Menopausal symptoms - Wokingham, Berkshire

1. Overview

Every woman will experience the menopause at some stage in her life. The age at which she does so varies considerably from woman to woman, but it typically occurs between the ages of 45 and 55, with the average age in the UK being 51. Perimenopause — the transitional phase leading up to the final menstrual period — can begin several years earlier, often in the mid-forties, and is frequently the phase during which symptoms are most intense and disruptive.

It is estimated that there are around 13 million perimenopausal or menopausal women in the UK, equivalent to approximately a third of the entire UK female population. The vast majority experience some degree of symptoms, and for many these are severe enough to affect work, relationships, sleep and quality of life. Hormone replacement therapy (HRT) is the most widely prescribed conventional treatment, but a significant proportion of women cannot take it, prefer not to, or find it insufficient for certain symptom clusters. Acupuncture and Chinese herbal medicine offer a well-evidenced, individually tailored approach that can significantly reduce hot flushes, night sweats, sleep disturbance, anxiety, low mood and other menopausal symptoms, both as a standalone treatment and alongside HRT.

2. Symptoms

Menopausal symptoms arise from the decline and fluctuation of oestrogen and progesterone and affect multiple body systems. The most common perimenopause and menopause symptoms include:

Hot flushes and night sweats — the most universal menopausal symptoms; sudden waves of intense heat, flushing of the face, neck and chest, profuse sweating and subsequent chills. Night sweats disrupt sleep and can occur multiple times per night
Sleep disturbance and insomnia — difficulty falling asleep, waking in the night (often triggered by night sweats), unrefreshing sleep and early morning waking are extremely common; sleep disruption compounds fatigue, mood disturbance and cognitive impairment
Anxiety and depression — mood changes, heightened anxiety, low mood, emotional volatility and, in some women, clinical depression; the neuroendocrine changes of perimenopause directly alter serotonin, noradrenaline and GABA activity
Brain fog and cognitive impairment — poor memory, difficulty concentrating, word-finding difficulties and mental fatigue; often distressing for women who were previously sharp and high-functioning
Irregular periods — cycles becoming shorter, longer, heavier or lighter; unpredictable bleeding patterns in perimenopause often precede cessation by several years
Elevated FSH levels — rising follicle-stimulating hormone is the pituitary’s attempt to stimulate failing ovaries; high FSH accompanies the transition into perimenopause and menopause
Vaginal dryness and urogenital symptoms — thinning and drying of vaginal tissues (genitourinary syndrome of menopause), discomfort during intercourse, urinary frequency, urgency and recurrent urinary tract infections
Low libido — reduced sexual desire driven by declining oestrogen and testosterone, vaginal discomfort and mood changes
Fatigue — persistent, often profound tiredness driven by sleep disruption, hormonal changes and the increased adrenal and neuroendocrine demands of the menopausal transition
Joint and muscle pain — oestrogen has anti-inflammatory effects; its decline increases joint stiffness, aching and musculoskeletal pain, sometimes mimicking early arthritis
Skin and hair changes — dry, thinning skin; loss of collagen; hair thinning and hair loss driven by the hormonal changes of menopause
Weight gain — particularly around the abdomen; driven by declining oestrogen, reduced muscle mass and changes in metabolism
Headaches and tinnitus — both may worsen during perimenopause due to hormonal fluctuations and changes in vascular tone
Palpitations — an awareness of the heartbeat, often described as fluttering or racing, related to vasomotor instability and autonomic nervous system changes

3. Causes

Menopausal symptoms arise from the natural decline and eventual cessation of ovarian function. The primary driver is the progressive reduction in oestrogen production as the ovarian follicle reserve is depleted. It is the monthly growth and rupture of an ovarian follicle that generates and releases oestrogens into the body. As ovulation becomes infrequent and eventually stops, oestrogen levels fall, progesterone drops (since it is primarily produced after ovulation), and the pituitary compensates by producing elevated levels of follicle-stimulating hormone (FSH) and luteinising hormone (LH) in an attempt to stimulate the failing ovaries.

