiovascular checkups. For women in high-risk groups (white women, fair-haired women, those who are very thin, smokers, and those with a family history), a bone density scan may be recommended.
• The smartest approach to menopause is to try the least harsh, most natural treatments first. That means first changing your diet, increasing supplements, reducing stress levels, increasing aerobic exercise, avoiding caffeine, using acupuncture and herbs, trying massage and meditation, and stopping smoking—which is the single worst trigger of symptoms.
A growing number of physicians use hormone replacement therapy (HRT) only as a last resort for menopausal symptoms. Several recent studies have shown that women using HRT have increased risk of breast cancer, stroke, heart disease, and blood clots. The Women’s Health Initiative (WHI), a study conducted over fifteen years that tracked more than 161,800 healthy, postmenopausal women, found that women who took HRT had an increased risk of heart disease. This study showed that the overall risk of long-term HRT use outweighed its benefits. However, newer data show that very low dose estrogen, either given systemically or vaginally, may be beneficial for menopausal symptoms, such as hot flashes, vaginal dryness, and osteopenia.15
Step Seven: Additional Herbal Therapy
In addition to the herbal soups outlined in the general gynecologic program, your Chinese medicine practitioner may suggest that you take the following herbal formulas or others, according to your individual Chinese patterns.
EXAMPLES OF CHINESE HERBAL FORMULAS FOR MENOPAUSE
|
FORMULA |
CHINESE FUNCTION |
INDICATIONS |
|
Da Bu Yin Wan |
Nourish Kidney Yin, remove Deficiency Heat |
Night sweats, chest and face flushing, hot sensation in the palms and soles, difficulty staying asleep, irritability, fidgeting/restlessness, ear ringing, steaming bones (which feels like hot bones from inside) |
|
Great Yin |
Nourish Kidney Yin, clear Heat, subdue Deficiency Fire, stop Sweating |
Night sweats, afternoon fevers, hot flashes, hot sensations, steaming bones |
|
Zhi Bai Di Huang Wan |
Enrich Yin, nourish Liver and Kidney Jing, reduce Deficiency Fire |
Night sweats, dry mouth and tongue, urinary difficulty, weakness and pain in the lower back, knees, and extremities, steaming bones |
Step Eight: Acupuncture and Moxibustion
Treatment is individualized to suit changing symptoms over the course of the premenopausal and menopausal interval. Whenever you receive treatment, you need to make a commitment of at least three months. If you go once a week and your practitioner is adept, you should see a dramatic change by your fourth cycle—for women who are still having menstrual periods.
A recent meta-analysis of 104 randomized controlled trials showed acupuncture’s effectiveness in relieving menopause-related symptoms. It was published in the peer-reviewed journal Menopause in July 2014. This meta-analysis confirmed that acupuncture improves hot flash frequency and severity, menopause-related symptoms, and quality of life in women who are undergoing natural menopause.16
Step Nine: Additional Supplements
For information on the use of natural progesterone to ease the symptoms of menopause, see the PMS section on page 262.
CONSCIOUS CONCEPTION: THE COMPREHENSIVE PROGRAM FOR NATURAL FERTILITY SUPPORT
According to the Centers for Disease Control and Prevention (CDC), about 11 percent of women ages fifteen to forty-four in the United States have difficulty getting pregnant or carrying a pregnancy to term, regardless of marital status (impaired fecundity). Infertility is not just a problem for women, but also for men.
A CDC study analyzed data from the 2002 National Survey of Family Growth and found that 7.5 percent of all sexually experienced men younger than age forty-five reported seeing a fertility doctor during their lifetime. This equals 3.3 to 4.7 million men. Of the men who sought help, 18 percent were diagnosed with a male-related infertility problem.17
Women need functioning ovaries and fallopian tubes and a uterus to get pregnant. Conditions affecting any one of these organs can contribute to female infertility. We’ll talk about a few of them here: ovarian function, fallopian tube patency, and uterine contour.
BETH’S STORY
“When you want to have a child, but your body betrays you, it is the most helpless, frustrating, world-shaking experience,” Beth said. “Since I was a teenager, when I thought of who I was, I saw myself as a mother. To not be able to become pregnant brought my whole world crashing down on me. I’m sorry it took me so long to try acupuncture and herbs. I could have saved myself and my husband a whole lot of heartache.”
Beth, age thirty-four, tried for five years to conceive. Her daughter, Faith, is a thriving toddler.
Ovarian Function
Having regular, predictable periods generally means you are ovulating. Your ovulation can be predicted by using an ovulation predictor kit, and it can be confirmed by a blood test to check your progesterone level.
On the other hand, a woman who is having irregular periods is likely not ovulating, at least some of the time. This may be because of several conditions, and she should be evaluated by a Western doctor. The most common hormone imbalance that causes lack of ovulation is polycystic ovarian syndrome (PCOS), which is lack of periods due to physical or emotional stress and diminished ovarian reserve. Several tests exist to evaluate a woman’s ovarian function.
