Treating Menopausal Women in Your Practice
I love what I do for a living. It's a great way to trade health for bread. And no topic of health, with the right bedside manner, is taboo. In fact, as I'm sure it's happened to you, patients are more than happy to openly discuss all of their health concerns if it is set up right.
I like to explain to female patients that menstrual health gives a Chinese medicine practitioner a lot of great diagnostic information. This is just as important as telling a patient that you are going to reach around and find their hip bone to landmark lumbar vertebrae. Communicating what you are going to do, and why, is a great way to keep your patient informed at all times.
After asking about menstrual health they are usually more comfortable to be asked how their sex drive is. However, it's important to be aware that most women don't get asked this question. Men get it all the time – because in society it is generally regarded as a man's problem and never affects women.
I usually don't give patients a scale or guidelines as how I want them to answer. This is because I never want to put words into their mouth. The last thing I want is for them to be describing a symptom and me to jump in with, "So it feels like a head wrapped in cheesecloth?" They might say, "Yes!" and then I'm in real big trouble. Letting a patient use their own language based on their own inner workings of mind and spirit is key to finding out what is really troubling them.
However, when I'm speaking to a patient about a sensitive topic such as libido I like to ask them, "How's your sex drive? High, medium or low?" It's important to watch their body language and the tone of their voice at this point. Sometimes answers and inflections don't match up. Sometimes, not unlike asking about mood change during menses, a patient will answer, "My partner says..." I'm quick to shut that down, making sure my patient knows that I'm only concerned about their reality through their eyes.
If a patient tells me that their sex drive is low, I usually ask a follow-up question in regards to if they think it's something they wish they could improve. This tactful question is something that will be expanded on later.
Kidney Energies and Libido
There is no question that peri-menopause, menopause and post-menopause are affected by the Kidneys. We all know that the Kidney Yin starts to deplete and eventually the Yang will follow. Most patients come into clinic concerned with all sorts of symptoms that can occur from this Empty Heat and deficiencies. A large part of my practice is quieting hot flashes and night sweating, and/or stopping menstrual flooding.
It is my professional belief that some of these symptoms are part of a natural decline; and it's only when they start to interfere with everyday life medical intervention is needed. I have had several patients exclaim that they are affected by hot flashes and wake up in a sweat several times during the night - to the point where they can't get any sleep. Obviously, this is a problem. If after many treatments and/or herbs, my patient finds that they are down to only a few flushes a week and the intensity and duration have decreased, I think this is a success.
The same goes for libido. There is a natural decline in men and women. It's only if and when this is starting to affect the rest of one's life that it should be viewed as a concern. There are many patients – from either sex – who have told me that they have a low sex drive and it wasn't a concern at all. Perhaps this patient didn't have a partner at the time, or had communication with their partner and there were no complaints all around.
Life Coach vs. Acupuncturist
Many times we end up walking the line between counselor and healer. Knowing what one's strengths, weaknesses, and professional boundaries are key. If certain topics are beyond the healthcare realm (or uncomfortable for a practitioner), it's important to refer to a colleague for all the right reasons: professional, specialist and legal.
However, there are times in clinic where when something is said at the right time, with the right tone, it can empower a person. I always keep it positive in the clinic. It's not hard to do so. The reason is because of the type of field I'm in – regulation. Acupuncture is very self-regulating and I'd have to seriously get a diagnosis very wrong to administer a detrimental treatment. Most acu-points simply just heal the body and with the right intent (to do no harm), it's hard to go wrong. Herbs, obviously, is another story.
If the acupuncture treatment is in the right direction, and the language I use is correct, healing ensues. And herein lies the crux of libido and Chinese medicine treatment: there are times when it has less to do with what can be controlled inside the clinic and more to do with what can't be controlled outside the clinic.
A good friend and colleague, Jennifer Salib-Huber, BSc (hons), RD, ND, has seen just as many patients complain of the same low sex drive. She also noted that sometimes when those patients who are having menopausal symptoms get a new partner, their libido increases.
For me, this completely jives with what I've seen. There has been the odd patient who has been honest and open about the fact that the drive isn't the only thing that has left – the spark in their relationship is gone. So while we as healers can try to spend a course of treatment tonifying Kidney-Yang, what we really need to be doing is calling up our patient's partner and telling them to pick up some flowers on the way home.
Working Theory & Subtle Suggestions
Doing what Chinese medicine does best, allows me to 'zoom out' and see the whole picture: Once upon a time, in the beginning of the relationship, there was passion. Outings were planned, dreams were made and romance flourished. Perhaps marriage and a honeymoon. Perhaps a job and some children. Perhaps a minivan.
Fast forward many years later and it's not hard to argue that, for many, the spark has gone out. The spark is not something that is gone forever, of course, because in the event that there is a new partner later on in life, the spark seems to come back. Why you may ask? Because both people are trying again – trying to create a romantic scenario.
So what's there left to do for us poor healers? Ask the patient to consider couple's counseling? (Not a bad idea if the conversation drifts that way.) However, as we tonify Kidney energy (Kidney 7) and perhaps open up an 'Empty' heart (Heart 6), it might not be a bad idea to ask a few questions.
Asking questions is better than telling someone what to do. They arrive at their own conclusions, and the one asking the questions is more of a catalyst for change than forcing something to happen. Healthy, easy questions would look like: "Did you ever go on a honeymoon?" "Tell me a story of when your partner surprised you with something nice?" "Have you and your partner ever been out dancing?"
Reminders of how things used to be, coupled with a comforting treatment can be very helpful because what the patient once had in the past, they can easily relate to. And daydreaming of the past is a sure-fire way to relive it in the future. Straddling the line between life coach and acupuncturist is not an easy one, but it all comes down to my favorite topic: good bedside manner.