Chinese Medicine Approaches to Menopause with Natalie Chandra Saunders

Natalie is a licensed acupuncturist, author and holistic health educator with a background in biomedicine, 20 years of experience in the field of Chinese medicine and a particular interest in menopause, midlife and healthy ageing. She has edited and co-authored “Menopause: A Comprehensive Guide for Practitioners” a textbook designed to help practitioners of Chinese and East Asian medicine support their clients through menopause. 

Natalie offers holistic menopause and healthy ageing coaching with a yangsheng twist. More about her here https://hsnholistic.com/about. Also, as a listener you get 50% OFF her online course “Embracing Menopause”. Just hit the link and use the discount code EMBRACE50 EMBRACE MENOPAUSE course.

Read below to hear more about:

  • Symptoms vs transitions

  • 2 reframes on tea

  • The thing to always look for in recommendations

  • Guidance around a traditional Chinese medical approach 

  • The benefits of acupuncture 

  • Reclaiming excitement!

Prefer to listen? Get the podcast here: Eastern approaches to Menopause.

I was really excited to have this conversation with Natalie and to be able to share it with all of you because it gives us two different perspectives on menopause and midlife. Natalie is an ex pharmacy technician, so a background in Western biomedicine and is also a licensed acupuncturist with 20 years of experience in the field of Chinese medicine with a particular interest in menopause, midlife and healthy ageing. So she is a holistic health educator who has also edited and co-authored Menopause, a comprehensive guide for practitioners, a textbook designed to help practitioners of Chinese and East Asian medicine to support their own clients. So she really has a breadth of knowledge and expertise, both from a Western and an Eastern perspective.

What we do in this conversation is look at some ways of framing menopause and some quote unquote symptoms in different ways. Thinking about menopause as a medical condition versus a gate of life or a natural transition for women. Thinking about what might support our bodies. Natalie also gives us some advice for tea that we might see as medicine and what might be cooling and supportive of our bodies, particularly if we're living through hot flashes and temperature changes, gives us some tips for deciphering internet information, for finding a Chinese practitioner, if that's something we're curious about. And she runs a course called Embracing Menopause, which I will link to down below. So I'm so grateful to Natalie for her time here today.

And I'm so excited for you to be able to listen to this conversation and take some of this information and wisdom away into your own lives and support for your own bodies and hormones going forward.

Natalie, thank you so much for being part of the series of conversations about midlife transitions and what happens in women's bodies. I'm so grateful for your time. Do you want to let us know who you are, where you are and what your work is in the world around this?

Thank you first of all so much for having me here. I'm really excited to talk to you today. My name is Natalie Chandra Saunders and I am a trained acupuncturist and author and an educator in the fields of midlife and menopausal health. My journey with this started well really many years ago. I've been working in healthcare for my whole life. I started originally as a pharmacy technician.

And then after doing that for several years, becoming quite disillusioned with the pharmaceutical industry, I became an acupuncturist. And that led me to China to do some extra training. During that time, I actually discovered I have a real passion for writing. And I actually like writing about Chinese medicine more than practicing acupuncture. So I've been doing that for the past few years. In 2018, I was lucky enough to meet Kath Berry, who I believe you have had on an earlier episode of your podcast.

And we started working together and she invited me to co -author the book Menopause, a Comprehensive Guide to Practitioners, which is a textbook designed to help Chinese medicine practitioners and acupuncturists support their patients through midlife and menopause. And I've just found this to be such rewarding and interesting work. I feel really grateful that she invited me to do it because not only am I now entering perimenopause myself, I'm feeling much better prepared than I would be if I hadn't had this opportunity.

But I'm also really excited to support other women who are transitioning through this period in their lives. And so I'm currently working on a course which is coming out in October, Embracing Menopause. And this is designed to condense a lot of the information that's in the book designed for health care practitioners, but to make it available to the general public because there's a lot of really good information in there. But it's quite dense and inaccessible at the moment. So rather than spending, another four years writing another book, I really wanted to get this out there now. So the course is coming out next month, but I'm really hoping that it will help a lot of people.

So a journey from a pharmacy technician to a writer, an educator, an acupuncturist working within Chinese medicine. Tell us about what's different and what's similar maybe between the Western pharma industry and the Chinese methodology or framework around menopause.

