Brain fog, memory loss, poor concentration, and sleep disturbances are some of the symptoms of brain changes that can commonly occur during menopause. Some of the more positive changes can be refocusing our attention to more self-care and new creative endeavors after spending prior decades focused on giving our time and energy to caring for others.
Menopause is a major life transition, and it is important to consider this shift in the years preceding the cessation of menses, as well as during the post-menopausal years, as it is not widely discussed in Western culture. We will approach this through the lens of both Western medicine and traditional Chinese medicine (TCM) with cultural considerations.
Western Medicine - the HPG (Hypothalamus-Pituitary-Gonadal) Axis
Starting with the HPG or HPO (Hypothalamus-Pituitary-Ovarian) axis, let’s review the organs and their functions.
The pituitary gland regulates many bodily functions because it produces hormones that control other endocrine glands, and in this context is important because it produces FSH (Follicle Stimulating Hormone) and LH (Luteinizing Hormone) which prompts ovulation.
The hypothalamus “monitors the entire nervous system on behalf of the pituitary gland and flags anything its special attention. This gland is a big deal, as it’s in charge of stimulating the production of LH and FSH by the pituitary, which results in the production of estrogen and progesterone in the ovaries. You could say it’s also head of homeostasis, controlling body temperature, sleep patterns, appetite, and blood pressure, therefore maintaining the body’s overall balance.” - Dr. Lisa Mosconi, The Menopause Brain.
The pineal gland produces melatonin which helps with our sleep-wake cycle, which is often disrupted during menopause.
The thyroid gland regulates our metabolism and temperature, and can affect weight gain and fatigue during menopause.
The parathyroid glands regulate calcium levels in our body and can contribute to memory or concentration issues if they become dysregulated.
The thymus has an important role in the development of T-cells and stimulates white blood cells for our immune system.
The pancreas makes hormones that regulate sugar in our bloodstream, and estrogen fluctuations during menopause can contribute to insulin resistance.
The adrenals regulate our stress response, metabolism, blood pressure, and our immune system.
The ovaries produce estrogen, progesterone, and testosterone under the supervision of the hypothalamus.
Type of Estrogen
There are three different kinds of estrogen: estradiol, estriol, and estrone.
Estradiol helps with neuroprotection, cell growth, brain plasticity, communication, mood,, cardiovascular health, and energy. Estradiol decreases considerably after menopause.
“Estrone is made by fat-rich adipose tissue and has a weaker effect than estradiol. After menopause, estrone is the main type of estrogen women’s bodies continue to produce.
Estriol is the estrogen of pregnancy. It is present in nearly undetectable amounts whenever one is not pregnant.” - Dr. Lisa Mosconi
Now we start to understand which parts of the HPG axis are responsible for brain fog, fatigue, memory loss, temperature regulation, and stress response. Dr. Lisa Mosconi points out that these changes happen to some extent during each of the three P’s: puberty, pregnancy, and perimenopause.
The Brain, Uterus, and the Heart-Kidney Connection According to TCM
From the perspective of TCM, the brain consists of the brain, spinal cord, and marrow, all of which are nourished by Kidney Jing. If the Kidney Jing is strong, “it will nourish the brain and memory and concentration, thinking and sight will all be keen.” - Giovanni Maciocia, The Foundations of Chinese Medicine
Seen through the TCM lens, the brain changes in perimenopause depend on the Kidneys, and the Heart also has a part to play. The Heart houses the Mind (Shen) and affects some functions of the brain, including memory, sleep, mental activity, consciousness, and thinking. Blood nourishes the Heart and the Mind.
In TCM, the uterus as an extraordinary organ includes the uterus, Fallopian tubes and ovaries. “Thus, the ‘Uterus’ and in particular, the Kidneys are responsible for all the functions that in Western medicine are related to uterus, tubes, and ovaries, and indeed including the hypothalamus-pituitary-ovarian axis.” - Maciocia Obstetrics & Gynecology in Chinese Medicine.
Instead of the HPG axis, TCM uses the framework of the Bao Mai and the Bao Luo. The Bao Mai (Uterus Vessel) connects the Heart to the Uterus. The Bao Luo (Uterus channel) connects the Uterus to the Kidneys. The flow of Qi, Blood, and Jing before menopause is from the Heart to the Uterus and the Kidneys to the Uterus.
