We’re going to talk about production. of hormones. We’re going to talk about follicles. We’re going to have a little bit of a chat about Jing.

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Hey everyone, and welcome! I’m Dr. Crystal Lynn Couture. The pelvic acu and I want to thank the American Acupuncture Council for supporting this flock. If you don’t already know this, the American Acupuncture Council has amazing vlogs hosted on their website almost every week. And within these vlogs are absolute gold.

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Michelle Gellis, Michelle Grasick, myself, and some other amazing practitioners have all shared lots and lots of vlogs. And trust me. They’re worth seeing. Today, we are going to be talking about the pelvic floor and menopause. Shall we get into it? In today’s chat, we’re going to define menopause. We’re going to reframe the menopause definition, which is going to help us and our clients.

We’re going to talk about production. of hormones. We’re going to talk about follicles. We’re going to have a little bit of a chat about Jing. We’ll talk about kidney deficiency and we’ll talk specifically about menopause and the pelvic floor. So let’s get into it. All right. The Western definition of menopause is as such.

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Menopause describes the stage of a woman’s life when her menstrual periods stop permanently and she can no longer get pregnant. The Siwen describes this as at the age of 49, the Ren Mai becomes deficient, the Chang Mai is depleted, and the Tian Gui dries up. Menstruation stops, she becomes weak, and can no longer conceive.

There’s a little bit of overlay between the two definitions, but there’s a different understanding between the two definitions, of course, and we know that as Chinese medicine practitioners. If we look further, Western medicine refers to the decline of hormones and the ovaries producing less and less estrogen and progesterone.

In TCM, we talk about the decline of the kidney gene and the body becoming deficient of yin and fluids. So clients are going through this. We ourselves might be going through this as practitioners, right? Women around the globe have been and will continue to go through menopause. And there is a stigma associated with menopause.

And that stigma is almost, even in the Siouan, it’s almost like a little bit of a death, right? And so I think it’s our job as acupuncturists to look beyond that and help our clients see that this is a second spring, a second bloom. A rebirth. And we see this in clients already. We see that at 50, I hear this so often from practitioners that I’m talking about.

I went back to acupuncture school at 50. I went back to whatever marketing school at 50. I wanted something new at this age, right? Because it’s a rebirth for their body. Everything is changing. Everything is transforming. And what an opportunity to look inside. And for clients to decide what they really want to experience through this second phase of life, how they want to live, how they want to access their relationships, their dreams their spirit within them.

So I think if we paint this as an opportunity, we have a beautiful way. To empower our clients and help them embody this transition that might not make it less uncomfortable. But the good news is we have tools in our toolkit to help make it less uncomfortable. So we have this unique opportunity as women.

To intentionally shift into this phase of our lives with grace, gratitude, desire, and passion for life. And as practitioners, if we can support this mindset and witness our clients flourish, that’s really where the magic happens. So let’s talk production of hormones because I think it’s important for under us to understand the Western science as well as the Eastern, right?

So estrogen, of course, is going to be produced by the ovaries. It’s also produced by the placenta. A small amount is produced by the adrenal glands on the kidneys and a small amount is produced by the adipose cells throughout the body. Now progesterone progesterone is produced by the o ovaries, by the placenta, a small amount by those adrenal glands.

And then in males, a small amount is produced within the testes. Okay. So we start to see that as the ovaries and the placenta are no longer involved in the picture. The big producers of estrogen and progesterone are on the bench. They are no longer on the forefront. They’re out of the game.

So what this means is there is going to be a decrease in estrogen and progesterone. Now, estrogen is most of the circulating estrogen in the premenopausal women is produced by the ovaries, largely as a result of secretion from the granulosa cells of developing follicles. And estrogen peaks, as we know, right before ovulation.

We talk about progesterone. Once the egg has been released at ovulation, that empty follicle that remains becomes the corpus luteum. The corpus luteum produces progesterone in higher amounts and estrogen in smaller amounts. So physiologically, scientifically, there’s a major change going on within the hormones at that menopause phase.

Let’s talk about the follicles for a moment. The ovary establishes several million non growing follicles at five months of gestational age. That’s huge, followed by a decline to menopause when approximately only 1, 000 remain. We have an average of 450 menstrual cycles in a reproductive lifespan. All of this to say that the decline in follicles is going to be, as well as hormones, thus, is going to be progressive due to the follicle death by apoptosis.

