Menopause and Traditional Chinese Medicine: Evidence, Syndromic Perspectives, and a Self-Care Protocol Proposal

Journal of Complementary Therapies in Health ISSN 2975-9323 |eISSN 2975-9552 Journal of Complementary Therapies in Health 2026:4(1). doi:10.5281/zenodo.17752642 institutoptc.com/journal-complementary-therapies Review Menopause and Traditional Chinese Medicine: Evidence, Syndromic Perspectives, and a Self-Care Protocol Proposal. Sebastiana Santos1*, Cláudia Pacheco e Sousa2, Gabriela Ramos Moreira2, Rafaela Oliveira Silva3, and Raquel Montenegro2. 1 IPN – Portuguese Institute of Naturology, Porto, Portugal; 2 Independent researcher; 3 Rafaela Silva Terapeuta Manual, Vila Nova de Famalicão, Portugal. * Correspondence: [email protected] Abstract Background: Menopause is a physiological transition characterised by ovarian failure and hypoestrogenism, leading to multisystemic symptoms that affect women’s physical, psychological, and social well-being. Traditional Chinese Medicine (TCM) provides a holistic framework for understanding this period through concepts such as Yin–Yang imbalance, Jing (essence) depletion, and Zang-Fu disharmonies. While Western medicine emphasises hormonal therapy and lifestyle modification, TCM offers complementary strategies aimed at systemic energetic regulation. Objective: To analyse menopausal care from the perspective of TCM, compare Eastern and Western therapeutic paradigms, identify predominant TCM syndromes, review available evidence on TCM interventions, and present a structured self-care protocol for climacteric women. Methods: A narrative review of classical TCM theory, Western biomedical literature, and 14 experimental studies on acupuncture, Qigong, herbal medicine, auriculotherapy, moxibustion, and diet therapy. Additionally, a self-care protocol grounded in TCM theory was systematised based on established clinical principles. Results: TCM conceptualises menopause as a decline in Kidney Jing and Yin, leading to disharmonies involving the Heart, Liver, Spleen, and key Extraordinary Meridians (Chong, Ren, Du). Reviewed studies showed that interventions such as Qigong, acupuncture (including ACE and laser), herbal formulas, and diet therapy significantly improved vasomotor symptoms, sleep, anxiety/depression, urogenital atrophy, metabolic parameters, and overall quality of life. A TCM-based self-care protocol was developed, integrating several relevant exercises targeting the core climacteric disharmonies by reinforcing Kidney energy, nourishing Yin, regulating the Heart– Kidney axis, and restoring Qi (vital energy) flow, supporting symptom relief and self-management. Conclusion: TCM offers a comprehensive and personalised approach to menopausal care, with evidence indicating effectiveness across vasomotor, psychological, urogenital, and metabolic domains. The proposed self-care protocol provides an accessible, low-risk tool for women to actively regulate symptoms and maintain energetic balance. Future research should include larger, standardised clinical trials and long-term follow-ups to validate TCM interventions and support their integration into evidence-based, integrative menopausal healthcare. Keywords: Menopause; Climacteric; Traditional Chinese Medicine; Qigong; Herbal Medicine; Integrative Medicine. Citation: Santos S., e Sousa C.P., Moreira G.R., Silva R.O., Montenegro R. Menopause and Traditional Chinese Medicine: Evidence, Syndromic Perspectives, and a Self-Care Protocol Proposal. Journal of Complementary Therapies in Health. 2026;4(1) 10.5281/zenodo.17752642 Academic Editor: Jorge Rodrigues Received: 15 October 2025 Reviewed: 10 November 2025 Revised: 25 November 2025 Accepted: 26 November 2025 Published: 28 November 2025 Publisher’s Note: IPTC stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Copyright: ©2026 by the authors. Submitted for open access publication under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Journal of Complementary Therapies in Health 2026: 4(1). 2 of 21 Santos S., e Sousa C.P., Moreira G.R., Silva R.O., Montenegro R. Menopause and Traditional Chinese Medicine: Evidence, Syndromic Perspectives, and a Self-Care Protocol Proposal. doi:10.5281/zenodo.17752642 1. Background Menopause is a milestone in a woman's reproductive life and corresponds to a physiological stage following the spontaneous cessation of menstruation, characterised by approximately one year of absence of the menstrual period, during which the menstrual and ovulatory cycles cease. In other words, it marks the end of the female sexual phases, a period in which the definitive cessation of ovarian activity in the release of follicles occurs, and therefore, the female reproductive capacity 