In Chapter 33, the Simple Questions says: ‘When the period does not come it means the Uterus Vessel is obstructed’. Maciocia writes “normal menstruation and fertility depend on the state of the Kidney-Essence and Heart-Blood. If Heart-Blood is deficient, Heart-Qi does not descend to the Uterus. If the Kidney-Essence is deficient, menstruation does not occur.“
During perimenopause, the patterns of disharmony find their roots in Heart Qi, Heart Blood, and Kidney Jing. In her practice supporting acupuncture patients through the menopause process, acupuncturist Lorie Dechar notes the tidal shift of the Bao Mai reverses from the Uterus to the Heart, which allows for more creativity and turning the focus of energy inwards. She says this change happens at the level of Qi, Blood, and Jing.
TCM Patterns with Corresponding Herbal Formulas and Acupuncture
Heart Blood Deficiency:
Signs for this pattern may include palpitations, dizziness, insomnia, poor memory, anxiety, tendency to be easily startled, and a pale complexion and lips. There may be a pale, dry tongue, and the pulse may be choppy or thin.
Acupuncture points to consider are:
- Heart 7 (Yuan Source point: tonifies Heart Blood and settles the Mind
- Pericardium 6 (Luo point of the Pericardium: tonifies Heart Blood and settles the Mind),
- Ren 15 (Luo point of the Ren channel: tonifies Heart Blood and settles the Mind),
- Bladder 17 (Hui Meeting point of Blood: nourishes Blood)
- Bladder 20 (Back-Shu point for the Spleen: strengthens Spleen Qi to make Blood).
Herbal Formulas to Consider
- Bai Zi Yang Xin Wan nourishes Heart Blood and Kidney Yin and calms the Spirit
- Bu Nao Pian / Wan nourishes Heart Blood and Kidney Jing
- Tian Wang Bu Xin Dan nourishes Heart and Kidney Yin
- Gui Pi Tang nourishes Heart Blood and tonifies Spleen Qi
Kidney Yin and Jing Deficiency:
Signs of Kidney Yin deficiency may include inability to concentrate, forgetfulness, palpitations with anxiety, insomnia, dry stools, and fatigue. The tongue may be red with less coat, and the pulse may be thin and rapid.
Acupuncture points to consider are:
- Ren 4 (Meeting point of the Ren channel with the Spleen, Liver, and Kidney channels: tonifies Kidney Yin and Jing)
- Kidney 3 (Yuan Source point: tonifies Kidney Yin and clears deficiency heat)
- Kidney 6 (confluent point of the Yin Qiao channel; nourishes Kidney Yin)
- Spleen 6 (meeting point of the Spleen, Liver, and Kidney channels: tonifies Kidney Yin and calms the Mind)
- Kidney 9 (Xi Cleft point of the Yin Wei vessel: tonifies Kidney Yin, especially for anxiety and stress)
Kidney Jing is part of Kidney Yin. Some signs may include weak knees and legs, hair loss or premature greying of hair, loose teeth, soft bones, and poor memory. The tongue may be red and peeled, and the pulse may be superficial and empty.
Additional points to nourish Jing include:
- Gallbladder 39 (tonifies Bone Marrow)
- Ren 4 (tonifies Jing), Bladder 23 (Back Shu of the Kidneys)
- Bladder 15 (Back Shu of the Heart, tonifies the Brain)
- Bladder 11 (Hui Meeting point of Bones)
- Du4 (alternate name is Palace of Essence)
- Du14 (stimulates Marrow to reach the Brain)
- Note: there may also be signs of Kidney Yang deficiency as part of Kidney Jing deficiency. Look for a pale tongue and a deep weak pulse.
Herbal Formulas to Consider
- Zuo Gui Wan nourishes Kidney Yin and Jing
- Huan Shao Wan nourishes Jing and Blood Deficiency
- Bu Nao Wan nourishes Kidneys and Astringes Jing
Liver Blood Deficiency with Heat:
“The Kidneys play a role in the formation of Blood and a deficiency of Kidney-Qi or Kidney-Essence can lead to deficiency of Blood. Therefore, any of the causes of Kidney deficiency, can also lead to deficiency of Liver-Blood.” - Maciocia, The Foundations of Chinese Medicine.
