By Dr. Erika F. Marie, DACM, LAc | Chiyu Integrative Health | Columbia, SC & Longmont, CO

More Than Hot Flashes: What Really Happens in Perimenopause and Menopause

If you grew up hearing that menopause meant hot flashes and the end of your period, you were not given the full story.

For many women, perimenopause — the transitional phase that can begin in the late 30s or 40s and last a decade or more — brings a cascade of changes that touch nearly every system in the body. Research from AARP found that women can experience as many as 28 distinct menopause-related symptoms, yet the majority of women surveyed did not recognize perimenopause as the cause.¹

There are the well-known symptoms: hot flashes, night sweats, irregular periods, vaginal dryness. And then there are the ones that often go unaddressed in a standard clinical visit — hair loss, profound fatigue, memory lapses, irritability, headaches, mood swings, low libido, joint pain, heart palpitations, electric shock sensations, skin crawling (called formication), tinnitus, digestive changes, urinary urgency, and a sense that your nervous system has become hypersensitive in ways it never was before.²˒³

Most of these symptoms stem from a common source: rapidly fluctuating and declining levels of estrogen, progesterone, and testosterone — and the downstream biological effects those hormonal shifts trigger across the nervous system, immune system, vascular system, and brain.

Hormone replacement therapy (HRT) is one option for addressing these symptoms, and it is an appropriate choice for some women. But a significant proportion of women have contraindications to HRT, prefer to avoid it, or find that it does not fully resolve their symptom picture. In addition, many women simply want a complementary layer of support so that they feel their best, even if they still must be on a low dose of hormone replacement. For all of these women, Chinese herbal medicine offers a well-researched, multi-target approach grounded in documented biochemical and endocrine mechanisms.

This article focuses specifically on what Chinese herbal medicine (CHM) does, how it works at the biochemical level, and which symptoms it is best positioned to address. (Spoiler Alert: All the symptoms listed above are treatable with CHM).

What Is Actually Happening in Your Body: The Biology of Perimenopause

Perimenopause begins when the ovaries start producing less consistent levels of estrogen and progesterone. This is not a simple linear decline — hormone levels fluctuate erratically, often surging and crashing within the same week, before eventually settling into the lower post-menopausal range.

These hormonal fluctuations set off a chain of downstream effects throughout the body:

• The hypothalamus and pituitary gland: as estrogen falls, the hypothalamus loses its normal feedback signal. It responds by increasing secretion of GnRH, which drives the pituitary to overproduce FSH (follicle-stimulating hormone) and LH (luteinizing hormone) in a futile attempt to stimulate the ovaries. Elevated FSH and LH are the biological signature of menopause — and the dysregulated hypothalamic activity directly contributes to hot flashes, night sweats, and the erratic temperature regulation that defines vasomotor symptom

• Neurotransmitter disruption: estrogen directly regulates serotonin, dopamine, and norepinephrine synthesis and receptor sensitivity. As estrogen declines, serotonin signaling becomes unstable — contributing to mood swings, irritability, depression, and disrupted sleep. Dopamine pathways involved in motivation, pleasure, and reward are also affected, which underlies the emotional flatness and low libido many women experience

• HPA axis dysregulation: estrogen normally buffers the hypothalamic-pituitary-adrenal (HPA) stress response. Without it, cortisol secretion becomes more reactive and harder to regulate — amplifying anxiety, fatigue, brain fog, and sleep disruption, and creating a stress-sensitive state that feels fundamentally different from how you experienced stress before

• Neurological and peripheral nerve changes: estrogen has direct neuroprotective and nerve-modulating effects. Its decline reduces the threshold for nerve signaling, contributing to headaches, the sensation of electric shocks, tingling, formication (skin crawling), tinnitus, and heightened sensory sensitivity

• Inflammatory shift: estrogen is anti-inflammatory. Its loss is associated with increased production of pro-inflammatory cytokines including IL-1β, IL-6, and TNF-α. This systemic inflammatory shift drives joint pain, fatigue, brain fog, and the increased cardiovascular and metabolic risk that accompanies menopause

• Androgen imbalance: as estrogen and progesterone fall, the relative ratio of androgens — including testosterone and its more potent derivative DHT — shifts. In scalp hair follicles, elevated DHT drives follicular miniaturization and hair thinning. Paradoxically, the same relative androgen excess can drive coarser facial hair growth

Understanding this biology makes clear why no single drug, supplement, or herb will address everything — and why a multi-target approach is so well-suited to the complexity of this transition.

