Hormone replacement therapy (HRT) drugs have been in the news in the UK lately, because of the shortage of some HRT products, particularly oestrogen. About one million women in the UK use HRT to cope with menopausal symptoms such as hot flushes, night sweats, insomnia, decreased libido, anxiety and poor concentration.

The good news is that Chinese medicine offers a safe and effective alternative to HRT. Systematic reviews and randomised controlled trials (which are the strongest types of research evidence) found that acupuncture is at least as effective as, and sometimes superior to, hormonal drug treatment. 

In my clinic I regularly give acupuncture treatment to women who need help for menopausal symptoms. About 30-70% of women in Western countries will experience vasomotor symptoms (related to constriction or dilatation of blood vessels) like hot flushes or night sweats. In extreme cases they might have been experiencing these for decades. The median duration for vasomotor symptoms is about four years, but in 10% of women, they last longer than 12 years. 

I see myself as walking proof of how Chinese medicine can help those transitioning through menopause, one of millions of women around the world. I manage the symptoms with regular acupuncture and Chinese medicine herbs, along with healthy food choices, regular exercise and stress reduction. And maybe more importantly, it's about appreciating this next stage in my life. Menopause doesn't have to be such a scary word. I'm older and wiser, and that brings with it confidence and serenity. 

Of course I am mindful that I am fortunate to enjoy good health. To some degree it's about luck (i.e. genetics), but there's a lot that middle-aged women can do to help ourselves.

Photo credit: yochim from Free Images

​A recent study by scientists at the Hebrew University of Jerusalem found that sperm counts among men in the west have fallen by around 50% in four decades. There is nothing new in this study, as it was an analysis of more than 100 previous studies in the field. But it certainly highlights what fertility experts have known for decades – that more and more couples worldwide are having problems conceiving.
 
According to the NHS, one in seven couples in the UK may have difficulty conceiving. The causes of fertility are myriad, from polycystic ovarian syndrome (PCOS), endometriosis and thyroid problems for women, to lower quality sperm and low sperm count for men. But for 25% of couples with fertility issues, a cause cannot be identified.
 
In vitro fertilisation (IVF) has gained wide acceptance since the world’s first baby was born through IVF in 1978 (remember Baby Louise?). In the UK, more than 250,000 babies were born through IVF. In the western world, 1% (and rising) of all babies are born through assisted reproductive technology.
 
However, IVF cannot help everyone, with its high emotional, social and financial burden. Fertility drugs have side effects, from bloating and mood swings, to ectopic pregnancy and ovarian hyperstimulation syndrome. The success rate of IVF is highly dependent on the age of the woman undergoing treatment, as well as the cause of infertility.
 
Unless couples have very specific reasons for going down the IVF route, it’s best to try boosting fertility the natural way first. Some of the suggestions are well-known - get healthy, lose weight, don’t leave it too late, have fun with sex. Less well known is the importance of keeping calm and relaxed and not getting too anxious.
 
In Chinese medicine, the Uterus Channel or Bao Mai is the channel which connects the Uterus to the Heart. The Heart is particularly susceptible to emotional stress such as anxiety, which in turn can affect the health and receptivity of the uterus. Trying to have a baby can be very stressful, and when the body is in an anxious state, many physiological reactions can adversely affect your ability to conceive. Hormones are released, blood vessels are constricted, and blood moves away from the torso to the limbs as your body gets ready to flee in a fight-or-flight response. This means that blood supply to the pelvic organs, the uterus and ovaries is reduced.
 
Acupuncture helps boost fertility by improving blood flow to the pelvic organs, therefore promoting the growth of endometrial tissue, optimising ovulation, and regulating menstruation. Acupuncture is safe and has very few adverse side effects, when done by properly trained practitioners. 
 
Click here to see research on how acupuncture can help with female infertility and male infertility.

This week my classmates and I found outselves in gynaecology. Yesterday we were with Dr Han Feng-juan, a lovely woman who is clearly a leader in her field but has a warmth that is just what you want in your gynaecologist. I also found out that she is the director of the 4th floor gynaecology ward, where we were this morning (although we followed a different doctor).

Dr. Han is well-known for treating polycystic ovarian syndrome (PCOS), dysfunctional uterine bleeding, irregular menstruation, for giving pre-natal care (especially for those with a gynaecological condition) and for "holding" the baby to avoid miscarriage.

She had a very busy clinic yesterday morning. She was quick and efficient, but clearly gave her patients a lot of attention and care. We saw many many cases of Kidney Deficiency, especially in problems of irregular menstruation or amenorrhoea.

But what struck us the most is the lack of privacy, especially for a place as intimate as a gynaecology clinic. At the back of Dr Han's office is an examination table with stirrups (very old fashioned!), separated from the main area with a pink room divider. Every so often, Dr Han got up to examine a patient, who had been prepped by a student and had undressed and climbed on to the table. Bearing in mind that the clinic is heaving with patients and relatives, it soon became apparent that it's considered normal for other patients to look at what's going on behind the screen. I know that the Chinese have a different concept of privacy, so I tried not to feel too sorry for the patients. At least men were not allowed in the room!

This morning we did the round of the 4th floor gynae ward with Dr Zhang and two of her students. I think we saw a total of 20 patients. There were a few cases of surgery (an 82-year-old woman with vaginal tumours, and a woman in her 30s who had a hysterectomy) -- but the vast majority of patients were there because they were in the early stage of pregnancy and had threatened abortion (in danger of miscarriage). The standard treatment seemed to be lots of rest (with an average stay of one month in the hospital), injections of progesterone, and Chinese herbs. 

Clearly there are big cultural differences between China and the UK for this sort of problem. My classmate Sharmin said that in the UK, women with this condition would simply be told to go home and rest. And then there is the argument that if your foetus is not strong enough to survive the first trimester, a miscarriage is (probably) nature's way of "healthy-baby selection".

Our translator said that in China, the pressure to have a baby is so strong, it (probably) overrides this ethical dilemma. There is clearly a strong demand for this service, such that someone like Dr Han has made a reputation for being able to "hold the baby".

And then there are other issues like artificial progesterone being injected into women's bodies. What implications does this have for the baby and the woman's health later on? I would love to see research into this.

Finally, I took a photo of a woman in the ward who was being fed a mountain of baozi (stuffed buns) and noodles by her mother (or maybe a mother-in-law?). I asked her permission for me to take this picture. I found her so beautiful, especially as she tucked into her lunch. Ethical dilemma aside, I hope she holds her baby to full term.

P.S. My classmate Kat later passed on a research paper from mainland China that looked into the effects of the use of progesterone in cases of threatened abortion. It found no difference in terms of birth weight of babies between those who were given progesterone treatment and with a control group. Interesting.