1. According to Duarte 2, this transition can be physiological or natural and will depend on the woman's individual natural biological process. This cessation commonly occurs around 51 years of age in European countries; however, age is not the only determining factor. There are others that can contribute to this process, such as genetic predisposition or lifestyle habits (tobacco consumption, diet, physical activity, or intense mental distress) 3. In this female condition, there is reproductive gland failure, as a reduction in oestrogen production occurs, stimulating the development of symptoms that influence the biological, physiological, and psychological aspects of her life 4. Numerous authors cite these manifestations: amenorrhoea (absence of menstruation), vasomotor manifestations (hot flushes, sweating/diaphoresis, and headaches), depression, emotional, mood, and sleep changes, increased risk of myocardial infarction, vulvovaginal atrophy, urinary incontinence, recurrent urinary tract infections, changes in the elasticity, thickness, and resistance of the skin, increased risk of Alzheimer's and Cerebral Vascular Accident (CVA), concentration deficits and recent memory loss, reduced salivary flow, higher frequency of dental caries and tooth loss, weight gain, changes in the hairline, joint and bone pain, reduction in vaginal lubrication and libido. Psychological health is directly influenced, thus causing a strong impact on work, social, and conjugal life, and consequently, on her quality of life 4-8. Menopause is not an isolated event, but a specific point within the climacteric, the transition period between the reproductive and non-reproductive phases. Its classification varies according to aetiology and chronology, including iatrogenic types (induced by medical interventions), early (<40 years), and late (>53 years). The phase preceding it is called perimenopause, characterised by menstrual irregularity and endocrine changes, while the postmenopause encompasses the entire subsequent period. From a therapeutic perspective, epidemiology is crucial: the age of menopause onset correlates directly with specific health risks for women. Early menopause is associated with higher overall and cardiovascular mortality due to the premature deprivation of oestrogen’s cardioprotective effects, demanding an approach focused on the prevention of osteomuscular and cardiometabolic comorbidities. Conversely, late menopause, with prolonged hormonal exposure, raises the risk of hormone-dependent neoplasms (e.g., breast, endometrium), requiring specialised action in post-surgical rehabilitation and the management of sequelae such as lymphoedema 2,9. Thus, therapeutic intervention should be initiated early, personalised, and based on the patient's individual risk profile, aiming to maintain functionality and quality of life throughout the entire climacteric spectrum. The care approach for these women must be personalised, involving the individualisation of clinical factors and biomarkers necessary to stratify risk, identifying the intervention that best suits each individual 10. Ultimately, it involves active and supportive listening to emphasise the pursuit of well-being for women during the climacteric. To achieve this, it is necessary to understand the complexity of this phase and its impact on their lives. It is the responsibility of healthcare professionals to support them through the grief of losing the capacity to conceive, or the fear of the unknown that lies ahead. It represents an opportunity to rethink life and accept that changes are natural facts in human evolution. Therapeutic assistance encompasses various practices, both in the Western and Eastern contexts 11. Western Medicine employs both medicinal and non-medicinal therapies. The former primarily focuses on Hormone Replacement Therapy (HRT) and vitamin supplementa- Journal of Complementary Therapies in Health 2026: 4(1). 3 of 21 Santos S., e Sousa C.P., Moreira G.R., Silva R.O., Montenegro R. Menopause and Traditional Chinese Medicine: Evidence, Syndromic Perspectives, and a Self-Care Protocol Proposal. doi:10.5281/zenodo.17752642 tion 6 to treat menopausal symptoms. However, the non-medicinal approach includes nutritional guidance, advocating for a suitable diet combined with physical activity, and modification of habits, such as avoiding smoking and/or excessive alcohol consumption 12, stress management, and attention to interpersonal relationships 13. In contrast, TCM offers complementary approaches such as acupuncture, herbal medicine, and changes in diet and lifestyle to rebalance the body's energy 14. In the East, health promotion also involves practicing breathing