Chinese Herbal Medicine for Menopause: The Clinical Evidence

Chinese herbal medicine has one of the largest bodies of clinical research of any integrative approach for menopausal symptoms. The evidence is substantial enough that the Cochrane Collaboration — the gold standard in evidence-based medicine — published a systematic review specifically on Chinese herbal medicine for menopausal symptoms.

A meta-analysis of 19 randomized controlled trials involving 2,469 patients found that Chinese herbal formulas had comparable effects to menopausal hormone therapy on vasomotor symptom scores and overall Kupperman Index scores — the standard clinical measure of menopausal symptom burden.⁴ A randomized controlled trial comparing Chinese herbal medicine alone, acupuncture plus herbal medicine, and hormone therapy found that herbal medicine alone significantly decreased Kupperman scores and reduced total symptom count, with no reported side effects.⁵

A meta-analysis of 17 RCTs involving 1,352 participants found that Chinese herbal medicine combined with hormone therapy was superior to hormone therapy alone in modulating FSH and estradiol levels and improving perimenopausal symptom scores.⁶ And a meta-analysis of 22 RCTs with 1,770 participants found that Chinese herbal medicine combined with pharmacotherapy significantly improved depression outcomes in menopausal women — with outcomes comparable to antidepressants, and without the sexual dysfunction, weight gain, and sleep disruption associated with SSRIs.⁷

How Chinese Herbal Medicine Works: What to Know Before Taking It

Chinese herbs are not taken as stand-alone herbs. Unlike Western methods of prescription, Chinese herbs do not directly correlate to “if Symptom A, take Herb B” types of thinking.

To effectively prescribe herbs, Chinese herbal practitioners must look at the patterns underneath the symptom and figure out the underlying systemic slow-down that is causing the symptom. It is like looking at a highway and trying to discern why the cars are all blocked up. The cars being blocked up (symptom) could be due to damage to the roadway (physical injury). They could be slowing due to water pooling on the roadway (poor fluid movement or lymph flow). They could be slowing because the traffic lights are misfiring or a new traffic signal is needed (neuro-conductivity issues). Or it could be that something foreign on the roadway needs removed (immune system problem). The causes of the symptom can be many, and the most effective solution will not be the same for all patterns — it will be different, depending on the underlying problem.

What this means is that Chinese herbal medicine is a systems-based medicine. Often, two people with the same symptoms will find relief with different combinations of herbs because their systemic patterns are unique.

This is even more complicated in real life due to the fact that most people show signs of multiple Chinese medical patterns — rarely will a person display one clear pattern alone. Trained practitioners know the systemic pattern differences to look for that will help them differentiate and methodologically prioritize between herbs and herbal formulas.

To provide an effective Chinese herbal formula, the practitioner must first identify the patterns and discern which underlying pattern to unravel first. Herbal formulas — even the most famous ones — are rarely prescribed without modification. The herbal formula will be modified (herbs removed or added) according to that individual’s needs to make it more targeted and effective for that person. The modified Chinese herbal formula will be prescribed, and then modified again, possibly in minor ways but also possibly into an entirely new formula (and underlying pattern) approach, based on the person’s response to the formula.

For these reasons, it is strongly discouraged to self-diagnose or self-treat with Chinese herbs.

Symptom by Symptom: What the Research Shows

Hot Flashes, Night Sweats, and Vasomotor Instability

Hot flashes occur because falling estrogen destabilizes the hypothalamic thermostat. This complex mechanism is now understood to involve dysregulated norepinephrine and serotonin signaling in the hypothalamus, as well as elevated circulating kisspeptin and neurokinin B from newly uninhibited hypothalamic neurons.

