Compiled by Joseph Brady MSTCM, L.Ac., Dipl. OM

Contact: taichiproj@earthlink.net | joe.brady@faculty.ccmu.edu

1529 York Street, Denver, CO 80206

Acknowledgements

Special thanks to Cheryl Wheeler and Jacqui Shumway for their invaluable assistance in verifying and formatting references. Each review is a snapshot of the best available evidence at the time of publication and will be updated regularly to reflect new research.

Author’s Note on AI Use

Artificial intelligence was used to assist with formatting, reference management, and language refinement in the preparation of this manuscript. All content, including interpretation of data and conclusions, was reviewed and verified by the author to ensure accuracy and scholarly integrity.

Chinese Medicine and Menopausal Symptoms: A Review of the Evidence

Introduction

Menopause, a natural biological transition in midlife, often brings distressing symptoms including hot flashes, night sweats, insomnia, anxiety, mood disturbances, and bone density loss. While hormone therapy (HT) remains the gold standard, safety concerns have led many women to seek alternatives. Traditional Chinese Medicine (TCM), encompassing acupuncture, Tai Chi, Qigong, dietary therapy, and herbal medicine, offers promising, non-hormonal strategies. This review synthesizes current evidence across these modalities, prioritizing systematic reviews, meta-analyses, and rigorously designed randomized controlled trials, with evidence categorized according to the GRADE system.

Acupuncture

Acupuncture is one of the most studied TCM interventions for menopausal symptoms, particularly vasomotor symptoms (VMS). A large umbrella systematic review by Befus et al. (2018) concluded that acupuncture provides a moderate reduction in hot flash frequency and improvements in health-related quality of life (HRQoL). While the placebo effect and patient expectation may contribute to perceived efficacy, the intervention consistently demonstrated clinical benefit over no treatment. A more recent meta-analysis comparing acupuncture to hormone therapy found it to be less effective at reducing hot flashes, but with a significantly safer profile (He et al., 2021). Safety reviews confirm that when performed by trained practitioners, acupuncture is generally safe with minimal adverse events.

GRADE: Moderate-quality evidence for VMS reduction; High safety profile.

Mind-Body Therapies: Yoga, Meditation, and Hypnosis

Mind-body therapies address the psychological and emotional dimensions of menopause. Multiple high-quality reviews suggest that these therapies may not directly reduce hot flash frequency, but significantly improve sleep, anxiety, and quality of life.

Mindfulness Meditation:

A landmark RCT by Carmody et al. (2011) found that mindfulness-based stress reduction (MBSR) improved the bothersomeness of hot flashes, sleep, and anxiety, though not the frequency or severity. Follow-up studies showed sustained benefit with daily 35-minute practices over 8 weeks (Thomas et al., 2021).

Yoga:

Cramer et al. (2018) conducted a meta-analysis that showed yoga improved mood, sleep, and psychological well-being. While the impact on VMS was limited, yoga offered an excellent safety profile.

Hypnosis:

Among mind-body therapies, hypnosis has the strongest evidence for reducing hot flash frequency and severity, with several RCTs demonstrating clinically meaningful results comparable to some pharmaceutical treatments (Johnson et al., 2019). However, hypnosis requires access to trained clinicians.

GRADE:

• Hypnosis: High-quality evidence for VMS
• Meditation & Yoga: Moderate-quality evidence for sleep, anxiety, and QoL
• All: High safety, patient-preferred, culturally adaptable

Tai Chi and Qigong

Tai Chi and Qigong, traditional Chinese mind-body practices, have demonstrated strong effects on sleep quality, mood regulation, and quality of life, though evidence for VMS is less robust.

A 2020 meta-analysis (Si et al.) involving 25 RCTs found moderate improvements in subjective sleep quality from Tai Chi (SMD = −0.512). Qigong and Baduanjin also improved sleep and mood across multiple trials. Psychological benefits included reduced anxiety and depression symptoms, often outperforming conventional aerobic exercise (Hui et al., 2023). Qigong significantly improved mental health, vitality, and bodily pain scores in perimenopausal women (Carcelén-Fraile et al., 2022).

Bone health data is mixed: some studies suggest Tai Chi increases spinal bone mineral density, but effects on hip BMD remain inconclusive (Zhang et al., 2024). These practices maintain a stellar safety record, making them ideal for older adults.

GRADE:

• Moderate-quality evidence for sleep and psychological symptoms
• Low-quality but promising evidence for bone density and general menopause symptom relief

Herbal Medicine and Dietary Interventions

Dietary Soy & Phytoestrogens:

A meta-analysis of 61 studies (Oh et al., 2024) reported that soy isoflavones reduce hot flashes by 40–75%, particularly at 50mg/day. A low-fat vegan diet with soybeans reduced moderate-to-severe hot flashes by 88% over 12 weeks (Kahleova et al., 2023). However, only 30–50% of individuals are “equol producers”—a gut microbiome factor that affects soy metabolism and symptom relief.

Herbal Medicines (e.g., Red Clover, Black Cohosh):

Red clover isoflavones show modest benefits, especially at 80 mg/day. Black cohosh remains controversial, with mixed results across systematic reviews. The strongest herbal interventions used combination formulas, such as EstroG-100 and Nutrafem, which showed significant Kupperman Index improvements with minimal side effects (Chang et al., 2012; Garcia et al., 2010).

