TCM for Menopause Symptoms: Hot Flashes, Sleep and Mood
What Cochrane reviews, trials and menopause guidelines found for acupuncture, Chinese herbal medicine, dong quai, black cohosh and tai chi used for hot flashes, sleep and mood in menopause.
Content last updated . This page has not been medically reviewed.
Start here: what guidelines say first
The 2023 position statement of The North American Menopause Society concluded that hormone therapy remains the most effective treatment for hot flashes and night sweats, and listed cognitive behavioral therapy, clinical hypnosis and certain prescription medicines as recommended nonhormone options. [1] The NHS likewise points to hormone replacement therapy (HRT) first, then other medicines or CBT if HRT does not suit you. [2] Whether any of this is right for you is a decision for you and your clinician. For the full plain-language picture see Perimenopause and Menopause and Hot Flashes.Low mood, anxiety or poor sleep are common in this life stage. If you feel hopeless or unsafe, call or text 988 in the United States (911 in an emergency); see TCM for Anxiety and Depression.
What the research found, by treatment
TCM describes menopause with traditional ideas such as kidney yin decline; those are frameworks, not tested here. See TCM Gynecology. The table reports what studies of specific treatments measured.| Treatment | What the sources found | Label |
|---|---|---|
| Acupuncture for hot flashes | NCCIH: studies versus no treatment showed fewer and milder hot flashes, but studies versus simulated acupuncture showed no difference, and acupuncture appears less effective than hormone therapy. [3] A review of 13 trials (1,784 women; 7 pooled) concluded acupuncture may not decrease hot flush frequency versus sham, with low-quality trials. [4] | Mixed |
| Acupuncture: individual sham-controlled trials | A trial of 100 women found acupuncture lowered hot flash scores. [5] A trial of 72 women found electroacupuncture and sham equal on hot flash scores at 6 weeks and 12 weeks after, though some secondary scores favored electroacupuncture. [6] | Mixed |
| Acupuncture for hot flashes during breast cancer treatment | A pooled analysis of three trials (158 women) found fewer hot flashes than a delayed-acupuncture control, which is not a sham. [7] A review of 8 sham-controlled trials (493 women) found a higher response rate but no difference in frequency or severity, with low to very low quality evidence. [8] | Promising but limited |
| Menopause position statement on acupuncture | The 2023 North American Menopause Society statement listed acupuncture among approaches not recommended (Level II evidence). [1] | Mixed |
| Chinese herbal medicine (oral formulas) | A Cochrane review of 22 trials (2,902 women) found little or no difference from placebo for hot flushes per day; evidence versus hormone therapy was very uncertain. [9] | No good evidence of benefit for hot flashes |
| Dong quai (Dang Gui) | NCCIH says very little research has been done, so no conclusions can be reached. [3] | Insufficient evidence |
| Tai chi, qigong and other mind-body exercise | A review of 11 trials (1,005 women) of tai chi, qigong, baduanjin, yoga, Pilates and mindfulness programs found better sleep quality, less anxiety, depression and fatigue, and higher bone density, but did not measure hot flashes. [10] | Promising but limited (not for hot flashes) |
| Black cohosh (a North American herb often sold for menopause; not a TCM herb) | NCCIH describes a 2023 review of 22 studies finding potential benefit for overall menopause symptoms and hot flashes but not anxiety or depression. [11] NCCIH also cites a 2012 review that found not enough evidence. [3] | Mixed |
The Cochrane herb review is the strongest herb source here. Adverse events reported with herbs were mild, such as diarrhea, breast tenderness, stomach discomfort and an unpleasant taste, but adverse effects were not fully reported in the studies. [9] The NHS says herbal remedies such as red clover and black cohosh have very little evidence about how well they work or how safe they are. [2]
Frequently asked questions
Does acupuncture help hot flashes?
Results are mixed: it beats no treatment in some studies but not simulated acupuncture, and a major menopause society does not recommend it. [3] [1]
Do Chinese herbs work for menopause?
A Cochrane review found little or no difference from placebo for hot flashes, and adverse effects were not fully reported. [9]
Is dong quai safe to take?
Little research exists on its benefit, and it may interact with warfarin, so ask a clinician or pharmacist. [3]
Is black cohosh a Chinese herb?