exercises, martial arts, or other therapeutic practices like Yoga, Taijiquan, Qigong, and meditation, which, besides enhancing physical fitness, contribute to the ascent of these women's mental and emotional balance 11. This work was developed with the aim of verifying assistance in menopause through TCM, justified by the influence of menopause and the associated bodily and mental changes, which impair several contexts of the affected women's quality of life. The objectives of this research are: To conduct a literature review on menopause and its repercussions on the human body, to draw a parallel between the TCM and traditional perspectives, to differentiate existing treatments between Western and Eastern views of menopausal care, and to identify the main TCM treatment lines and their responses. 2. Menopause Menopause is a biological process inherent to female ageing. The average life expectancy has increased in recent years, and consequently, mortality has decreased, a factor that contributes to the global ageing of the population, resulting in an increasingly large percentage of the female population being in the postmenopause phase. Currently, in general, women will live about one-third of their life in postmenopause 15-17. When referring to the term menopause, it is of utmost importance to respect the internationally pre-established definitions: • Pre-menopause – encompasses the entire reproductive phase preceding Menopause 18. • Menopause – represents the date of the last menstruation, consequently, definitive ovarian failure. The clinical diagnosis is only confirmed retrospectively after 12 consecutive months of amenorrhoea, not resulting from another pathological or physiological cause. • Perimenopause – includes the phase preceding menopause (the preamble of the endocrinological, biological, and clinical modifications of the proximity of menopause) and the first year after menopause 18. • Postmenopause – designates the period subsequent to the last menstruation 18,19. The aetiology of menopause is neither consensual nor definitive, as it is a natural and inevitable biological process. In about 74% to 90% of cases, it is classified as idiopathic, being identified by a set of symptoms 20. As of the present moment, there is no independent biological marker to determine this diagnosis, thus dispensing with the serial measurement of oestradiol or Follicle-Stimulating Hormone (FSH). The common age marker is between 45 and 55 years, mostly established genetically, but there are other attributes involved, such as external factors (lifestyle). Among these, smoking is the most notorious 15,17, as, in smoking women, menopause tends to occur two years earlier 15,17,19. Besides smoking, there are other less explicit correlated factors: nulliparity, endometriosis, manifestation of autoimmune diseases, medication, surgical intervention, exposure to toxic chemicals, chemotherapy, pelvic radiation, epilepsy, and treatment for depression 15. There are also factors that can postpone the onset of menopause, such as obesity, multiparity, and alcoholism, being classified as late when its occurrence is evidenced after Journal of Complementary Therapies in Health 2026: 4(1). 4 of 21 Santos S., e Sousa C.P., Moreira G.R., Silva R.O., Montenegro R. Menopause and Traditional Chinese Medicine: Evidence, Syndromic Perspectives, and a Self-Care Protocol Proposal. doi:10.5281/zenodo.17752642 53 years of age. Due to prolonged oestrogen exposure, increased attention is warranted for the risk of breast and endometrial cancer in these cases 15,21. Menopause is a natural process, but it can be artificially induced with the total and instant loss of hormonal production, as in cases of Iatrogenic Menopause, which is defined by the cessation of menstrual flow due to surgical intervention on the ovaries (with or without hysterectomy) or after iatrogenic ablation of ovarian function (chemotherapy or radiation) 18. After characterising the different types of menopause, it is important to highlight that the progressive decline in ovarian function, associated with the inherent hormonal changes, is not limited to the reproductive scope. This process triggers a wide range of physiological and psychosocial repercussions that, in the short, medium, and long term, can compromise a woman's quality of life. The symptomatology is multisystemic, interfering with physical health, emotional balance, and the performance of daily activities, whether in the work, relational, or affective context 19. The intensity, duration, and combination of symptoms vary significantly among women, reflecting a complex interaction between biological, psychological, social, and cultural factors. This heterogeneity shows that the clinical manifestations of menopause constitute an individualised phenomenon, whose understanding is essential for defining appropriate therapeutic strategies 2. 