At puberty, a woman's kidney energy increases, sending excess blood to the uterus. During her reproductive years, the kidneys supply enough blood for fertility, but as a woman matures, the blood flow from her kidneys diminishes, leading to menopause. Menopausal problems occur when kidney energy is depleted and cannot sustain the rest of the body. In other words, the body's vital life energy, or qi, (in particular the kidney energy) is out of balance.

During the perimenopausal years the Chinese believe that there is an increase in the active, dry, hot element called yang energy. Before thirty-five, a woman is more yin (moist, receptive, passive) but during the change of life her yang begins to express itself. She becomes more passionate about ideas, quicker to anger, faster to defend herself or others. As more "hot" yang energy begins to move through the acupuncture meridians, at first the flow is kind of jerky as we get accustomed to using the new energy. Those jerky manifestations of rising yang give rise to hot flashes. But as the meridians open to the yang energy and we get used to using it, so the theory goes, the flow stabilizes.

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