Perimenopause and Menopause: A Traditional Chinese Medicine Perspective

If you’re moving through perimenopause or menopause, you already know it’s more than hot flushes and missed periods. Sleep changes, mood shifts, weight creeps on differently, and food that never used to bother you suddenly does. In Traditional Chinese Medicine, all of this is understood as a natural, predictable transition — not a malfunction — and there’s a lot you can do through food, lifestyle, and movement to make it smoother.

The “Second Spring”

In Chinese, menopause has traditionally been called 第二春 (dì èr chūn) — the “Second Spring.” Rather than framing this stage as decline, TCM sees it as a renewal: the Blood and Qi once devoted to the reproductive cycle are redirected inward, particularly toward the Heart and Shen (spirit), supporting wisdom, creativity, and vitality in this next chapter of life. The concept draws on the Huangdi Neijing (the Yellow Emperor’s Inner Classic), the foundational text of Chinese medicine, which frames a woman’s life as unfolding in seven-year cycles — with menopause marking the shift out of the fertility phase and into this new one [13].

The TCM View: Kidney Essence in Decline

TCM sees this stage of life through the lens of Kidney Jing — the essence you’re born with that governs growth, reproduction, and ageing. From around age 35, Jing naturally begins to decline, and by the mid-to-late 40s that decline accelerates, showing up as the classic signs of perimenopause. Researchers investigating this framework describe perimenopausal syndrome as being closely tied to declining kidney function and shifting metabolic states, which lends some scientific grounding to a theory that’s over two thousand years old [1,2].

As Kidney Yin (the cooling, moistening, calming aspect of the body) diminishes faster than Kidney Yang, the body tips toward relative excess heat. This is why hot flushes, night sweats, irritability, and insomnia are so common — it’s not “too much heat” being generated, but not enough Yin left to keep things in check.

Two other organ systems play a big supporting role:

• Liver Blood and Liver Qi — the Liver stores Blood and keeps Qi flowing smoothly. As Blood becomes relatively scarcer, Liver Qi can stagnate, contributing to mood swings, tension, irritability, and irregular cycles in perimenopause.
• Spleen Qi — the Spleen governs digestion and the transformation of food into usable Qi and Blood. Spleen Qi naturally weakens with age, which is a big part of why metabolism feels different now (more on that below).

The Chong and Ren meridians, closely tied to the reproductive system and both rooted in the Kidneys, gradually become less abundant during this time — which is the TCM explanation for the physical changes in the menstrual cycle itself.

Why Your Metabolism Is Changing

This is where the Spleen comes in. In TCM, the Spleen is responsible for extracting Qi and nourishment from food and transforming it into usable energy and Blood. As Kidney Yang (the body’s metabolic “fire”) declines alongside Jing, Spleen function is affected too — digestion slows, foods that used to be fine now sit heavier, and energy extraction from food becomes less efficient.

This is why the eating habits that worked in your 20s and 30s often stop working now. A body with weakening Spleen Qi struggles more with cold, raw, greasy, or heavily processed foods — they’re harder to “transform,” and the result is sluggish digestion, bloating, and more of what’s eaten being stored rather than used. It’s not that your body is failing you; it’s that its digestive fire genuinely needs more support than before.

This lines up with conventional nutrition research too: declining oestrogen during the menopausal transition is associated with shifts in body composition and fat distribution, which is part of why dietary strategy matters more now than it did a decade ago [8].

Foods to Eat More Of

• Yin-nourishing foods: pears, tofu, black sesame seeds, mung beans, seaweed and other sea vegetables, barley, millet, black beans — these build fluids and moisture to counter dryness and heat.
• Kidney-strengthening foods: black sesame seeds, walnuts, goji berries, kidney beans, bone broth — traditionally used to replenish Jing.
• Blood-nourishing foods for the Liver: dark leafy greens, beetroot, dark grapes, goji berries — support smoother Liver Qi flow and steadier moods.
• Warm, cooked, easy-to-digest meals: soups, stews, congee, steamed vegetables — these are gentler on a Spleen that’s already working harder than it used to.
• Cooling fruits in moderation (if heat symptoms like hot flushes are prominent): pear, watermelon, Asian pear, mulberry.
• Soy foods (tofu, tempeh, edamame): a meta-analysis of 36 studies found women consuming 30–80mg of soy isoflavones daily had around 21% fewer hot flushes, with roughly 26% less severity, compared with placebo [9]. TCM has independently recommended soy-based foods like tofu for centuries as part of Yin-nourishing eating.

Foods to Cut Back On

• Spicy and heavily heating foods (chilli, excess ginger, deep-fried food) — these can intensify hot flushes, night sweats, and irritability by adding fuel to an already Yin-deficient system.
• Alcohol and excess caffeine — both are drying and depleting to Yin, and tend to worsen sleep disruption and hot flushes.
• Excess sugar and refined carbohydrates — these burden the Spleen and contribute to the energy dips and weight changes many women notice in this transition.
• Cold and raw foods in excess (iced drinks, large raw salads, food straight from the fridge) — these are harder for a weakened Spleen to process; even healthy foods count more when warm and cooked.
• Greasy, heavily processed foods — these generate dampness, which shows up as bloating, heaviness, and fatigue.

