Acupuncture for Perimenopause: Why My HRT Worked Better When I Combined the Two
Many women ask me whether acupuncture can help alongside - or even replace - HRT during perimenopause. I wondered exactly the same thing.
When I started hormone replacement therapy (HRT), I expected it to be the missing piece. Instead, I experienced only partial improvement.
It wasn’t until I combined HRT with regular acupuncture that things really began to change. My periods became more manageable, my energy improved, I cooled down and I simply felt more like myself.
That experience made me question something I had always assumed.
Perhaps the question isn’t simply:
“How much and how balanced are the oestrogen/progesterone do we have?”
Perhaps it’s:
“How well is our body able to use, process and respond to the hormones we have?”
As an acupuncturist specialising in women’s health, I’ve become fascinated by the growing body of research exploring the relationship between hormones, metabolism, the nervous system, the gut and inflammation. While we still have much to learn, it suggests that hormones don’t work in isolation—and perhaps our approach to supporting women through perimenopause shouldn’t either.
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Is Perimenopause Really Just a Hormone Deficiency?
For decades, menopause has largely been viewed as a condition caused by declining hormone levels.
There’s no question that falling oestrogen and progesterone contribute to many symptoms, and HRT has transformed the lives of countless women. For many, it is life-changing.
But declining hormones may not be the whole story.
If hormone levels alone explained perimenopausal symptoms, we might expect women with similar hormone levels to experience similar journeys.
Yet that’s not what we see.
Some women move through perimenopause with very few symptoms.
Others experience years of hot flushes, heavy bleeding, migraines, breast tenderness, anxiety, poor sleep, weight gain and fatigue.
Blood tests tell us how much hormone is circulating in the bloodstream.
They don’t tell us how efficiently those hormones are metabolised.
They don’t tell us how individual tissues respond to hormones.
And they don’t tell us how factors such as insulin sensitivity, inflammation, liver function, gut health and nervous system regulation may influence the body’s response.
Rather than viewing hormones as the whole story, perhaps we should think of them as one piece of a much larger physiological puzzle.
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Hormones Don’t Work in Isolation
Hormones are continually being:
Produced
Converted
Transported
Metabolised
Stored
Eliminated
Every one of these processes depends upon the health of multiple body systems.
Our liver metabolises hormones.
Our gut microbiome influences whether certain oestrogens are eliminated or recycled.
Our nervous system influences stress hormones, inflammation and sleep.
Our metabolic health affects insulin sensitivity, body fat distribution and inflammatory signalling.
Hormones don’t simply circulate around the body doing their job independently.
They function within an incredibly complex biological environment.
Perhaps that is why two women taking the same HRT, or with similar blood hormone levels, can experience completely different outcomes.
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What About “Oestrogen Dominance”?
You may have come across the term “oestrogen dominance.”
Although it isn’t a formally recognised medical diagnosis and isn’t consistently defined in scientific research, it is often used to describe symptoms such as:
Heavy or prolonged bleeding
Breast tenderness
Bloating
Fluid retention
Menstrual migraines
Mood changes
Historically, these symptoms have often been explained simply as “too much oestrogen” or “not enough progesterone.”
But emerging research suggests the picture may be far more complex.
The way our bodies metabolise, transport and eliminate hormones may also influence how those hormones behave.
Scientists are now investigating how metabolic health, inflammation, insulin resistance, liver function and the gut microbiome affect hormone metabolism.
Rather than asking only:
“How much oestrogen do I have?”
Perhaps we should also be asking:
“How effectively is my body processing the oestrogen I have?”
That doesn’t mean metabolism explains every symptom, nor does it mean HRT isn’t appropriate. It simply reminds us that hormone levels alone may not tell the whole story.
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The Fascinating Science of Intracrinology
One of the most interesting developments in menopause research is the science of intracrinology.
Professor Fernand Labrie demonstrated that after menopause the ovaries are no longer the primary source of oestrogen. Instead, many tissues throughout the body are capable of producing small amounts of hormones locally from adrenal precursors, using them where they are needed rather than releasing large quantities into the bloodstream.
This helps explain why blood hormone levels don’t always reflect what is happening inside tissues.
It doesn’t mean blood tests aren’t useful.
It simply means they are only one part of understanding hormone biology.
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Why Metabolic Health Matters
Research increasingly suggests that metabolic health influences hormone metabolism.
Factors including:
Insulin sensitivity
Visceral fat
Chronic inflammation
Liver function
Gut microbial balance
may all influence how hormones are processed and responded to within the body.
Another exciting area of research is something called the estrobolome.
The estrobolome is the collection of bacteria in our gut that helps regulate how oestrogen is metabolised and eliminated from the body.
Here’s why that’s important.
After oestrogen has been processed by the liver, it is released into the gut ready for elimination. However, certain gut bacteria produce enzymes that can “unlock” some of that oestrogen, allowing it to be reabsorbed back into the bloodstream rather than leaving the body.
Researchers are now investigating whether differences in the estrobolome may influence hormone activity and contribute to conditions associated with altered oestrogen exposure, including endometriosis, fibroids and some breast conditions. This is still an emerging area of science, but it highlights just how interconnected hormone health and gut health really are.