This oestrogen withdrawal disrupts the hypothalamus — particularly its thermoregulatory centre, which is responsible for hot flushes and night sweats — as well as the limbic system (mood and anxiety), the sleep centres, the vaginal and urogenital tissues, bone density, cardiovascular function and cognitive processing. The multisystem impact of menopause reflects the breadth of oestrogen’s biological roles across the body. In some women, premature ovarian insufficiency (POI) or surgical menopause (bilateral oophorectomy) can cause the same hormonal changes at an earlier age, often with more abrupt and severe symptoms.

4. Menopause in Chinese medicine

In traditional Chinese medicine (TCM), the menopause is understood through the lens of the Kidney system, which governs reproductive function, Jing (essence), Yin and Yang. Classical TCM texts describe the menopause as occurring when the Tian Gui (heavenly water — the reproductive essence) is exhausted, the Chong and Ren channels (the Sea of Blood and Conception Vessel) become depleted, and the menstrual flow gradually ceases. In TCM, the menopause is not a disease but a natural transition, though the symptoms arise when the body is unable to adapt smoothly to the decline in Kidney Yin and Yang. The most common TCM patterns in perimenopausal and menopausal women include:

Kidney Yin deficiency with Empty Heat — the most common menopausal pattern, producing hot flushes, night sweats, afternoon heat sensations (particularly in the afternoon and evening), flushed cheeks, dry mouth and throat at night, scanty dark urine, restless sleep and a red tongue with little coating. The declining Kidney Yin is no longer sufficient to anchor and cool Yang, which rises upwards as Empty Heat, generating the characteristic vasomotor symptoms. Treatment nourishes Kidney Yin and clears Empty Heat with formulae such as Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron and Rehmannia) and Liu Wei Di Huang Wan (Six Flavour Rehmannia)
Kidney and Heart Yin deficiency — Heart and Kidney not communicating — produces hot flushes combined with pronounced anxiety, palpitations, restlessness, severe insomnia, vivid or disturbing dreams and emotional instability. In TCM, the Heart governs the Shen (mind) and requires nourishment from Kidney Water; when Kidney Yin is deficient, Heart Fire rises and the Heart-Kidney axis is disrupted. Treatment nourishes Kidney Yin, clears Heart Fire and calms the Shen, with formulae such as Tian Wang Bu Xin Dan (Emperor of Heaven’s Special Pill) and Jiao Tai Wan
Kidney and Liver Yin deficiency — produces hot flushes alongside significant irritability, low mood, emotional volatility, dizziness, headaches, tinnitus, dry eyes and scanty periods. The Liver stores Blood and relies on Kidney Yin for nourishment; when both are deficient, Liver Yang rises and Liver Qi stagnates. Treatment nourishes Kidney and Liver Yin and gently regulates Liver Qi, with formulae such as Qi Ju Di Huang Wan (Lycium, Chrysanthemum and Rehmannia) and Yi Guan Jian
Kidney Yang deficiency — less common as the sole pattern but present in women who are constitutionally Yang-deficient, previously cold, or who have exhausted Yang reserves. Produces cold extremities, low energy, lower back weakness, cold sensations rather than heat, frequent urination, urinary incontinence, oedema and a pale, moist tongue. Treatment warms Kidney Yang and tonifies Kidney Qi with moxibustion and formulae such as Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet)
Kidney Yin and Yang deficiency (mixed pattern) — the most complex and common pattern in clinical practice, where both Yin and Yang are deficient, producing a confusing alternation of hot and cold symptoms: hot flushes and sweating alternating with cold limbs and fatigue, disturbed sleep, lower back weakness, urinary symptoms, emotional lability and variable mood. Treatment simultaneously nourishes Yin and gently warms Yang, requiring carefully balanced formulae and acupuncture protocols
Liver Qi stagnation with Blood deficiency — seen particularly in perimenopausal women where the transition has been accompanied by stress, overwork or emotional difficulty, producing irritability, depression, breast tenderness, irregular periods, fatigue and poor sleep. Treatment moves Liver Qi, nourishes Blood and supports the Spleen, with formulae such as Xiao Yao San (Free and Easy Wanderer) and Jia Wei Xiao Yao San