That's a really interesting question. So there are actually a lot of similarities and a lot of differences. Because I've had this training in both modalities, I tend to always see things through both sets of eyes. I tend to see things first in my Chinese medicine eyes, because that's what I've studied for the longest, and it's what I'm really passionate about. But then my brain always wants to kind of translate this into the biomedicine. So when we're talking about qi, what are we talking about in terms of the biology of what's happening in the body? What are we talking about when we think of yin and yang?

So I always look at everything through this kind of dual lens. So it's really interesting in terms of menopause. It's not really something that's actually been recognised in Chinese medicine for a very long time. It hasn't been seen as a medical condition in the same way that it is kind of treated very often in the West. In the West, we often look at menopause and we say, you're going to have this symptom and that symptom. And it's very medicalised, which personally I feel is quite a big issue because it sets people up going into it believing that all these things are going to happen, which then means that it's far more likely that they will. Whereas in Chinese medicine, it's seen more as a gate of life that you transition through and it's something that's very natural and something that is really embraced and celebrated. So this difference in attitude, is one of the biggest things. And of course, in terms of what's going on in the body, in Western medicine terms, we see this decline in the female reproductive hormones, oestrogen and progesterone. And in Chinese medicine terms, this equates to a decrease in the body's yin energies. And this is a massive oversimplification because it's far more complicated than this. But generally speaking, we're seeing a decline in yin energies, which results in a relative imbalance between yin and yang. And that's why we often see these symptoms such as hot flushes, which is a sign of yang flaring up in the body and things like anxiety and irritability because the Yang energies of the body are not being anchored by the Yin.

Interesting to think about the difference in how we describe what's going on or how we see what's going on in the body as either a symptom, a thing to be managed, an illness or a transition, a degeneration, whatever the choice is from a more Western perspective and a natural transition, which maybe has some fluctuation of what kind of energy we're holding, which sounds more in line with an Eastern approach. When you think about the work that you do in supporting women through this time, what would you say their most common challenges are?

I think it really varies a lot from person to person. There's so much variation. And of course, hot flushes is the thing that everybody's mind immediately goes to. For me, I actually see a lot of people coming with mood changes that are becoming bothersome. People are noticing that they feel more anxious or more irritable, perhaps that they're having kind of a resurgence of menstrual symptoms that they might have had during the teenage years. Speaking from my personal experience here as a teenager, I had terrible, terrible PMS and then through my 20s and 30s, it somewhat settled down. But now that I'm coming into perimenopause, I really see that coming back again. So it's things like this.

And I think a lot of times people are not necessarily aware that that's what's going on, especially in early perimenopause. People don't necessarily correlate it with, menopausal symptoms because perhaps they're not having hot flushes yet. Perhaps they're not having cycle irregularity. And they're noticing these small mood changes. And without realising that menopause is what's beginning to happen. It can be quite distressing for people, so it's really helping to increase awareness around that and to say, hey, do you think maybe this is what's going on?

In the work that I do around stress management and burnout prevention. And I'm asking women around their hormonal cycles or where they are at with that. Or if they know where they're at with that, they're often surprised because I think we often see that as quite separate. What goes on in my brain and what goes on in my body and actually linking those two things together can be really different when we come with our mindset of duality.

When you think about treating that, and I know that you are also an expert in tea, is that right? Herbs and tea. What would you say some practical solutions are for people who starting to notice hot flashes or changes in mood? What's a simple recommendation that maybe someone could go away and do or ask their local practitioner for?

Well, there are lots of different things and it's interesting that you mentioned tea because I think tea is an amazing thing that people can be looking at. It's really accessible, it's easy to do and it's enjoyable. So of course green tea is an amazing drink for health in general and it can also be quite beneficial if people are experiencing menopausal symptoms because in Chinese medicine terms green tea is cooling whereas black tea is warming. So if people are having hot symptoms like hot flushes then it's going to be more beneficial for them to drink cooling teas like green tea rather than lots of black tea and things like coffee as well, which are very like heating and stimulating. And then herbal teas are a whole other area and there's so many to choose from. It's quite a personal decision. So I think it depends how you're drinking the herbal tea. This is quite important. So, for example, if you're drinking a lot of different herbal teas and maybe having a different herbal tea every day, it's probably going to be a kind of here or there effect that it has on your body but if you have one particular herbal tea, say if you're drinking peppermint tea three times a day, every day, then you're medicating yourself essentially. And if you're going to do something like that it is quite important to find a tea that is right for your bodily constitution. So if you're a very hot person you'll be wanting to drink a tea that's cooling, so for example green tea or peppermint tea, things like chamomile.

