Menopause
Insomnia, mood, and a changing cycle are the typical perimenopausal pattern, and the first thing Dr. Schiff treats.
Perimenopause Sleep and Mood
The years before the last period can be harder than the change itself. You do not have to wait them out.
Perimenopause can begin as early as 40, and the first signs are rarely hot flashes. They are a cycle that is no longer what it was, sleep that will not hold, and a mood that feels bigger and faster than it used to. Chinese medicine treats this as a transition, not a disease, and the sleep and mood are where we usually start.
Reviewed by Dr. Susan G. Schiff, A.P., DOM. Last reviewed October 2026.
Understanding
perimenopause
In the years before menopause, estrogen and progesterone stop rising and falling on schedule. Progesterone, which has a calming effect, often drops first, while estrogen swings, and the result is broken sleep, night sweats that wake you, irritability, anxiety, and low mood, along with a cycle that arrives early, late, heavy, or light. The old menopause page notes that symptoms can begin at 40 and last until 55, and that number, type, and severity depend on overall health, support, and stress.
Chinese medicine recognizes menopause as a change in a woman's body chemistry and a natural transitional process. Ideally it is relatively uneventful; in a fast-paced, stressful life, underlying patterns of disharmony surface, most often kidney yin deficiency, an overheated and depleted system with night sweats and restless sleep, or a mix of yin and yang deficiency with fatigue and low mood. The pattern is read from your history, tongue, and pulse.
Where the disharmony lies decides the plan. You do not have to wait for periods to stop to begin.
Insomnia, mood, and a changing cycle are the typical perimenopausal pattern, and the first thing Dr. Schiff treats.
When symptoms overlap with stress and fatigue, care addresses hormonal balance as a whole.
How we work on it
Under menopause, treatment is a weekly series with a Chinese herbal formula prescribed to your pattern and whole food nutrition in support; joint achiness, bloating, and weight gain are part of the picture and nutrition is where much of that work happens. Acupuncture is used to calm the nervous system and address the vasomotor symptoms, hot flashes and night sweats, that break sleep; a course of treatment has been shown to lower cortisol and shift the autonomic balance toward rest-and-digest.
When the symptoms overlap with stress, fatigue, and a cycle that is still changing, the plan widens under women's health to address hormonal balance as a whole. Insomnia has its own page under insomnia and poor sleep because the causes overlap with perimenopause but are not limited to it.
What the evidence shows
The best trial evidence is for vasomotor symptoms. A 2016 trial in the journal Menopause found that women who received acupuncture had about 36 percent fewer hot flashes at six months, compared with about 6 percent in the waitlist group, and the benefit persisted after treatment ended. Trials against sham acupuncture show smaller differences, which we say plainly; our hot flashes article goes through it. Evidence for sleep and mood specifically is smaller, with several trials reporting improvement in sleep quality.
Hormone therapy remains the most effective treatment for vasomotor symptoms, and for some women it is the right choice; acupuncture or hormone therapy compares them honestly. Acupuncture and herbs fit alongside hormone therapy, alongside an SSRI, or on their own for women who cannot or prefer not to use hormones. Dr. Schiff has treated women's health for over 20 years.
Where we would start.
Listed in the order we most often recommend them for perimenopause sleep and mood. Your first visit decides which actually fits your pattern and your goals.
Women's Health
When symptoms overlap with stress and fatigue, care addresses hormonal balance as a whole.
Questions we hearfrom patients dealing with perimenopause sleep and mood.
No. Symptoms of perimenopause can begin as early as 40, well before the last period, and a changing cycle is often the first sign. You are welcome to come in at that stage rather than waiting for the last period.
Several trials report better sleep quality after a course of acupuncture in menopausal women, often alongside fewer night sweats, which are a common cause of the waking. The evidence is smaller than for hot flashes but points the same way. Herbs and nutrition are part of the plan for sleep.
Yes. Acupuncture and Chinese herbal medicine fit alongside hormone therapy and alongside SSRIs, and on their own for women who cannot or prefer not to use hormones. Tell us what you take so the herbal formula is chosen with it in mind, and keep your physician informed.
It varies widely. The old menopause page puts it at anywhere from six months to more than two years, and how many symptoms you have and how severe they are depends on your health, support, and stress. Treatment is adjusted as your body responds through the transition.
Where to next?
Does acupuncture reduce hot flashes?
Learn More
In the largest US trial, about 20 sessions over six months cut hot flashes roughly 36 percent, with the benefit lasting six months after treatment ended.
Read the answerAcupuncture or hormone therapy for menopause: how do they compare?
Learn More
Hormone therapy cuts hot flashes by about 75 percent, acupuncture by roughly a third. Acupuncture has no hormonal risks and suits women who avoid estrogen.
Read the answerInsomnia and Poor Sleep
Related concern
Fall asleep, stay asleep.
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Over 25 years of serving patients in South Florida. Tell us what has been going on and we will work out the pattern behind it together.
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