5. Acupuncture for menopausal symptoms

Acupuncture has a well-established evidence base for menopausal symptom management, with clinical trials and systematic reviews demonstrating significant reductions in hot flush frequency and severity, improvements in sleep quality, and reductions in anxiety and depression scores compared with sham acupuncture and waitlist controls. Acupuncture addresses menopausal symptoms through multiple mechanisms:

Modulating the hypothalamus and its thermoregulatory centre, reducing the dysregulation of vasomotor control that causes hot flushes and night sweats. Research demonstrates that acupuncture influences the hypothalamic neuropeptide Y and beta-endorphin systems, which are directly involved in vasomotor instability
Regulating oestrogen levels by stimulating the hypothalamic-pituitary-ovarian (HPO) axis, influencing FSH, LH and oestradiol. Multiple RCTs have demonstrated measurable changes in serum hormone levels following a course of acupuncture
Modulating the brain’s mood chemistry by reducing serotonin reuptake, increasing beta-endorphin release and regulating the HPA axis, thereby reducing anxiety and depression
Improving sleep quality through melatonin regulation, reduction of nocturnal sympathetic nervous system activity, and calming of the Heart-Kidney axis in TCM terms
Reducing joint and muscle pain through endorphin release, anti-inflammatory cytokine modulation and improvement of local microcirculation
Improving overall quality of life, energy, cognitive function and sense of wellbeing, which are captured in randomised controlled trials using validated quality of life instruments

Research evidence

A systematic review and meta-analysis by Liu et al. (2022), published in Acupuncture in Medicine, searched 10 databases and confirmed that acupuncture significantly reduces hot flush frequency and severity and produces measurable changes in serum hormone levels (oestradiol, FSH, LH) in menopausal women. A systematic review and meta-analysis by Li et al. (2023), published in Medicine, included 15 RCTs involving 1,188 perimenopausal patients with insomnia and found that acupuncture combined with Chinese herbal medicine was significantly more effective than Western medicine alone for improving sleep quality (PSQI WMD: −2.77, P < .0001), reducing FSH (WMD: −31.45, P < .001) and reducing anxiety scores (HAMA WMD: −2.62, P < .0001). A further systematic review and meta-analysis published in PLOS ONE (2025), analysing 28 RCTs of acupuncture for menopausal insomnia across 7 databases to April 2024, found that acupuncture significantly lowered PSQI scores, increased total sleep time and sleep efficiency, and reduced waking after sleep onset compared with both sham acupuncture and standard care, with effects maintained at four-week follow-up.

Randomised controlled trials suggest that many women experience significant improvement in quality of life following acupuncture treatment for menopausal symptoms, and that this is not simply a placebo effect: women in the acupuncture group show significantly reduced hot flushes compared to the sham control group, demonstrating the effectiveness of acupuncture point stimulation.

6. Chinese herbal medicine for menopause

Chinese herbal medicine provides daily hormonal and constitutional support between acupuncture sessions and is particularly valuable for the more persistent or deeply constitutional aspects of menopausal symptoms. The combined research evidence (including the Li et al. 2023 meta-analysis) confirms that acupuncture combined with Chinese herbal medicine produces superior outcomes to either treatment alone or to Western medicine for perimenopausal insomnia and symptom scores. Formulae are individually prescribed based on the patient’s TCM pattern diagnosis. Clinically relevant formulae include:

Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron and Rehmannia) — the most widely used formula for Kidney Yin deficiency with Empty Heat; specifically targets hot flushes, night sweats, afternoon heat, restless sleep and the classic menopausal Yin-deficient heat pattern
Liu Wei Di Huang Wan (Six Flavour Rehmannia) — the foundational Kidney Yin tonic formula; used in purer Kidney Yin deficiency without strong Empty Heat, and as a base formula for many modifications
Tian Wang Bu Xin Dan (Emperor of Heaven’s Special Pill) — for Kidney and Heart Yin deficiency with Heart Fire; specifically targets severe insomnia, palpitations, anxiety and restless mind with hot flushes; one of the most important formulae for menopausal sleep disturbance and anxiety
Qi Ju Di Huang Wan (Lycium, Chrysanthemum and Rehmannia) — for Kidney and Liver Yin deficiency with Liver Yang rising; targets hot flushes with irritability, dizziness, headaches, dry eyes and tinnitus
Jia Wei Xiao Yao San (Augmented Free and Easy Wanderer) — the most important formula for Liver Qi stagnation with Blood deficiency; addresses irritability, depression, emotional volatility, breast tenderness, poor sleep and irregular cycles in perimenopause
Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet) — for Kidney Yang deficiency with cold, fatigue, urinary frequency, lower back weakness and oedema; used for colder menopausal presentations or mixed Yin-Yang deficiency with dominant Yang deficiency
The combined Tian Huazhang and Zhang Chunyan protocol — a clinical report of 63 menopausal syndrome cases using combined acupuncture and Chinese herbal medicine published in the Journal of Traditional Chinese Medicine (2008) demonstrated strong clinical outcomes across the breadth of menopausal symptom clusters

In addition to prescribed formulae, certain food-grade herbs can be incorporated into daily cooking to support the menopausal transition. Women in East Asia — including Japan, where menopausal symptoms are markedly less prevalent — traditionally consume foods rich in Yin-nourishing, phytoestrogenic properties, including soy products, black sesame seeds (Hei Zhi Ma), mulberry (Sang Shen), goji berries (Gou Qi Zi) and black beans, which in TCM nourish Kidney Yin and supplement the Jing. All herbs prescribed at this clinic are pharmaceutical-grade granule extracts supplied by Sun Ten (Taiwan), ensuring consistent potency and safety. An online Chinese herbal medicine consultation is available for those who cannot attend in person.

7. Moxibustion for menopause

Moxibustion — the warming of acupoints with burning moxa (Artemisia vulgaris) — is particularly valuable for the Kidney Yang deficiency and mixed Yin-Yang deficiency patterns of menopause, as well as for addressing the fatigue, cold limbs and urinary symptoms that often accompany the transition. Moxa at CV4 (Guanyuan, the Gate of Original Qi), CV6 (Qihai, the Sea of Qi), and ST36 (Zusanli) directly tonifies Kidney and Spleen Qi and Yang, supporting the body’s constitutional reserves during the menopausal transition. For women with pronounced night sweats and Empty Heat, moxibustion is used more selectively and in smaller doses at specific points to avoid aggravating the Yin-deficient heat. Heat therapy with an infrared TDP lamp is a complementary option for warming the lower back and kidney area during treatment sessions.

8. Diet and lifestyle

Diet and lifestyle play an important supporting role in managing menopausal symptoms, both from a conventional and TCM perspective. Key evidence-based recommendations include:

Yin-nourishing foods — in TCM, foods that nourish Kidney Yin and supplement the Blood are strongly recommended: black sesame seeds, mulberries, goji berries (Gou Qi Zi), black beans, tofu and other soy products (which also provide phytoestrogens), eggs, oily fish and dark leafy greens. Research consistently shows that Japanese women have fewer menopausal symptoms than Western women, in part attributed to a traditional diet high in these Yin-nourishing and phytoestrogenic foods. Guidance on these foods is covered in the principles of Chinese food therapy
Reduce aggravating foods — spicy foods, alcohol, caffeine, refined sugar and very hot drinks can trigger or worsen hot flushes and disturb sleep. Reducing or eliminating these is particularly recommended for women with strong Yin-deficient heat patterns
Regular gentle exercise — consistent aerobic exercise reduces hot flush frequency and severity, improves sleep quality, supports bone density, reduces cardiovascular risk and improves mood. Mind-body practices including Tai Chi and yoga are particularly well suited to the menopausal transition, supporting Qi, calming the Shen and improving balance and flexibility
Sleep hygiene — creating a cool, dark sleep environment, maintaining consistent sleep and wake times, and managing night sweats with breathable bedding helps protect sleep quality. Combined acupuncture and herbal treatment significantly improves menopausal insomnia
Stress reduction — chronic stress worsens all menopausal symptoms by further depleting adrenal and Kidney Qi reserves. Practices including mindfulness, meditation, breathing exercises and regular acupuncture directly support the nervous system during the transition
Natural supplements — phytoestrogen-rich plant foods (soy isoflavones, red clover, black cohosh) are commonly used. In TCM terms, herbs such as He Shou Wu (Fo-Ti), Nu Zhen Zi (Privet fruit), Han Lian Cao and E Jiao (donkey-hide gelatin) are classical Kidney Yin and Blood tonics used within prescribed formulae to nourish the reproductive essence during the menopausal transition

