Why is menopause called the second spring: Brehan Crawford, L.Ac., explaining that in Chinese medicine every woman lives two lives

Why Is Menopause Called the Second Spring?

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    Menopause is usually talked about as an ending. In Chinese medicine it is a threshold. One life closes, another opens, and the name for what comes next is the second spring. Here is where that idea comes from, what is happening in your body during the change, and how to come through it with your reserves intact.

    The short answer

    In Chinese medicine every woman lives two lives. The first is organized around tian gui, the heavenly water that makes menstruation and pregnancy possible. When it runs dry, the energy your body spent on reproduction is yours to keep. That next stage is called di er chun, the second spring. The transition can be demanding, but it is a change of season, not a disease.

    The short version, on video.

    Why is menopause called the second spring?

    Because Chinese medicine sees two lives in every woman. In the first, your body's biology is organized around creating the next generation of human beings. In the second, it is not. Di er chun (第二春) means second spring, and it is the name for the stage that begins once the menopausal transition is complete.

    Spring is a deliberate word: the season when growth starts again after a long period of storage. The energy your body sent toward reproduction every month for decades is now fully yours. You are certainly not losing relevance. It is quite the opposite, and the research below supports the Chinese view. Helping people understand the stage of life they are in, and work with it, is a large part of what we do inside Gut Brain Synchrony.

    What is menopause in Chinese medicine?

    It is the natural end of tian gui. To see what that means, you need the idea of tian gui itself.

    Tian gui, the heavenly water

    Tian gui (天癸), usually translated as heavenly water, is the substance Chinese medicine holds responsible for fertility. A 2010 paper in the Journal of Chinese Integrative Medicine describes it as the essence that is essential to menstruation and pregnancy, and notes that the working of the ovary is consistent with the classical account of tian gui in timing, state and rhythm.[1]

    The Huangdi Neijing, the foundational text of Chinese medicine, maps a woman's life in seven-year steps. At two times seven, age 14, tian gui arrives, the Ren and Chong vessels fill, and the period begins. At seven times seven, age 49, those vessels empty, tian gui is exhausted, and the period stops. The phrase for that moment is tian gui jie: the heavenly water running dry.

    The number has held up. A meta-analysis of 46 studies across 24 countries put the average age of natural menopause at 48.8 years.[2]

    Yin, jing and the heat that rises

    Tian gui is produced from jing, the essence stored in the Kidneys, which is your deepest reserve. As tian gui declines, yin declines with it. Yin is the cooling, moistening, settling half of your physiology. When there is less of it to anchor yang, heat rises. That is the Chinese medicine reading of hot flashes, night sweats, dryness and a mind that will not switch off at night.

    Physiology describes the same event in its own language. A hot flash is a sudden, exaggerated heat-dumping response, set off by a small rise in core body temperature inside a comfort zone that has become very narrow. Falling estrogen is part of the reason for that narrowing, and heightened sympathetic nervous system activity is another.[3] Two descriptions of one body.

    Is menopause a disease?

    No. If you zoom out, the transition itself is not a disease. There is nothing wrong with you. You are moving from one stage of life to the next.

    Western medicine is moving in the same direction. In 2024 The Lancet opened a series on menopause with a paper that argues against treating it as an endocrine deficiency. Almost one billion women worldwide are postmenopausal, the authors note. The biology is universal, the experience varies substantially, and many of the psychological, social and contextual factors that shape it can be changed.[4]

    The story you have been told is one of those factors. In a systematic review of 13 studies, 10 found that women with more negative attitudes toward menopause reported more symptoms during the transition.[5] What you expect of this stage is part of the terrain.

    Ask women directly and many describe the other half. In a Danish study, 393 women aged 51 answered an open question about menopause, and 194 of them described something positive: relief at being finished with periods and premenstrual symptoms, the end of worry about pregnancy, and room for personal growth and their own needs.[6]

    Why does menopause make me so tired?

    Because your body is reorganizing how it runs, and doing it on broken sleep. This transition can leave you feeling exhausted and completely out of balance.

    Start with sleep. In a survey of 12,603 American women aged 40 to 55, 38 percent reported difficulty sleeping, and the rate rose to 45.4 percent in late perimenopause. It was the stage of the transition that predicted poor sleep. Age on its own did not.[7]

    Then the fatigue itself. In a community study of 683 women aged 45 to 60 in Sri Lanka, 53.9 percent reported physical and mental exhaustion. That was more than the 39.1 percent who reported hot flashes.[8]

    Chinese medicine explains the two together. Yin is what lets you sink into sleep and stay there. When it runs low you wake hot in the small hours, and a body that does not rest at night draws on its reserves, its jing, by day.

