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This is a woman’s ultimate guide to holistic perimenopause treatment. Are you aged 35+ and noticing changes to your bleeding, cycle, skin, mood, weight or sleep? Perimenopause is on the horizon for you and this article outlines the foundations for thriving through perimenopause and beyond.
What Is Perimenopause?
Perimenopause is the normal phase in a woman’s life when her body starts to transition from reproductive adulthood into menopause. It typically can begin anywhere from the mid 30s to the early 50s. It ends with menopause – the cessation of menstrual periods – the end of the reproductive years. A woman is said to have experienced menopause 1 year after her final period.
Perimenopausal Symptoms
You may still be having monthly periods during early perimenopause, but you may start to experience symptoms that are cyclical that impact your cycle. Often women first start to notice symptoms during their luteal phase such as mood changes, depression, anxiety, irritability, headaches, acne, and breast tenderness.
As perimenopause progresses your periods can change, your cycle becomes more spaced out and your symptoms can occur all through the cycle, and you may experience symptoms of low estrogen.
Some women get through perimenopause with relatively little symptoms or issues, but for others there are significant symptoms that disrupts quality of life.
Read about 34 symptoms of perimenopause.
Integrative Medicine: Holistic Perimenopause treatment
A holistic approach to perimenopause begins with a foundational lifestyle approach to create sustainable self-care habits for life involving:
Hormone Replacement Therapy
Moving the body
Nourishing the body and mind
Creating meaningful connections
Supporting sleep
Managing stress
Avoiding smoking
Use of appropriate contraception if wanting to avoid a pregnancy.
1. Hormone Replacement Therapy During Perimenopause
Hormone replacement therapy is an effective and safe treatment for most women to ease symptoms, improve quality of life, support sleep, regulate cortisol and insulin levels and support energy so that you can get on with feeling like yourself, and living your best life.
Read more about Hormone Replacement Therapy.
2. Movement: Exercise and physical activity during perimenopause
Movement is important to maintain muscle and bone mass and strength, insulin sensitivity and for mental health. Movement includes exercise as well as non-exercise movements such as taking a short walk break every hour during sedentary work or taking the stairs instead of the lifts. Exercise consists of planned physical activity that improves cardiovascular endurance and muscle strength.
The key for exercise during perimenopause is:
resistance training 2-3 times per week, with ideally 48 hrs between each training for muscles to rest and recover.
Aerobic, weight bearing exercise 2-3 times per week
Total moderate intensity exercise (i.e. can talk but not sing while exercising) 150 mins per week.
For those who are not currently moving your body regularly:
Start with the basics. Walk for 7 minutes a day.
Slowly increase the number of minutes walking and speed of walking each week until you reach 30 mins 5 times per week
A Fitbit or similar device can be an amazing motivator to show you how much movement you already do and to show your improvements.
Do resistance training with your body weight. Start with 5-10 (or fewer if that’s your current capacity) push-ups, sit-ups and squats.
Joining a gym and seeing a personal trainer can help you ensure you have good form and reduce the risk of injuries.
For those who are time-poor, who need to squeeze in exercise at random moments around other commitments online programs can be the way to go. There are many free and paid exercise programs online. Many of the paid subscriptions have free classes so you can check them out before you purchase.
Yoga
Yoga has a particularly helpful role during perimenopause for women. It has many benefits that not only improve metabolic status but also improve and benefit many other areas of health and life.
A systematic review and meta-analysis in 2019 has shown that a regular yoga practice in people with prediabetes or metabolic syndrome (Ramamoorthi 2019):
improves insulin sensitivity,
improved cholesterol,
reduced blood sugars
reduced blood pressure.
This plays important role in reducing long term risk of diabetes, heart disease and Alzheimer’s disease.
In perimenopausal women 8 weeks of integrated yoga therapy had a better effect compared with a standard exercise program (Chattha 2008) at reducing:
hot flashes,
sweating
vaginal dryness
stress
anxiety
Additionally in post-menopausal women, yoga reduces insomnia and other sleep disturbances, improving sleep patterns (Khalsa 2004, Khalsa 2021).
Yoga also reduces cortisol, a hormone released by the adrenal glands in response to stress. Lowering cortisol levels has benefits for immune system, sleep, reducing fatigue and reducing vulnerability to chronic disease.
Finally yoga has been shown to create a sense of well being, feeling of relaxation, improved concentration, self confidence, improved efficiency, good interpersonal relationships, increased attentiveness, lowered irritability, and an optimistic outlook in life (Malathi 1999).
3. Nourishing foods during the perimenopause
Wholefood lifestyle
The FLEMENCO project found that women who consumed a Mediterranean diet (higher consumption of whole-grain cereals, nuts, fruits, pulses, whole dairy products and olive oil, and a lower consumption of sweetened beverages) had more stable body composition during perimenopause. These women had lower waist circumferences and less abdominal fat (Flor-Alemany 2020).
Similarly pre-menopausal, perimenopausal and menopausal women who consumed diets high in plant proteins (such as beans, lentils, chickpeas, peas, nuts and seeds) improved lean/fat body composition ratio and improved HDL cholesterol and systolic blood pressure.
These studies suggests that dietary patterns high in unprocessed plant foods improve metabolic status during perimenopause.
Phytoestrogen containing foods
Phytoestrogens are plant-based compounds that mimic estrogen in the body. They do not bind estrogen receptors as strongly as estrogen in the body so their effects are weaker.
Common phytoestrogens include lignans and isoflavones. They are found in abundance in many plant foods including:
Nuts and seeds (flax, sunflower, sesame seeds, walnuts and almonds)
Fruit (apples, pomegranate, strawberries, grapes)
Vegetables (yams, mung bean sprouts)
Soy (soybeans, tofu, tempeh, miso)
Herbs (red clover, licorice root, hops)
Grains (oats, barley wheat germ).
