Chinese medicine edged out drugs for menopause insomnia

Insomnia is one of the most disruptive symptoms of the perimenopausal transition, when shifting hormones unsettle sleep, mood and daily life. In China, traditional Chinese medicine is widely used to manage it, yet comprehensive evidence on whether it actually works, and how safely, has remained thin. This review set out to gather every randomised trial comparing traditional Chinese medicine against Western medicine for perimenopausal insomnia and ask whether the accumulated data supports the practice, and at what level of confidence.

The reviewers searched eight databases from inception to August 1, 2025 for randomised controlled trials comparing traditional Chinese medicine interventions with Western medicine in patients with perimenopausal insomnia. Methodological quality, risk of bias and certainty of evidence were assessed using the PRISMA guidelines and the GRADE framework, and the pooled analysis was run in RevMan and R software. In total, 48 randomised trials involving 5,037 patients met the criteria and were combined.

Traditional Chinese medicine came out ahead of Western medicine on overall efficacy, with a relative risk of 1.20, and adverse reactions were markedly less common, with a relative risk of 0.30. Sleep quality improved by 2.57 points on the Pittsburgh Sleep Quality Index. Hormone measures moved too: luteinising hormone and follicle-stimulating hormone fell, while estradiol rose by 9.64 units. Menopausal symptom scores on the Kupperman index dropped by 6.01 points, and anxiety and depression ratings also improved. The reviewers note that methodological limitations and disagreement between studies temper all of these results.

This is the most comprehensive pooling of this question to date, and its direction is consistent: across sleep, hormones and mood, the traditional Chinese medicine arms did better. But the reviewers' own conclusion is candid that methodological weaknesses and variability between studies undercut certainty, and every trial comes from a single country and population. Whether the advantage would survive large, rigorously designed multicentre trials is precisely the open question the authors say still needs answering.

For women navigating perimenopausal sleep problems, this is a reason to see traditional Chinese medicine as an approach with a genuinely large body of trial evidence behind it, rather than pure folklore, while also understanding that the quality of that evidence is contested. The reported advantage over standard drugs, including fewer side effects, may be real, smaller than reported, or an artefact of weak trial design. Anything touching hormones and sleep medication is a conversation to have with a clinician, not a switch to make on the strength of one review.