As far as tests for fertility, several tests are currently used to predict fertility: follicle-stimulating hormone (FSH) on day 3 to 5 of the menstrual cycle, anti-mullerian hormone (AMH), and ultrasound for the antral follicle count (AFC). However, there is no infallible predictor of fertility.
Fallopian Tube Patency
This term refers to whether the fallopian tubes are open, blocked, or swollen. Blocked fallopian tubes may be a result of pelvic infection, a ruptured appendix, gonorrhea or chlamydia, endometriosis, or abdominal surgery. The tubes may be checked through a type of X-ray called a hysterosalpingogram (HSG) or by chromopertubation (CP) during a laparosopic surgical procedure.
Uterine Contour
This term refers to the physical characteristics of the uterus. Uterine function can be evaluated by ultrasound to look for fibroids or other abnormalities. If suspicion exists that the fibroids are blocking pregnancy, a sonohysterogram (SHG) or hysteroscopy (HSC) may be performed.
Because many fertility symptoms are not obvious as overt health conditions, sometimes underlying issues are only discovered once a woman starts trying to conceive. Some symptoms that may indicate the need for closer examination include painful periods, missed or irregular periods, no periods, mid-cycle bleeding or pain, and abdominal masses. Also, if a woman has gone through treatment for cancer, it would be good to have a Western evaluation before trying to conceive.
CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) SUMMARY OF INFERTILITY RISK IN WOMEN18
Female fertility is known to decline with:
Age: Many women are waiting until their thirties and forties to have children. In fact, about 20 percent of women in the United States now have their first child after age thirty-five, and this leads to age becoming a growing cause of fertility problems. About one-third of couples in which the woman is older than thirty-five years have fertility problems. Aging decreases a woman’s chances of having a baby, and it also increases her chances of miscarriage and of having a child with a genetic abnormality. Aging decreases a woman’s chances of having a baby in the following ways:
• Her ovaries become less able to release eggs.
• She has a smaller number of eggs left.
• Her eggs are not as healthy.
• She is more likely to have health conditions that can cause fertility problems.
• She is more likely to have a miscarriage.
Other factors that affect fertility include:
• Smoking
• Excessive alcohol use
• Extreme weight gain or loss
• Excessive physical or emotional stress that results in amenorrhea (absent periods)
Fertility Support in Chinese Medicine
Evidence that acupuncture and herbal medicine have been used to aid fertility can be found in early medical literature dating back to 3 CE. The condition of infertility was first recorded by Zhang Zhong-Jing, a famous physician from the Han Dynasty, in his discussion of diseases in women in the Jin Gui Yao Lue (Essentials of the Golden Cabinet).
The benefits of using Chinese medicine treatments—acupuncture, Qi Gong, herbs, and nutritional therapy—to support healthy fertility and to remedy infertility have been used since before that time.
Modern researchers have confirmed that these therapies benefit in the following areas:
• Regulating the menstrual cycle
• Helping to overcome hormonal imbalances
• Eliminating immune system incompatibilities
• Easing tubal obstructions
• Enhancing general health
• Reducing stress, controlling anxiety, enhancing sleep, and increasing energy
• Balancing the endocrine system
• Improving blood flow in the pelvic cavity
• Invigorating sperm, enhancing a man’s sperm count and motility
• Reversing ejaculatory defects and erectile dysfunction
• Increasing the chance of pregnancy for women undergoing in-vitro fertilization (IVF)
By following the Comprehensive Program for Natural Fertility Support, you can identify methods for optimizing your reproductive health and potentially avoiding more invasive procedures. And when necessary, you can support your body for potentially incorporating appropriate Western medical treatments for family building.
Before beginning this program, let’s expand on the Chinese and Western concepts of a woman’s reproductive system that we outlined in the general gynecology section and delve into more specific origins of disharmonies and disorders as they relate specifically to the pursuit of fertility.
The primary Organ Systems involved in Chinese reproductive medicine are the Spleen, Liver, Kidney, and Heart Systems. By enriching the blood in the uterus, the Spleen System governs the nutrition in the uterus, such as to the uterine lining (endometrium). The Liver System dictates the timing of menstruation and ovulation. The Kidney System is associated with the entire endocrine and reproductive system, including all of the important hormone-producing glands, such as the pituitary, thyroid, and adrenal glands.
In Chinese medicine, the mind is stored in the Heart, and the Heart Xue descends to nourish the uterine Xue. This can be thought of as an ancient description of the hypothalamus-pituitary-ovarian axis, which in Western medicine we know is a pivotal piece of assessing and treating fertility.
Chinese medicine diagnoses for fertility-related problems include Deficient Jing, Deficient Qi and Xue, Heat Injury of the Channels, Stagnant Qi and Xue, Deficient Yin of Kidney and Liver, Cold Uterus, and Deficient Yang, along with Extraordinary Channel disturbances.