Several Chinese herbal compounds address this via phytoestrogenic activity via a remarkable, gentle, and natural mechanism. Plant compounds bind “weakly” to estrogen receptors (ERα and ERβ), providing a mild estrogenic signal that restabilizes hypothalamic feedback without the risks of full estrogen replacement. Multiple Chinese herbs have been confirmed to contain phytoestrogens via gas chromatography-mass spectrometry.⁴ In addition, modified Chinese herbal formulas have been studied for phytoestrogenic effects and impact on FSH and estradiol levels in perimenopausal women, and at least one has been found to be more effective than HRT.⁸

Black cohosh (used in both Western and East Asian botanical traditions) has terpene glycosides that bind to estrogen receptors and selectively suppress LH secretion — directly targeting the hypothalamic-pituitary dysregulation that drives hot flashes — without affecting FSH levels.⁹

Mood Swings, Irritability, Anxiety, and Depression

Perimenopausal mood disruption is not psychological — it has clear neurochemical underpinnings. Estrogen regulates serotonin transporter activity, tryptophan hydroxylase expression (the rate-limiting enzyme in serotonin synthesis), and the density of dopamine receptors in the prefrontal cortex. As estrogen fluctuates and declines, serotonin signaling becomes erratic and dopaminergic tone drops — producing irritability, emotional reactivity, anxiety, and depression that feel distinctly different from earlier mood challenges in life.

The most studied Chinese herbal formula for perimenopausal mood symptoms is Xiao Yao San (Free and Easy Wanderer powder), a nine-herb formula that has been the subject of multiple RCTs and systematic reviews. A rigorous pilot RCT found this Chinese herbal formula comparable to tibolone (a synthetic hormone) in reducing Hamilton Depression Scale scores over 12 weeks, with concurrent reductions in FSH and increases in estradiol.¹⁰ Its mechanisms include phytoestrogenic activity at ERα receptors, modulation of serotonin reuptake, and regulation of the HPA axis to normalize cortisol reactivity — addressing the neurochemical and neuroendocrine roots of perimenopausal mood disruption simultaneously.⁴˒⁸

Brain Fog, Memory Lapses, and Cognitive Changes

Estrogen receptors are densely expressed in the hippocampus and prefrontal cortex — the regions most critical for memory formation, working memory, and executive function. Declining estrogen reduces dendritic spine density, impairs long-term potentiation (the brain's primary mechanism for learning and memory), and disrupts acetylcholine signaling, which is essential for attention and cognitive processing. The brain fog and word-finding difficulty that women describe during perimenopause are real, measurable changes in neurological function.

Chinese herbal medicine addresses this through several mechanisms. Phytoestrogenic compounds in formulas like Liu Wei Di Huang Wan partially restore estrogen receptor signaling in the hippocampus. Research has specifically studied the relationship between memory quotient, estrogen levels, and kidney-nourishing Chinese herbal formulas in perimenopausal women, finding improvements in cognitive scores associated with herbal treatment.¹¹ The compound osthole — found in herbs used in Chinese herbal practice — has been shown to ameliorate estrogen deficiency-induced cognitive impairment in animal models by restoring hippocampal neuronal signaling.¹² Panax ginseng has demonstrated improvements in memory and quality of life in symptomatic postmenopausal women in a double-blind placebo-controlled trial.¹³

Fatigue

Perimenopausal fatigue is multi-causal: disrupted sleep from night sweats, HPA axis dysregulation causing abnormal cortisol rhythms, declining estrogen reducing mitochondrial efficiency, and the physical drain of managing a body in significant hormonal flux. This is not simple tiredness — it is a systemic depletion that does not respond to rest in the usual way.

In studies of healthy adults, adaptogenic herbs — including Panax ginseng, Ashwagandha, Astragalus (Huang Qi), and Rhodiola rosea — address fatigue through multiple pathways: HPA axis modulation to normalize cortisol rhythms, mitochondrial protection to improve cellular energy production, and upregulation of ATP synthesis. Astragalus polysaccharides have demonstrated mitochondrial protective effects alongside immune modulation. Panax ginseng ginsenosides have been shown in human RCTs to improve physical and mental energy, with double-blind placebo-controlled evidence supporting quality-of-life improvements in postmenopausal women.¹³ These effects operate through steroid receptor modulation, antioxidant enzyme activation, and GABAergic nervous system calming — not by stimulating the adrenal axis further.

