Menopause: The Second Spring

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By Lauren Barrett, L.Ac, MSTOM

In Chinese Medicine, women are said to age in seven-year cycles. The seventh cycle (age 49), referred to as ‘Second Spring’, is approximately the age when a woman reaches menopause. At this stage in a woman’s life, the creative energy shifts from providing resources for a new being to conserving, sustaining, and nourishing her own body.

Menopause is a natural biological event that signifies the end of the menstrual cycle. Guided by the wisdom of the body, this natural progression helps to balance its systems. A woman reaches menopause when menstruation ceases for one full year. Leading up to menopause and one-year following is a process referred to as perimenopause. Most of the undesirable symptoms that women associate with menopause occur during this phase. 

Acupuncture and Chinese Herbal Medicine provide a holistic approach to manage and treat signs and symptoms associated with menopause.  Similar to menstrual irregularities, menopausal signs and symptoms have become normalized, but they are not something one must suffer through. While menopause is homeostatic by nature, it can exacerbate pre-existing imbalances, presenting as hot flashes and night sweats, vaginal dryness, insomnia, emotional disturbance, weight gain, and migraines. 

Menopause is an event that occurs within the endocrine system, but its symptoms involve many other areas of the body. Research studies show that acupuncture affects internal regulatory systems, including the endocrine, neuroendocrine, and sympathetic nervous system.[i] This is important when it comes to treatment of menopausal symptoms because the occurrence, intensity, and severity of these symptoms involve an interaction of all three of these systems. In a randomized controlled trial, acupuncture treatment was found to significantly reduce hot flash frequency and severity as well as improve sleep, anxiety, memory, and mood compared to no treatment in menopausal women.[ii]Unlike most therapies, acupuncture addresses the entire being and helps to balance the body and mind. It was also studied to stimulate endorphin release and possibly other neurotransmitters including dopamine and serotonin, which can enhance mood. [iii]

Embrace your Second Spring! Menopause offers a challenge and a chance to transform the condition of your health and accept the beautiful process of transition. Adopting more sustainable and supportive lifestyle and dietary changes in addition to Acupuncture and Herbal medicine can significantly prevent and relieve symptoms associated with Menopause. 

 

[i] Stener-Victorin, E., & Wu, X. (2010). Effects and mechanisms of acupuncture in the reproductive system. Autonomic Neuroscience, 157(1-2), 46-51. doi:10.1016/j.autneu.2010.03.006

[ii]  Avis, N. E., Coeytaux, R. R., Isom, S., Prevette, K., & Morgan, T. (2016). Acupuncture in Menopause (AIM) Study: a Pragmatic, Randomized Controlled Trial. Menopause (New York, N.Y.)23(6), 626–637. http://doi.org/10.1097/GME.0000000000000597

[iii] Cheng, K. J. (2014). Neurobiological Mechanisms of Acupuncture for Some Common Illnesses: A Clinicians Perspective. Journal of Acupuncture and Meridian Studies, 7(3), 105-114. doi:10.1016/j.jams.2013.07.008

PGS Testing in a Nutshell

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Opinions on Embryo Screening from an Integrative Perspective

By Mary Sabo, L.Ac. DACM

Patients undergoing a cycle of In Vitro Fertilization (IVF) have the option of screening embryos using a process called Preimplantation Genetic Screening.  PGS testing involves analyzing the number of chromosomes in a few cells of an embryo to determine if it contains the correct number of chromosomes (normal or “euploid”) or the wrong number (abnormal or “aneuploid”).  Aneuploid embryos may contain too many chromosomes (trisomy) or too few (monosomy) and when transferred often lead to miscarriage or failed implantation.  Occasionally, an embryo is “mosaic” and has both normal and abnormal cells, which is also not ideal for transfer.  Another version of testing called PGD (Preimplantation Genetic Diagnosis) looks for specific genes in an embryo that may put a baby at risk for severe inherited health issues such as cystic fibrosis or other genetic diseases. 

PGS testing is a way to improve the likelihood that a normal embryo will implant and develop into a healthy baby.  The technology has been around since the 90’s, but has come a long way in the past 5 years.  Initial PGS testing was done on embryos that were 3 days old (when an embryo is a ball of only 6-8 cells).  It required extracting a few cells, so it ran the risk of damaging the embryo and, due to the early stage of development, was not always accurate.  Currently, testing is done when an embryo is a blastocyst (5-6 days old) when there are enough cells for it to start to differentiate into three regions: an outer shell, the eventual placenta (trophectoderm), and the inner mass (which will become the fetus).  The sample is taken from the trophectoderm so damage to the embryo is less likely. 

When and why should you test?

Women of all ages produce abnormal embryos.  While it is more likely that women over the age of 35 will have a higher number of aneuploid (abnormal) embryos in an IVF cycle, women in their 20s still produce a percentage of abnormal embryos each cycle during an IVF.  If you ask 10 different doctors about whether or not to test embryos, you may hear 10 different opinions.  Some clinics advise testing all embryos.  Other clinics advise against testing, especially in younger patients.  Some let the patient choose.  Why?  Cost can be a factor. A batch of biopsied embryos can add thousands to an already expensive IVF process.  There is also some speculation that some embryos that test mosaic  (abnormal and normal cells) might be able to self-correct over time.  While there are a handful of cases that may support this as a possibility, the overwhelming evidence suggests that the newest technology for testing blastocysts called Next Generation is accurate and trustworthy. 