Fertility in Western Medicine
While Chinese medicine looks at the Organ Systems to determine a woman’s fertility potential, Western medicine uses markers such as hormone panels, age and assessment of the fallopian tubes, and uterine environment to arrive at a diagnosis or prognosis for fertility.
CHARTING BASAL BODY TEMPERATURE AND CERVICAL MUCUS
Experts say the best way to detect ovulation is to combine a daily reading of your basal body temperature with monitoring the texture of your cervical mucus. Chart your cycle for a few months so you can recognize your pattern and have a better chance of predicting your most fertile days.
Charting basal body temperature: Basal body temperature (BBT) is your temperature when you first wake up in the morning. Before you ever get out of bed to brush your teeth or start your day, pop a basal thermometer (available at drugstores) into your mouth. This particular type of thermometer shows the minute incremental degree changes that a regular thermometer does not show. It is important to try to wake up and take this reading about the same time each morning.
Your BBT probably ranges from 97.2°F (36.2°C) to about 97.7°F (36.5°C) before ovulation. During the two or three days after you ovulate, hormonal changes cause a rise in your BBT of between 0.5°F and 1.6°F, which lasts at least until your next period. You’ll probably notice your temperatures spiking on other days, but unless it stays that way, you probably haven’t yet ovulated. If you become pregnant, your temperature will stay elevated throughout your pregnancy.
It’s helpful to chart your temperature for a few months so you can see whether there is a pattern to your cycle. If you’re sick or fail to take your temperature immediately upon awakening, any pattern you find may be inaccurate.
Charting cervical mucus: There are many different types of vaginal discharge, one of which is cervical mucus. The type of mucus your body produces provides clues to your fertility. You can check your cervical mucus using either your fingers or toilet paper. On days when you’re not fertile, the mucus from the cervix is either light or sticky (about the same texture as sticky rice).
During the few days leading up to ovulation, when you are most fertile, you’ll have more discharge that is clear and slippery with the consistency of raw egg white. You are most fertile on the last day you notice egg white–type cervical mucus. It usually happens either the day before, or the day of, ovulation.19
Putting them together: Start keeping track of your temperature on the first day of your period using a basal body thermometer. Take your basal body temperature, and plot it on a chart. Then check the consistency of your cervical mucus and plot it on the same chart.
Most women will see a spike in temperature, signaling that you’ve ovulated, and notice that their mucus looks and feels like raw egg white around the same time. When the two coincide, you are more fertile.
Basic Fertility Work-Up for Women
Have the following tests ordered at any time by your practitioner or physician to get a clear picture of the current state of your body:
• Comprehensive metabolic panel (glucose, kidneys, fluids and electrolytes, calcium, and liver)
• Lipid profile (total, HDL, LDL, risk ratio, and triglycerides)
• Complete blood count (CBC) with differential
• Luteinizing hormone (LH)
• Thyroid panel (TSH, T3, T4, etc.)
• Testosterone
On day three of your menstrual cycle (the third day of your period), have the following tests:
• Cycle day 3 FSH (Follicle Stimulating Hormone)
• Cycle day 3 E2 (Estradiol)
• Cycle day 3 LH (Luteinizing Hormone)
• Prolactin
Seven days (ideally) before your next period, have the following test:
• Mid-luteal progesterone
For example, if you have a twenty-eight day cycle, you would have this test done on cycle day 21.
The following optional tests can be done at any time:
• Anti-mullerian hormone (AMH) is a substance produced by granulosa cells in ovarian follicles. Because AMH is produced only in small ovarian follicles, blood levels of this substance have been used to attempt to measure the size of the pool of growing follicles in women. Research shows that the size of the pool of growing follicles is heavily influenced by the size of the pool of remaining primordial follicles (microscopic follicles in “deep sleep”). Therefore, AMH blood levels are thought to reflect the size of the remaining egg supply or “ovarian reserve.” An AMH test can be done on any day of a woman’s cycle.
• Ultrasound: It is important that you have an ultrasound done to check your ovarian follicle development, providing information about the number and size of developing follicles and the reaction of the uterine lining (endometrium) to follicle growth. Ask your fertility physician to guide you as to time in the cycle.
RECURRENT PREGNANCY LOSS
While one in three women experience a pregnancy loss in the context of a normal reproductive history, miscarriage does not mean you cannot have a healthy successful pregnancy and birth.
Recurrent pregnancy loss (RPL) is the occurrence of three or more consecutive pregnancies that end in miscarriage of the fetus during the first trimester or one or more second-trimester miscarriages.
With RPL, it is important to be evaluated by a reproductive endocrinologist for clotting factors, genetic abnormalities, and autoimmune problems (including sperm allergy).