‍ ‍Please note: Adaptogens can have dangerous “opposite” effects for people with known or suspected autoimmunity, leaky gut, gut biome dysregulation or flora overgrowth, Gu syndrome, or other conditions. If you drink a beverage or take a vitamin supplement containing an adaptogenic herb (such as rhodiola, ashwaganda, or ginseng) and feel awful 30-90 minutes later, stop taking that product immediately. The adaptogenic herbs in that product are worsening your condition.

‍ ‍Having these sort of “opposite” responses to herbs that normally make people feel better is partially diagnostic for Gu syndrome, a traditional Chinese medicine diagnosis of latent pathogen infection. If you “crash” after consuming adaptogenic herbs, you will need help restoring your foundational health before you can safely consume any products containing adaptogens.

Hair Loss and Hair Thinning

Hair loss affects up to 52% of postmenopausal women, yet it is rarely addressed with the same seriousness as other menopause symptoms.¹⁴ The biology involves multiple intersecting mechanisms: falling estrogen (which normally supports the anagen or active growth phase of the hair cycle), relative androgen dominance, and increased conversion of testosterone to dihydrotestosterone (DHT) by the enzyme 5-alpha-reductase in scalp hair follicles. DHT binds to androgen receptors in the follicle, activating pathways that progressively miniaturize the follicle. This shortens the anagen phase and produces finer, shorter, thinner hairs. Oxidative stress and impaired scalp microcirculation — both worsened by estrogen withdrawal — compound this by reducing oxygen and nutrient delivery to the follicle.¹⁴

Chinese herbal medicine and botanically related compounds address hair loss through several documented mechanisms:

• 5-alpha-reductase inhibition: saw palmetto (Serenoa repens) — used in integrative botanical practice — inhibits 5-alpha-reductase and reduces DHT levels by approximately 30–40% in androgen-sensitive scalp regions, with a favorable safety profile compared to pharmaceutical 5-alpha-reductase inhibitors like finasteride¹⁵

• Reishi mushroom (Ling Zhi): used in Chinese herbal medicine for centuries, reishi was found to have the strongest 5-alpha-reductase inhibitory activity of 20 mushroom species tested, reducing conversion of testosterone to DHT and offering meaningful anti-androgenic effects for hair preservation¹⁶

• Phytoestrogenic support for the hair cycle: phytoestrogens from herbs and soy isoflavones mimic estrogen's role in extending the anagen (growth) phase of the hair cycle, counteracting the follicular miniaturization driven by relative androgen excess¹⁴

• Wnt/β-catenin pathway activation: the flavonoid biochanin A — found in several herbs used in Chinese practice — stimulates hair follicle dermal papilla cells by activating Wnt3a, Wnt5a, and the Wnt/β-catenin signaling pathway, a key driver of hair follicle regeneration. It also prevents DHT from translocating to the androgen receptor nucleus in follicle cells, blocking its miniaturizing effect¹⁷

• Scalp microcirculation: Panax ginseng ginsenosides promote hair growth by improving scalp blood flow, inhibiting 5-alpha-reductase, and extending the anagen phase. Korean red ginseng extract has been shown in clinical research to improve hair density and thickness in patients with androgenetic alopecia¹⁸

Low Libido and Sexual Function

Low libido in perimenopause and menopause has multiple biological drivers: declining estrogen reduces genital tissue sensitivity and vaginal lubrication; falling testosterone (which is produced partly by the ovaries and declines with them) reduces sexual desire; dysregulated dopamine signaling blunts the brain's reward and motivation response to sexual stimuli; and elevated cortisol from HPA axis dysregulation actively suppresses gonadotropin-releasing hormone (GnRH), further depressing testosterone production.