Now, Jing is the basis for follicle development. Menopause is a progressive decline of Jing over time. So hopefully this is starting to illuminate the overlay between the Western and the Eastern medicine here. The progressive nature means a couple of really important things for us. That lifestyle can improve or inhibit one’s menopause experience.

Over stress. Emotional stress. Overwork. Tobacco use. Irregular eating habits. Eating to excess. Coffee consumption, alcohol consumption, drug use just to name a few, can all contribute to one’s menopause experience. The great news about this is that if we are seeing clients before they are going into the phase of menopause or perimenopause, we have the opportunity to help them impact their menstrual health through the phases of their life so that their menopause can potentially change their life.

be a better experience. Now, a lot of Chinese texts that are out there in particular, Seven Times a Woman talks really about this nature of starting to prepare for menopause at age 35 that references by Leah Andrews. Sorry, I forgot the name for a sec. It’s a great book, one that you should definitely have in your clinic.

So starting to have this conversation with clients at age 35, one is going to really help their menstruation journey from 35 to let’s say 50, but it’s also going to really help prepare them for the menopause experience as well. Now a decrease in kidney jing. Kidney means that kidney yang and kidney yin or both can become deficient.

So the kidneys are the root of the original water and fire, right? They’re that origination of the Tian gui, which comes from the kidneys with the minister fire acting upon it and creating the menstrual blood, right? They are interdependent and inseparable. The minister fire is part of this experience, the formless, there’s a connection between heaven where as emperor fire heart and form is human.

Now kidney deficiency is Yin deficiency, right? We’re going to see, with Yin deficiency, we’re going to see night sweats, we’ll see hot flushes, we’ll see the feeling of heat, we might see those cold feet, and frequency of urination. The tongue generally here is going to have no coat, and redness may be present.

When there’s yang deficiency, we can still see the hot flashes, we’ll see the low back pain, the feeling of coldness, the cold feet, and that frequency of urination as well. But in this case, the tongue can be pale. Now, when we see some combination of kidney yang deficiency and kidney in deficiency, we’ll see all of these symptoms concomitantly existing.

And the person really having this dig dysregulation of temperature and this dysregulation of temperature is going to be annoying and uncomfortable for them and something that they can’t quite, put their finger on. So that’s really important for us. to be aware of and to utilize our good diagnostic skills as Chinese medicine practitioners to find out what’s happening in the system.

Let’s talk about menopause and the pelvic floor specifically. We know because we’ve talked about it in previous chats that estrogen is going to preserve muscle mass. It’s going to support muscle repair. It’ll help generate muscle force. It increases the collagen content. It plays a role in muscle metabolism and it protects against muscle apoptosis, right?

Apoptosis. So when estrogen is decreased, The muscle is at a disadvantage, which means there can be less muscle suppleness, less strength, less power and function of the muscles within the body and the muscles of the pelvic floor, right? So you can see that there’s a lot of research that comes out for women at the menopausal age that encourage strengthening exercise, especially weight bearing or resistance exercise, right?

And this is because those muscles are at a disadvantage. You can also very commonly hear the complaint that women that are going through the menopause phase are feeling weakness in their bodies. I want to take just a moment to point out that we know that estrogen also comes from the adipose cells, right?

And so we can also see some weight gain. There’s a number of reasons that we can see weight gain through the process of menopause. But one of them is going to be that those adipose cells may be trying to produce estrogen for the body. So it’s important to consider that as well. And that’s, I think, one of the reasons that a lot of women go on the hormone replacement therapy to try to really help their bodies for weight gain, for muscle balance, and to just feel better because the symptomology is real.

Everything is changing in the body without good muscle contraction. Without that muscle suppleness as well, we can a lot of times see strain on the fascia and those fascial chains that exist within the body can produce pain for clients. So it’s probably pain that was latent. It’s probably pain that was there and it was being held by the suppleness of the tissues.

And then all of a sudden as the suppleness decreases, it starts to really pick up because the body is holding itself up. on those fascial chains because the musculature is not having good contraction. So what do we know about progesterone? Progesterone is going to support muscle relaxation.

It’s also going to support protein synthesis within the muscles, and it’s going to help maintain connective tissue elasticity. So if we think about estrogen and progesterone, what they do is they are strength and flexibility in harmony, which we can liken a little bit to what’s happening in menopause with the wood element, right?

There’s this decrease in progesterone and that can contribute to the muscle weakness. It can contribute to muscle tightness. It can contribute to proprioceptive confusion within the body and stiffness within the tissues. Now, if you’ve seen my pregnancy, Workshop. We talked a lot about what is proprioceptive confusion.