Assisted Reproduction Technologies
If you are unable to become pregnant naturally and have exhausted everything else, your body may need some additional Western medicine treatments. The Centers for Disease Control and Prevention (CDC) defines assisted reproduction technologies (ART) to include all fertility treatments in which both eggs and sperm are handled. These include procedures that involve surgically removing eggs from a woman’s ovaries, combining them with sperm in the lab, and returning them to the woman’s body or donating them to another woman. The CDC does not include treatments in which only sperm are handled or procedures in which a woman takes medicine only to stimulate egg production without the intention of having eggs retrieved. However, for our purposes I am including all conventional treatments that are in addition to natural fertility support.
In addition to ART, you will still use all the natural fertility support modalities previously discussed. The less invasive, the better. Here is a brief list of the ART treatments. Discuss these with your physician. It is best to see a reproductive endocrinologist (RE) for evaluation and treatment if you can.
Fertility drugs: These are often the first line of treatment if you are not becoming pregnant naturally. These may include drugs to stimulate ovulation, such as clomiphene and gonadotropins. There is a small risk of ovarian hyperstimulation syndrome in which the ovaries are overstimulated and too many follicles are produced and get very large.
Intrauterine insemination (IUI): IUI is when sperm are “washed” and placed in sterile fluid, concentrated, and injected directly into the uterus. Drug treatment is commonly used to increase the success of IUI.
In vitro fertilization (IVF): IVF is the most common ART. Currently, 99 percent of all ART in the United States is IVF. In IVF, the woman injects fertility drugs to develop several eggs, may take other drugs to prevent premature release of the eggs, and egg development is monitored by ultrasound along with hormone testing. When the follicles are the correct size, human chorionic gonadotropin (HCG) is injected to complete the maturation of the egg. Thirty-six to forty-eight hours later, eggs are removed from the ovary under anesthesia. During the same time, sperm is collected from the partner or donor. Then the eggs and sperm are combined and monitored for fertilization. For the next two to five days, the fertilized eggs develop, and then the embryos are ready to be transferred into the uterus. Unused embryos may be frozen and saved for future use.
In my opinion, IVF as a first line treatment should be limited to women who have difficulty conceiving due to severely scarred and blocked fallopian tubes, poor sperm quality in the partner or donor, or fertility unexplained after every possible evaluation. IVF is very expensive, comes with risk of multiple pregnancies, includes risks of high doses of drugs to support the IVF procedures, and possibly increases the risks of birth defects and low birth weight. Acupuncture is often used to improve the outcomes of IVF treatments.
Intracytoplasmic sperm injection (ICSI): ICSI is a type of IVF in which one sperm is injected directly into an individual egg. Generally, the best times to use ICSI are for low sperm count, poor sperm motility, poor morphology (structural problems), or for a male partner or donor who had a vasectomy.
Other transfer options: These options are generally out of date; however, they are part of ART. These include gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT).
Donor eggs: Donor eggs are generally used for women over the age of forty-three whose eggs are damaged or insufficient in some way, or not enough are produced when using fertility drugs. Eggs are donated by another woman, and they are fertilized by sperm from either a male partner or donor. This is a similar process to IVF; however, it is the woman donating the eggs who is given the fertility medications and her eggs are collected. The woman receiving the eggs also takes drugs to synchronize her estrogen levels with the donor’s levels and is also given progesterone to build the uterine (endometrial) lining to accept the donor embryo during the IVF procedure.
Step One: Expanding the Daily Journal
As you begin this program, to support natural fertility, you will expand the Comprehensive Program for Gynecologic Health to include targeted therapies. Follow the guidelines in the general gynecologic program plus the suggestions that follow here.
Along with your daily journal of your cycle, symptoms, diet, sleep patterns, exercise, stress, and emotions, record the following information:
• Chart your cycle for a few months.
• Track your basal body temperature (BBT).
• Monitor the texture of your cervical mucus.
• Monitor the quality of menstrual blood, including color, heaviness of flow (light or heavy), and clotting (small, large, color).
• Jot down how you feel during ovulation: Is there ovulation-related bleeding or spotting?
Step Two: Additional Dietary Guidelines
In addition to the general gynecological guidelines, you should make extra sure that you are getting plenty of high-quality protein. During menstruation, make sure that you are eating foods rich in iron.
To support the Kidney and Spleen Systems and maintain enough Yang Qi for development of the egg, make sure that 90 percent of your diet is cooked and that the foods you eat eliminate Dampness.
During the time between your period and ovulation, protein consumption is very important. It is best to eat foods that support the Kidney System to nourish the follicles as they mature. Foods that support the Spleen System are important for maintaining uterine function. Vitamin-E-rich foods such as cold-pressed organic oils, nuts, seeds, and avocados support the developing egg as well. During this time, it is important to completely avoid alcohol.