Libido involves a complex interplay of neurotransmitters: dopamine and norepinephrine facilitate sexual desire and arousal; serotonin (when elevated centrally) actually inhibits it; and oxytocin drives bonding and orgasm. This is why SSRIs — which elevate serotonin — so commonly cause sexual dysfunction. Chinese herbal medicine that modulates serotonin balance, supports dopamine pathways, and restores estrogenic tone offers a more nuanced biological approach.¹⁹

Research-supported herbal mechanisms for libido support include saponins (which elevate dopamine, serotonin balance, and BDNF while modulating the HPA-cortisol axis), phytoestrogenic herbs that restore tissue sensitivity, and Chinese herbal formulas found to improve sexual function as part of broader perimenopausal symptom improvement in clinical trials.⁴˒⁷˒²⁰

Headaches

Perimenopausal headaches — including new-onset migraines or worsening of existing ones — are driven by the same estrogen-withdrawal effects on serotonin signaling and vascular reactivity. Rapidly falling estrogen causes serotonin levels to drop and triggers vasodilation and vasoconstriction cycles in cerebral blood vessels. The same Chinese herbal compounds that stabilize serotonin signaling (via phytoestrogenic and serotonin-modulating mechanisms) and support cerebrovascular tone have documented effects on cerebral blood flow and vasomotor stability that are relevant to hormonal headaches.²¹

Joint Pain and Musculoskeletal Symptoms

Menopausal arthralgia — joint pain and stiffness — is one of the most prevalent yet least-discussed menopause symptoms. A 2023 retrospective review in PubMed confirmed its clinical significance.²² The mechanism is primarily inflammatory: estrogen normally suppresses pro-inflammatory cytokines including IL-1β, IL-6, and TNF-α in joint tissue. Its withdrawal allows these cytokines to rise, driving synovial inflammation and cartilage degradation. Estrogen also supports collagen synthesis and ligament elasticity, so its loss contributes to the stiffness and reduced range of motion many women notice, often mistakenly attributed to aging alone.

Chinese herbal medicine addresses menopausal joint pain through the same cytokine-suppressing, NF-κB-inhibiting, and antioxidant mechanisms documented in the autoimmune and inflammation literature. Curcumin (from turmeric, integrated into Chinese herbal formulas) is supported by a systematic review and meta-analysis in Frontiers in Immunology for its effects on inflammatory joint conditions, reducing IL-1β, IL-6, and TNF-α.²³ Baicalin from Huang Qin (Scutellaria baicalensis) and ginger compounds further reduce synovial inflammation through prostaglandin inhibition and cytokine downregulation. These are just a few of many compounds in Chinese herbs known to have anti-inflammatory and pro-microcirculatory effects.

Sleep Disruption

Poor sleep during perimenopause is driven by night sweats (which fragment sleep architecture), declining progesterone (which has GABAergic, sedative properties that promote deep sleep), dysregulated cortisol rhythms (which produce early waking and hyperarousal), and serotonin instability (which disrupts the tryptophan-to-melatonin conversion pathway). Chinese herbal medicine addresses sleep through multiple pathways: phytoestrogenic stabilization of vasomotor symptoms to reduce night sweats, GABAergic herbs to restore progesterone-like calming effects, HPA axis modulation to normalize cortisol, and serotonin-supportive compounds to support melatonin synthesis. Chinese herbal formulas have been specifically studied for perimenopausal insomnia, with documented effects on intestinal flora changes that correlate with sleep improvement.⁴‍ ‍

The Symptoms Nobody Warned You About and Their Biology

Research confirms that the clinical symptom list for perimenopause and menopause extends well beyond what most women are told to expect. A peer-reviewed critical review of Chinese herbal medicine for menopause explicitly lists the following as documented manifestations of menopausal syndrome: vasomotor episodes, urogenital problems, sleep disturbance, mood disorders, uterine bleeding changes, somatic symptoms, vertigo, headaches, palpitations, skin formication, and sexual dysfunction.³

Here is what is happening biologically with the lesser-discussed ones:

• Heart palpitations: affect an estimated 42–54% of peri- and postmenopausal women. Estrogen normally stabilizes cardiac electrical pathways; its withdrawal increases adrenergic sensitivity, raises resting heart rate during hot flashes (by 8–16 beats per minute), and produces the irregular cardiac rhythm sensations many women find alarming. These are typically benign, but always warrant evaluation to rule out other causes.²˒³

