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A Natural Approach to Perimenopause

If you are a woman in her late forties and beyond then you are probably familiar with the symptoms of perimenopause and menopause. Perimenopause is known as the period before menopause (menopause is classified as

the end of menstruation, having at least one year of no menses).

What we know about perimenopause:

  • It can last anywhere between months to years (usually experienced in 40s/early 50s): the average age of menopause is around 52

  • It is the stage of hormonal fluctuations where a woman will experience symptoms but still have a menstrual period

  • Smoking, malnourishment and living at high altitude can bring on earlier menopausal symptoms

  • Genetic: if you want to estimate when you may enter menopause, take a look at how old your mother and grandmother were when they entered menopause!

  • Ovarian function begins declining: what this means is that estrogen begins to decrease and this decrease causes hormonal fluctuations and symptoms

  • As estrogen decreases women have a greater risk for bone density loss (osteoporosis)

  • Changes in fertility: while a woman’s chance of becoming pregnant begins to significantly diminish in her 30s, if a woman is still ovulating and menstruation then she can get pregnant

Common symptoms can include:

  • hot flashes

  • night sweats

  • changes in libido

  • breast tenderness

  • vaginal dryness (or dryness overall)

  • hair loss/thinning

  • mood changes: irritability, anxiety, depression

  • insomnia (difficulty with sleep)

  • fatigue and changes in energy

  • changes in digestion

  • changes in weight

With all of this in mind, here is what the naturopathic approach has to offer to help you transition with your health in mind. The foundations of health: diet/digestive health, sleep, exercise/movement, and emotional health should be the supportive base for the body.

What you can start to focus on now: A diet high in leafy greens, plenty of vegetables and berries, as well as healthy protein and fats (building blocks of hormones) are essential

Cut back (or out) refined foods and alcohol, they are inflammatory and put stress on the liver

Don’t skip meals and make sure they are balanced and wholesome: insulin and cortisol (our sugar metabolizing and stress hormones will also be changing in response to our fluctuations in estrogen) – this can lead to increased cravings, fatigue and weight gain

Having good sleep hygiene: a calm night-time routine, going to bed before 10:30pm, staying away from screens in the evening (blue light stimulates the brain to produce hormones) is key – hormones work in a cycle that are responsive to melatonin and cortisol (two key hormones that govern our sleep/wake cycle), so if we have regular sleep/wake times we balance out the rest of our hormones, as well as get the much needed rest!

Take care of stress and your mood: try a yoga class, meditation, deep breathing, or getting in deep nature walks weekly

Exercise: the cause for mid-section/abdominal weight gain in perimenopause is because as estrogen decreases cortisol increases – focus on decreasing stress and including weight bearing exercise (bone protective)

What about supplements or herbs?

In terms of supplements and minerals, any nutritional deficiencies should be tested and corrected. Dosages and recommendations should be made by a healthcare practitioner who knows your health history and any medications you are currently taking. However, some of the common supplements I may consider for my patients are:

Vitamin D, Magnesium, Calcium: to support bones

B-vitamins: if there is marked fatigue, a period of high stress or demand preceding or during perimenopause

Probiotics: if there is gut health issues, poor bowel movements, or immune problems


Milk-thistle: liver supportive (the liver processes our hormones and contains major detoxification systems)

Burdock Root: liver supportive

Dandelion: liver

Sage: shown to reduce hot flashes

Black Cohosh: hormonal balancing, hot flashes

Passionflower: soothes anxiety and helps with sleep

In summary, a focus on diet and lifestyle should be the first intervention. If symptoms do not improve, herbs and supplements may then be beneficial for symptom management. Lastly, some women may even consider oral/topical hormone therapy through their doctor. If you are interested in continuing this conversation I offer 15 min consults to see how I could help you.

Yours in health,


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