Traditional Herbal Formulas:

Erxian Decoction (EXD) and Danggui Buxue Tang have been widely studied. A 2024 meta-analysis (Wang et al.) of 42 studies with 3,112 breast cancer patients reported significant reductions in hot flash scores and improvements in sleep and anxiety. East Asian herbal medicine also demonstrated strong evidence for menopausal insomnia across 70 RCTs (Kwon, 2024). These formulas appear safe and do not interfere with endocrine therapy.

GRADE:

• Soy Isoflavones: Moderate-quality evidence for hot flashes
• East Asian Herbal Formulas: Moderate-quality evidence for sleep and psychological symptoms
• Black Cohosh/Red Clover: Low-to-moderate evidence
• Safety: High for dietary soy and traditional formulas, caution for individual herbs due to variability

Conclusion

Chinese medicine offers multiple evidence-based, low-risk interventions for managing menopausal symptoms. Acupuncture and hypnosis provide moderate-to-high quality evidence for reducing vasomotor symptoms. Tai Chi, Qigong, yoga, and meditation are strongly supported for improving sleep, mood, and quality of life, and are safe for long-term use. Soy isoflavones and select herbal formulations like EXD and EstroG-100 show promise for symptom relief, though responses vary. A personalized, integrative approach—guided by patient preferences and safety considerations—appears most effective. Future research should focus on long-term efficacy, standardization of herbal products, and trials inclusive of diverse populations.

Key References

Befus, D., Coeytaux, R. R., Goldstein, K. M., et al. (2018). Management of menopause symptoms with acupuncture: An umbrella systematic review and meta-analysis. *Journal of Alternative and Complementary Medicine, 24*(4), 314–323. https://doi.org/10.1089/acm.2016.0408

Carmody, J., Crawford, S., Salmoirago-Blotcher, E., et al. (2011). Mindfulness training for coping with hot flashes: Results of a randomized trial. *Menopause, 18*(6), 611–620. https://doi.org/10.1097/gme.0b013e318204a05c

Cramer, H., Peng, W., & Lauche, R. (2018). Yoga for menopausal symptoms—a systematic review and meta-analysis. *Maturitas, 109*, 13–25. https://doi.org/10.1016/j.maturitas.2017.12.005

He, Y., Chen, H., Li, Y., et al. (2021). Acupuncture versus hormone therapy in the treatment of menopausal symptoms: A meta-analysis. *Menopause, 28*(5), 555–563. https://doi.org/10.1142/S0192415X21500853

Thomas, T., Kamath, N., Kumar, A., & D’Silva, F. (2021). Effect of Mind-Body Approaches on Menopausal Symptoms among Women: A Community-Based Pilot Study. *Journal of Health and Allied Sciences NU* DOI: 10.1055/s-0040-1722423.

Johnson, A., Roberts, L., & Elkins, G. R. (2019). Complementary and Alternative Medicine for Menopause. *Journal of Evidence-Based Integrative Medicine* DOI: 10.1177/2515690X19829380

Si, Y., Wang, C., Yin, H., Zheng, J., Guo, Y., Xu, G., & Ma, Y. (2020). Tai Chi Chuan for Subjective Sleep Quality: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. *Evidence-Based Complementary and Alternative Medicine, 2020*, 4710527. https://doi.org/10.1155/2020/4710527

Carcelén-Fraile, M. D. C., Hita-Contreras, F., Martínez-Amat, A., et al. (2022). Impact of Qigong exercises on the severity of the menopausal symptoms and health-related quality of life: A randomised controlled trial. *European Journal of Sport Science, 22*(2), 1–10. https://doi.org/10.1089/acm.2011.0133

Zhang, C., et al. (2024). Effect of Tai Chi exercise on bone health and fall prevention in postmenopausal women: A meta-analysis. *Journal of Orthopaedic Surgery and Research, 19*, 1–12. DOI: 10.1186/s13018-024-04962-y

Oh, M. R., Park, J. H., Park, S. K., & Park, S. (2024). Efficacy of plant-derived dietary supplements in improving overall menopausal symptoms in women: An updated systematic review and meta-analysis. *Phytotherapy Research*. https://doi.org/10.1002/ptr.8112

Kahleova, H., Holtz, D., Strom, N., et al. (2023). A Dietary Intervention for Postmenopausal Hot Flashes: A Potential Role of Gut Microbiome. *Complementary Therapies in Medicine, 72*, 103002. https://doi.org/10.1016/j.ctim.2023.103002

Chang, A., Kwak, B. Y., Yi, K., & Kim, J. S. (2012). The effect of herbal extract (EstroG-100) on pre-, peri- and post-menopausal women: a randomized double-blind, placebo-controlled study. *Phytotherapy Research, 26*(4), 510–516. https://doi.org/10.1002/ptr.3597

Garcia, J. T., Gonzaga, F., Tan, D., et al. (2010). Use of a multibotanical (Nutrafem) for the relief of menopausal vasomotor symptoms: A double-blind, placebo-controlled study. *Menopause, 17*(2), 325–331. https://doi.org/10.1097/gme.0b013e3181bf8e92

Wang, R., Wang, Y., Fang, L., et al. (2024). Efficacy and safety of traditional Chinese medicine in the treatment of menopause-like syndrome for breast cancer survivors: A systematic review and meta-analysis. *BMC Cancer, 24*(1), 42. https://doi.org/10.1186/s12885-023-11789-z

Kwon, C. Y. (2024). Effectiveness and safety of East Asian herbal medicine for menopausal insomnia: A systematic review and meta-analysis. *Frontiers in Pharmacology, 15*, 1414700. https://doi.org/10.3389/fphar.2024.1414700