The goal isn’t strict elimination — it’s shifting the balance so digestion has less to fight against and more raw material to build Yin and Blood.

Lifestyle and Movement: Training Smarter, Not Harder

The exercise habits that served you well before often need adjusting now, and this is one of the most overlooked pieces of the puzzle.

• Favour gentler, sustained movement over depleting, high-intensity training. Long, hard cardio sessions and constant high-intensity workouts can actually drain Qi and Blood further, worsening fatigue and hot flushes rather than helping. Walking, swimming, cycling at a moderate pace, and strength training two to three times a week (important for bone and muscle health as oestrogen declines) tend to work better than daily high-intensity sessions.
• Bring in Qigong or Tai Chi. These practices combine slow movement, breath, and focus in a way TCM considers ideal for this stage — they build and circulate Qi rather than exhausting it, and specific Kidney Qigong forms are traditionally used to support Jing directly. This isn’t just tradition: a randomised controlled trial of 125 women found Qigong significantly reduced the severity of menopausal symptoms and improved quality of life compared with controls [10], and a systematic review found Tai Chi improved general health, vitality, mental health, and even spinal bone mineral density in perimenopausal women [11].
• Prioritise recovery and sleep. Rest is when Yin and Blood are replenished. Overtraining or under-sleeping during this transition undermines everything else you’re doing with food.
• Manage stress deliberately. Because Liver Qi stagnation is so central to mood symptoms, anything that keeps Qi moving gently — walking outdoors, stretching, breathwork, time away from screens — has an outsized effect on irritability and sleep.

The Bigger Picture

Perimenopause and menopause aren’t a problem to be fixed but a transition to be supported — one where the Kidneys, Liver, and Spleen all need a bit more help than before. Small, consistent shifts in what you eat, how you move, and how you rest can make a real difference to how this stage of life feels.

This article is general information based on TCM theory and isn’t a substitute for personalised care. If you’d like a treatment plan tailored to your own symptoms and constitution, book in for a consultation.

Finer Point Acupuncture offers a free 20-minute consultation. It’s a chance to meet your practitioner, get a feel for the space, and have an initial conversation about your stress from a Chinese Medicine perspective.

References

1. Xu, W. et al. (2020). The Metabolomic Rationale for Treating Perimenopausal Syndrome as Kidney Deficiency. PMC. pmc.ncbi.nlm.nih.gov/articles/PMC7746443
2. Zhu, X. et al. (2018). Traditional Chinese medicine: perspectives on and treatment of menopausal symptoms. Climacteric, Taylor & Francis. tandfonline.com/doi/full/10.1080/13697137.2018.1434983
3. Lee, M. S. et al. (2020). The treatment of menopausal symptoms by traditional Chinese medicine in Asian countries. PubMed. pubmed.ncbi.nlm.nih.gov/33094658
4. Yin, X. et al. (2020). Acupuncture for menopausal symptoms in Chinese women: a systematic review. PubMed. pubmed.ncbi.nlm.nih.gov/32729333
5. Chen, N. et al. (2025). Comparative effectiveness of different acupuncture therapies for perimenopausal syndrome: a systematic review and network meta-analysis. Frontiers in Neurology. frontiersin.org/articles/10.3389/fneur.2025.1696085
6. Effect of Combining Therapy with Traditional Chinese Medicine-Based Psychotherapy and Herbal Medicines in Women with Menopausal Syndrome: A Randomized Controlled Clinical Trial. PMC. ncbi.nlm.nih.gov/pmc/articles/PMC3523610
7. Herbal Medicines (Danggui Liuhuang Decoctions) for Management of Menopausal Symptoms: A Systematic Review of Randomized Controlled Trials. PMC. ncbi.nlm.nih.gov/pmc/articles/PMC7355969
8. Dietary interventions and nutritional strategies for menopausal health: a mini review (2025). Frontiers in Nutrition. frontiersin.org/articles/10.3389/fnut.2025.1702105
9. Effects of soy isoflavones on menopausal symptoms in perimenopausal women: a systematic review and meta-analysis. PMC. ncbi.nlm.nih.gov/pmc/articles/PMC12296567
10. Jang, S. et al. (2022). Impact of Qigong exercises on the severity of the menopausal symptoms and health-related quality of life: A randomised controlled trial. PubMed. pubmed.ncbi.nlm.nih.gov/35179431
11. Tai Chi Exercise for the Quality of Life in a Perimenopausal Women Organization: A Systematic Review. PubMed. pubmed.ncbi.nlm.nih.gov/28742289
12. Mind-Body Health Benefits of Traditional Chinese Qigong on Women: A Systematic Review of Randomized Controlled Trials. PMC. ncbi.nlm.nih.gov/pmc/articles/PMC8457943
13. Traditional Chinese medicine—What are we investigating?: The case of menopause. PMC. pmc.ncbi.nlm.nih.gov/articles/PMC2233879

Note: These are general educational references reflecting current TCM and biomedical literature. They support the framework used in this article but aren’t a substitute for individualised clinical assessment.