Understanding what is happening during perimenopause – and how acupuncture and a more holistic approach can form part of your support through this transition.
Perimenopause can be a confusing time.
Perhaps your periods have suddenly become heavier or less predictable. You’re sleeping badly, feeling more anxious, struggling to concentrate, getting headaches or hot flushes – or perhaps you simply don’t feel quite like yourself.
It’s very easy to assume that all of this means one thing: your oestrogen is getting low.
But the hormonal picture during perimenopause is actually much more complicated than that.
Perimenopause is a transition – not simply a hormone deficiency
Menopause is defined as the point at which you have gone 12 months without a period. By this stage, hormones – particularly oestrogen – are generally consistently lower.
Perimenopause is different.
During the years leading up to menopause, hormones can fluctuate considerably rather than simply declining in a straight line. This is one reason symptoms can feel so unpredictable – and why you might feel completely different from one month to the next.
Periods may become shorter, longer, heavier or irregular. Other symptoms can include hot flushes and night sweats, disrupted sleep, anxiety or irritability, changes in mood, brain fog, fatigue, headaches or migraines, breast tenderness, changes in libido and changes in weight or body composition.
This distinction is important because perimenopause isn’t necessarily a straightforward case of replacing something that is missing.
Your hormones are still active – they are simply becoming less predictable.
What about HRT?
Hormone Replacement Therapy (HRT) is one of the main medical treatment options for menopause-associated symptoms.
There are now many different formulations and ways of taking HRT, and finding the right approach can take time. This can be particularly true during perimenopause, when your own hormones are still fluctuating alongside the hormones being prescribed.
HRT during perimenopause can therefore sometimes be about trying to stabilise that hormonal rollercoaster rather than simply replacing hormones that have disappeared.
It’s also important that symptoms are looked at properly rather than automatically assuming that everything happening in your 40s is hormonal.
Take iron deficiency, for example.
Heavy or irregular periods can occur during perimenopause, and significant menstrual blood loss can contribute to iron deficiency or anaemia. Symptoms such as fatigue, dizziness, palpitations, headaches and difficulty concentrating can overlap with symptoms women may otherwise attribute to perimenopause.
If periods have become particularly heavy, or there has been a significant change in your bleeding, it is worth discussing this with your GP.
This is one reason I think it is so important to look at the person, rather than simply treating the label of “perimenopause”.
How does Chinese medicine look at perimenopause?
Chinese medicine has recognised menopause as a natural transition in a woman’s life for thousands of years.
Interestingly, the classical Chinese medical text the Huangdi Neijing describes significant changes in a woman’s reproductive system occurring at around the age of 49 – remarkably close to the average age of menopause today.
In Chinese medicine, however, we wouldn’t expect every woman going through perimenopause to experience the same symptoms – and therefore we wouldn’t necessarily treat them in the same way.
Two women of exactly the same age experiencing perimenopause might present completely differently.
One might be struggling with hot flushes, night sweats and anxiety.
Another might have extremely heavy periods, exhaustion and headaches.
Someone else may primarily be experiencing insomnia, irritability, digestive symptoms and brain fog.
From a Chinese medicine perspective, these differences matter. Although menopause is traditionally associated with changes in Kidney energy and Jing (Essence), in clinical practice women can present with combinations of patterns involving Blood, Liver, Spleen, Kidney and the Shen – our traditional concept relating to the mind and emotional wellbeing.
This is why there isn’t a single “menopause acupuncture treatment”.
So where does acupuncture fit?
When I see someone experiencing perimenopausal or menopausal symptoms, I’m interested in much more than whether or not she is taking HRT.
I want to understand what has changed, when it changed and how the different symptoms fit together.
That might include looking at menstrual cycles, sleep, stress, digestion, energy levels, headaches, temperature changes, emotional wellbeing and other aspects of health.
An acupuncture treatment can then be tailored to that individual presentation rather than using the same set of acupuncture points for everyone experiencing menopause.
And importantly, I don’t think acupuncture needs to sit on one side of an “HRT versus natural treatment” divide.
Women may come for acupuncture while taking HRT, while considering HRT, because they cannot or do not want to take it, or simply because they would like additional support alongside their existing healthcare.
For me, the important thing is understanding the individual woman and considering what combination of support may be most appropriate for her.
Looking beyond hormones
Another important part of navigating perimenopause is remembering that our health is influenced by much more than our reproductive hormones.
A useful way of looking at this is to consider several different pillars of health:
Nourish – supporting good nutrition, blood sugar balance, digestion and nutrient absorption.
Strengthen – maintaining muscle, bone health, metabolic health and physical resilience.
Regulate – supporting the nervous system, managing stress and looking after emotional wellbeing.
Restore – prioritising sleep, recovery and the things that allow our bodies and minds to recharge.
Support – getting additional help where appropriate, which might include acupuncture alongside conventional healthcare or other therapies.
It doesn’t mean trying to overhaul your entire life overnight.
Sometimes identifying the area that is struggling most and making a few realistic changes is a much better place to start.
A period of transition, not decline
Perimenopause can undoubtedly be a difficult time. Hormonal changes can affect how you feel physically and emotionally, sometimes at a point in life when you are already juggling an enormous amount.
But I think there is another side to this conversation that we don’t talk about enough.
Women are incredibly resilient. And one of our strengths is that we don’t necessarily have to sit back and accept feeling exhausted, anxious, uncomfortable or simply “not ourselves” as an inevitable consequence of getting older.
Instead, this can be an opportunity to take stock. To understand what is happening in your body, identify the areas that might need more support and start doing something about them.
That might mean exploring HRT with your doctor, having symptoms properly investigated, looking at nutrition and movement, prioritising sleep and recovery, addressing stress, or incorporating treatments such as acupuncture.
Often, it isn’t about finding one magic solution, but about putting several pieces of the puzzle together.
And perhaps there is a bigger picture too.
For many women, the years ahead can bring new freedoms. Children may be getting older and becoming more independent. Careers and finances may feel more established. There can be more opportunity to rediscover interests, relationships and ambitions that have perhaps taken a back seat while caring for everybody else.
So rather than seeing perimenopause purely as something to endure, perhaps we can also see it as a time to lay the foundations for the next stage of our lives – looking after our bodies, protecting our long-term health and working towards feeling as strong and well as we can.
The aim isn’t to turn back the clock or pretend that ageing doesn’t bring change. It’s to understand those changes, get support where we need it, and give ourselves the best possible chance of embracing what comes next feeling like the best version of ourselves.
Further information
This article was informed by practitioner education on perimenopause and menopause care, including Emma Eaton’s presentation Bridging the Gap in Peri/Menopause Care: What Every Acupuncturist Needs to Know (Especially about HRT), alongside current UK clinical guidance.
NICE – Menopause: identification and management
NICE – Heavy menstrual bleeding: assessment and management
Information in this article is intended for general educational purposes and should not replace individual medical advice. New, persistent or concerning symptoms, including abnormal or very heavy bleeding, should be discussed with an appropriate healthcare professional.