• Electric shock sensations: sudden jolts or zapping sensations — often experienced in the head, neck, or limbs — result from estrogen's role in maintaining the myelin sheath integrity and lowering nerve firing thresholds. As estrogen falls, nerve signaling becomes less regulated, producing these spontaneous discharge phenomena

• Formication (skin crawling): affects an estimated 20% of women during the menopausal transition. Estrogen supports skin barrier function, collagen production, and peripheral nerve sensitivity. Its decline thins the skin, reduces barrier integrity, and lowers the threshold for cutaneous nerve signaling — producing the crawling, tingling, or itching sensations without any external cause. Stress and sleep deprivation amplify this by further sensitizing the nervous system.²

• Tinnitus: estrogen modulates auditory pathways in the brain and has protective effects on cochlear blood flow. Its withdrawal can alter auditory signal processing, contributing to new-onset ringing or humming in the ears

• Digestive changes and GERD: estrogen affects smooth muscle tone and gastrointestinal motility. Declining levels can slow peristalsis, increase esophageal reflux, and worsen bloating and constipation. Research has documented the prevalence of GERD symptoms specifically in perimenopausal and menopausal women

• Urinary urgency and recurrent UTIs: the urethral and bladder lining share estrogen receptors with vaginal tissue. As estrogen declines, these tissues thin and lose elasticity, reducing the barrier against bacterial colonization and creating urgency, frequency, and increased UTI susceptibility even without anatomical infection

• Changes in taste, smell, and sensory sensitivity: fluctuating hormones alter olfactory nerve pathways and can produce heightened sensitivity to smells, altered taste perception, and the phenomenon of burning mouth syndrome — all driven by estrogen's role in peripheral nerve function and mucosal tissue integrity

Chinese herbal formulas — particularly those with phytoestrogenic activity, anti-inflammatory cytokine suppression, gastrointestinal motility support (via improved peristalsis through enteric nervous system modulation), and nervous system stabilizing effects — address many of these symptoms through the same root biological pathways.

Key Chinese Herbal Formulas Used in Perimenopause & Menopause Care

In clinical practice, herbal formulas are prescribed based on the individual's specific symptoms and underlying systemic patterns contributing to pathology. It is not a one-size-fits-all approach. This is especially true for women who have any sort of complicating health condition, such as a history of TBI, autoimmunity, or any other chronic, complex condition. In such cases (which is the majority of women), receiving customized Chinese herbal medicine becomes vital to best outcomes.

That said, certain formulas appear consistently in both the clinical literature and research on menopausal symptoms:

• Xiao Yao San (Free and Easy Wanderer): the most studied formula for perimenopausal mood, depression, and anxiety. Mechanisms include phytoestrogenic ERα activity, serotonin modulation, and HPA axis/cortisol normalization

• Liu Wei Di Huang Wan (Six Ingredient Rehmannia): broadly used for the hormonal and neurological aspects of menopause. Contains confirmed phytoestrogens affecting FSH, estradiol, and cognitive function. Well-studied for hot flashes, cognitive support, and bone health

• Kun Bao Wan: a patent formula specifically studied in a randomized controlled trial for menopausal symptoms, demonstrating significant Kupperman score reduction comparable to hormone therapy at 2 months

• Dang Gui Buxue Tang (Angelica and Astragalus): studied in a double-blind, placebo-controlled RCT for menopausal symptoms in Hong Kong women; addresses fatigue, energy, and phytoestrogenic support

• Tian Wang Bu Xin Dan: specifically studied for perimenopausal insomnia, with documented effects on gut microbiome restoration that correlate with sleep improvement — illustrating the gut-brain axis intersection with menopausal sleep disruption

Safety, Individualization, and Professional Guidance

Phytoestrogenic herbs are generally considered safe for most women, including many who cannot use pharmaceutical estrogen, which is great news for an entire population of women who cannot receive HRT. But, as discussed earlier, effective prescription is more complex than “if A, take B.” In addition, women with estrogen receptor-positive breast cancer history should discuss phytoestrogenic herbs carefully with their oncologist and a trained herbalist. Herb-drug interactions — particularly with anticoagulants, thyroid medications, and antidepressants — require professional screening.