During ovulation, eat foods that support the Liver System and Spleen System. Make sure you are taking a sublingual vitamin B that includes folic acid, B12, and B6 during this time to support egg release and implantation. Eat foods high in zinc, such as eggs, whole grains, and fish to support progesterone production.
After ovulation, consider eating organic ripe pineapple. Bromelain, contained in pineapple, has been shown to help with egg implantation. After confirmed ovulation or embryo transfer during IVF, begin consuming one to two slices of pineapple each day. Stop when implantation has occurred.
Step Three: Additional Exercise Guidelines
Moderate exercise is best for women trying to conceive. Also, proper weight is associated with improved chances of becoming pregnant. Research shows that being underweight or overweight can reduce the chances of becoming pregnant. Ovulation can be compromised in women who don’t consume enough calories and good fats every day. Being overweight or obese can also create difficulty in conception because obesity can interfere with normal hormone function and therefore fertility.
However, just being skinny by itself is only part of the issue. We know that estrogen is stored in fat tissue, and it is an important part of conceiving and holding a pregnancy. Even if you are thin, if you are eating enough good fats and exercising moderately, you are fine.
While you are trying to get pregnant, don’t stop exercising if you are doing moderate exercise. Exercise increases the flow of Qi and Xue, helps endorphin production, decreases pain, decreases stress, and improves your mood. If you exercise throughout your time of trying to conceive, it becomes natural for you to continue throughout pregnancy. During pregnancy, exercise is important for many reasons.
Step Four: Additional Soaks and Compresses
You may use the Gingerly compress during the time before conception to warm the uterus and ovaries and to improve blood flow in these areas (see page 217).
You can buy readymade compresses and herbal packs in your local herb or natural foods stores for supporting fertility.
Step Five: Additional Self-Massage
Ear massage: For supporting fertility, you can perform ear massage every day using the Uterus point, the Endocrine point, the Ovaries point, the Sympathetic point, the Shenmen point, and the Kidney point. (See page 203 for the locations of the points.)
Uterine massage: To increase blood flow to the uterus, or if you have a history of endometriosis, fibroids, or scar tissue, you can perform uterine massage. Find your uterus just above the pubic bone on the midline of your lower abdomen. Massage using lifting and pressing motions over the uterus area. Then use all of your fingers or the heel of your hand to make a pumping movement to increase blood flow in the area. To be on the safe side, do not do this massage during your period or after you have ovulated.
Ovary massage: To increase blood flow to the ovaries, or if you have a history of ovarian cysts, scarring, or adhesions, you can perform ovary massage. The ovaries are approximately four fingers from the midline, about two fingers above the pubic bone. The acupressure point Zigong (uterus) is located here. Massage over each ovary with your fingers or thumbs in circles. You can go deeper as you find areas of tenderness; however, don’t go so deep as to bruise yourself and cause pain. Make a pumping movement over the whole area to increase blood flow. To be on the safe side, do not do this massage during your period or after you have ovulated.
Reflexology: You may massage the areas of the ovary, uterus (womb), and pelvic area on both the hands and feet (see pages 210 and 211).
Ask your practitioner to show you other types of massage for additional issues.
Step Six: Additional Self-Moxibustion
You may perform moxibustion over the whole lower abdomen from the navel to the pubic bone out to ovary areas. The points Ren 3, Ren 4, Ren 6 (page 40), and Zi Gong (page 206) are especially important. Ask your practitioner what points you may use if you become pregnant.
Step Seven: Assembling the Team
When it comes time to bring in a Western doctor, Chinese practitioner, and others who offer health care and healing, you want to remember the following:
• If you are trying to get pregnant naturally, although you may not be seeking Western treatment for infertility, make sure you have had your yearly gynecological checkup and all of your other regular medical exams. Men involved as partners or sperm donors should also have regular checkups to make sure they are healthy.
• The first approach to natural fertility support is to try the least harsh, most natural treatments first. That means changing your diet, increasing supplements, reducing stress levels, increasing your exercise routine, avoiding caffeine, stopping smoking, and using acupuncture, Chinese herbs, massage, and meditation.
• After a certain amount of time trying to conceive without success, most Western experts recommend that you see a fertility specialist. If you are younger than thirty-five, most experts suggest you try to become pregnant every month for at least one year. However, if you are thirty-five years or older, you should see a fertility specialist after six months of trying unsuccessfully.
Conventional wisdom is that the chance of having a successful pregnancy and birth rapidly decreases each year after the age of thirty. Because some health problems also increase the risk of infertility, you should talk to a health care provider if you have any of the following:
• Irregular menstrual periods
• No menstrual periods
• Very painful menstrual periods
• Diagnosed endometriosis
• History of pelvic inflammatory disease (PID)
• More than one miscarriage
Ideally, it is appropriate for any woman, and her male partner or donor, to talk to a fertility-knowledgeable Western medical provider prior to trying to get pregnant. The provider can help you get your body ready for a healthy baby, and she or he can also answer questions on fertility and give tips on proper conception.