9. Treatment at my clinic

I treat menopausal and perimenopausal symptoms at my clinic in Wokingham, Berkshire, using a combination of acupuncture, Chinese herbal medicine and, where appropriate, moxibustion. Each treatment programme is individually tailored to the patient’s presenting TCM pattern, the predominant symptoms and their severity, and any other health conditions or medications in use. Treatment can work alongside HRT for women who are already taking it, addressing residual symptoms and supporting the transition as HRT is gradually reduced. For women who cannot take or prefer not to take HRT, TCM provides an effective and safe alternative approach.

Most patients notice improvement in hot flushes, sleep and anxiety within four to six sessions. A full course of eight to twelve sessions is typically recommended for sustained improvement, with periodic maintenance sessions to support the ongoing transition. Chinese herbal medicine, taken daily between sessions, significantly accelerates the process. Visit the prices page for treatment costs. Related pages that may be of interest include acupuncture for insomnia, acupuncture for anxiety, acupuncture for depression and acupuncture for stress.

10. Frequently asked questions

Can acupuncture help with hot flushes?

Yes. Multiple randomised controlled trials and systematic reviews confirm that acupuncture significantly reduces the frequency and severity of hot flushes compared with both sham acupuncture and waitlist controls. A 2022 systematic review and meta-analysis in Acupuncture in Medicine searched 10 databases and confirmed these effects alongside measurable changes in serum hormone levels. The effect is not simply a placebo response: sham-controlled trials consistently show that real acupuncture produces significantly greater reductions in vasomotor symptoms.

How many acupuncture sessions are needed for menopause symptoms?

Most women begin to notice improvements in hot flushes, sleep and anxiety within four to six sessions. A full initial course of eight to twelve sessions is recommended for sustained benefit, delivered weekly or fortnightly. Periodic maintenance sessions every four to six weeks thereafter help to sustain the improvements as the hormonal transition continues. Chinese herbal medicine taken daily between sessions significantly accelerates the response and addresses the deeper constitutional patterns that drive symptoms.

Is acupuncture a good alternative to HRT for menopause?

Acupuncture and Chinese herbal medicine are effective options for women who cannot take HRT, choose not to, or find HRT insufficient for certain symptoms. The clinical evidence supports their use for hot flushes, night sweats, sleep disturbance, anxiety and mood. They can also be used alongside HRT to address residual symptoms or to support a gradual reduction in HRT dose over time. The decision between HRT and TCM approaches is individual and should be made in consultation with your GP or specialist.

Can Chinese herbs help with menopausal insomnia?

Yes. A systematic review and meta-analysis of 15 RCTs including 1,188 patients found that acupuncture combined with Chinese herbal medicine was significantly more effective than Western medication alone for improving sleep quality (Pittsburgh Sleep Quality Index scores), reducing FSH and reducing anxiety in perimenopausal women with insomnia. Formulae such as Tian Wang Bu Xin Dan and Zhi Bai Di Huang Wan are specifically targeted at the Kidney-Heart Yin deficiency pattern that drives menopausal insomnia.

