Traditional Chinese medicine: perspectives on and treatment of menopausal symptoms

This comprehensive editorial examines how Traditional Chinese Medicine (TCM) understands and treats menopausal symptoms, offering a holistic perspective grounded in thousands of years of clinical practice. Menopause affects approximately 84.2% of women aged 40-60 years globally, manifesting through hot flashes, emotional disturbances, insomnia, fatigue, and other symptoms related to declining estrogen levels. In TCM, menopause is understood through the concept of "kidney deficiency," where the kidney is viewed not merely as an organ but as a system responsible for regulating temperature, fertility, and fluid balance. According to TCM theory, the female life cycle is divided into 7-year phases, and at age 49 (the seventh phase), a natural decline in organic functions occurs, particularly renal.

The imbalance between Yin and Yang, complementary concepts that maintain the harmonious functioning of the organism, results in dysfunction of visceral organs and the appearance of menopausal symptoms. For hot flashes, which affect 60-80% of menopausal women, TCM primarily uses methods to nourish Yin and clear heat. A randomized controlled trial of 123 women compared the Kuntai capsule, a patented Chinese medicine, with estradiol valerate over 3 months. Both treatments showed similar efficacy in reducing hot flashes (92.3% vs 96.5%, p>0.05), demonstrating that Chinese medicine can be as effective as conventional hormone therapy.

Another study with Zhibai Dihuang showed significant improvement in vasomotor symptoms compared with placebo. Acupuncture also demonstrated notable efficacy, with studies showing that more than 62% of patients reported improvement within 24 hours, compared with only 27% in the control group. For emotional disturbances such as depression and anxiety, TCM identifies the cause in renal deficiency that affects the heart, liver, and spleen. The liver, responsible for emotional regulation in TCM theory, presents depression (stagnation), while inadequate interaction between kidney and heart aggravates psychological symptoms.

Studies with Xiangshao granules showed regulation of serum neurotransmitters, including serotonin, norepinephrine, and epinephrine. Bilateral acupuncture at specific points (Feishu, Xinshu, Ganshu, Pishu, Shenshu, and Geshu) demonstrated efficacy comparable to fluoxetine hydrochloride in the treatment of menopausal depression, with superior results at weeks 2 and 4. For sleep disturbances, TCM attributes the main cause to renal deficiency and Yin-Yang disharmony. A systematic review of six randomized studies with 510 patients compared JiaWeiSuanZaoRen soup with sleep medications, showing efficacy comparable to diazepam and alprazolam, but superior to estazolam.

Furthermore, the Chinese formula significantly improved sleep quality according to the Pittsburgh Sleep Quality Index and produced fewer adverse events. A small placebo-controlled trial with acupuncture showed significant improvement in the sleep quality index, with polysomnography indicating increased duration of deep sleep. TCM treatment is based on syndrome differentiation, a concept that identifies specific patterns of imbalance to guide individualized therapies. These may include Chinese herbal therapy, acupuncture, moxibustion, Tuina massage, auriculotherapy, emotional therapy, and dietary therapy.

The holistic TCM approach considers not only physical symptoms but also emotional and energetic aspects, seeking to restore Yin-Yang balance and strengthen renal Qi. The studies demonstrate that TCM can significantly relieve symptoms, improve quality of life, and offers a favorable cost and safety profile. However, the author acknowledges the need for additional multicenter, randomized, double-blind, controlled studies with larger samples to develop reliable and reproducible clinical guidelines for the treatment of menopausal symptoms through TCM.