No, it is native to North America; rare liver problems have been reported with commercial products. [3] [11]
Can tai chi help during menopause?
A review found better sleep, mood and fatigue scores in menopausal women doing mind-body exercise, though it did not measure hot flashes. [10]
More details: evidence, limits and cautions
The details behind this page: cautions, limits of the evidence and where sources disagree. Open any note to read it.
Safety
- Liver: rare cases of liver damage, some very serious, have been reported with commercial black cohosh products, though it is uncertain the herb caused them. Seek advice for abdominal pain, dark urine or jaundice. [3] Some commercial black cohosh products contained the wrong herb or unlisted mixtures. [11] See Liver Injury From Chinese Herbal Products.
- Blood thinners: dong quai may interact with the anticoagulant warfarin. [3] See Dong Quai (Dang Gui) in Chinese Medicine.
- Product quality: in a review of acupoint application plus Chinese herbs for perimenopausal syndrome, none of the 8 trials described independent testing of purity or potency of the herbs. [12] Some Chinese herbal products have been contaminated with toxic compounds and heavy metals. [13]
- Breast cancer: it is uncertain whether black cohosh reduces hot flashes related to breast cancer treatment. [11] Tell your oncology team about every herb you use. [13]
- Acupuncture: generally safe when performed by an experienced practitioner using sterile needles; improper delivery can cause serious side effects. [3]
Related: Botanicals for Menopause and Hormone Claims, What Is Acupuncture? and TCM for Insomnia and Sleep.
References
- The North American Menopause Society. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause (New York, N.Y.) 2023. PubMed 37252752. Read 2026-10-22.
- National Health Service (NHS, UK), Menopause: treatment. Read 2026-10-22.
- National Center for Complementary and Integrative Health (NCCIH, US), Menopausal Symptoms: In Depth. Read 2026-10-22.
- Liu C et al. Effect of acupuncture on menopausal hot flushes and serum hormone levels: a systematic review and meta-analysis. Acupuncture in medicine : journal of the British Medical Acupuncture Society 2022. PubMed 34894774. Read 2026-10-22.
- Soares JM et al. Acupuncture ameliorated vasomotor symptoms during menopausal transition: single-blind, placebo-controlled, randomized trial to test treatment efficacy. Menopause (New York, N.Y.) 2020. PubMed 32898024. Read 2026-10-22.
- Wang HX et al. Electroacupuncture for hot flashes in early menopause: A randomized sham-controlled trial. Journal of integrative medicine 2025. PubMed 40846522. Read 2026-10-22.
- Lu W et al. Acupuncture for hot flashes in hormone receptor-positive breast cancer: A pooled analysis of individual patient data from parallel randomized trials. Cancer 2024. PubMed 38924035. Read 2026-10-22.
- Xu DF et al. Acupuncture Relative to Sham Control in Managing Breast Cancer-Related Hot Flashes: A Meta-Analysis of Randomized Controlled Trials. Complementary medicine research 2025. PubMed 40934138. Read 2026-10-22.
- Zhu X et al. Chinese herbal medicine for menopausal symptoms. The Cochrane database of systematic reviews 2016. PubMed 26976671. Read 2026-10-22.
- Xu H et al. Effects of mind-body exercise on perimenopausal and postmenopausal women: a systematic review and meta-analysis. Menopause (New York, N.Y.) 2024. PubMed 38669625. Read 2026-10-22.
- National Center for Complementary and Integrative Health (NCCIH, US), Black Cohosh: Usefulness and Safety. Read 2026-10-22.
- Xing W et al. Effects of acupoint application therapy combined with chinese herbal medicine on perimenopausal syndrome: A systematic review and meta-analysis of randomized controlled trails. Complementary therapies in medicine 2023. PubMed 36623609. Read 2026-10-22.
- National Center for Complementary and Integrative Health (NCCIH, US), Traditional Chinese Medicine: What You Need To Know. Read 2026-10-22.
Education, not medical advice. This page is for general information. It does not diagnose or treat any condition and is not a substitute for care from a qualified health professional. Natural does not automatically mean safe. Ask a clinician or pharmacist before changing your care, especially if you take medication, are pregnant or breastfeeding, or have a health condition.