Perimenopause and Menopause

Conditions & context

Perimenopause can begin years before the final menstrual period, and its effects are not always immediately recognized. Changes in sleep, mood, concentration, temperature regulation, menstrual cycles, joints and muscles, or the cardiovascular sensations of palpitations may appear gradually and can seem unrelated.

For some women, hot flashes are the defining symptom. For others, it is suddenly waking at night, feeling unusually anxious or irritable, struggling to find words, developing new aches and pains, or watching a previously predictable menstrual cycle become anything but predictable. Often it is the accumulation of several of these changes that finally makes the larger pattern apparent.

Chinese medicine has been observing this transition for a very long time. The opening chapter of the Huángdì Nèijīng (黃帝內經) describes a woman’s life in cycles of seven years, from the beginning of menstruation through the eventual transition out of the reproductive years. The larger subject of the chapter is yǎng shēng (養生), the cultivation or nourishment of life — how we care for ourselves as the body changes through different stages of life.

That perspective continues to inform how we approach perimenopause and menopause today. Adele studied the Neijing in classical Chinese with Dr. Wan Duk-Huang and completed postgraduate clinical training in the gynecology ward at Xi Yuan Hospital in Beijing, including study with a physician specializing in menopausal disorders.

What we treat

Women come to us during perimenopause and menopause for many different combinations of symptoms, including:

• Hot flashes and night sweats
• Difficulty falling or staying asleep
• Anxiety, irritability, low mood, or increased emotional sensitivity
• Brain fog, difficulty concentrating, and word-finding problems
• Menstrual cycles that become shorter, longer, heavier, lighter, or increasingly unpredictable
• Joint and muscle pain
• Palpitations
• Vaginal dryness and discomfort with sex
• Changes in libido
• Urinary symptoms
• Changes in skin and hair
• Fatigue

Not every symptom that appears in your forties or fifties is caused by hormonal change. Part of good care during this transition is recognizing the larger pattern while also knowing when something needs to be investigated separately.

How Chinese medicine understands the transition

Chinese medicine does not view menopause as a disease. It is a normal physiological transition, but that does not mean the symptoms surrounding it need to be dismissed or simply endured.

One of the changes described in Chinese medicine is a gradual decline in the body’s reserves as the reproductive years draw to a close. In some women, this appears as a loss of the cooling, moistening, and settling aspects of the body: heat rises more easily, sleep becomes lighter, vaginal tissues become drier, and the nervous system can feel less settled. This is one reason patterns of yin deficiency and deficiency heat are so closely associated with menopausal symptoms in Chinese medicine.

But that is not the only presentation.

Other women have more pronounced fatigue, digestive changes, fluid retention, weight changes, headaches, emotional constraint, heavy or erratic bleeding, or musculoskeletal symptoms. Several patterns often coexist, particularly during perimenopause, when hormone levels and menstrual cycles are still fluctuating.

Treatment is therefore based on the individual presentation rather than on a standard “menopause protocol.” We look at temperature, sleep, digestion, energy, mood, menstrual history, sweating, pain, urinary and sexual symptoms, and the way these have changed over time.

Three months — a season of treatment

As with other areas of Chinese medical gynecology, we generally give treatment about three months before judging the overall response.

Three months is roughly a season of treatment. It gives us time to see which symptoms are changing, which are persistent, and whether those changes are holding rather than simply reflecting a particularly good or bad week.

Treatment is generally weekly at first. Acupuncture forms the foundation of care, with Chinese herbal medicine added when appropriate. Dietary and lifestyle recommendations may also be part of treatment, particularly when sleep, alcohol, nutrition, exercise, or other daily factors are amplifying symptoms.

Some changes may become apparent well before three months. We still prefer to assess the larger pattern over time.

Chinese herbal medicine

Chinese herbal medicine can be particularly useful during the menopausal transition, and there is a long history of treating these patterns within Chinese gynecology.

The formula depends on the presentation. A woman whose primary symptoms are night sweats, dryness, and insomnia may need something quite different from someone experiencing fatigue, digestive changes, heavy irregular periods, and a sense that her entire system has become less stable.

Formulas are adjusted as symptoms change. During perimenopause in particular, the clinical picture can move considerably from month to month.

Herbs are not necessary for everyone, and we take medications, hormone therapy, medical history, and other supplements into account before recommending them.

Acupuncture alongside hormone therapy

Acupuncture and hormone therapy do not have to be an either-or decision.

Some patients come to us while already using menopausal hormone therapy and doing well with it overall, but still experiencing symptoms such as sleep disturbance, hot flashes, anxiety, fatigue, or musculoskeletal pain. Others begin acupuncture while they are considering hormone therapy or adjusting a treatment plan.