Seeking a fertility support consultation from a Chinese medicine practitioner is important as well. You can learn your Chinese medicine diagnosis, decide if you would like to use acupuncture to support becoming pregnant, and learn which herbs, supplements, and foods are appropriate for your particular Chinese medicine patterns.
Step Eight: Additional Herbal Therapy
In addition to the herbal soups outlined in the general gynecologic program, your Chinese medicine practitioner may suggest that you take the following herbal formulas or others according to your diagnosis.
EXAMPLES OF CHINESE HERBAL FORMULAS FOR FERTILITY
|
FORMULA |
CHINESE FUNCTION |
INDICATIONS |
|
Channel Flow |
Regulate Qi and Xue, warm the Channels |
Menstrual pain and cramps, menstrual clotting, abdominal pain, infertility |
|
Women’s Precious Pills |
Tonify Qi and Xue |
Irregular menstruation, painful menses, light or no menstrual flow, pale complexion, irritability, poor memory |
|
Maternal Herbal |
Tonify Liver Yin and Kidney Yang, relax Shen, invigorate Qi and Xue, nourish Xue, tonify Qi |
Promote fertility, reduce coldness |
Step Nine: Acupuncture and Moxibustion
Acupuncture and moxa treatments are individualized to suit your specific Chinese diagnoses and your specific menstrual issues, timing, and age. With acupuncture and herbal fertility support, it is often a long-term treatment, anywhere from one month to one or two years. If you have normal menstrual cycles, are eager to become pregnant immediately, or are older than age thirty, you may want to start fertility support treatment right away.
If your cycle is irregular or absent, or if you have endometriosis, PCOS, or other conditions associated with higher rates of infertility, it is best to address these issues for some period of time prior to focusing on direct fertility support. Some of the treatments for those issues are inappropriate while trying to actively become pregnant. After several months or even a couple of years, you then would be ready to support treatment for becoming pregnant.
You should plan to make a commitment of at least three months minimum, especially if cycle regulation is the first part of your treatment. Because it can take a year for normal conception to occur, plan on at least twelve months of treatment. When you become pregnant, plan to get acupuncture treatments throughout pregnancy.
In general, the best candidates for acupuncture and Chinese herbal medicine for natural fertility support are women (and men) who have a functional, rather than structural, reason for infertility. Infertility due to hormonal problems, immune disorders, amenorrhea, irregular menstruation, stress, and age-related factors all fall into the category of functional infertility.
Acupuncture is also used for support during in vitro fertilization (IVF).
A very important study, published in 2002 in Fertility and Sterility, found that acupuncture significantly increases the chances of a woman becoming pregnant. In this study, eighty patients received two 25-minute acupuncture treatments—one prior to having fertilized embryos transferred into their uterus, and one directly afterward. A second group of eighty patients, who also underwent embryo transfer, received no acupuncture treatments.20
Some evidence suggests that needle stimulation may improve blood flow to the uterus. Researchers are looking at whether acupuncture might make the uterine wall more receptive to the embryo. Also, egg production may be improved with the use of acupuncture.
Step Ten: Additional Supplements
Follow the supplement recommendations in the Comprehensive Program for Gynecologic Health (see page 241). Your practitioner should guide you as to doses, depending on your specific conditions and where you are in your fertility process.
Prenatal nutritional supplements are recommended while you are trying to conceive and throughout pregnancy.
Coenzyme Q10 (CoQ10) improves pelvic blood flow and reduces miscarriages. Studies in IVF and ICSI show that women who take CoQ10 have higher pregnancy rates.21 L-arginine also increases blood flow to the pelvis; however, it should not be taken if you have herpes. Women with higher rates of miscarriage have low glutathione; glutathione is made in the body from N-acetyl cysteine (NAC). Therefore, supplemental NAC or whey protein is often recommended. Royal jelly is another Chinese food substance that may help fertility.
Your naturopathic physician, Chinese medicine doctor, or integrative physician will give you additional recommendations according to your specific situation.
SUPPLEMENTS FOR ENHANCING MALE FERTILITY
• L-Carnitine 3 grams per day increases motility22
• L-Arginine 4 grams per day increases motility (Do not take if you have herpes.)
• Zinc Sulfate 24 milligrams per day increases testosterone and sperm count
• Vitamin E 600 milligrams per day increases motility (Take with food.)