2.1. Manifestations in the Short and Medium Term: • The first changes include menstrual irregularities, such as changes in flow pattern and cycle duration, resulting from ovarian dysfunction and anovulation 22. • Vasomotor symptoms (VMS), such as hot flushes and night sweats, are the most characteristic, affecting up to 75% of women, with pathophysiology related to the dysregulation of the hypothalamic thermoregulatory centre 23. • Sleep disturbances, such as insomnia and recurrent awakenings, are common and often associated with VMS 24. • Genitourinary Syndrome causes vaginal and urethral atrophy, dryness, urinary urgency, dyspareunia, and recurrent urinary tract infections 25. • Skin changes include skin thinning, loss of elasticity, hirsutism, and alopecia 26. • Psychological impacts, such as emotional lability, irritability, and depression, are frequent and multifactorial, intensified by physical symptoms and psychosocial factors 27. 2.2. Clinical Manifestations in the Long Term In the postmenopausal period, oestrogen deficiency triggers a series of physiopathological changes that substantially increase the risk of developing cardiovascular diseases and osteoporosis. • The redistribution of body fat to the abdominal compartment promotes a state of chronic inflammation and thrombogenicity (capacity to induce blood clot formation), characterised by the elevation of inflammatory markers (TNF-alpha, IL-6, CRP) and reduced adiponectin levels, while the lipid profile becomes progressively atherogenic (capable of inducing/favouring the formation of fatty plaques that accumulate on artery walls), with increased low-density lipoproteins (LDL), triglycerides, and lipoprotein(a), and decreased cardioprotective subclasses of high-density lipoproteins (HDL) 28. • Endothelial dysfunction, resulting from reduced nitric oxide availability and increased oxidative stress, exacerbates arterial hypertension and insulin resistance, fundamental components of the metabolic syndrome, whose prevalence increases significantly during the menopausal transition 29. • The risk of cardiovascular events quadruples in the first decade after menopause, with arterial hypertension affecting approximately three-quarters of women in this Journal of Complementary Therapies in Health 2026: 4(1). 5 of 21 Santos S., e Sousa C.P., Moreira G.R., Silva R.O., Montenegro R. Menopause and Traditional Chinese Medicine: Evidence, Syndromic Perspectives, and a Self-Care Protocol Proposal. doi:10.5281/zenodo.17752642 phase, often aggravated by greater sensitivity to sodium and hyperactivity of the Renin-Angiotensin-Aldosterone System (RAAS) (hormonal mechanism for regulating blood pressure and fluid and electrolyte balance in the body) 30,31. Concomitantly, oestrogen deficiency potentiates osteoclast activity, accelerating the rate of bone resorption and leading to an accelerated loss of Bone Mineral Density (BMD) of 2-3% per year during the first 3-4 years of postmenopause, subsequently stabilising to 1-1.5% per year 32. This process results in the deterioration of bone microarchitecture, increasing skeletal fragility and the risk of fragility fractures. Approximately 30% of women develop osteoporosis, with vertebral and hip fractures being particularly prevalent (the latter associated with a mortality of 5-20% in the first year after the fracture and permanent disability in 25% of cases) 33. Bone loss is especially pronounced in Caucasian and Asian women, and the combination of low BMD with changes in dermal collagen composition may constitute an indirect marker of osteoporotic risk 34. The clinical manifestations of menopause, ranging from vasomotor symptoms and genitourinary changes to cardiometabolic and osteoarticular complications, reflect the complex pathophysiology of the climacteric. This transition period, marked by the progressive decline of ovarian function and the resulting state of hypoestrogenism, is not limited solely to the end of reproductive function 35. The climacteric involves not only hormonal changes but also transformations of a biological, psychological, and social nature, requiring an integrative approach that considers the interaction between endocrine, metabolic, emotional, and contextual factors 19. Understanding this phase as a continuous set of interconnected changes is essential for developing comprehensive therapeutic strategies that seek not only to alleviate symptoms but also to prevent long-term comorbidities and promote quality of life during this inevitable stage of female ageing. 