Perimenopause: Natural Treatment with Acupuncture and Chinese Herbs
By Dr (TCM) Attilio D'Alberto | Traditional Chinese Medicine Practitioner, Wokingham
Perimenopause — the transitional phase preceding menopause — is one of the most physically and emotionally turbulent periods in a woman’s life, yet it is frequently under-recognised and undertreated. It can begin as early as the mid-30s and typically lasts four to eight years before the final menstrual period. Acupuncture and Chinese herbal medicine are particularly well suited to this phase because they address the specific mixed and fluctuating pattern of symptoms it produces, without the risks associated with hormone replacement therapy.
What is perimenopause?
Perimenopause is the period during which the ovaries gradually reduce their production of oestrogen and progesterone, leading to hormonal fluctuations and eventually the cessation of menstruation. Unlike menopause itself (defined as 12 consecutive months without a period), perimenopause is characterised by erratic hormonal changes that produce a wide and often confusing mix of symptoms. Periods may become irregular — heavier, lighter, longer or shorter — and the classic menopausal symptoms of hot flushes, night sweats and mood disturbance begin to appear well before periods stop. The average age of onset is 47, though it can start considerably earlier in women with premature ovarian insufficiency, after certain cancer treatments, or constitutionally.
Symptoms of perimenopause
- Irregular periods — cycle length becomes unpredictable; flow may increase or decrease; spotting between periods; these changes reflect fluctuating oestrogen and declining progesterone
- Hot flushes and night sweats — vasomotor symptoms caused by declining oestrogen destabilising the hypothalamic thermostat; they may begin years before periods stop
- Sleep disturbance — difficulty falling asleep or staying asleep, often compounded by night sweats; poor sleep worsens mood, cognitive function and fatigue
- Mood changes — irritability, anxiety, low mood and emotional reactivity; progesterone decline reduces GABA receptor sensitivity, increasing anxiety; oestrogen fluctuations affect serotonin and dopamine; many women are misdiagnosed with depression or anxiety disorder at this stage
- Brain fog and cognitive changes — difficulty concentrating, poor memory and mental clarity; oestrogen plays an important role in brain function and its decline affects cognitive performance
- Joint aches and fatigue — widespread musculoskeletal aching and profound fatigue that is often dismissed or attributed to other causes
Perimenopause in TCM
In traditional Chinese medicine, perimenopause represents the natural decline of the Tian Gui — the menstrual substance governed by the Kidney — that begins around age 35 according to classical TCM physiology (the Nei Jing states that at 7 x 5 = 35, the Yangming channel begins to decline). The characteristic symptoms of perimenopause arise from the depletion of Kidney Yin and the relative excess of Yang that results when Yin can no longer contain and anchor it. However, perimenopause also commonly involves a complex mixed pattern:
- Kidney Yin deficiency with Empty Fire rising — the most common pattern; night sweats, afternoon and evening heat sensations, hot flushes, insomnia with vivid dreams, dry mouth at night, tinnitus; the specific formula Zhi Bai Di Huang Wan nourishes Kidney Yin and descends Empty Fire
- Kidney and Liver Yin deficiency with Liver Yang rising — hot flushes with prominent headaches, dizziness, irritability, tinnitus and high blood pressure; Qi Ju Di Huang Wan nourishes Yin and subdues Liver Yang
- Kidney Yin and Yang deficiency (mixed pattern) — the hallmark of perimenopause and the pattern where TCM excels; hot flushes alternating with cold sensations, fatigue alongside heat, lower back cold and weak yet upper body hot; Er Xian Tang (Two Immortals Decoction) was specifically developed for this mixed pattern and is the primary formula for perimenopausal hormone fluctuations
- Liver Qi stagnation with Blood deficiency — emotional volatility, irritability, mood swings, breast tenderness, cycle irregularity; treated with Jia Wei Xiao Yao San
- Heart and Kidney not communicating — the pattern underlying perimenopausal insomnia and palpitations; Tian Wang Bu Xin Dan re-establishes the Heart-Kidney axis
Acupuncture for perimenopause
Acupuncture regulates the hypothalamic-pituitary-ovarian axis, the destabilisation of which is the central mechanism driving perimenopausal vasomotor symptoms. Multiple RCTs and a Cochrane review have confirmed that acupuncture significantly reduces hot flush frequency and severity, improves sleep quality and reduces mood disturbance in perimenopausal and menopausal women. In TCM terms, treatment focuses on nourishing Kidney Yin, anchoring Yang, calming the Shen and regulating the Liver. Sessions are typically weekly or fortnightly, adjusted as the pattern changes during the transition.
Chinese herbal medicine for perimenopause
Chinese herbal medicine is the most effective TCM treatment for perimenopause because the hormonal fluctuations of this phase require daily systemic treatment to stabilise the Kidney Yin/Yang balance. The formula is reassessed at each consultation and adjusted as the pattern evolves. Key formulae include Er Xian Tang for the mixed Yin-Yang deficiency pattern, Zhi Bai Di Huang Wan for predominant Yin deficiency with Empty Heat, and Tian Wang Bu Xin Dan for Heart-Kidney disharmony with prominent insomnia. Herbs are prescribed as pharmaceutical-grade granules from Sun Ten (Taiwan).
See also: Menopausal symptoms treatment | HRT alternatives | Can you get pregnant during perimenopause?
To discuss perimenopause treatment at my clinic in Wokingham, contact me or book a consultation.
