Menopause: Your Role as a Clinician

Menopause is a natural and inevitable phenomenon, yet its effects can be highly variable. Some individuals experience minimal disruption to their everyday lives, while others endure debilitating symptoms for years before and after the cessation of their menses.

With a limited range of medical treatments available, a growing number of people are turning to acupuncture and TCEAM to relieve their menopausal symptoms. So, how do we practice TCEAM with menopausal patients in a way that will facilitate their transition to a healthy older age?

This question could be truncated to: how do we practise TCEAM?

There are general guidelines for establishing a therapeutic relationship that focuses on promoting change to relieve our patients’ suffering. It is this relationship that provides the foundations from which healing can emerge. In brief, this includes:

• Attending to the patient’s needs with empathy, expressed through what has been described as ‘‘the art of doing nothing,’’ i.e. listening, noticing, thinking, waiting, witnessing, and preventing harm.
• Undertaking the activity of attuning (tiaohe). This allows us to cooperate with the patient during a clinical encounter to determine the meaning of their presenting symptoms and their categorization within the discourse of TCEAM, and thus, a path to effective treatment.
• Developing a therapeutic alliance which enables the patient to become active in their own healing.
• Allowing space for both analytical and intuitive knowledge to emerge.
• Ensuring patients feel cared for during the consultation to promote treatment adherence.
• Reconfirming our knowledge that remedy and consultation are complementary. Acupuncture, herbs, massage, exercises, and diet (that is, the core of our practices) do work and are required ingredients for successful outcome(s). However, the ‘therapeutic relationship’ fostered by our consultations also plays a crucial role.
• Continually studying and revising to keep our knowledge up-to-date and better serve our patients.

If these principles need to be applied in any TCEAM encounter then do menopausal women require something more?

Indeed, there are strong arguments supporting more effort for, and a broader understanding of, these patients in our clinics. This is because a woman’s attitude toward menopause, and aging in general, can significantly affect her experience.

We know that older women are located in our western societies in a particular way and face particular challenges. For example, we live in a world where great value is attached to youth and esthetic beauty, while aging is usually seen as something to fight against.

Older women also often have fewer financial and other resources to support themselves in their old age compared to men.

These factors directly correlate with health and the incidence of disease, meaning a woman’s social position can significantly influence her physical and emotional wellbeing. We may not be able to remove these challenges for our patients but, as clinicians, we are uniquely placed to help them shift their attitudes.

Reframing the major physical and psychological change that menopause presents as a transformation rather than a pathology may make the process far more manageable. In fact, it is widely accepted that the ‘medicalization’ of menopause contributes to the occurrence of symptoms and that adopting a more positive viewpoint can ease the transition.

Of course, genetics, ethnicity, education, economic background, and lifestyle factors also have a significant impact. But helping our patients to change their perspectives is one way in which we can assist them in entering the next stage of their lives with optimism and confidence. We may even be able to utilize menopause as a healing opportunity and reduce or eliminate symptoms that have been troublesome earlier in life.

We can also offer advice that allows women to continue their healing journey beyond the treatment room. However, it is essential that this advice is presented in a sensitive, compassionate, and non-blaming manner.

For instance, women are the main target of the wellness industry. It is said to be an industry that offers a seductive distraction from the issues that are really impacting women’s lives and glosses over the cultural and societal issues undermining their wellbeing.

So, how should TCEAM position itself within this industry?

When giving advice, we need to not only focus on what a woman ‘should do’ but also engage our understanding of why she is in this position today. To practice ethically, we need to support women to recognize the broader context of their situation and their efforts to transform their circumstances.

To become well, older menopausal women need allies who value them and can explain that it is not some failure on their part that has brought them to your door. Coming to the end of one’s reproductive life is a chance to reassess what is really going on and how much influence one can have over one’s situation. As TCEAM practitioners, we are in an ideal position to help our patients accept and understand their journey through menopause and enable them to enter later life with serenity, joy, and good health.

References

Saunders, N.C., Cochrane, S., Berry, K., (2022) The Great Transformation - Altering Attitudes Toward Menopause with Chinese Medicine, Journal of Chinese Medicine. Jun 2022, Vol. 129, (pp 17-22).