AN INTEGRATIVE FRAMEWORK FOR MANAGING MENOPAUSAL INSOMNIA: A CRITICAL REVIEW OF CONVENTIONAL AND TRADITIONAL CHINESE MEDICINE INTERVENTIONS

Background: Menopausal insomnia is a highly prevalent condition that significantly impairs quality of life and increases the risk for adverse health outcomes. While numerous treatments exist, they are often presented within separate therapeutic paradigms, leaving clinicians and patients without a clear, integrated management strategy. Objective: This review critically synthesizes the evidence for both conventional Western and Traditional Chinese Medicine (TCM) interventions for menopausal insomnia to propose a comprehensive, integrative management framework. Methods: We conducted a systematic review of the literature, focusing on meta-analyses and randomized controlled trials of pharmacological, non-pharmacological, and complementary therapies for insomnia in perimenopausal and postmenopausal women. Findings: Conventional treatments, such as Menopausal Hormone Therapy (MHT) and certain non-hormonal medications, are effective primarily for insomnia secondary to vasomotor symptoms (VMS). Cognitive Behavioral Therapy for Insomnia (CBT-I) stands as the gold-standard first-line treatment for chronic insomnia, yet access remains a barrier. TCM offers a distinct holistic framework, addressing systemic imbalances with therapies like acupuncture and herbal medicine, which show promise for improving sleep quality and overall well-being. Notably, emerging evidence on external TCM therapies, such as aromatic herbal sachets, suggests a safe, accessible, and potentially effective modality for promoting relaxation and sleep. Conclusion: A "one-size-fits-all" approach is insufficient for the multifactorial nature of menopausal insomnia. We conclude that an integrative model, which judiciously combines the targeted strengths of conventional medicine with the holistic and personalized strategies of TCM, offers the most effective, safe, and patient-centered paradigm. Future research should focus on rigorous, head-to-head trials of these combined modalities.