Once again, it reminds us that hormones don’t act in isolation. They depend upon the health of the systems responsible for processing them.
This is an exciting and rapidly developing field of research.
While we don’t yet have all the answers, it reinforces the idea that our internal environment matters.
Hormones don’t work independently of the body that is processing them.
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Where Does Acupuncture Fit?
Traditional Chinese Medicine has always viewed health as the interaction of multiple body systems rather than focusing on a single hormone or organ.
Interestingly, modern research is beginning to uncover biological mechanisms that may help explain this whole-body approach.
While there is currently no evidence that acupuncture directly alters the estrobolome, research suggests acupuncture may influence gut function, gut-brain communication and digestive health. Supporting healthy digestive function may be one of the many ways acupuncture contributes to whole-body wellbeing during perimenopause, although more research is needed in this area.
Supporting the Nervous System
One of acupuncture’s most consistent physiological effects is regulation of the autonomic nervous system.
By encouraging a shift away from chronic “fight or flight” activation and towards the parasympathetic (“rest and digest”) state, acupuncture may help improve stress resilience, sleep and overall physiological regulation.
Many women tell me the first thing they notice isn’t that their hormones feel different.
It’s that they feel calmer.
Supporting Metabolic Health
Research suggests acupuncture may improve insulin sensitivity and glucose metabolism in certain conditions, particularly polyendocrine metabolic ovarian syndrome (formerly PCOS)
Although more research is needed specifically in perimenopause, maintaining metabolic health is increasingly recognised as an important part of healthy ageing.
Improving Circulation
Acupuncture has consistently been shown to increase local blood flow.
Improved circulation supports healthy tissue function by delivering oxygen and nutrients while helping remove metabolic waste products.
Modulating Inflammation
Low-grade inflammation is increasingly recognised as a contributor to many symptoms experienced during midlife.
Research suggests acupuncture may influence inflammatory signalling pathways, helping explain improvements in pain, fatigue and general wellbeing.
Supporting Better Sleep
Sleep affects almost every hormone in the body.
Poor sleep influences cortisol, insulin sensitivity, appetite regulation, mood and energy.
Many studies have shown acupuncture can improve sleep quality in women experiencing menopausal symptoms.
Sometimes improving sleep alone creates a remarkable improvement in how women feel.
Supporting Digestive Health
Research into the gut-brain axis suggests acupuncture may influence gut motility and communication between the digestive system and nervous system.
Although this remains an evolving area of research, it reinforces the interconnected nature of hormone health.
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Does Acupuncture Balance Hormones?
This is probably the wrong question.
The better question may be:
Can acupuncture improve the environment in which hormones are functioning?
Current evidence suggests it may.
Rather than directly increasing or decreasing hormone levels, acupuncture appears to influence several body systems—including the nervous system, sleep, circulation, inflammation and metabolism—that affect how our bodies respond to hormonal change.
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Why I Believe HRT and Acupuncture Work So Well Together
I don’t see acupuncture as an alternative to HRT.
Nor do I see HRT as the whole answer.
For many women, they complement one another beautifully.
HRT changes hormone availability.
Acupuncture may help optimise the biological environment in which those hormones are functioning.
Perhaps that is why some women respond brilliantly to HRT while others continue to struggle despite taking the same medication.
My own experience certainly made me wonder whether supporting the body’s physiology—rather than focusing solely on hormone levels—may sometimes be the missing piece.
Every woman’s journey through perimenopause is unique.
Some thrive with lifestyle changes alone.
Some benefit enormously from HRT.
Others find that combining evidence-based medicine with acupuncture provides the greatest improvement.
For me, this isn’t about choosing one approach over another.
Hormones don’t work in isolation. They depend on the health of the nervous system, the liver, the gut, metabolism, sleep, inflammation and even the microbes living within us.
Perhaps the future of supporting women through perimenopause isn’t simply about replacing hormones—but about creating the healthiest possible environment in which those hormones can do their job.
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If you're looking for acupuncture for perimenopause in York, book your appointment today and take the first step towards feeling more like yourself again.
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References
Labrie F. All sex steroids are made intracellularly in peripheral tissues by the mechanisms of intracrinology after menopause. Journal of Steroid Biochemistry and Molecular Biology. 2017.
Labrie F. Intracrinology. Molecular and Cellular Endocrinology. 1991.
Befus D, et al. Management of Menopause Symptoms with Acupuncture: An Umbrella Systematic Review and Meta-analysis. Journal of Alternative and Complementary Medicine. 2018.
Comparative Effectiveness of Different Acupuncture Therapies for Perimenopausal Syndrome: A Systematic Review and Network Meta-analysis. Medicine (Baltimore). 2024.
Qin Y, et al. Acupuncture for menopausal symptoms in Chinese women: A systematic review. Climacteric. 2021.
Cochrane Database of Systematic Reviews. Acupuncture for menopausal hot flushes.
Baker JM, et al. The Estrobolome: The Intestinal Microbiome and Estrogen Metabolism. Cell Host & Microbe. 2017.
International Menopause Society. Complementary therapies for menopausal symptoms. 2025.
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