But if you're more of a cold person with a cold constitution and you're drinking cold teas, that can be quite damaging. So if you're drinking herbal tea regularly with a cold constitution, it's better to go for something warming like ginger teas, the turmeric teas, chai, things like that. So it's quite important to speak to professionals, so a Chinese medicine practitioner or an acupuncturist, a herbalist, and they will be able to look at what's going on with your body and tell you what your constitutional type is and therefore what kind of teas and indeed what kind of foods you should be eating to seek your constitution. It's very much a personal thing.

I love the thought of tea as medicine because I drink tea constantly. When you're taking something regularly, it can actually have such a big effect on you. And that is quite something to bring into your drinking.

I often see food and nutrition as something important and building blocks and doesn't have all the things, but tea is just by the way. So actually seeing that as something that can help or hinder how we're feeling in our body is something quite different and unusual.

Yeah, it's true. And the other thing that's really nice about tea is that it's such a ritual as well, and it can be a real mindful experience. Brewing the tea, listening to the kettle boiling and then pouring the hot water over, watching the water change colour, smelling the smells, holding the warm cup in your hands, just taking a few minutes out of your day just to pause and be with your tea and relax. It can be really important when we're all rushing around like headless chickens so much of the time. I think tea is like a welcome break.

Bringing that mindfulness or that moment of I'm here, I'm present into the small rituals of the day can be much more accessible than, 45 minutes of meditation, at least for the busy clients that I work with. When you talk about challenges, we talked about what people may come and present with in their bodies or in their mindset and maybe not even knowing what's going on for themselves.

What I also see is that it can be confusing out there in terms of information available for women. What challenges do you see within the health industry in general for women who maybe are looking for information or curious or trying to gather some kind of support for themselves as they enter into their perimenopause?

I think in this case that the internet is a real blessing and a curse because there's so much information out there and it's all available with the click of a mouse. And of course, this is fantastic, but it can be really difficult to know which sources to trust. There can be a lot of conflicting information sometimes and it can be really difficult to know, one website saying one thing, another website saying something else, which one is correct. So I think for me, what I've found to be really useful is learning which websites are reputable sources. And I'm always looking for references, so references to research studies. I don't take anything at face value anymore. So if I read an article that's, for example, about the benefits of HRT versus the risks, I want to see where they're getting their information from. So if it's just a stream of information saying, you know, this is how it is and it just is, then I might be like, hmm, yeah, okay, according to who?

I really want to see the studies and preferably large scale systematic reviews that people have done that actually back up what they're saying. So without finding links to these studies, I find it very difficult to believe anything these days, unfortunately.

Such a good point and something small and useful that I think everybody can take away is where does this information come from? What is behind this information or what is backing it up versus, influencers touting the latest miracle, cream, pill, whatever exercise moment. Looking for what is behind it.

Don't get me wrong. I think sometimes these personal recommendations can be really useful because it can bring things into your awareness that you might not necessarily know about. But I think it's really important just to kind of keep in mind that what works really well for one person might not necessarily work very well for another. So in terms of, for example, supplements and herbal remedies that people often take to cope with menopausal symptoms the evidence out there for most of them, it's really, really mixed. So lots of studies are quite positive and say, yeah, this really helps. And then some of the studies will be saying, actually, there's no strong evidence at all that this works. So we have to look and ask ourselves, well, why is this? And a lot of the time it's because of the way the studies were done. So we're getting conflicting results. But a lot of the time it's because going back to what we were saying about the Chinese medicine, energetics, everyone's body is different.

What works for one person isn't necessarily going to work for the next person, even if two people present with very similar symptoms on the surface. What's going on underneath might be completely different and therefore the way that we would look at treating them is going to need to be different too.

