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Dr. Jones: For some women, menopause is tough. We have this hormone thing going on, but we're also aging, and our joints hurt. And our teens are trouble, and that makes us cranky. So what are the options and therapy for the menopausal transition? This is Dr. Kirtly Jones from obstetrics and gynecology at University of Utah Health, and this is The Scope.

Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: Although hot flashes are the signature symptom of menopause, there are a number of other physical and emotional symptoms that are common for women in their 50s. Insomnia, anxiety, joint aches, and headaches come to mind. Some of these are clearly related to the loss of estrogens, but some are not so clearly related to hormones. Whatever we think the biological cause might be, women don't feel well.

How do we take the women as a whole person and not just the sum of her symptoms? And what are some of the options? Today in The Scope studio we're talking with Dr. Lisa Taylor-Swanson. She's an assistant professor in the College of Nursing and an expert in acupuncture. Lisa, thank you for joining us to help us think this through.

So give us some thoughts about the care of women in menopausal transition thinking about all of these symptoms. You know, women certainly can wander their way through the traditional health care system. They can get estrogen for their hot flashes, they can get a triptan for their migraine, they can get sleeping pills for their insomnia, they can get Ibuprofen for their joints, they can get Prozac for their anxiety. But women don't want to think of themselves like that. They don't see themselves siloed in so many pill prescriptions. So what do we do?

Dr. Taylor-Swanson: That's something I've thought a lot about. And I know as a clinician practicing traditional East Asian medicine including acupuncture and Chinese herbal medicine, I've always been drawn to thinking about the whole person. And in that tradition the way we diagnose, for example, a hot flash in woman A would really depend on how her sleep is, her bowels, her mood, and depending upon compared to say woman B who has no problem sleeping but does have hypertension, I would use different acu-points and different herbal prescriptions to treat the same, say primary concern of hot flashes, because we have to understand the whole person.

So that whole person view is literally at the theoretical foundation of East Asian medicine. And that's why I study that. It's really very interesting.

Dr. Jones: So I would say coming from the church of Harvard medicine, that although I want to know about a woman's hypertension and the way her bowels work, the dose that I would give for her hot flashes would be more just to her hot flashes and not to her guts I'd say?

Dr. Taylor-Swanson: Absolutely. And that's exactly not how East Asian medicine is practiced. And so those symptoms really inform one another, and then, of course, we look at the tongue and feel the pulse as well to have additional signs that we look at.

Dr. Jones: Look at the tongue?

Dr. Taylor-Swanson: Yeah, absolutely. Top and bottom.

Dr. Jones: Okay, ladies you're going to have to wash your mouth out and brush your teeth before you go.

Dr. Taylor-Swanson: But don't brush your tongue.

Dr. Jones: Don't brush your tongue, okay, okay. So what are some of the options in the field of alternative and complementary medicine that women might choose to pursue? I know women are already making these choices, because when they come to see me, they've got bottles of supplements. They've got dong quai. They've got some Chinese herbal medicines, I say I don't know that they . . . these Chinese herbal medicines may not actually have estrogen in them, so I'm always worried about what they're taking with these bags that they're going through.

But I can't stop them. You know, and I probably shouldn't, and I shouldn't negate their efforts to make themselves feel better through options other than my office. So what should we be thinking about and what are the choices?

Dr. Taylor-Swanson: There are many choices. Definitely, acupuncture is one to consider again for the whole person perspective. And what's interesting is that not only kind of clinically or intuitively we can imagine, say if someone receives acupuncture and her hot flashes are better, and then her sleep is a little better, and then her moods a little better that makes sense certainly.

But the fascinating thing as a researcher is that we have basic science, types of data that demonstrate how that happens. So we have changes in our serotonin production and re-uptake. We have changes in our muscles, changes in the connective tissue around the muscles, other changes in the central nervous system, peripheral nervous system changes, etc. And those all happen simultaneously. And so I think it's fascinating to consider. I know you asked what are the various options. But one is acupuncture, and that we know all those symptoms are affected simultaneously and we know more about why.

There's other good options too. There's definitely Ayurvedic medicine, traditional medicine from India that treats the whole person much in the same sort of way. Definitely massage therapy can be helpful for those joint aches and pains, and it's very relaxing and might help a woman sleep better. Reiki healing touch. I mean there are so many options nowadays, and most of them have been investigated to try to find out really do they work. But I think another really important message for our listeners is that acupuncture I can say for sure is safe. It doesn't hurt. It's very relaxing.

Dr. Jones: It doesn't hurt.

Dr. Taylor-Swanson: I know, right? Who would think that?

Dr. Jones: Well, I'm not needle phobic, and you mentioned that you started as an acupuncturist. I'm not needle phobic, but I know perfectly well when I have needles put in my skin, because I'm also a seamstress, so I poke myself with little needles and it's usually my finger, the most sensitive place to poke. But it hurts.

