Menopause

What is Menopause?

Menopause is the natural and permanent end of menstruation, caused by the ovaries making much less estrogen, and it is confirmed after 12 months without a period.^[1] It usually happens between ages 45 and 56, with a median age of 51 in the United States.^{[1, 2]} The years before the final period are called perimenopause, a transition marked by wide hormone swings and irregular periods.^[3]

Common symptoms

Hot flashes and night sweats, known together as vasomotor symptoms, affect roughly 50% to 75% of women during the transition, and more than half have genitourinary symptoms such as vaginal dryness and discomfort.^[2] Hot flashes typically last more than 7 years, and genitourinary symptoms are often long-lasting.^[2]

Other common changes include mood disruption, temporary problems with thinking and memory, and poorer sleep.^[3] Many women also notice aches in muscles and joints.^[4]

Causes and risk factors

Natural menopause results from the gradual loss of egg-containing follicles in the ovaries and the fall in estrogen that follows.^[3] Menopause can also be induced by surgery to remove the ovaries or by cancer treatments, and it can occur early because of premature ovarian insufficiency.^[1] Each woman's experience differs, and symptoms vary widely from person to person.^[3]

How it is diagnosed and treated conventionally

Natural menopause is usually recognized from your age, symptoms and menstrual history rather than a blood test.^[1] Your physician can check other causes if your periods change unusually or you are younger than expected.

For bothersome hot flashes and genitourinary symptoms, estrogen-based hormone therapy is the first-line treatment. Systemic estrogen reduces hot flash frequency by about 75%, and low-dose vaginal estrogen helps genitourinary symptoms.^[2] Hormone therapy is not suitable for everyone, for example women with certain cancers or cardiovascular disease.^[5] Non-hormonal options include certain antidepressants and gabapentin, which lower hot flash frequency by about 40% to 65%.^[2]

Why Menopause calls for a whole-person approach

Menopause is a hormonal change, but its effects reach sleep, mood, bones, joints, weight and the heart. Symptoms in one area often feed into another, so a plan that looks at the whole person can make sense next to hormone-based treatment.^[6]

Supportive care aims at day-to-day symptoms and general wellbeing. It does not take the place of screening or treatment for bone and heart health from your physician.

Sleep and mood

Sleep disturbance and mood changes are part of the transition, and a meta-analysis of 55 studies found that about 36% of menopausal women had depression, although the studies varied widely.^[7] Poor sleep and low mood may also affect cardiovascular risk.^[6]

Heart and metabolic health

The menopause transition brings shifts in body composition, blood pressure, cholesterol and insulin sensitivity, and it appears to be a cardiovascular risk factor beyond ageing alone.^[6] Regular checkups of blood pressure, lipids and blood sugar belong to your physician's care.

Muscles, joints and bones

More than 70% of women report musculoskeletal symptoms during the transition, including joint pain, loss of muscle mass and loss of bone density.^[4] Low estrogen also raises the risk of osteoporosis, which needs medical assessment.

Acupuncture for Menopause

What the research shows

The research on acupuncture for menopause is mixed, and it is strongest for sleep and general symptoms rather than hot flashes.

For hot flashes, a Cochrane review of 16 trials (1,155 women) found no clear difference between acupuncture and sham acupuncture in frequency, with low-quality evidence, and acupuncture was less effective than hormone therapy. It did appear to help compared with no treatment, but those trials had no sham control, so expectation may explain some of the effect.^[8] A larger, well-designed trial of 327 women in Australia found real acupuncture no better than sham for hot flashes.^[9] A later sham-controlled trial of electroacupuncture in 72 women also found no difference in hot flash scores, although sleep quality and some menopausal symptom scores improved more with electroacupuncture.^[10] A 2022 meta-analysis of 13 trials (seven could be pooled) found that acupuncture did not change end-of-treatment hot flash frequency or severity compared with sham, and the authors judged the trials to be few and of low quality.^[11]

For perimenopausal insomnia, a 2025 meta-analysis of nine trials (968 women) reported better sleep scores with acupuncture than with the comparison treatments, and called for larger, longer trials.^[12] Reviewers for the International Menopause Society found promising but mostly low-certainty evidence for acupuncture overall.^[13] The North American Menopause Society does not recommend acupuncture for hot flashes, citing limited or inconsistent evidence.^[5]

How acupuncture may work

How acupuncture might ease menopausal symptoms is not settled. Some trials measured estrogen, FSH and LH levels, but results were inconsistent, and the 2022 review found no clear difference from hormone therapy on those measures from low-quality studies.^[11] Any benefit for sleep and wellbeing may involve relaxation and expectation as well as physical effects, and the sham-controlled results above suggest these play a large role.^{[9, 10]}

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points on the body, usually left in place for about 20 to 40 minutes. The two sham-controlled trials above gave 10 sessions over 8 weeks and 18 sessions over 6 weeks. We reassess after a short course of visits.^{[9, 10]}