2.3. The Climacteric and its Physiology The climacteric constitutes the transition period between the reproductive and nonreproductive phases of a woman, characterised by the progressive decline of ovarian function and follicular exhaustion, resulting in sustained hypoestrogenism 35. This phase encompasses a set of signs and symptoms, designated as the "climacteric syndrome", which include menstrual irregularities, vasomotor symptoms, mood swings, and sleep disturbances, among others, with a significant impact on the woman's biopsychosocial well-being. The climacteric is divided into three non-linear phases: pre-menopause, perimenopause, and postmenopause, with menopause (permanent cessation of menstruation, confirmed after 12 months of amenorrhoea) being its central event, occurring on average at 51 years of age 36,37. Physiologically, the process begins around 35-40 years of age with the accelerated depletion of ovarian follicles and hypothalamic-pituitary dysfunction 38-40. In perimenopause, the endocrine compensation by the elevation of FSH and LH levels attempts to maintain folliculogenesis, leading to anovulatory cycles, menstrual irregularities, and the appearance of symptoms such as hot flushes and sleep disturbances 41,42. The Menopausal Transition (MT), as defined by the STRAW system, is divided into the early phase (>7 days variation in cycle duration) and the late phase (≥ 60 days amenorrhoea and/or FSH ≥ 40 IU/L), culminating in menopause and subsequent entry into postmenopause, marked by permanent hypoestrogenism 36,43. Hormonal Characterisation The endocrine changes of the climacteric result from the progressive depletion of the ovarian follicular reserve and the dysfunction of the remaining oocytes and granulosa cells. This dysfunction initially manifests as a decrease in Inhibin B (a glycoprotein hormone), produced by the ovarian granulosa cells, reducing the negative feedback on the pituitary gland and leading to the early elevation of FSH levels 37,44. About six years before Journal of Complementary Therapies in Health 2026: 4(1). 6 of 21 Santos S., e Sousa C.P., Moreira G.R., Silva R.O., Montenegro R. Menopause and Traditional Chinese Medicine: Evidence, Syndromic Perspectives, and a Self-Care Protocol Proposal. doi:10.5281/zenodo.17752642 menopause, the acceleration of follicular depletion intensifies the drop in Inhibin B and the elevation of FSH, triggering a compensatory follicular response with shortening of the follicular phase and transient maintenance of normal or elevated oestrogen levels – a state of transient hyperoestrogenaemia characteristic of the early phase of the menopausal transition 36,43. The pronounced reduction in oestradiol production begins in the late phase of the menopausal transition, deepening up to one year after menopause and continuing gradually in subsequent years. The resulting hypoestrogenism is responsible for the typical climacteric symptomatology 45. In postmenopause, a state of hypergonadotrophic hypogonadism is established, with FSH levels 10-15 times higher and LH levels 3-5 times higher than in the reproductive period, associated with low oestradiol and undetectable Inhibin B 37. Oestrogen production then depends exclusively on the extragonadal aromatisation of androgens into oestrone 46. In parallel, there is a 50% reduction in androstenedione levels and a 25% reduction in total testosterone, although ovarian secretion of testosterone persists due to the stimulation of the stroma by elevated LH. The decrease in Sex Hormone-Binding Globulin (SHBG) increases the bioavailability of testosterone, which may explain the development of hirsutism and virilising symptoms in some postmenopausal women 47. 3. Traditional Chinese Medicine and Western Medicine: A Parallel on Menopausal Care Western Medicine approaches menopause as a biological milestone resulting from ovarian failure. This perspective emphasises the loss of fertility as the central axis, attributing a determining role to hormonal changes in clinical manifestations and a woman's quality of life 35,48. In contrast, TCM interprets this transition as part of a natural movement of transformation of Jing, Yin, and Yang, in which the cessation of menstruation is not understood as a loss, but as a reorientation of Qi towards the cultivation of longevity, emotional balance, and spiritual strengthening 49,50. A woman's vitality is understood by the fundamental principle of Yin and Yang, where Yin represents the feminine essence (receptivity, internalisation, and materiality) while Yang symbolises an active and transformative energy. The climacteric is interpreted as a period of accentuated Yin depletion, resulting in energetic