Signs may include dizziness, insomnia, blurred vision, floaters (visual disturbance), weak muscles, pale complexion, dry skin, and dry hair. There may be a pale tongue with slightly orange sides and a choppy or thin pulse.
Acupuncture points to consider include:
- Bladder 18 (Back-Shu point of the Liver, nourishes Liver Blood)
- Bladder 20 (Back-Shu point for the Spleen: strengthens Spleen Qi to make Blood)
- Bladder 17 (Hui Meeting point of Blood, nourishes Blood)
- Ren 4 (Meeting point of the Ren channel with the Spleen, Liver, and Kidney channels: tonifies Blood with direct moxa), and Liver 8 (He-Sea point of the Liver channel, nourishes Liver Blood)
- Stomach 36 (He-Sea point of the Stomach channel) and Spleen 6 (meeting point of the Spleen, Liver, and Kidney channels) both tonify Post-Heaven Qi to make Blood.
Herbal Formulas to Consider
- Suan Zao Ren Tang / Wan nourishes Liver Blood and clears Heat.
- Liu Wei Di Huang Tang / Wan nourishes the Yin of the Liver, Heart and Kidneys
- Tian Wang Bu XIng Dan / Wan nourishes the Yin, Blood, Heart and Kidneys
TCM Nutrition recommendations and recipes
Ancient people discovered that many foods not only satisfy the appetite, but also have preventative and therapeutic effects. You can also read more about Nutritional Therapy in TCM and the benefits of incorporating food-herbs into everyday diet in our previous article.
Foods that nourish blood:
Adzuki bean, apricots, beef, beets, bone marrow, dark leafy greens, eggs, dates, figs, grapes, kidney beans, sardines, spinach, sweet rice, and watercress.
Foods that nourish Yin and Jing
Apple, asparagus, cheese, eggs, duck, honey, kidney beans, lemon, mango, peas, pineapple, pomegranate, pork, string beans, tofu, tomatoes, watermelon, and yam.
Foods that Clear Heat
Asparagus, bamboo shoot, banana, egg white, eggplant, grapefruit, lemon, lettuce, millet, mung bean and its sprout, peppermint, potato, tofu, watermelon, and wheat.
Dr. Mao has a recipe for a nut and fruit brain mix that supplies “essential fatty acids, carotenoids, and antioxidants that will maintain a steady supply of fuel and energy for your brain.” The mix includes:
- 1 cup walnuts (Hu tao ren) - tonifies Kidneys
- ½ cup pine nuts - nourishes Liver Yin
- ¼ cup sesame seeds (Hei zhi ma) - nourishes and tonifies Liver Blood and Yin, and Kidney Yin
- ½ cup pumpkin seeds - tonifies the Spleen
- ⅓ cup of dried goji berries (Gou ji zi) - nourishes and tonifies Liver and Kidneys, benefits the eyes
- ½ cup dried apricots - nourishes Yin and Blood
- ½ cup dried blueberries - tonifies the Spleen
Choline is a “precursor to the neurotransmitter acetylcholine, which contributes to the efficiency of brain processes,” Dr. Maoshing Ni says. He recommends choline supplements up to 1200 mg a day and foods high in choline. These include eggs, soybeans, black beans, kidney beans, peanuts, cabbage, cauliflower, Brussels sprouts, and broccoli.
Ginkgo leaf (Bai guo ye or Yin xing ye) tonifies Kidney Jing to promote brain health and improve focus and memory.
Green tea contains the amino acid L-theanine and can improve mood, memory, and focus.
Dr. Mao recommends 120 mg of ginkgo and 100mg of L-theanine daily, or drinking 2 to 3 cups of ginkgo and green tea every day.
Brain Tonic Soup
This is a recipe from Seven Times a Woman with TCM function information.