When you think about how a Chinese medical practitioner would approach discovering the body in order to devise a treatment plan for somebody who's maybe only had experience with a 15 minute consultation in a GP's office, what would be different or the same about walking into a Chinese medical practitioner's space?

Well, the first 15 minutes might be quite similar. So I guess the first thing to discuss is what's brought you here today? What is the main thing that you need support with? And so we might spend maybe 10, 15 minutes talking about that and the specific symptoms that are going on in that moment. But we would often delve into far more detail about each one. So, for example, if someone came and they said, I'm having headaches, we want to know what kind of headaches, whereabouts in your head are they? What do they feel like? When do you get them? Is there anything that makes them better or worse? And there's lots of different questions that we can ask to try and determine what's going on at the root cause of the symptom. And then we would look at the person's health as a whole. So we look at medical history going all the way back to childhood, any kind of significant illnesses, operations, even things like broken bones can affect what's going on in the body right here and now. And then things like family history.

We would look at health and lifestyle in general, so people's diet, their eating habits, their sleep, their bowel movements, that's always a favourite topic, just to really get a detailed picture of what's going on in the landscape of the body.

Just you saying that makes me feel like I'm relaxing in my body as I hear it. Having somebody be curious about my whole health versus being rushed into a short consultation. That's something that I feel like is really different when I think about the breadth and the expanse of what is being looked at in treatment.

Depending on the doctor and the medical practitioner, of course, there are plenty of people out there who taking their time and asking about that, but it's not so much part of Western medical culture in general. When you think about somebody who maybe wants to dip their toe into treatment from a Chinese perspective, what are some pieces of advice that you would give them?

I think my first piece of advice would be to find a reputable practitioner in your area so that you can have a proper in-depth consultation and find out what's going on for you. So it may be that you go to see them for acupuncture or perhaps for herbs, or it may be that you just go to see them as a one-off consultation to try and find out what is going on in my body. So what changes can I then make to my lifestyle to balance that out? Because everything in Chinese medicine really is about balance.

And so it is only through understanding the patterns of disharmony, we call them, that are going on in the body, that we can understand what we need to do to counterbalance those patterns.

There are some resources online that you can read through and get a bit of an idea of what's going on, but to really get a truly accurate picture, it's necessary to see a professional because there's lots of other things that we can't do online. For example, we feel the pulse. That's a very important part of diagnosis, look at the tongue. Sometimes we might palpate around a person's abdomen to see how that feels. And all of these things come together to help us build up a really detailed picture of that person's kind of unique internal landscape.

How would I go about finding somebody that is quote unquote reputable? Are there boards of certification? Are there registration processes? What's your recommendation there?

Yeah, there are and it differs from country to country. So here in the UK we have a governing body called the British Acupuncture Council and in order to register with the British Acupuncture Council you have to have a certain level of training. They then have a database so you can type in your postcode and it will give you a whole list of practitioners in your area who meet up to their training standards which are very high and every country has its own version of this.

Depending on where you are the first step is to find out what is the governing body for acupuncturists or Chinese medicine practitioners in your country. Go on there, have a look at what their training requirements are. So you will know, for example, that they've trained for three years or four years, that they're doing so many hours of continuing professional education every year. And then you will know that you're getting a really high standard of treatment. And then you can go to the next step, which is finding somebody close to you so you can go and pay them a visit.

I think what you're saying about following these steps and also making time to go in person is a useful picture to create. Like maybe these are steps of how I could research, I need to build in some time. And it sounds like it may be also I need to build in some time over the course of a few weeks if there's a treatment plan developing. Does that sound true? Or is it a one-off session that you walk away with a plan for change?

I think it can be. Very often it is an ongoing process. So if you want to go for acupuncture, usually you will need a course of several treatments to start noticing a difference. You generally say maybe four to six treatments, you should start noticing some benefits. And often people just love acupuncture so much. It's really, really relaxing. People will just keep coming back anyway, because it's almost similar to going and having a massage. Sounds quite counterintuitive that having needles stuck into you would be relaxing, but it really gets you into that super chilled out parasympathetic state that I think is so rare in today's world. So people just love it and they do like coming back sometimes even after their symptoms have improved, they'll come back for little top ups every couple of months.