disharmonies that manifest physically and psycho-emotionally. Symptoms such as hot flushes, night sweats, insomnia, and mucosal dryness are understood as direct expressions of this deficiency, while agitation, emotional instability, and the tendency towards depression reflect difficulties in finding a new axis of balance 51. These manifestations arise from specific disharmony patterns, involving fundamental Organs (Zang) according to the Theory of the Five Energetic Movements (Wu Xing). • The Kidney (Water), the root of reproductive vital energy (Jing), is associated with hot flushes and menopausal symptoms when deficient. • The Liver (Wood), responsible for storing blood and the free circulation of Qi, manifests through menstrual irregularities and mood changes. • The Spleen-Pancreas (Earth), central to the formation of Qi and Blood, can lead to dysfunctional bleeding and fluid retention when compromised 51,52. In addition to the Organs, TCM attributes a crucial role to the Extraordinary Meridians in integrating reproductive functions. • The Chong Mai (Sea of Blood), associated with the Earth and Water elements, nourishes the uterus with Xue (Blood) and Jing. • The Ren Mai (Vessel of Conception), linked to Yin and Water, regulates gestation. Journal of Complementary Therapies in Health 2026: 4(1). 7 of 21 Santos S., e Sousa C.P., Moreira G.R., Silva R.O., Montenegro R. Menopause and Traditional Chinese Medicine: Evidence, Syndromic Perspectives, and a Self-Care Protocol Proposal. doi:10.5281/zenodo.17752642 • The Du Mai (Governing Vessel), related to Yang and Fire, sustains reproductive vital energy. • The Yin Qiao Mai and Yin Wei Mai meridians, associated with Water and Earth, organise menstrual cycles and stabilise Yin energy 53. The interaction between extraordinary meridians and associated Organs of the Five Elements is fundamental for understanding the aetiopathology of gynaecological disorders, as they function as energy reservoirs that connect reproductive functions to the body's natural cycles 53. The most common syndromic patterns in the climacteric – such as Kidney and Liver Yin Deficiency, Disharmony between Heart and Kidney, and Kidney and Spleen Yang Deficiency – require distinct therapeutic approaches to restore Yin-Yang balance and harmony between the Organs 54. This holistic view, which integrates body, mind, and vital energy, contrasts with the biomedical approach focused on hormonal physiology, offering distinct possibilities for care and promotion of well-being for women in the non-reproductive phase. 3.1. Female Physiology Female reproductive ageing is a continuous and programmed physiological process, characterised by the progressive decline of ovarian reserve. In TCM, this process is conceptualised in seven-year cycles, as described in the classic Huang Di Nei Jing. According to this perspective, menopause occurs around 49 years of age, an age at which the decline of the Ren Mai and Chong Mai meridians is observed, resulting in the cessation of menstruation and physical changes associated with ageing 55. Curiously, this millenary prediction aligns with modern epidemiological observations indicating the mean ages of natural menopause around 51 years in Western populations 56,57 and 50.7 years in Malaysian women 58, suggesting a universal and relatively constant biological basis for this developmental milestone. From a pathophysiological point of view, menopause constitutes the clinical expression of ovarian follicular exhaustion. A woman has approximately 7 million primordial follicles during foetal life, a value that decreases to about 600,000 at birth, 300,000 at menarche, and only 10,000 at the transition to menopause 59. This gradual decline, which begins in utero, confirms the prolonged and inexorable nature of reproductive ageing. This process is articulated with the concept of Jing, understood as an innate energeticmaterial substrate that governs growth, development, reproduction, and ageing. Jing, which notably expresses itself in follicular formation and maturation, is considered a finite, non-renewable resource. Its depletion is influenced by factors such as nutrition, sleep patterns, physical activity, stress, sexual behaviours, parity, and inter-gestational intervals 53. Thus, the preservation of Jing through healthy lifestyles since childhood is considered crucial for modulating the trajectory of reproductive ageing. However, menopause is often medicalised and culturally stigmatised as a symbol of decline, generating anxiety and negative perceptions 51. A more integrative approach, such as that proposed by Campiglia 51, views this transition as a natural "eventide", a phase of transformation and