In either case, acupuncture can be used alongside hormone therapy as part of a broader approach to managing the menopausal transition.

When hormone therapy is not an option

There are also women for whom systemic hormone therapy may not be appropriate, including some people with a history of or a family history of hormone-sensitive cancers.

Acupuncture has been studied as a nonhormonal approach to menopausal symptoms, including hot flashes and night sweats, and it has also been studied specifically in breast cancer survivors and in women experiencing side effects from endocrine therapy.

This is an area where coordination with oncology and other medical care is particularly important. If you are taking tamoxifen, an aromatase inhibitor, or another cancer-related medication, tell us. Acupuncture can generally be incorporated alongside conventional treatment, while Chinese herbal medicine requires additional consideration because some herbs and medications can interact.

For patients experiencing difficult side effects from medically necessary treatment, our goal is straightforward: to make the treatment period more manageable without interfering with the care prescribed by the oncology team.

Bone, cardiovascular, and overall health

Acupuncture and Chinese medicine address symptoms and the experience of the menopausal transition. They do not replace the broader preventive care that becomes increasingly important during these years.

Bone health, cardiovascular risk, blood pressure, cholesterol, metabolic health, breast and gynecological screening, exercise, strength, nutrition, and other aspects of preventive care deserve attention alongside symptom treatment.

This is particularly important when hormone therapy is not being used. Chinese medicine can be one part of a larger plan for navigating this stage of life well.

When symptoms need medical investigation

Perimenopause can explain a surprisingly broad collection of symptoms, but it should not become an explanation for everything.

Very heavy or unusual bleeding, bleeding after sex, new or persistent palpitations, unexplained weight loss, significant shortness of breath, new severe headaches, marked or persistent fatigue, or other substantial changes in health deserve appropriate medical evaluation.

Changes in menstrual bleeding during perimenopause are common, but some patterns still require gynecological assessment. If something in your history concerns us, we will tell you.

What we’re looking for

The goal is not to stop the normal transition into menopause. It is to help you move through it with fewer symptoms and less disruption to your daily life.

That might mean sleeping through the night again, having fewer or less intense hot flashes, feeling steadier emotionally, thinking more clearly, having less pain, or simply feeling more like yourself.

Chinese medicine also views periods of transition as important opportunities for health. Menarche, pregnancy and postpartum, and menopause are times when the body is undergoing profound change. Traditionally, these are periods when particular attention to rest, nourishment, treatment, and the way we care for ourselves can influence not only how we move through the transition, but the state of our health afterward.

This is part of the idea of yǎng shēng — nourishing or cultivating life. Rather than seeing menopause only as something to get through, we can use this period to take stock of health more broadly, address patterns that may have been developing for years, and support the constitution for the years ahead.

Perimenopause can last for years. Our aim is not only to make those years more manageable, but to help you emerge from the transition in as strong and healthy a position as possible.

Common questions

How long before I know whether treatment is helping?

Some symptoms may begin to change within the first several treatments, but we generally give treatment about three months — a season — before evaluating the overall response.

Can I receive acupuncture while taking hormone therapy?

Yes. Many patients use acupuncture alongside hormone therapy. Tell us what you are taking, including the type and dose of any hormones and other medications.

What if I cannot take hormone therapy?

Acupuncture is a nonhormonal treatment option that can be considered for symptoms such as hot flashes and night sweats, including for some women with a history of breast cancer. We work within the recommendations of your medical or oncology team.

Is treatment mainly for hot flashes?

No. Hot flashes and night sweats are common reasons people seek treatment, but sleep, mood, fatigue, musculoskeletal pain, brain fog, and other symptoms may be equally important.

My periods have become unpredictable, but I’m only 43. Could this be perimenopause?

Yes. Perimenopause commonly begins before periods stop and can include changes in cycle length or flow as well as changes in sleep, mood, temperature regulation, and other symptoms. We also consider whether anything else needs to be investigated rather than automatically attributing a new symptom to perimenopause.

Will I need Chinese herbs?

Not necessarily. We use them frequently in this area of gynecology, but the decision depends on your symptoms, medical history, medications, and preferences.

How long do people continue treatment?

We generally begin weekly and reassess after about three months. From there, treatment can be spaced out according to how you are doing. Some patients no longer need regular treatment; others find periodic treatment useful as their symptoms continue to change.

Can you treat vaginal dryness and changes in libido?

Yes. Vaginal dryness, discomfort with sex, and changes in sexual function can be part of the menopausal transition and can be included in the treatment plan. These symptoms may also benefit from conventional treatments, including local therapies, so we encourage patients to discuss persistent symptoms with their gynecologist as well.