Second Spring

Menopause is a second spring. The research is catching up to the frame.

Michael G. Hunter, L.Ac. · October 2026 · About 7 minutes

Chinese medicine has a name for menopause that is older than the word menopause: second spring. The idea is that the energy a woman spent for decades on cycles and childbearing gets returned to her, and the second half of her life runs on it. I learned that frame in acupuncture school in the nineties and spent 25 years watching it play out on the table. Then I watched Western culture tell the same women they were drying up.

My line in The Book of Menopause is "Menopause isn't a crisis, it's a coronation." That's a frame, and I'd be a hypocrite to sell a frame without checking it against the evidence. So here's the check.

The decline story came from one study, read badly

In 2002 the Women's Health Initiative trial reported that hormone therapy raised the risk of breast cancer, stroke and heart disease, and millions of women were taken off it overnight. Over the next twenty years, re-analysis of the same data showed the picture was more specific than the headline: the risks were concentrated in older women who started hormones more than a decade after menopause, on one particular formulation. For women who start within ten years of their last period or before 60, the balance tipped the other way.

That is now the formal position of The Menopause Society (formerly NAMS). Its 2022 hormone therapy statement says that for symptomatic women under 60 or within ten years of menopause onset, the benefits of hormone therapy generally outweigh the risks. Two decades of women were told to white-knuckle it because of a headline that the field itself has walked back. That's not a wellness opinion. That's the position paper.

I'm an acupuncturist, not a prescriber. I'm telling you this because a woman who's been told HRT is dangerous deserves to know that the people who wrote the guidelines no longer say that for most women her age. Take it to your doctor.

What works that isn't hormones

The Menopause Society's 2023 nonhormone statement reviewed the evidence for everything from soy to clinical hypnosis. The things it recommends: cognitive behavioral therapy for hot flashes and night sweats (two UK trials, the MENOS studies, showed CBT reduced how much hot flashes bothered women and improved sleep, with gains held at six months), clinical hypnosis, and several prescription drugs including the newer neurokinin-receptor blockers. The things it says have insufficient evidence: most supplements, and, to be honest about my own field, acupuncture.

Acupuncture: what my own profession's evidence looks like

I'm not going to oversell this. Two good trials, two different answers. The Acupuncture in Menopause study (Avis and colleagues, 2016) randomized 209 women to acupuncture or a waitlist and found hot flash frequency dropped about 37 percent in the acupuncture group over six months, with the benefit holding after treatment stopped. Then Ee and colleagues, same year, Annals of Internal Medicine, compared real acupuncture to sham needling in 327 women and found both groups improved about the same, roughly 40 percent. Read together: acupuncture helps hot flashes, and a large share of that help comes from the ritual, the attention and the expectation rather than from where the needles go.

In the clinic, I never found that embarrassing. A treatment that reliably cuts hot flashes by a third with no side effects, whatever the mechanism, is a treatment. The honest claim is "it works and we're not sure why," not "it rebalances your qi." I'll take the honest claim.

The brain is reorganizing, not degrading

The part of this story that matters most to me is the brain. Lisa Mosconi's imaging work at Weill Cornell shows the menopausal transition as a period of measurable change in brain energy metabolism and connectivity, and in most women those measures stabilize or recover post-menopause. Her reading, and I share it, is that the brain is adapting to a new hormonal environment, not failing. The brain fog is real and it is usually temporary. "Usually temporary" is a very different story from "the beginning of the end," and women are told the second one far more often.

The dementia question is contested. Observational data suggest a window where starting hormones near menopause may be protective, and starting late may not be. The randomized evidence is incomplete. I flag it because you'll hear confident claims in both directions and neither is settled.

Why the frame matters physiologically

Here's where my nervous system work and this topic meet. The story a woman believes about her body is not decoration. Expectation shapes symptom severity in every condition that's been studied, and hot flashes are among the most expectation-sensitive symptoms in medicine, which is exactly why sham acupuncture works and CBT works. A woman who believes she's drying up walks into every symptom braced. A woman who believes she's being handed her energy back walks in curious. Same hormones. Different physiology. That is not magic. It's the placebo and nocebo literature, which is the most replicated finding in clinical research, applied to a transition instead of a pill.

Second spring is a frame. So is decline. Only one of them has the evidence on its side.

What to do

1. If you're symptomatic and under 60 or within ten years of your last period, ask a menopause-trained clinician about hormone therapy using the current Menopause Society guidance, not the 2002 headline.
2. For hot flashes without hormones: CBT or clinical hypnosis have the best evidence. Acupuncture is reasonable and low-risk.
3. Be suspicious of supplements with no trial behind them, and of anyone who tells you the dementia question is settled either way.
4. Pick your frame on purpose. It's doing physiological work whether you choose it or not.

Sources

1. The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause. 2022;29(7):767-794.
2. The 2023 Nonhormone Therapy Position Statement of The North American Menopause Society. Menopause. 2023;30(6):573-590.
3. Ayers B, Smith M, Hellier J, Mann E, Hunter MS. Effectiveness of group and self-help cognitive behavior therapy in reducing problematic menopausal hot flushes and night sweats (MENOS 2): a randomized controlled trial. Menopause. 2012;19(7):749-759.
4. Avis NE, Coeytaux RR, Isom S, et al. Acupuncture in Menopause (AIM) study: a pragmatic, randomized controlled trial. Menopause. 2016;23(6):626-637.
5. Ee C, Xue C, Chondros P, et al. Acupuncture for menopausal hot flashes: a randomized trial. Annals of Internal Medicine. 2016;164(3):146-154.
6. Mosconi L, et al. Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition. Scientific Reports. 2021;11:10867.
7. Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women. JAMA. 2002;288(3):321-333.