Clinical evidence on integrated Chinese-Western medicine in perimenopausal syndrome

Perimenopausal Syndrome (PS) results from estrogen fluctuations due to ovarian dysfunction, leading to autonomic and neuropsychological symptoms. Existing therapeutic methods have certain limitations, and integrated Chinese-Western medicine (ICWM) treatment can achieve complementary advantages. We defined 16 clinical questions and outcomes for PS and searched CNKI, PubMed, the Cochrane Library, and other databases and relevant websites from inception to August 29, 2025. Relevant clinical practice guidelines/consensus statements (CPGs/CSs), systematic reviews (SRs), and randomized controlled trials (RCTs) were included, and their methodological quality was apprised using AGREE II, AMSTAR 2, and ROBUST-RCT, respectively. Data synthesis and visualization were performed using Microsoft Excel 2021 and R. 280 studies (5 CPGs/CSs, 38 SRs, 237 RCTs) were included, of which 84.6% were Chinese publications. Acupuncture and oral Chinese herbal medicine (CHM) had abundant evidence, some Chinese Medicine interventions had little or no evidence, and study quality varied across types. Evidence summaries showed acupuncture versus conventional Western therapy and integrated oral CHM and western medication (WM) versus WM alone were superior or equivalent in efficacy and safety for PS. This study mainly assesses the available evidence on acupuncture and integrated oral CHM and WM interventions for PS. Both treatment strategies demonstrate potential benefits for PS. Nevertheless, inconsistencies in the evidence base across different interventions, methodological shortcomings, and limited international applicability weaken the overall quality of current findings. Future research should target these gaps to advance evidence-based, personalized ICWM strategies, improving outcomes for women with PS worldwide.