• Selenium 1000 milligrams per day increases sperm count
• Folic acid 800 micrograms per day improves sperm quality
• Vitamin B12 1000 milligrams per day increases motility
• Vitamin C 1000 milligrams per day increases motility
• CoQ10 100 milligrams per day increases sperm count and motility23
• Chinese herbal formulas from your practitioner
AT A GLANCE: COMPREHENSIVE PROGRAM FOR GYNECOLOGIC HEALTH
|
SELF-CARE PLAN |
|
|
Self-monitoring |
In addition to the general guidelines, your daily journal will include the following in relation to your monthly cycle: food cravings, changes in appetite, alcohol and caffeine consumption, energy levels, symptoms that make it difficult to exercise, emotional ups and downs, when you ovulate, when your period starts, description of the flow, color, texture, intensity, and duration. |
|
Dietary guidelines |
Eat a diet of warm, cooked foods. Avoid excess dairy products, eliminate caffeine, and drink a minimum of alcohol. Increase fiber and use whole grains to avoid premenstrual constipation. Eliminate excess salt from your diet to ease water retention. Eliminate any foods that your daily log indicates are associated with premenstrual syndrome (PMS), cramps, irregularity, or any of the emotional and physical symptoms surrounding the progress of your cycle. |
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Exercise |
Use Yoga, Qi Gong warm-up exercises, and walking to stimulate balanced flow. Once a routine is established daily for thirty minutes, you can expand your exercises to include aerobics, such as jogging, cycling, and swimming. Try to walk 10,000 steps per day. |
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Meditation |
Use the Lotus Blossom Meditation for a quick time-out from cycle-related discomfort and stress. Use the Buddha’s Breath exercise to help ease Stagnation. Regular practice of the longer Qi Meditation does much to restore harmony. |
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Moxibustion |
Perform self-moxa on Spleen 6 and Ren 6 once a week for three weeks, with a week off during the period. |
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Massage |
Practice Qi Gong abdominal massage for cramps and to dispel Stagnation and Dampness. Use reflexology as well as acupressure on Liver 3. A monthly breast self-exam and massage are important for all women. |
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Soaks and Compresses |
Use ginger compresses and soaks to ease cramps and lower back pain. A Sleep Ease soak can help you relax. |
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Nutritional supplements |
Follow the general nutritional supplement guidelines with the modifications made in this chapter. Include omega-3 fatty acids, vitamin D, antioxidants, calcium with other substances, and sublingual B12/folic acid/B6. Make sure you take a regular dose of Lactobacillus acidophilus. |
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PMS SELF-CARE (GENERAL GUIDELINES ABOVE PLUS …) |
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Dietary guidelines |
In addition to the general guidelines, women with PMS should eliminate all refined sugars from the diet; eliminate decaffeinated coffee, chocolate, and dark sodas; reduce fat content of diet to 25 percent of daily calories; avoid over-the-counter diuretics. Adjust diet to eliminate excess salt and increase grains. Drink 48 ounces (1.4 L) of filtered or spring water a day. |
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Nutritional supplements |
Considering taking zinc and non-heme plant iron for PMS symptoms only with your practitioner’s advice. Increase magnesium for leg cramps and fluid retention, if necessary. See the chapter for additional recommendations. |
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MENOPAUSE SELF-CARE (GENERAL GUIDELINES ABOVE PLUS …) |
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Self-monitoring |
In addition to the daily journal of your cycle, note changes in the length of your cycle and how long your period lasts and the quality of your menstrual blood. See if there is mid-cycle bleeding or spotting or pain. Is there increased depression, bloating, or breast tenderness? Note skin dryness, vaginal dryness, and changes in secretions. Are you having temperature changes, hot flashes, or sweating? |
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Dietary guidelines |
In addition to the general guidelines for gynecology, isoflavone-containing foods may help ease the symptoms of menopause associated with lowered estrogen. Foods high in calcium and magnesium are recommended. Dietary fat (especially animal fats) should be consumed moderately, especially during perimenopause, when estrogen levels are unopposed by progesterone. |
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Additional exercise recommendations |
Weight-bearing exercise three times a week. Aerobic exercise is important for women who gain weight or are at higher risk of heart disease. |
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Soaks |
For hot flashes, cooling soaks such as Peppermint Cooler are useful. |
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Additional self-massage |
Ear massage daily plus ten minutes of acupressure on varying points. |
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Moxibustion |
If you are having hot flashes, moxa should not be used without consulting a practitioner. However, it can be soothing for problems of fatigue and vaginal dryness. Moxa Stomach 36, Spleen 6, and Ren 6. |
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FERTILITY SUPPORT SELF-CARE (GENERAL GUIDELINES ABOVE PLUS …) |
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Self-monitoring |
In addition to the daily journal of your cycle, chart your cycle for several months, check your basal body temperature, monitor your cervical mucus, and observe your menstrual blood and how you feel during ovulation and whether there is bleeding or spotting. |
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Dietary guidelines |
In addition to the general guidelines for gynecology, make sure you are eating enough high-quality protein, eat 90 percent of your diet cooked and follow the guidelines in the chapter for the correct foods during the different parts of your menstrual cycle. |
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Additional exercise recommendations |