    Why old conditions flare during the transition

    The change can also aggravate medical conditions you were carrying before. Migraine is a clear example. Among 3,664 women with migraine in a large American survey, 8.0 percent of those who were premenopausal had 10 or more headache days a month. In perimenopause the figure was 12.2 percent.[9]

    Mood follows the same pattern. In a Pittsburgh cohort of 221 women interviewed every year, a major depressive episode was two to four times more likely during perimenopause and early postmenopause than before it, and a history of depression was a strong predictor throughout.[10]

    From a terrain point of view this makes sense. A body in the middle of a major reorganization has less in reserve to keep an old problem quiet.

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    Why do humans go through menopause?

    Because, as far as biology can tell, the years after it are valuable to everyone around you. A long life after reproduction is rare in nature. Human females routinely live 30 years beyond it, and a 2015 study could name only two other species with anything comparable: killer whales and short-finned pilot whales.[11]

    The whales show what those years are for. In wild resident killer whales, females past reproductive age lead their groups through the salmon foraging grounds, most prominently in the difficult years when salmon are scarce. The authors called it the wisdom of elders.[11]

    A later study found that killer whale grandmothers who had stopped reproducing improved the survival of their grandoffspring more than grandmothers who were still breeding. In humans the same pattern is called the grandmother effect: grandmothers increase the number of their grandchildren who survive.[12]

    The women themselves do well, too. A Melbourne study began with 438 women aged 45 to 55 and tracked them for 20 years. Negative mood and depressive symptoms were highest during the menopausal transition and lowest in late postmenopause, easing as the women grew older.[13]

    This is the second spring. Your energy is now fully yours, so you can teach the younger people, nurture community, leave a legacy in your career, or do qigong in your garden.

    Can Chinese medicine help with menopause? Six practices for the transition

    Yes, and it starts with daily life. The health practices of traditional cultures that embrace this transition share one aim: giving your body the materials, the time and the space to adapt.

    01 Nourish yin. In Chinese medicine yin is built by rest, stillness, fluids and sleep, and spent by heat, hurry and late nights. Do less of what burns it and more of what restores it.
    02 Protect your jing. Kidney essence is your deepest reserve, and the transition draws on it. Work, train and commit at a level you can sustain.
    03 Eat warm, nourishing food. Cooked meals, soups and stews ask less of your digestion than cold and raw food. In a nine-year study of 6,040 Australian women, those who ate the most fruit or followed a Mediterranean-style pattern had about 20 percent lower odds of hot flashes and night sweats. Those eating the most fat and sugar had 23 percent higher odds.[14]
    04 Get enough sleep. Sleep is when yin is restored, so give it a regular hour and guard it. Because hot flashes are triggered by small rises in core temperature, keeping your body cool helps, and so does slow, paced breathing.[3] I cover the foundations in Gut Health Basics: Your Sleep.
    05 Move, moderately. The aim is circulation without depletion. A meta-analysis of 11 randomized trials in 1,005 perimenopausal and postmenopausal women found that mind-body exercise such as tai chi, qigong and yoga improved bone density, sleep quality, anxiety, depressed mood and fatigue.[15] For a place to begin, see Yoga as Therapy: Start Here.
    06 Give it time and space. In a long-running American study, the 1,449 women who had frequent hot flashes or night sweats lived with them for a median of 7.4 years.[16] Plan for a transition measured in years, and let your body complete it.

    Menopause and the second spring, answered

    Is perimenopause the second spring?

    Not yet. Perimenopause is tian gui jie, the heavenly water running dry. It is the passage between the two lives, and it is the demanding part. The second spring begins once that transition is complete.

    Does acupuncture help menopause symptoms?

    The trial evidence says yes. In a randomized trial of 209 women aged 45 to 60 with four or more hot flashes or night sweats a day, up to 20 acupuncture treatments cut their frequency by 36.7 percent at six months, while the waitlist group rose by 6.0 percent. Six months after treatment ended, most of that improvement remained.[17]

    What is kidney yin deficiency in menopause?

    It is the Chinese medicine name for the pattern behind the familiar signs of these years. As jing and tian gui decline there is less yin to cool and settle the body, and you see heat that rises in waves, night sweats, dryness and restless sleep. The traditional answer is the list above.