For best results, it is strongly recommended to obtain Chinese herbal medicine from someone who has received formal education in their prescription. The most effective herbal formulas will be individualized to your specific symptom profile, reviewed against your full medication list, and adjusted over time as your hormonal landscape changes. Two women with perimenopause may present very differently and may receive entirely different formulas — or different versions of a base formula — based on which biological patterns are most prominent.

About the Author

Erika F. Marie, DACM, LAc is a Doctor of Acupuncture and Chinese Medicine, and a licensed acupuncturist in South Carolina and Colorado. She is a West Point graduate and the founder of Chiyu | Acupuncture and Integrative Medicine in Longmont, Colorado and Chiyu Integrative Health worldwide. She is also a published researcher and peer-reviewer for EXPLORE: The Journal of Science and Healing. Dr. Marie consults with and treats patients in-person in Colorado and remotely via phone or video, specializing in complex, multi-system chronic conditions.

Ready to Address Your Full Symptom Picture?

Perimenopause and menopause do not have to be something you simply endure. In fact, in ancient Chinese texts, menopause was exalted as a woman’s “Second Spring.” With the right personalized herbal support, the biology underlying your symptoms can be resolved at their roots — and this transition can be not only manageable, but a joyful, exciting, season of renewal.

Dr. Marie offers in-person consultations in Longmont, Colorado and remote consultations by phone or video, so wherever you are in your journey, we are here. To schedule, visit chiyuacupuncture.com or you can text or call (720) 213-4999.

References

‍1. AARP Research: Women can experience up to 28 menopause-related symptoms, few recognize perimenopause as the cause. As cited in: What Are Some Atypical Symptoms of Menopause? AARP, 2025. https://www.aarp.org/health/conditions-treatments/unusual-menopause-symptoms/

2. Lesser-known menopause symptoms: palpitations, formication, electric shock sensations, tinnitus, and sensory changes. Dr. Louise Newson. https://www.drlouisenewson.co.uk/knowledge/10-surprising-menopause-symptoms

3. Efficacy and Side Effects of Chinese Herbal Medicine for Menopausal Symptoms: A Critical Review — full symptom list including formication, palpitations, vertigo, headaches, sexual dysfunction. PMC3551256. https://pmc.ncbi.nlm.nih.gov/articles/PMC3551256/

4. Chinese herbal formulae for menopausal hot flushes: systematic review and meta-analysis of 19 RCTs (2,469 patients). Phytoestrogen identification in Dang Gui, Bai Shao, Shu Di Huang, Zhi Mu, Yin Yang Huo. PLOS One, 2019. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0222383

5. Menopause-related symptoms: CHM vs. acupuncture+CHM vs. hormone therapy — CHM alone significantly decreased Kupperman score and symptom count, no side effects. PubMed ID: 22314633. https://pubmed.ncbi.nlm.nih.gov/22314633/

6. TCM combined with hormone therapy for premature ovarian failure: meta-analysis of 17 RCTs (1,352 participants) — superior FSH and E2 modulation vs. HRT alone. PMC5416635. https://pmc.ncbi.nlm.nih.gov/articles/PMC5416635/

7. Adjuvant oral Chinese herbal medicine for menopausal depression: meta-analysis of 22 RCTs (1,770 participants). PMC6016167. https://pmc.ncbi.nlm.nih.gov/articles/PMC6016167/

8. The Efficacy and Safety of Modified Xiaoyao San (XYS) for Perimenopausal Syndrome: Systematic Review and Meta-Analysis — ERα phytoestrogenic mechanisms, serotonin and HPA axis modulation. ResearchGate/PMC. https://www.researchgate.net/publication/332449388

9. Effective herbal medicines for menopausal symptoms — black cohosh terpene glycosides: LH suppression via ER binding, no effect on FSH; phytoestrogen mechanisms. PMC5783135. https://pmc.ncbi.nlm.nih.gov/articles/PMC5783135/

