Traditional Persian Medicine approaches to perimenopausal menorrhagia: A narrative review with a comparison to modern biomedical and other traditional systems

Objective Perimenopausal menorrhagia, or heavy menstrual bleeding (HMB), is a major gynecological issue that may ultimately lead to invasive surgery like hysterectomy for a subset of patients when other treatments fail. There is a growing interest in traditional medical systems for their holistic approaches. This narrative review explores the conceptual framework, etiological theories, and therapeutic strategies for menorrhagia (Efrat-e-tamth) within Traditional Persian Medicine (TPM) and integrates these with contemporary biomedical evidence to evaluate the concepts' potential contribution to evidence-informed integrative gynecological care. Materials and methods We analyzed major classical TPM texts to synthesize data on TPM concepts such as uterine temperament ( mizāj ), the six essentials of health ( sette-ye ḍarūriyye ), and plant-based and non-pharmacological treatments . A comparison with modern biomedical and other traditional systems was also performed. Results TPM provides a comprehensive humoral and systemic model for HMB, attributing it to uterine dystemperament, weakness of the uterine retentive faculty ( qovve qabz ), humoral excess, and lifestyle factors. The core therapeutic approach is individualized and involves ( Dreisler et al., 2024 ) regulating the six essentials of health, ( Selvam et al., 2024 ) correcting uterine temperament, and ( Douligeris et al., 2025 ) using astringent and uterine-tonic medicinal plants. Key medicinal plants identified include Myrtus communis L. (Myrtle), Punica granatum L. (Pomegranate) peel, and Quercus infectoria G. Olivier (Oak galls). Recent clinical evidence corroborates the efficacy of these herbs in reducing bleeding. Conclusion TPM offers a rich, systematic paradigm for understanding and treating menorrhagia, centered on the use of specific medicinal plants with emerging scientific support. Its holistic, patient-centered approach presents a valuable resource for developing novel, non-invasive integrative care models and for informing future ethnopharmacological research.