One major benefit of testing embryos is getting a better understanding of a couple’s fertility struggles.  If a batch of embryos tests better than average (50%), it can be assumed problems conceiving are potentially caused by something other than egg quality.  If the embryos test mostly or all abnormal, it can be assumed the cause of infertility is egg quality and using donor eggs or another round of IVF might be recommended.  If a clinic performs more than two transfers with “normal” embryos and there is still lack of implantation or early pregnancy loss, further testing may be needed to check for uterine abnormalities, blood clotting, or immune issues, hidden infections, or endometriosis.  Another benefit of testing embryos is screening to rule out certain genetic diseases.  If either partner is a carrier of a genetic disease, the embryos can be screened for that disease using PGD. 

Screening embryos also results in fewer miscarriages and reduces the occurrence of multiples (twins, triplets). When embryos have been screened, most doctors transfer single embryos resulting in singleton pregnancies. While twins and triplets are appealing to some couples, multiples pregnancies are much more dangerous for both the mother and babies.

PGS testing is recommended for women over 35 and for couples who wish to reduce the risk of miscarriage.  Women under 35 or those who produce a lot of embryos may also want to test to help decide which embryos are ideal to transfer.  While it can add costs to an already expensive process, miscarriages and subsequent transfers are also costly, as well as emotionally difficult and time-consuming. 

The Basics of Egg Freezing

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By Mary Sabo, L.Ac, DACM

On average, women in developed countries are delaying childbearing until later in life.[i]Many modern women are waiting until their 30s and early 40s to start a family in order to focus on their careers, gain financial stability and find the right partner.[ii]Women who learn to take excellent care of their bodies and health can sometimes delay the appearance of aging and feel great, but unfortunately eggs and ovarian function decline whether they are in perfect health or not, and the age at which they decline can, unfortunately, be unpredictable. 

In Chinese medicine, we support fertility naturally using herbs, acupuncture, and dietary and lifestyle changes. We help women conceive with these tools either alone, or in conjunction with assisted reproductive techniques like In Vitro Fertilization (IVF) and Intra Uterine Insemination (IUI). Acupuncture and herbs can improve hormone balance and overall health, which optimizes fertility at any age. However, the biggest determinant of conceiving a healthy child is the chromosomal quality of eggs and sperm, which declines naturally as we age. We now know that the uterus can remain healthy and able to carry a baby long after the ovarian health and egg quality prohibits pregnancy. For this reason, egg freezing has become a popular option for women to preserve their younger egg health for use later in life. It’s a type of fertility insurance. Egg freezing is more affordable than ever and new advances in techniques have made it more reliable, improving outcomes. 

Plenty of women conceive easily in their thirties and early forties, but the likelihood of struggling with fertility at this age is higher.[iii]Screening for infertility in women not trying to get pregnant is not yet standardized in our medical system and many couples who struggle to conceive are “unexplained”, meaning that all tests look normal but pregnancy is still not possible. Conceiving as an older woman can become a bit of a gamble then. Miscarriage rates are higher in this population and the reasons for both higher rates of infertility and miscarriage are commonly the “quality” or chromosomal makeup of the eggs and sperm. Researchers are exploring ways to influence this chromosomal content, and it is suspected that some agents like antioxidants can influence the overall health of the egg, which can potentially improve the quality, but currently the biggest determining factor is age. The older a woman gets, the more eggs in her ovaries mature with chromosomal abnormalities. Until we understand how to directly influence this development predictably and reverse the effects of aging on eggs, the best way to preserve them is to extract and freeze them when we are young.  

Currently, there is no test to determine egg quality. There are some tests to determine the health of the ovary and the “ovarian reserve”, but they do not assess the health of the chromosomes inside the eggs. According to Reproductive Endocrinologists at CCRM New York and authors of Truly-MD.com, Dr. Jaime Knopman and Dr. Sheeva Talebian, the ideal time to freeze eggs is between 30-34 years of age. Freezing at a younger age, in theory, will produce healthier eggs, but you’ll pay more over time to keep those eggs frozen longer as facilities charge an annual “rent” for your frozen eggs. You also may not need them. Waiting until later means more eggs may be abnormal. However, if you are older than 34 and having a child is nowhere in sight, it’s worth discussing your options with an RE. Egg freezing is insurance, not a guarantee, but it is the only option for women who know they’d like to have a family one day, but it’s taking a bit longer to feel ready than they expected. 