Ingredients:
- ½ pound of beef, cut into pieces - nourishes Yin, Qi, and Blood
- ½ cup of walnuts (Hu tao ren) - tonifies Kidneys
- ½ cup chestnuts - tonifies Kidney Yang
- 6 Longan fruit (Long yan rou) - tonifies Heart and Spleen, nourishes Blood and calms the spirit
- 1 carrot, chopped - soothes Liver, regulates Qi
- 2 stalks of celery, chopped - soothes Liver and clears Heat
- ½ onion
- Salt and pepper to taste
- 3 cups of soup stock
Directions:
Add ingredients to a pot and bring them to a boil. Reduce heat and simmer for 30 minutes. Pour into a blender. Blend until smooth and serve. Eat one bowl in the evening.
Lifestyle Recommendations
- Regular exercise, five times a week for 30 minutes, elevating the heart rate up to 120 beats per minute, is recommended for cardiovascular health.
- Tai Chi, Qigong, yoga, and meditation can help improve sleep and promote calm.
- Learning new skills enhances neuroplasticity of the brain such as languages, fiber arts, and puzzles.
Emerging cultural conversations about menopause
The etymology of the word menopause is about something ending, stopping. We can also think of it as a beginning, a transition, and a portal to another stage of life, just as puberty and pregnancy are. Women (and people with uteruses) may leave behind their biological fertility at the portal but there’s a different kind of fertility; personal creativity and freedom have a chance to grow and bloom.
In my article on TCM for Postmenopause I discussed the concept of Second Spring as a positive interpretation of postmenopause in Chinese Medicine terms. Dr. Lisa Mosconi uses the term “menostart” for this time of life. After menopause, she says, “the brain-ovary connections necessary to make babies are no longer needed . . . It only makes sense, then, that the brain would eventually start pruning away those expired connections — and what better biological clue to do so than menopause.”
Increasingly, conversations about menopause are happening more openly. The Menopause Summit with recorded presentations from The Center for Body Trust is one such example. During the summit, people discuss menopause from different cultural perspectives and their emotional, gender-identity, racial, sexual, social, spiritual, and weight-inclusive intersections.
The way the brain changes in menopause can impact the way women view the world. In Bloody Hell! Adventures in Menopause from Around the World, Marilyn Muthoni Kamuru writes:
“What if the point of menopause is women’s being? Freedom. That women get to be themselves for THEMSELVES without purpose for OTHERS. What if the revolutionary evolutionary purpose of menopause is women’s freedom?”
It’s important to have a space where people can talk about this portal openly with others who are going through it, even if perimenopause and menopause are not the same for everyone. As part of my acupuncture practice, I offer an online monthly discussion group for my patients.
Conclusion
There is not a one-to-one correspondence of the Western model of the brain-ovary connection to the TCM model of the Brain, Uterus, Heart, and Kidneys, but we can see some overlap in how each model affects the brain in menopause. As TCM practitioners, we look at patterns related to the Heart and Kidney to see how to support people in menopause through herbal medicine, acupuncture, and lifestyle changes. And lastly, we can encourage conversations about the portal of menopause and how each of our patients experiences it.
Resources:
- 7 Times a Woman by Dr. Lia Andrews, 2013.
- Chinese Herbal Medicine Formulas & Strategies by Dan Bensky & Randall Barolet, 2009.
- Live Well Live Long: Teachings from the Chinese Nourishment of Life Tradition by Peter Deadman, 2022.
- A Manual of Acupuncture by Peter Deadman & Mazin Al-Khafaji with Kevin Baker, 1998.
- Bloody Hell! Adventures in Menopause from Around the World, edited by Mona Eltahawy, 2025.
- Helping Ourselves: A Guide to Traditional Chinese Food Energetics, by Daverick Leggett, 1995.
- Obstetrics and Gynecology in Chinese Medicine, Giovanni Maciocia, 1998.
- The Foundations of Chinese Medicine, by Giovanni Maciocia, 1989.
- The Menopause Brain by Lisa Mosconi, PhD, 2024.
- Second Spring: Dr. Mao’s hundreds of natural secrets for women to revitalize and regenerate at any age, Dr. Maoshing Ni, 2009.
- https://centerforbodytrust.com/the-menopause-summit/
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https://www.taoofwellness.com/newsletters-blog/2021/2/5/balance-amp-restore-heart-amp-brain
