As the menopausal years are a time of great life changes, external stress has more impact on emotional and mental reactions rather than the hormonal changes themselves. Many women tend to develop symptoms such as depression, anxiety, irritability, mood swings, fatigue, poor memory and lack of concentration. It should be noted that mood or mental problems are not inevitable during menopause; many women experience no noticeable changes or only in a mild form. Personality, job, education and living environment are all important factors that contribute to mental and emotional changes in menopause. Unhealthy psychological activities can easily disturb the body's physiological functioning, leading to indigestion, poor appetite and unstable blood pressure; as time passes some real physical damage will occur. A positive attitude is crucial during menopause.

In TCM understanding, before and after the cessation of the menstrual periods, the kidney system declines gradually, the essence and blood become depleted which fail to nourish the organs and lead to a non-smooth flow of qi (vital energy). These internal disharmonies can easily create fire evils and result in mind problems:

• Deficiency of heart and liver: depression, mood swings, irritability, hot sensations in the body or there may be a low fever, red tongue, the pulse is taut and thready. Other possible signs include menstrual irregularities, menstrual pain and breast tenderness.
• Yin deficiency creating virtual fire: irritability, easily anger, insomnia, palpitations, red cheeks, mouth dryness, scanty urine, constipation, red tongue and a thready, rapid pulse.
• Disharmony between heart and kidney: poor memory, irritability, palpitations, dream-disturbed sleep, dizziness, ear ringing, lumbar soreness, mouth dryness, oral sores, menstrual irregularities, red tongue and rapid pulse.
• Qi and phlegm stagnation: depression, absentmindedness, suspicious, insomnia, chest oppression, suffocating sensation in the throat, excessive throat secretion, belching, bloating, pale tongue covered by greasy white fur, and a taut, rolling pulse.