In prospective studies, about 9 in 100 patients had a minor reaction such as brief bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000.^[14] Tell the practitioner first if you have a bleeding disorder, take blood thinners, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine for Menopause

The Ayurvedic view

Ayurveda describes the years of menopause as the Vata phase of life, when the drying, cooling and mobile qualities of Vata are said to increase. Hot flashes and night sweats are described as aggravated Pitta, and dryness, anxiety and restless sleep as Vata. These are traditional frameworks, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Diet and daily routine, such as regular meals, cooling foods for heat symptoms and steady sleep hours
• Warm oil massage, which is traditionally used for dryness and restlessness
• Breathing practices, gentle yoga and other stress-reducing habits
• Herbs traditionally used for women's health, such as ashwagandha, shatavari and fenugreek

Panchakarma is not appropriate during acute illness, frailty, or when a medical evaluation is incomplete, and it is not appropriate during pregnancy. Because menopause is a time of changing bone and heart health, any intensive cleansing program should be discussed with your physician first.

What the research shows

Evidence for Ayurvedic treatment of menopause is limited, and it consists of a few small trials of single herbs. In an 8-week placebo-controlled trial of 100 perimenopausal women, an ashwagandha root extract lowered menopause rating scale scores and raised estradiol while lowering FSH and LH compared with placebo.^[15] The trial was short and larger confirmation is needed. We found no systematic review of Ayurvedic medicine for menopause. Quality control also matters, because one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[16]

Herbal medicine for Menopause

Herbs and formulas that have been studied

Herbal products studied for menopausal symptoms include Chinese herbal formulas, black cohosh, and phytoestrogen-containing plants such as soy isoflavones.^{[17, 18, 19]}

What the research shows

The evidence is limited and mixed, and most trials have a high risk of bias. A Cochrane review of 22 trials (2,902 women) found insufficient evidence that Chinese herbal medicine was better or worse than placebo or hormone therapy for hot flashes, with evidence quality from very low to moderate.^[17] A JAMA meta-analysis of 62 trials found that phytoestrogens modestly reduced the frequency of hot flashes and vaginal dryness, but not night sweats, and about three quarters of the trials had a high risk of bias.^[18] The same analysis found no benefit from Chinese medicinal herbs on vasomotor symptoms.^[18]

A meta-analysis of 22 trials (2,310 women) found that black cohosh extracts improved overall menopausal symptoms and hot flashes more than placebo, though not anxiety or depression.^[19] The International Menopause Society review rated the evidence for black cohosh and Chinese herbal medicine as moderate in certainty for some outcomes, and concluded that overall evidence remains limited.^[13] The North American Menopause Society does not recommend supplements and herbal remedies for hot flashes.^[5]

Safety and herb-drug interactions

Herbs are active substances, and some products have caused harm. Products labeled as black cohosh have been linked to clinically apparent liver injury, in some cases severe, and the herb is claimed to have estrogen-like effects.^[20] Women with a history of breast or other hormone-sensitive cancer, or taking tamoxifen or an aromatase inhibitor, should check with their oncologist before using any herb.

About one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[16] Herbs should come from tested sources and be prescribed individually. Tell us about all your medicines and supplements, and if you have liver or kidney disease, take blood thinners or thyroid medicine, or are pregnant or breastfeeding.

Translating traditional medicine into modern biological language

This is interpretation, not equivalence. Chinese medicine often describes menopausal symptoms as kidney yin deficiency with heat, the pattern targeted in one of the trials above, along with liver qi stagnation when mood symptoms are prominent.^[9] Ayurveda describes aggravated Vata and Pitta. Researchers instead study the fall in estrogen, the effect on the brain's temperature control, sleep and stress responses, and some trials measure estradiol, FSH and LH.^{[11, 15]}

No study has shown that a TCM pattern or a dosha corresponds to a specific hormonal or biological change.

How this care fits with your medical care

Integrative care for menopause is complementary. Keep seeing your gynecologist or primary care physician, continue any hormone therapy or other medicine as prescribed, and do not stop or change prescribed treatment without your prescriber. We do not diagnose the cause of changing periods or hormone-related symptoms, so new or unusual symptoms should be medically evaluated.

Please bring your diagnosis, a list of all medicines and supplements including hormone therapy, recent bone density, blood pressure and blood test results, and any history of cancer or blood clots.

When to seek urgent medical care

Some symptoms need prompt medical attention and are not routine menopausal changes.

• Any vaginal bleeding after 12 months without a period
• Very heavy bleeding that soaks through a pad or tampon every hour for several hours
• Chest pain or pressure, shortness of breath, or a racing or irregular heartbeat
• Sudden weakness, trouble speaking, facial droop or a sudden severe headache
• A red, swollen or painful leg, which can signal a blood clot
• Thoughts of harming yourself or feeling unable to cope

If any of these occur, call 911 or go to the nearest emergency department.