Proper weight is associated with improved chances of becoming pregnant. Exercise moderately and don’t stop while trying to conceive. Exercise throughout your time of trying to conceive and then it becomes natural for you to continue throughout pregnancy. |
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Soaks |
Use ginger compresses during the time before conception to warm the uterus and ovaries and improve blood flow in these areas. |
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Additional self-massage |
Ear massage daily plus regular uterine massage and ovary massage. Reflexology on the ovary, uterus, and pelvic areas can be done. |
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Moxibustion |
You may perform moxibustion over the whole lower abdomen from the navel to the pubic bone out to ovary areas. The points Ren 3, Ren 4, Ren 6, and Zi Gong are especially important. Ask your practitioner which points you may use if you become pregnant. |
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GENERAL PROGRAM: ADDING PRACTITIONERS TO THE HEALING TEAM |
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Obtaining a Western baseline |
For screening for cancer, HIV, and sexually transmitted diseases, see your gynecologist yearly. Other tests according to the general program. |
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CHINESE MEDICINE |
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Evaluation and diagnosis |
Using the Four Examinations, the practitioner is able to design a treatment course that will restore harmony to your Organ Systems and Essential Substances and, as a consequence, alleviate your gynecological problems. |
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Acupuncture |
The inclusion of Qi and Xue harmonizing acupuncture treatments at least once a month will promote gynecological harmony. |
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Moxibustion |
In addition to the points you can do at home, the practitioner may use those points plus ones on your back such as Urinary Bladder 20 and Urinary Bladder 23. |
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Herbs |
For prevention of disharmonies, you can eat Dang Gui Chicken Soup and San Qi Chicken Soup. |
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Other therapies |
To increase Shen harmony and to reduce irritability, mood swings, stress, and/or depression, include other forms of Eastern meditation, biofeedback, hypnosis, or psychotherapy. To dispel digestive imbalances, some women adopt an Ayurvedic diet or Paleo diet. Abdominal massage can also ease digestive problems and alleviate period pain. |
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PMS PROGRAM: ADDING PRACTITIONERS TO THE HEALING TEAM |
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Herbs |
Formulas such as Woman’s Balance, Xiao Yao Wan, and Heavenly Water alleviate PMS symptoms. A trained practitioner should prescribe any herbal formulas. |
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Additional modalities |
Some practitioners—especially naturopathic physicians (N.D.s) and some natural medicine M.D.s—use natural progesterone topical creams to combat PMS. |
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MENOPAUSE PROGRAM: ADDING PRACTITIONERS TO THE HEALING TEAM |
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Herbs |
Formulas such as Da Bu Yin Wan, Great Yin, and Zhi Bai Di Huang Wan alleviate menopausal symptoms, such as hot flashes, mood swings, and urinary problems. A trained practitioner should prescribe any herbal formulas. |
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Acupuncture and moxibustion |
Treatment is individualized to suit changing symptoms over the course of the premenopausal and menopausal interval. Make a commitment of at least three months to see the changes in your cycles and symptoms. |
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Additional modalities |
Your doctor may prescribe use of natural progesterone to ease the symptoms of menopause. |
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FERTILITY SUPPORT PROGRAM: ADDING PRACTITIONERS TO THE HEALING TEAM |
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Obtaining a Western baseline |
If you are trying to get pregnant naturally, make sure you have had your yearly gynecological checkup and all your other regular medical exams. Men involved as partners or sperm donors should also have regular checkups. If you are thinking about becoming pregnant, see a fertility specialist if you are having irregular periods or no periods, have a history of endometriosis or PID, have a history of more than one miscarriage, are older than thirty-five, have been a smoker, have used excessive alcohol, have had extreme weight gain or loss, have excess physical or emotional stress, or have a history of treatment for cancer. Also, if you are not becoming pregnant after a year of trying monthly if age thirty-five or younger, or after six months if over age thirty-five, you should seek evaluation with a Western fertility specialist. You may need to consider ART. |
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CHINESE MEDICINE |
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Evaluation and diagnosis |
Seek a fertility support consultation from a Chinese medicine practitioner. Learn your Chinese medicine diagnosis, decide if you would like to use acupuncture to support becoming pregnant, and learn which herbs and supplements are appropriate for your particular Chinese medicine patterns. |
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Herbs |
Some herbal formulas used in fertility treatment are Channel Flow, Women’s Precious Pills, and Maternal Herbal. Your practitioner will prescribe formulas based on your individual diagnosis. |
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Acupuncture and moxibustion |
Treatment is individualized to your Chinese diagnoses and menstrual issues, timing, and age. Acupuncture is often a long-term treatment, anywhere from one month to one or two years. Acupuncture can also support IVF cycles. |
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Additional supplements |
Prenatal vitamin supplements, CoQ10, NAC, or whey protein to support glutathione production and royal jelly might be used. Your naturopathic physician, Chinese medicine doctor, or integrative physician will give you additional recommendations according to your specific situation. |