potential renewal, whose experience varies significantly between individuals. Acceptance of this physiological transition, rather than its pathologisation, appears to be fundamental for promoting physical and psychological well-being during this period. In summary, the study of female physiology benefits from an integrated view that combines the ancestral knowledge of TCM (with its intuitive description of life cycles and the importance of Essence) with the quantitative precision of modern biomedicine, which details follicular dynamics and the epidemiology of menopause. Recognising menopause as a natural and universal biological process and not as a disease allows for a more holistically informed and empowering approach to this fundamental phase of a woman's life. 3.2. The Domain of Yin Journal of Complementary Therapies in Health 2026: 4(1). 8 of 21 Santos S., e Sousa C.P., Moreira G.R., Silva R.O., Montenegro R. Menopause and Traditional Chinese Medicine: Evidence, Syndromic Perspectives, and a Self-Care Protocol Proposal. doi:10.5281/zenodo.17752642 The Yin principle represents the material and structural basis of the organism, manifesting in body fluids, blood, organic matter, and temperature maintenance. In the context of female physiology, Yin prevails as the dominant force, conferring a denser and less active nature compared to masculine Yang energy. This Yin predominance explains the tendency towards recollection and lower tolerance to cold temperatures in the female sex 60. The decline of Yin associated with reproductive ageing directly influences the symptomatology of the climacteric. As Yin diminishes, an energetic imbalance occurs that tends to manifest through a relative excess of Yang, making the woman more vulnerable to emotional fluctuations, irritability, and restlessness. This energy transition is mediated by the Uterus Meridian (Bao Mai), which establishes a functional connection between the Heart (Fire) and the Kidneys (Water). While Water governs the ancestral matrix (genetic heritage and phenotypic expression), Fire regulates the hormonal axes, particularly the hypothalamic-pituitary-ovarian axis 61,62. As described in the Yellow Emperor's Classic, women reach a critical energy transformation at 49 years of age; the Qi undergoes transmutation without corresponding changes in Xue, a process that fundamentally depends on the Kidney energy 63. When this transition does not occur harmoniously, imbalances manifest through specific symptoms 64: 1. Heart (Xin) Changes: anxiety, irritability, insomnia, fatigue, depression, reduced libido, and impaired memory. 2. Kidney (Shèn) Changes: hot flushes, night sweats, palpitations, headaches, and dizziness. 3. Extraordinary Meridian Imbalances: dyspareunia, vulvar pruritus, irregular bleeding, fibroids, and dysfunctional uterine haemorrhages. 4. Liver (Gan) and Dai Mai Changes: pain and mammary dysplasia. 5. Spleen-Pancreas (Pi) and Liver (Gan) Deficiency: joint pain, muscle pain, and osteoporosis. 6. Compromised Tissue Nutrition: atrophy and cutaneous dryness. The primary causes of these disharmonies include: (1) aggression to Qi and Xue, (2) depletion of the Essential Jing, and (3) chronic processes of energy degradation that affect the Kidney, Liver, Spleen-Pancreas, and Heart 60. The fundamental therapeutic principle is based on strengthening the Jin Ye (body fluids), tonifying the Jing, and reinforcing Kidney energy, aiming to restore the balance between Yin and Yang during this natural physiological transition 62. 3.3. Difference Existing Between Care Perspectives In the context of the different care perspectives on the climacteric, contemporary Western medicine predominantly emphasises evidence-based interventions, while the Eastern perspective integrates traditional holistic approaches. As Duarte 2 highlights, this dichotomy reflects distinct paradigms for understanding the physiological transformations inherent to this phase of a woman's life. Western Perspective Physical Activity The contemporary Western approach prioritises physical activity as a fundamental pillar for healthy ageing. Regular practice is proven to improve muscle elasticity, blood circulation, and joint mobility, constituting determining factors for the comprehensive health of women in the climacteric. Evidence indicates a reduction in polypharmacy, particularly in conditions such as Alzheimer's and osteoporosis, in addition to a significant improvement in functional capacity, flexibility, balance, and motor coordination 65. Journal of Complementary Therapies in Health 2026: 4(1). 