"When the sun reaches midheaven, it begins to set; when the moon is full, it begins to wane. The waxing and waning of heaven and earth proceed in accordance with time." — I Ching·Feng Gua (Hexagram Abundance)

Around menopause, estrogen undergoes "fluctuating withdrawal"—it is not merely a state of deficiency, nor is it simply pathological chaos, but a profound physiological transitional process. For clinicians, achieving precise management of menopause requires a cognitive upgrade from viewing it as "deficiency" to recognizing it as "withdrawal."

✦ The primary cause of perimenopausal symptoms is estrogen "fluctuating withdrawal," not mere "deficiency."✦ "Withdrawal" is a dynamic, fluctuating process.✦ The core goal of Menopause Hormone Therapy (MHT) is to stabilize this "disordered withdrawal," rather than merely compensating for "deficiency."