    The only thing I will tell you not to do is listen to the people saying that your world has to be small.

    — Brehan Crawford, L.Ac.

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    References

    1. Wang B, Yan W, Hou LH, Wu XK. Disorder of Tiangui (kidney essence) and reproductive dysfunction in patients with polycystic ovary syndrome [in Chinese]. Zhong Xi Yi Jie He Xue Bao. 2010;8(11):1018-1022. doi:10.3736/jcim20101103
    2. Schoenaker DA, Jackson CA, Rowlands JV, Mishra GD. Socioeconomic position, lifestyle factors and age at natural menopause: a systematic review and meta-analyses of studies across six continents. Int J Epidemiol. 2014;43(5):1542-1562. doi:10.1093/ije/dyu094
    3. Freedman RR. Menopausal hot flashes: mechanisms, endocrinology, treatment. J Steroid Biochem Mol Biol. 2014;142:115-120. doi:10.1016/j.jsbmb.2013.08.010
    4. Hickey M, LaCroix AZ, Doust J, et al. An empowerment model for managing menopause. Lancet. 2024;403(10430):947-957. doi:10.1016/S0140-6736(23)02799-X
    5. Ayers B, Forshaw M, Hunter MS. The impact of attitudes towards the menopause on women's symptom experience: a systematic review. Maturitas. 2010;65(1):28-36. doi:10.1016/j.maturitas.2009.10.016
    6. Hvas L. Positive aspects of menopause: a qualitative study. Maturitas. 2001;39(1):11-17. doi:10.1016/s0378-5122(01)00184-0
    7. Kravitz HM, Ganz PA, Bromberger J, Powell LH, Sutton-Tyrrell K, Meyer PM. Sleep difficulty in women at midlife: a community survey of sleep and the menopausal transition. Menopause. 2003;10(1):19-28. doi:10.1097/00042192-200310010-00005
    8. Waidyasekera H, Wijewardena K, Lindmark G, Naessen T. Menopausal symptoms and quality of life during the menopausal transition in Sri Lankan women. Menopause. 2009;16(1):164-170. doi:10.1097/gme.0b013e31817a8abd
    9. Martin VT, Pavlovic J, Fanning KM, Buse DC, Reed ML, Lipton RB. Perimenopause and Menopause Are Associated With High Frequency Headache in Women With Migraine: Results of the American Migraine Prevalence and Prevention Study. Headache. 2016;56(2):292-305. doi:10.1111/head.12763
    10. Bromberger JT, Kravitz HM, Chang YF, Cyranowski JM, Brown C, Matthews KA. Major depression during and after the menopausal transition: Study of Women's Health Across the Nation (SWAN). Psychol Med. 2011;41(9):1879-1888. doi:10.1017/S003329171100016X
    11. Brent LJN, Franks DW, Foster EA, Balcomb KC, Cant MA, Croft DP. Ecological knowledge, leadership, and the evolution of menopause in killer whales. Curr Biol. 2015;25(6):746-750. doi:10.1016/j.cub.2015.01.037
    12. Nattrass S, Croft DP, Ellis S, et al. Postreproductive killer whale grandmothers improve the survival of their grandoffspring. Proc Natl Acad Sci U S A. 2019;116(52):26669-26673. doi:10.1073/pnas.1903844116
    13. Campbell KE, Dennerstein L, Finch S, Szoeke CE. Impact of menopausal status on negative mood and depressive symptoms in a longitudinal sample spanning 20 years. Menopause. 2017;24(5):490-496. doi:10.1097/GME.0000000000000805
    14. Herber-Gast GC, Mishra GD. Fruit, Mediterranean-style, and high-fat and -sugar diets are associated with the risk of night sweats and hot flushes in midlife: results from a prospective cohort study. Am J Clin Nutr. 2013;97(5):1092-1099. doi:10.3945/ajcn.112.049965
    15. Xu H, Liu J, Li P, Liang Y. Effects of mind-body exercise on perimenopausal and postmenopausal women: a systematic review and meta-analysis. Menopause. 2024;31(5):457-467. doi:10.1097/GME.0000000000002336
    16. Avis NE, Crawford SL, Greendale G, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015;175(4):531-539. doi:10.1001/jamainternmed.2014.8063
    17. Avis NE, Coeytaux RR, Isom S, Prevette K, Morgan T. Acupuncture in Menopause (AIM) study: a pragmatic, randomized controlled trial. Menopause. 2016;23(6):626-637. doi:10.1097/GME.0000000000000597