Perimenopause: Understanding Hormones Through Western & Chinese Medicine

What is happening hormonally during perimenopause using both Western medicine and Traditional Chinese Medicine (TCM). It reflects the integrative, root-cause philosophy of Traditional Chinese Medicine, combining evidence-informed care with holistic support.

Hormones in perimenopause

What is Perimenopause?

Perimenopause is the transitional phase leading up to menopause, often beginning in the late 30s to 40s. During this time, hormone levels fluctuate rather than steadily decline, which can cause a wide range of physical and emotional symptoms.

Common symptoms include:

• Irregular or heavy periods

• Hot flashes and night sweats

• Anxiety or low mood

• Sleep disturbances

• Brain fog

• Fatigue

• Weight changes

• Joint Pain

Western Medicine Perspective

Key Hormones Involved

Estrogen (Estradiol)

• Fluctuates significantly

• Can be relatively high or low at different times

• Symptoms: hot flashes, breast tenderness, headaches, heavy bleeding, mood changes

Progesterone

• Declines earlier than estrogen due to reduced ovulation

• Symptoms of low progesterone: anxiety, poor sleep, PMS, spotting, heavy periods

FSH & LH (Brain hormones)

• Increase as the brain tries to stimulate the ovaries

• Lead to irregular cycles and hormone swings

Testosterone

• Gradual decline

• Symptoms: low libido, fatigue, reduced muscle mass

Cortisol (Stress Hormone)

• Chronic stress worsens hormonal imbalance

• Stress can further reduce progesterone levels

Chinese Medicine Perspective

TCM views perimenopause as a natural life transition involving changes in the Kidney, Liver, Heart, and Spleen systems.

Kidney System (Hormonal Foundation)

Kidney Yin (Cooling, Nourishing)

• Similar to estrogen and body fluids

• Signs of deficiency: hot flashes, night sweats, dryness, insomnia

Kidney Yang (Warming, Activating)

• Similar to progesterone and metabolic drive

• Signs of deficiency: fatigue, cold intolerance, low libido, depression

Liver System (Hormone Regulation & Emotions)

Liver Qi Stagnation

• Mood swings, irritability, breast tenderness, PMS, irregular cycles

Liver Blood Deficiency

• Light or skipped periods, anxiety, dry skin/hair, dizziness

  
  

Heart–Kidney Connection

When communication between the Heart (mind/emotions) and Kidney (hormonal foundation) weakens:

• Anxiety

• Palpitations

• Insomnia

• Night waking with racing thoughts

  
  

Spleen System (Digestion & Hormone Metabolism)

Weak Spleen Qi may lead to:

• Poor hormone detoxification

• Weight gain

• Bloating

• Heavy bleeding

Common Patterns & Support Strategies

1. Kidney Yin Deficiency (Hot flashes, night sweats, dryness)

Herbs (TCM – practitioner guided):

• Zhi Mu

• Huang Bai

• Shu Di Huang

• Nu Zhen Zi

Supplements:

• Magnesium glycinate

• Omega-3 fatty acids

• Vitamin E

Foods:

• Black sesame seeds

• Tofu, tempeh

• Bone broth

• Stewed pears

• Dark leafy greens

Lifestyle:

• Prioritize sleep

• Avoid overheating

• Gentle evening routines

• Meditation, yin yoga

2. Kidney Yang Deficiency (Fatigue, cold, low libido)

Herbs:

• Rou Gui

• Du Zhong

• Tu Si Zi

• Ba Ji Tian

Supplements:

• Vitamin D

• B-complex

• Iron (if deficient)

Foods:

• Warming soups and stews

• Lamb, chicken

• Ginger, cinnamon

• Root vegetables

Lifestyle:

• Keep lower back and feet warm

• Regular meals

• Moderate strength training

3. Liver Qi Stagnation (Mood swings, PMS, breast tenderness)

Herbs:

• Chai Hu

• Xiang Fu

• Bai Shao

• He Huan Pi

Supplements:

• Magnesium

• B6

• Adaptogens (ashwagandha, rhodiola – case dependent)

Foods:

• Leafy greens

• Citrus peel

• Beets

• Lightly cooked vegetables

Lifestyle:

• Stress management

• Walking, stretching

• Emotional expression

• Avoid skipping meals

  
  

4. Heart–Kidney Disharmony (Anxiety, insomnia)

Herbs:

• Suan Zao Ren

• Bai Zi Ren

• Long Yan Rou

Supplements:

• Magnesium

• L-theanine

• Glycine

Foods:

• Oats

• Dates

• Walnuts

• Warm evening meals

Lifestyle:

• Screen-free evenings

• Consistent bedtime

• Breathing exercises

• Acupuncture support

  
  

5. Spleen Qi Deficiency (Bloating, weight gain, heavy periods)

Herbs:

• Dang Shen

• Bai Zhu

• Fu Ling

• Chen Pi

Supplements:

• Digestive enzymes

• Probiotics

• Chromium

Foods:

• Cooked grains

• Squash

• Sweet potato

• Ginger tea

Lifestyle:

• Eat regular meals

• Avoid excessive raw/cold foods

• Mindful eating

How We Support You at The Remedy Room

At The Remedy Room, we view perimenopause as a meaningful transition—not something to "push through" or suppress. Our care focuses on:

• Regulating hormonal rhythms

• Supporting nervous system balance

• Nourishing the body through food and lifestyle

• Individualized acupuncture and herbal medicine

  
  

Treatment plans may include acupuncture, custom Chinese herbal formulas, nutrition guidance, lifestyle support, and collaborative care when needed.

Kelsey Bru is a licensed acupuncturist and TCM Herbalist in the Courtenay, British Columbia. She loves working with women's health, hormones, menopause, fertility, mental health, and beyond through her online articles and at her clinic, The Remedy Room, on Cliffe Avenue, Courtenay. Call for an appointment at 250-800-7738.