What is the TCM view of the menopause?

In traditional Chinese medicine, the menopause is understood as a natural depletion of Kidney Yin and Kidney Jing (reproductive essence), which in the classical texts is said to be exhausted at around 49 years of age (seven sevens). The hot flushes and night sweats of menopause are understood as Empty Heat rising from insufficient Kidney Yin, unable to cool and anchor Yang. The anxiety, insomnia and palpitations reflect a failure of communication between Kidney Water and Heart Fire. TCM treatment aims to nourish the Kidney Yin, clear Empty Heat, calm the Heart-Mind and restore the balance between Yin and Yang — addressing root causes rather than just suppressing individual symptoms.

11. References

Susan Cohen, Mary Rousseau, Bonnie Carey. Can acupuncture ease the symptoms of menopause? Holist Nurs Pract. 2003 Nov–Dec;17(6):295–9. doi: 10.1097/00004650-200311000-00003.

Tian Huazhang, Zhang Chunyan. The combined use of acupuncture and Chinese medicines for treatment of menopausal syndrome — a clinical report of 63 cases. J Tradit Chin Med. 2008;28(1):3–5. doi: 10.1016/S0254-6272(08)60001-1.

Hongguang Dong, Frank Lüdicke, Isabelle Comte, Aldo Campana, Patrick Graff, Paul Bischof. An exploratory pilot study of acupuncture on the quality of life and reproductive hormone secretion in menopausal women. J Altern Complement Med. 2001 Dec;7(6):651–658. doi: 10.1089/10755530152755207.

E Borud, S Grimsgaard, A White. Menopausal problems and acupuncture. Auton Neurosci. 2010 Oct 28;157(1–2):57–62. doi: 10.1016/j.autneu.2010.04.004.

Nancy Avis, Claudine Legault, Remy Coeytaux, et al. A randomized, controlled pilot study of acupuncture treatment for menopausal hot flashes. Menopause. 2008 Dec;15(6):1070–8.

Einar Borud, Terje Alraek, Adrian White, et al. The Acupuncture on Hot Flushes Among Menopausal Women (ACUFLASH) study: observational follow-up results at 6 and 12 months. Menopause. 2010 Mar;17(2):262–8.

Liane Venzke, James F Calvert, Barbara Gilbertson. A randomized trial of acupuncture for vasomotor symptoms in post-menopausal women. Complement Ther Med. 2010 Apr;18(2):59–66. doi: 10.1016/j.ctim.2010.02.002.

Porzio G, Trapasso T, Martelli S, Sallusti E, Piccone C, Mattei A, et al. Acupuncture in the treatment of menopause-related symptoms in women taking tamoxifen. Tumori. 2002 Mar–Apr;88(2):128–130. doi: 10.1177/030089160208800209.

Liu C, Wang Z, Guo T, Zhuang L, Gao X. Effect of acupuncture on menopausal hot flushes and serum hormone levels: a systematic review and meta-analysis. Acupunct Med. 2022 Aug;40(4):289–298. doi: 10.1177/09645284211056655. PMID: 34894774.

Li Z, Yin S, Feng J, Gao X, Yang Q, Zhu F. Acupuncture combined with Chinese herbal medicine in the treatment of perimenopausal insomnia: a systematic review and meta-analysis. 15 RCTs, 1,188 patients. PSQI improved (WMD: −2.77, P < .0001); FSH reduced (WMD: −31.45, P < .001); HAMA reduced (WMD: −2.62, P < .0001). Medicine. 2023 Nov 10;102(45):e35942. doi: 10.1097/MD.0000000000035942. PMID: 37960761.

Systematic review and meta-analysis of acupuncture as independent or adjuvant therapy for menopausal insomnia: 28 RCTs, 7 databases to April 2024. Acupuncture significantly lowered PSQI scores, increased total sleep time and sleep efficiency, and reduced waking after sleep onset versus sham acupuncture and standard care; effects maintained at 4-week follow-up. PLOS ONE. 2025 Feb.