9 of 21 Santos S., e Sousa C.P., Moreira G.R., Silva R.O., Montenegro R. Menopause and Traditional Chinese Medicine: Evidence, Syndromic Perspectives, and a Self-Care Protocol Proposal. doi:10.5281/zenodo.17752642 Resistance exercise assumes special relevance in the preservation of muscle mass, counteracting the basal metabolic reduction and adipose accumulation characteristic of this phase. The pathophysiological mechanism involves the secretion of hypothalamic endorphins, with direct action on thermoregulation and the attenuation of vasomotor symptoms, in addition to musculoskeletal strengthening and improved respiratory capacity 1,66. Exercise plays a crucial role in modulating anthropometric and biochemical parameters, particularly in the conversion of body composition, lipid profile, and prevention of cardiometabolic comorbidities 67-69. Additionally, the mechanical stimulus of resistance exercise promotes an increase in Bone Mineral Density through greater calcium absorption post-exercise, counteracting the 2-3% annual bone loss post-menopause 33. Hormonal Therapy: Conventional and Bioidentical Approaches Conventional Western medicine has conventional Hormone Replacement Therapy (HRT) as its main pharmacological intervention 70,71. However, bioidentical HRT emerges as a promising alternative, using hormones molecularly identical to endogenous ones, potentially minimising adverse effects. This approach reflects a growing trend towards more naturalised therapies, although regulatory gaps and the need for greater scientific evidence persist 71,72. Research in bioidentical HRT remains in evolution, seeking to optimise formulations and administration routes within a personalised and multidisciplinary perspective 73,74. This orientation converges with the Eastern view by considering individual needs, albeit through Western scientific paradigms. While the Western approach focuses on specific evidence-based interventions, the traditional Eastern perspective prioritises energy modulation and global organism balance 2. Both perspectives, however, recognise the importance of non-pharmacological interventions, particularly physical activity, as a fundamental element in climacteric management. The convergence between these perspectives suggests the emergence of an integrative model, where Western scientific precision dialogues with the Eastern holistic view, potentialising more comprehensive and personalised care strategies for women's health during the climacteric. Eastern Perspective Studies on TCM Treatments for Menopause Our article searchs on digital platforms provided 14 papers that were grouped in Table 1, allowing for a global analysis of the types of TCM approaches to menopause and the responses to symptoms. Reference Design Sample Size Method Outcomes 75 Randomised controlled 49 women Qigong Significantly improved genital self-image and sexual function. 76 Randomised 125 women Qigong Significant reduction in symptoms and improvement in health-related quality of life (HRQoL) in Spanish postmenopausal women. 77 Randomised 125 women Qigong Significant improvement in somatic, psychological, and urogenital levels, in the total MRS scores. Also showed improvements in general health, physical fitness, vitality, and mental health according to the SF-36. Journal of Complementary Therapies in Health 2026: 4(1). 16 of 21 Santos S., e Sousa C.P., Moreira G.R., Silva R.O., Montenegro R. Menopause and Traditional Chinese Medicine: Evidence, Syndromic Perspectives, and a Self-Care Protocol Proposal. doi:10.5281/zenodo.17752642 This study confirms the viability of TCM as a valuable complementary or alternative resource to the conventional medical model. To fully integrate these practices into mainstream clinical guidelines, future research must overcome the observed methodological limitations. Standardised clinical trials with larger sample sizes, long-term follow-up, and comprehensive analyses of cost-effectiveness are essential. Ultimately, embracing an integrative model of care combining the quantitative precision of modern Western diagnostics with the time-tested principles of TCM's energy and essence regulation is paramount to promoting a humanised, personalised, and sustainable quality of life for women throughout the entire climacteric spectrum. Credit author statement: Conceptualization: S.S.; Investigation: S.S., C.P.S., G.R.M., R.O.S. and R.M.; Writing, reviewing and editing: S.S., C.P.S., G.R.M., R.O.S. and R.M. All authors have read and agreed to the published version of the manuscript. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Conflict of Interest: The authors declare that there are no conflicts of interest. Institutional Review Board Statement: Not applicable. Informed Consent Statement: Not applicable. 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