And again, if you're going for herbal medicine, usually there will be a follow-up. You might take a prescription for two weeks and then go back and see, is it working? Is it not working? Does anything need to be tweaked? So that will be ongoing over the course of several months.

However, sometimes if you are just looking to make lifestyle changes that are appropriate to you, it might be that a single consultation is enough. I do offer online holistic health consultations and my aim is actually that one should be enough. What I really want to do is that in that hour and a half that we spend together is arm somebody with all the information that they need to go away and start making these changes.

What I do recommend is that people make these changes slowly because if you go away and you've got 10 different things that you want to do and you try and do them all at once, it's quite likely that most of them are going to fall by the wayside quite quickly because trying to do 10 different things at once is a lot for anybody, especially when they're busy. So I say, small steps one by one. Here are 10 things. Decide which one's most important to you and do that for a couple of weeks and then decide which is the next important and add that in. It's definitely an ongoing process.

Two things I'm thinking about. So I'll ask you the first question first. If you would be able to explain, in lay person terms, how acupuncture, how sticking needles into ourselves helps that feeling of relaxation and massage. That's my first question. I'll pause there.

So there are two different ways that we can look at this. So from a Chinese medicine perspective, depending on which points we select, we're activating different elements within the body. So if somebody comes and they're really, really stressed out, we might choose points that we know are going to calm down and relax people. We pull this tapping into a person's shen, it means like spirit or mind. So we might tap into those particular points.

And this is just to help to regulate the body systems to get things that are not balanced back into balance. In biomedical terms, what's happening when we put the needles into somebody's body, it's releasing endorphins, which are the body's field of hormones, the same ones that are released when we do exercise. It's acting on the parasympathetic nervous system. We're getting into that rest and recover state rather than being in fight or flight, which so many of us spend so much of our time in.

It's two different ways of saying the same thing, really. We're just helping to relax people's nervous systems and just let them chill out and breathe for half an hour while they're lying on the couch.

So there's something about activating hormones in that. Does that sound true?

Yeah, hormones are definitely involved. When we put a needle into somebody's body, all kinds of different chemical reactions are happening, as well as electrical ones. So yeah, hormones are definitely a part of the equation. We're still really trying to understand exactly how acupuncture works on a biochemical level. There's been some studies done, and we're getting closer to understanding it. But there's still some mysteries. But certainly, hormones are a part of the equation. Neurotransmitters also.

The second question that I had was you were talking about lifestyle changes and creating maybe a context or an environment or a way of living in your day to day that feels supportive to your body as you're going through hormonal transitions or life transitions. What would you say the pillars are or the foundations of lifestyle changes are that you see over and over again?

I think for me the three really key things are nutrition. So that comes down to diet. So what foods we're eating, but also eating habits. So how we're eating the foods that we're eating. So I think everybody kind of understands the basics of a healthy diet, plenty of fruit and vegetables, healthy fats, lean protein, complex carbohydrates and then avoiding too many animal products and bad fats, we call them, refined sugars, processed foods and so on.

So we've all got a pretty good idea of the kind of things that we should and shouldn't be eating. But what we often forget is to pay attention to how we're eating them. And that's really important because sitting down and taking the time with your meal, paying attention to what you're eating and not being distracted by your phone or eating at your desk while you're answering your emails, chewing your food properly and appreciating the flavours. That's really important because it helps our body to secrete saliva and digestive enzymes that mean we're going to digest the food better.

We're going to get the most nutrition out of it that we possibly can. So that's one thing that I often stress to people, pay attention to how you're eating as well as what you're eating. The other thing that is really key is breathing. We all need to breathe. In Chinese medicine, we talk about qi, which is this kind of like life force or vital energy that our bodies rely on to remain healthy. And qi is formed from a combination of food and air, basically. So we need to eat and we need to breathe.

Breathing is something that we do automatically without thinking, but actually really tapping into your breathing, breathing consciously and intentionally with breathing exercises is also a really good way to make sure we're getting enough oxygen, and just to be really mindful for a few moments. If things are feeling overwhelming and stressful, just to stop, breathe into it, and usually within a few minutes we can feel a lot calmer and more able to carry on with whatever it is that we're doing.