Dr. Taylor-Swanson: So these are different. One they're tiny. They're literally the size of about two hairs, 40 gauge, 36 gauge, for those of you clinicians out in the audience. And they're solid and the interesting thing is blind acupuncturist several hundred years ago figured out if they had a tube around the acupuncture needle, one, to help them locate the points and be safe clinicians because they couldn't see, but two, it was less painful.

So the Japanese tradition of acupuncture and that we've pretty much adopted in the U.S. is to use these guide tubes. So first the patient will feel the pressure of the tube, and what's happening is it sets up those little [node receptors 00:06:21], so they perceive pressure, and then you pop in the needle and you hardly even notice it for the most part.

Dr. Jones: Kind of like when you're giving a horse a shot, if you slap them three times on their skin and then you give them a shot, they don't feel a shot. Okay, okay. Well, I'm feeling better already. I'm feeling more calm about having needles put in my skin.

Dr. Taylor-Swanson: Most people do fall asleep. Or they go to this . . . a colleague of mine calls it acu land. And you just kind of drift off to this really mellow, quiet, relaxing place. Usually, the clinician will turn the lights down and have some nice music, and you're cozy with the needles in place. So it's really a very surprisingly comfortable experience.

Dr. Jones: Well, it sounds like it's a total time out from your week experience. It's not just hopping up on a table and getting poked a couple places. You're actually having some little time out. I can't say . . . well, sometimes the doctor's office, I get to look at magazines I would never ever buy at the store, but if people in the doctor's office are upset, I kind of, you know, while I'm waiting and wanting to say I'm not in a clinic and, you know, I'm just having a quiet time. But other people's moods while I'm waiting affect me. When I get in the room as much as I love my doctors, there's this third patient in the room called the computer that seems to get all my doctor's attention.

Dr. Taylor-Swanson: Well, and I think for women going through the menopausal transition and for midlife women overall there's this sandwich generation phenomenon where often women are working, taking care of kids, like you said in your intro, taking care of parents sometimes, and so to have that little time out just an hour once a week, once every couple weeks it can make a world of difference.

Dr. Jones: Well and when we talked before the interview, we talked about the fact that in medicine sometimes we silo women's symptoms so they get this for this problem, and this for that problem, and that prescription for that. But you talked about the spider web. Can you talk a little bit about that?

Dr. Taylor-Swanson: Absolutely. It's my favorite metaphor for how, again the theory and also the intervention of acupuncture in East Asian medicine works. If you were to imagine a woman as a spider web and say for example, that spider web includes her symptoms, it includes all of her body systems, so the endocrine system, all of your hormones, your digestive system, etc. And also includes your social life, so caring for kids, your friends, your church, your work, etc.

And so if there's a tug on one end of the web, say you're caring for an aged parent and she or he falls, then that's going to affect your whole spider web, your whole person. It's not just that, "Oh, gosh I have to schedule my time differently." But you're probably going to be worrying, and [perseverating 00:09:03], and scheduling appointments, and not sleeping as well.

So I think to really consider a woman as her whole self, not only all of the symptoms, it's great that science is moving that way. We talk about symptom clusters now instead of only a single symptom. But it's a real whole person phenomenon that includes her social life, her work life, her body as well, and not only the symptoms.

Dr. Jones: Well, we're just making you the poster child of our Seven Domains of Health. Because here, The Scope radio we believe in the seven domains, meaning there are many parts of us that have to be well for us to feel well. But I like the Native American, particularly Navajo tradition of the Spider Woman who weaves the web of life into this sense of wholeness. So who should a woman go to if she wants this particular approach?

Dr. Taylor-Swanson: Well, the good news is nowadays acupuncture is regulated by state departments of health in all but just a handful of states in the country, so you can just go to the website for your local Department of Health, look up an acupuncturist in your area. They're absolutely going to be board certified nationally, and they're absolutely going to have a master's degree. They might also have a doctoral degree either in acupuncture or something else. So you can be confident they'll be well trained and properly licensed.

Dr. Jones: Do you go and see if they're a good fit, or do you ask your friends because some might be really good for sports therapy and joint problems, but they don't get women.

Dr. Taylor-Swanson: Right. Well, and modern life definitely most of my patients when I practiced in Tacoma, Washington, where I just moved from most of my patients were either referred from their primary care or other specialty care practitioners or from their friends, and that's always a good way to find an acupuncturist. And modern life most acupuncturist have websites too. So you can check the web and get a sense of who they are from their website.

Dr. Jones: And see if they put midlife women transition kind of stuff.

Dr. Taylor-Swanson: Yeah.

Dr. Jones: Well, we're waiting for you to hang out your shingle now that you're here in town and for you continue your research in the area of midlife women now that you're here at this College of Nursing. And we're here because getting old isn't for sissies. And 50 isn't even old. Many of us want to take an approach to our midlife concerns that helps our body and our mind. And we're grateful for Lisa for coming to help us think about it. And thanks everybody for listening on The Scope.

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