If you are considering freezing your eggs, you can take some steps now to improve your health and potentially optimize the health of your eggs. Dr. Knopman and Dr. Talebian recommend stopping smoking, decreasing alcohol use, and increasing foods that are high in antioxidants for three months before your egg freeze cycle.  I also work with women in those three months before their egg freeze cycles to optimize overall health and egg quality with acupuncture, customized dietary and lifestyle changes, and customized supplement and herbal plans. Because fertility potential and egg health cannot be determined until a woman starts trying to conceive, there is no way to know your fertility status or egg quality, but you can absolutely maximize your chances of freezing healthy eggs with the right support and empowering changes. 

 

[i]Matthews TJHamilton BE. NCHS Data Brief.Delayed childbearing: more women are having their first child later in life. 2009 Aug;(21):1-8. 

[ii]Hammarberg K1, Clarke VE. Reasons for delaying childbearing--a survey of women aged over 35 years seeking assisted reproductive technology. Aust Fam Physician.2005 Mar;34(3):187-8, 206.

[iii]Baird DTCollins JEgozcue JEvers LHGianaroli LLeridon HSunde ATempleton AVan Steirteghem ACohen JCrosignani PGDevroey PDiedrich KFauser BCFraser LGlasier ALiebaers IMautone GPenney GTarlatzis BESHRE Capri Workshop Group. Hum Reprod Update.2005 May-Jun;11(3):261-76. Epub 2005 Apr 14.

An Integrative Approach to Managing Endometriosis

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By Mary Sabo, L.Ac, DACM

Endometriosis is a condition where endometrial cells that normally grow inside the uterus grow elsewhere in the body. It affects about 10% of women and can range in symptoms from extremely painful periods, severe PMS, painful intercourse, painful urination or bowel movements to absolutely no symptoms at all. Many women do not realize they have endometriosis until it interferes with their fertility. While it can be a confusing condition to diagnose and treat, there are many ways to manage symptoms and improve fertility using both Western and Chinese medicine techniques. Recent studies have also shown promising results when integrating the two.

Endometrial cells are sensitive to hormone fluctuations and are responsible for building the uterine lining, which grows and sheds each menstrual cycle. While these cells are part of our own bodies, when they grow outside the uterus where they shouldn’t grow (often on the bladder, fallopian tubes, ovaries, intestines, outer uterine wall, or peritoneum), the body can treat them as if they are invaders and will launch immune and inflammatory responses. This reaction can potentially interfere with egg quality, ovarian health, uterine receptivity and therefore, fertility. The confusing thing about endometriosis is that many women with the condition are able to conceive and carry to term easily. Because of that, women are not screened for it in initial fertility testing and it is often only considered once a woman has undergone In Vitro Fertilization (IVF) with multiple failed embryo transfers or miscarriages. 

While endometriosis can be difficult to detect and diagnose, some testing is possible.  Endometrial cysts can be seen on ovaries in an ultrasound. MRIs can reveal lesions in the abdomen, most commonly in advanced cases. Exploratory laparoscopic surgery is the gold standard for diagnosis and treatment to remove obvious lesions inside the abdomen, but microscopic lesions can be left behind, as well as scar tissue. An endometrial biopsy can assess inflammatory markers that reflect a high likelihood of endometriosis or inflammation in the uterus. Treatments to decrease endometrial growth such as Lupron after laparoscopic surgery or in the months leading up to a frozen embryo transfer cycle from an IVF may help decrease inflammation and immune activity, improving implantation and pregnancy rates.

Acupuncture and customized Chinese herbs, along with following an anti-inflammatory diet, have been shown in studies to help decrease the size of lesions, improve fertility, and reduce associated symptoms of endometriosis[1]. I also find some supplements helpful in my clinical practice, including N-Acetyl Cystein (NAC) and pycnogenol[2]. Because patients with endometriosis can have different underlying diagnoses in Chinese medicine theory, it is wise to work with an experienced practitioner who can prescribe an appropriate custom blend of herbs as well as dietary and lifestyle changes. Acupuncture can be helpful in reducing inflammation and regulating the immune system while patients are preparing or undergoing IVF and are in treatment or recovery for endometriosis.

Whether you are trying to manage endometriosis symptoms, trying to conceive naturally, or are undergoing fertility treatments such as IVF, working with an experienced acupuncturist can be a helpful addition for managing endometriosis.

 

[1] Sai Kong, 1 Yue-Hui Zhang, 2 , 3 Chen-Fang Liu, 1 Ilene Tsui, 4 Ying Guo, 1 Bei-Bei Ai, 1 and  Feng-Juan Han 2 ,*The Complementary and Alternative Medicine for Endometriosis: A Review of Utilization and Mechanism. Evid Based Complement Alternat Med. 2014; 2014: 146383

 

[2] Maria Grazia Porpora, 1 Roberto Brunelli, 1 Graziella Costa, 2 Ludovica Imperiale, 1 Ewa K. Krasnowska, 2 Thomas Lundeberg, 3 Italo Nofroni, 4 Maria Grazia Piccioni, 1 Eugenia Pittaluga, 2 Adele Ticino, 1 and  Tiziana Parasassi 2 ,*. A Promise in the Treatment of Endometriosis: An Observational Cohort Study on Ovarian Endometrioma Reduction by N-Acetylcysteine. Evid Based Complement Alternat Med. 2013; 2013: 240702.