So food, breathing and number three, something that you're very familiar with is stress management because that just has such an impact on everything else. When we're stressed, it's hard to eat properly. When we're stressed, it's hard to remember to breathe. When we're stressed, we forget to exercise. We forget to do all the things that we know are good for us. So finding ways to deal with stress, I think, is really, really key. Particularly the way most of us live now, we're all so busy so much of the time. We do tend to have quite a high baseline of stress. So finding ways to manage that is really, critical.

When I hear you talk about the how of eating and almost the how of breathing. It's also bringing intention to not just the things that we're doing maybe habitually, but slowing down to notice how we're doing it. And that sounds like a shift in how we view those parts of life. So thank you for that.

Yeah, stress is such a big one in our day to day. And obviously something that I work with so much with our clients and in terms of what's coming at you, what's going on in your brain, what's going on in your body. And I feel like we're at a point where what the humans are capable of holding and what the world is presenting are just mismatched right now. So taking those moments to slow down and be with our health, be with our bodies can be so, useful.

When you think about where you're at, you were saying, maybe you're coming into perimenopause and maybe some people are surprised that that might be in their late thirties or early forties versus later on in their lives.

What is your best advice for women who are starting to notice changes?

I think really it's pay attention. If you notice your body doing something that's different from what it normally does, your body's telling you something. The best thing that we can do is notice that and not just notice it and go, okay. And then brush it aside, but to really notice it and keep noticing it. So I think it can be really helpful for people to keep noticing. You can get lots of apps that are things like cycle trackers where you can track your bleeds and also any other signs or symptoms that you notice around that time and throughout the month.

Or you can just write it down in a diary or on a calendar if you're old fashioned like me. But I think it's really useful to note these things and that way you can look back and see, there's a pattern month on month. I see that around this day I'm having these feelings and on this day I'm having these symptoms. And when you start to see a pattern emerging through them, you can start to understand that your body is actually changing over time.

These aren't just random things that are occurring here and there. And then talk about them, talk about them with your friends, because you may find that they're going through a similar thing and that way you can support each other. Can you compare notes and say, hey, yeah, maybe this isn't something that's just happening to me. Leaning on your community for support as well is really, really important in terms of understanding, but also in terms of managing those stress levels and sharing things.

There's a piece of maybe noticing and tracking in some way what's happening for us and then having open and honest conversations about what we're feeling or what we're going through with friends, with community, with peers, with coaches, with doctors. When you think about the conversation we've had, is there anything I haven't asked you that you feel like is important or you'd like to say and share for anyone listening to this conversation?

Wow, I feel like we've really covered quite a lot in a short space of time. So I don't think that there's much. The one overarching theme is mindfulness. Being mindful of how you eat, being mindful of how you breathe, being mindful of your stress levels, being mindful of what's going on with your body and with your mind, noticing it and embracing it. Embracing menopause is the title of my course and I feel like this is really important, having this attitude going towards menopause that we're just entering the next phase of life, it's not something to fear or something to resist. Just notice it and say, hey, this is what's happening and that's okay.

Embracing sounds warm and sounds close and sounds almost exciting in a way. Good title.

We have this cultural narrative in the West that menopause and aging in general is often viewed as a very negative thing, but I don't think it has to be. I personally feel very excited to enter into the next phase of my life. If we look at this traditional image of the crone, it’s quite a derogatory term, but historically, the crone was a wise woman, a healer, somebody who the community would turn to for help and support.

If we can reclaim this image of an elder female being a really positive figure, we can feel really excited going into this next phase of life.

It's been so wonderful having these conversations with women who are in midlife or sometimes post-menopausal and to hear from them how they are enjoying being in their bodies, enjoying their careers, able to focus, feeling strong in themselves. And I think it really helps to build that counter story, the counter narrative of like, hey, this is us being alive. This is us being powerful at no matter what age we're in.

I know that I've had a few times where I haven't had a period for a couple of months. I'm in my forties and I've been so excited. was like, is this it? Am I on the other side? I've still got a couple of roller coaster rides to go. So not yet, but, there's definitely a feeling of anticipation from my side.

Beautiful. Well, thank you so much for the time. I appreciate it.

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