Proprioceptive confusion with pregnancy, we can see, right? We see rebellious chi. We see the acid reflux. We see this kind of energy going up when it needs to be going down. And all of those changes that occur. During menopause, that can happen as well because there are changes deep within the system that are Allowing the meridians to be resourced in a different way than they might have been resourced before.

And so it’s important to consider that. Now, what does that mean for the pelvic floor? If there’s proprioceptive confusion within the pelvic floor, that generally means that the body is not relaxing and contracting the pelvic floor when it’s meant to. Now, what does this mean? If, for instance, on the exhale, the pelvic floor is relaxed, What are we going to have?

We’re going to have leakage because those tissues are relaxed when they’re meant to be contracted. That could be of the bowel. It could also be of the bladder. And what’s happening is that we are relaxing the tissues. When we are exhaling. So that’s a sneeze, a cough, a breath, a push breath out all of those things.

And what our pelvic floor is supposed to be doing during the exhale is going up and in. That goes the opposite too. On the inhale, the pelvic floor is meant to be relaxed, right? We’re filling the body with breath when we inhale. So that’s a relaxation of the pelvic floor. That’s that pelvic floor ballooning and relaxing, taking the chi, taking the breath of the heavens.

in and then on the exhale pulling up and in, releasing out, right? So proprioceptive confusion in the pelvic floor is one of the number one things that we want to work on with our clients that are having issues with leakage. Now, progesterone in particular with reduction in the connective tissue elasticity and that sort of decrease in muscle relaxation, what we can end up with is actually excessive tightening of the pelvic floor.

Now with excessive tightening, And reduced yin and fluids, what we’re going to end up with is over contraction that leads to pain, particularly could be pain, spontaneous pain, but it also could be pain with sex and intercourse, right? Even pain with the, with very shallow penetrate penetration or very narrow penetration of a finger can be very painful because these muscles are over tightened and over contracted because there is a reduction in the elasticity.

So this is something for us to be very aware of with our clients and to be good investigators as we’re evaluating our clients and find out what’s happening and having a basis of understanding of what’s happening with the hormones helps us to understand why this is happening and also give us information and insight into the connections between what we’re finding within the meridians and our TCM.

Diagnostics, right?

There’s more to this estrogen and progesterone business within menopause, right? It is actually that the receptors for estrogen and progesterone are present on the pelvic floor. So when the body is producing less estrogen and progesterone, the receptors begin to decrease because they’re not used. If we don’t, if we don’t use it, we lose it, right?

And those tissues can weaken. So this is another contributing factor. to what’s happening within the pelvic floor is a reduction in receptors. Let’s go menopause and beyond, right? Progesterone and the mood. Okay, so progesterone controls overall mood. and sense of well being. Estrogen low estrogen in particular can increase susceptibility to stress and anxiety.

Estrogen and serotonin are linked, they are interconnected. Which means that when estrogen drops, So does serotonin, which is linked to an increased risk of depression. Now, as we know, serotonin and melatonin are also linked. So this is where we can see these interruptions in sleep cycle. So we’ve got physiological changes going on.

On top of those physiological changes, we have emotional changes that are going on. There is nothing that we can do as acupuncturists to stop these changes from happening, because there is a transitionary period. in the body that is physically proven that is proven through Chinese medicine through the energetics.

Jing changes right at this phase. So the only thing that we can do is help our clients to be prepared and then help our clients to go through the transition in the smoothest way as possible. We can clearly understand if we’re looking at this if we have not been through menopause ourselves. If we are looking at this data right now, we are We can clearly see why, as women are going through menopause, they can feel like they are drowning.

They can feel like the world is coming up against them. They can feel like they are so disconnected from their bodies, and it is because they are in a whole new experience. Which is why that reframe of the rebirth, that discomfort, that vulnerability of a rebirth, can be really helpful in helping them to come into their power.

During the menopause phase, so I really hope you enjoyed our time today If you’ve been with me before, you know I’ve presented a pelvic floor intro, menstruation, fertility, pregnancy, and postpartum, all in relation to the pelvic floor. And these workshops were all sponsored by the American Acupuncture Council.

And here’s some references. I just want to once again thank you so much for spending this 20 minutes or so with me today sharing in information about menopause and the pelvic floor. I really hope that this is something, there are little nuggets here that you can take back to your practice that are going to help you to support your clients.

In the best way possible. So I want to thank you for, from the bottom of my heart. I also want to thank the American Acupuncture Council for sponsoring this vlog. Thank you so much, and I’ll see you next time.

 

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