10. Chinese medicinal formula GNL vs. tibolone for perimenopausal depression: 12-week RCT, comparable Hamilton Depression Scale scores, FSH reduction, E2 increase. PubMed ID: 19769482. https://pubmed.ncbi.nlm.nih.gov/19769482/

11. Clinical study on memory quotient, estrogen levels, and kidney-nourishing Chinese herbs in perimenopausal women. Cited in: Chinese herbal medicine for menopausal symptoms (Cochrane). PubMed ID: 26976671. https://pubmed.ncbi.nlm.nih.gov/26976671/

12. Osthole ameliorates estrogen deficiency-induced cognitive impairment in female mice via hippocampal neuronal signaling. Front Pharmacol. 2021. PMC: 34025413. https://pubmed.ncbi.nlm.nih.gov/34025413/

13. Standardized Panax ginseng extract: double-blind placebo-controlled trial demonstrating quality of life and physiological improvements in symptomatic postmenopausal women. Cited in PMC3551256. https://pmc.ncbi.nlm.nih.gov/articles/PMC3551256/

14. Botanical drug preparations for menopausal hair loss — 52% prevalence; DHT/5-alpha reductase mechanisms; phytoestrogen, antioxidant, and microcirculation pathways; saw palmetto (30–40% DHT reduction), ginseng, rosemary. Frontiers in Pharmacology, 2025. PMC12689892. https://pmc.ncbi.nlm.nih.gov/articles/PMC12689892/

15. Herbal remedies for hair loss — saw palmetto, ginseng, pumpkin seed oil: 5-alpha-reductase inhibition, improved hair density and thickness, anagen phase extension. PMC12324729. https://pmc.ncbi.nlm.nih.gov/articles/PMC12324729/

16. Plant-derived anti-androgens: Reishi (Ling Zhi) — strongest 5-alpha-reductase inhibitory activity of 20 mushroom species; licorice phytoestrogen and testosterone reduction; green tea epigallocatechin 5-alpha-reductase inhibition. PMC3693613. https://pmc.ncbi.nlm.nih.gov/articles/PMC3693613/

17. Protective role of flavonoids in hair follicle disruption — biochanin A activates Wnt/β-catenin signaling in follicle dermal papilla cells, prevents DHT nuclear translocation in androgen receptor. PMC7013965. https://pmc.ncbi.nlm.nih.gov/articles/PMC7013965/

18. Herbal alternatives for androgenetic alopecia — Korean red ginseng improves hair density/thickness, inhibits 5-alpha-reductase; future of alopecia treatment review. PMC12115063. https://pmc.ncbi.nlm.nih.gov/articles/PMC12115063/

19. The action of herbal medicine on the libido — neurotransmitter mechanisms (dopamine, norepinephrine, serotonin, oxytocin), hormonal and androgenic pathways. Nutrire/Springer, 2018. https://link.springer.com/article/10.1186/s41110-017-0051-0

20. Effects of traditional Chinese medicine on symptom clusters during the menopausal transition — mood, sleep, cognitive function, and pain co-occurring with hot flushes; systematic review of 11 TCM trials. PubMed ID: 25017715. https://pubmed.ncbi.nlm.nih.gov/25017715/

21. Network pharmacology analysis of Guizhi decoction molecular targets in menopausal syndrome — cerebral vasomotor and serotonin pathway mechanisms. Medicine, 2022, as cited in: Springer Nature/Current Medical Science. https://link.springer.com/article/10.1007/s11596-023-2733-6

22. Arthralgia of menopause — a retrospective review confirming menopausal joint pain prevalence and clinical significance. PubMed ID: 37127408. https://pubmed.ncbi.nlm.nih.gov/37127408/

23. Effect of curcumin on rheumatoid arthritis — systematic review and meta-analysis, IL-1β, IL-6, TNF-α reduction. Frontiers in Immunology, 2023. https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2023.1121655/full

Disclaimer: This article is for educational purposes only and does not constitute medical advice or a diagnosis. Always consult with a qualified healthcare provider about your individual health situation, especially before beginning herbal therapy if you are taking prescription medications or have a history of hormone-sensitive conditions.