| Weight Gain and Amenorrhea Case Study Translated and explained By: Joe Hing Kwok Chu Amenorrhea and Weight Back Ground: A young Asian woman, age 31, complained that she had not had menses for 2 and a half years. She also suffered from chronic back pain, coarse hair and hair loss, difficulty in concentrating, irritability, insomnia, depression with suicidal thoughts, painful sex with vaginal dryness, and low libido. She was always cold, especially while sleeping. She had to get up to urinate a few times after going to bed. Her past medical history included depression, weight fluctuation, and binging and purging, besides amenorrhea. Clinical reports show a decrease of creases in the wall of vagina, pale labia, vaginal dryness, decreased elasticity of the vagina wall, atrophy of the labia minora, and coarse hair, some edema, cold extremities, scoliosis of spine, and bruises. Her pulse reading was weak and her heart rate was low. Sometimes her tongue and pulse readings showed water retention. The systolic blood pressure was around 90 mmHg to 100 mmHg, and diastolic pressure was around 49 mmHg to 65 mmHg; her heart rate about 49 to 51. Past blood tests showed that her cortisol level was unstable, the TSH was marginally high, she had high levels of serum LH and FSH, a low level of estradiol, and low aldosterone. The result of the two 24hr urine tests showed that the urine volume were over 5,000 c.c. with high level of cortisol. After 3 months of using chi and herb therapy the menses came back. The patient then had to go to Hong Kong to attend her sister's wedding and after her return, she was under stress. Her marriage was unstable; she was taking a full load in graduate school and also preparing for her international law exam. Her period stopped again for 6 months but then returned. During the last 4 months of the her visits, she gained 27 kilograms. Her height is 1.68 meters, and her weight at the time of this report was 77 kg. Her BMI was 27.3, which is over weight or slightly over the cut off point of 27 BMI for obesity for Chinese. Her body became very warm and her heart rate went up from around 50 to 70s to 90s. Clinical examination showed serious flatulence and odor of yeast. The patient mistakenly thought that over-eating had caused the excess body heat and the speeding heart rate, and thought the herb she was taking caused the eating problem. Discussion: The clinical observation and lab tests show that there is a risk of premature menopause. Initially the cortisol level was low with syndrome of shenyangxu (kidney yang deficient). The last two urine tests report showing high level of cortisol with high level of urine samples could not accurately reflect the level of corisol [1] because of the high water consumption and urine excretion due to the condition of shenyangxu (kidney yang deficient) where the diuretic hormone is usually high. Later, the high stress level of the patient’s marital situation and school load caused extra secretion of cortisol, epinephrine, and norepinephrine which in turn increased her heart rate, body temperature, and the urge to overeat. This was when the condition of shenyangxu (kidney yang deficient) changed into the shenyinxu (kidney yin deficient) condition. The platelet coagulation caused bruises and the leaching out of serotonin; the low level of serotonin then contributed to her mood swings and craving for carbohydrates. Her over-consumption of sugar caused a yeast infection of the digestive tract. The decreasing estradiol (E2) contributed to some degree to osteoporosis and scoliosis of the spine, creating the chronic lower back pain. Her old injuries and the condition of shenxu (kidney deficient) also contribute to the chronic pain. Unless the condition of shenxu is addressed the chronic pain, due to inflammation, will be difficult to solve. Beside solving the of endocrine effect on eating, psychological issue should be addressed. The decreasing estradiol (E2) also contributed to some extent to the weight problem. Her body cycled from kidney yang deficient to yin deficient and pixu . At issue was to control the stress, the weight gain/urge to eat carbohydrates, depression, bone loss, and to reverse the premature ovarian aging. The therapy : psychotherapy to lighten the psychological burden group therapy for psychological support for stress and eating issue chi training to learn to control the mind and to balance the endocrine system which in turn controls the mood, and mitigates bone loss. herbs to help balance the system and to help prevent bone loss which contributes the one of the causes of her back pain, and to help prevent the premature aging of the ovarian system.
Result: The patient's periods continued for 8 more months and her weight dropped to around 60 kg. Then she stopped using her herb and stopped using chi therapy. After 5 months her period stopped again. This patient is similar to four others, who out of a group of 96 patients, had regained their periods but because of financial burden, stopped using the ovarian health maintaining herb; in all four cases, their periods stopped after a few months and they went into pre-mature menopause. The other 92 patients, all of whom continued taking herbs until their bodies became balanced, continued having regular periods, and did not go into pre-mature menopause. These patients had previously used estrogen, Clomiphene citrate, and progesterone and did not have satisfactory result; then switched to traditional Chinese therapy methods. Note: Compared to the West, in China, some hospitals do follow up to track the patients to see how they are doing when it is possible and when it is important to do so. Herb formulae: shi quan da bu tang 十全大補湯, gan qi yu jie formulae 肝氣鬱結, si wu tang 四物湯 with adjustments, dan zhi xiao yao san 丹梔逍遙散, gui dhen tang 歸腎丸 with adjustments, pai luan fang 排卵方, jiao san xian 焦三仙 (temporary to address flatulence). liu wei di huang wan 六味地黃丸, according to traditional Chinese diagnostics. Back to weight gain page http://jcem.endojournals.org/cgi/content/full/83/2/682 |