Unlike oral estrogen tablets which contribute to endometrial thickening and increased breast density (growth of breast tissue), phytoestrogens from food or supplements do not (Mareti 2019).
Additionally phytoestrogen supplement in doses of 25-100mg daily have been shown to relieve depression symptoms among perimenopausal women (Li 2021). A diet rich in the plant foods above therefore is likely to have a beneficial effect on mood symptoms.
Perimenopause and the gut microbiome.
Perimenopause alters the gut microbiome which plays a role in the changes to perimenopausal metabolism.
Plant fibers are prebiotics, foods that feed the microbiome. Food has been shown to be one of the strongest influencers on the gut microbiome. Eating a variety of plant foods contributes to a diverse gut microbiome.
Some examples of prebiotics and colonic foods include:
Inulin – found in dandelion greens, Garlic, Jerusalem artichokes, Leeks, chicory root (coffee substitute)
Fructo-oligosaccharides (FOS) – found in yacon root, garlic, onion, leeks, chicory root, Jerusalem artichokes, asparagus, bananas
Galacto-oligosaccharide (GOS) – found in legumes, including beans, chickpeas, and lentils.
beta-glucan fiber – found in raw oats
Pectin – found in apples.
Overall research points towards consuming a dietary pattern rich in whole plant foods.
4. Connection: Relationships during perimenopause
Women experience hormonal, physical and psychological changes during perimenopause. Unlike adolescence, when most have parents to walk them through this stage, women navigate perimenopause with a variety of relationship support and/or dependents.
Some women are in relationships with an intimate partner, some are parenting young children or teens or have adult children leaving home. Other women are navigating perimenopause as single adults. Some women are caregivers of their own parents.
Navigating this stage of life affects how we make and find meaning in our life. It can bring up numerous issues for women such as:
recognizing your finitude and aging as realities
mourning the loss of fertility
celebrating the loss of fertility
regret for unfulfilled wishes or recognizing unmet needs,
recognizing unfulfilling intimate relationships,
discovering new hobbies, horizons, areas for personal growth,
triggering a stock-take of one’s original life goals (Mishra 2006),
re-orientation of life goals/values/relationships/roles (Süss 2020),
difficulties in their family or working lives,
discrimination in the workplace and even unemployment (Rees 2022),
dealing with unresolved trauma, conditioning, or previously undiagnosed ADHD/PTSD.
Feeling life is fulfilling and has meaning to you can have profound influence on how you feel about yourself and how you experience perimenopause.
Intimate relationships play an important role in how women experience perimenopause. For women in intimate relationships, those with deeper levels of intimacy and better mutual communication experience fewer and less intense symptoms compared with women who have less intimate relationships with poorer mutual communication (Jarecka 2016).
Having a supportive partner, family and friends that you can be open with and share the most intimate part of yourself with can make an important difference in your life.
Many women find working with an experienced perimenopause clinician, therapist or life coach can help them adapt to life changes that come up during perimenopause, find and make meaning out of their experiences and thrive.
5. Sleep
Sleep is important during all life stages and perimenopause is no exception. Sleep disturbances increase during the perimenopause, with the most common complaint being night time awakenings (Shaver 2015).
Causes for disturbed sleep include:
Changing hormone levels (growth hormone, prolactin, cortisol and melatonin)
Vasomotor symptoms (sweating and flushing)
Mood disorders (depression and anxiety)
Circadian rhythm disturbances (estrogen is a key hormone in the circadian rhythm system- Alvord 2022)
Other conditions (snoring, airway obstruction, restless legs syndrome, periodic limb movement disorder, pain and bladder instability)
Worsening of primary insomnia
Lifestyle factors (poor sleep routines/schedules, caffeine, alcohol, snoring partner, stress).
Sleep disturbances impact women’s quality of life, work productivity, and increase their need for healthcare during perimenopause. Poor sleep also can have long-term effects on health and wellbeing including concentration, productivity, immunity, cardiovascular health and emotional well-being.
There are a few things you can do to improve your sleep during perimenopause:
create a regular sleep schedule
get plenty of outdoor light exposure in the morning when you first wake to lower early morning melatonin.
get outdoor light exposure in the late afternoon to inhibit an early melatonin rise.
avoid caffeine after 2pm and alcohol 3 hours before bed
exercise regularly, preferably in the morning or afternoon, avoid 90 mins prior to bed (unless restorative yoga)
establish a regular relaxing bed-time routine/ritual in the 1 hr before bed – this is your time.
avoid screen time in the 1 hr before bed and dim the lights.
create a cool, comfortable sleeping environment
If you are struggling to sleep despite making these changes, talk to your healthcare provider about possible treatments, which could include herbal support, melatonin or menopause hormone therapy (MHT). Additionally your doctor can exclude other medical conditions impacting on your sleep as outlined above.
6. Stress and Perimenopause
Stress is well documented to worsen physical and mental perimenopause symptoms (Bauld 2009). In particular vasomotor symptoms such as hot flashes and night sweats occur more for women who experience distress to stressful life/events (Arnot 2021). Meditation and mindfulness based stress reduction (MBSR) are both helpful strategies for managing stress during perimenopause.
Meditation is beneficial in reducing distress and mood symptoms (Sung 2020).
Women using mindfulness based stress reduction (MBSR) in a randomized controlled trial reported fewer depressive symptoms, less perceived stress, less anxiety, increased resilience, and improved sleep (Gordon 2021).
7. Smoking and Perimenopause
Women who smoke generally transition to menopause 2 years earlier than women who do not. Additionally the Nurses II Health Study showed that heavier smokers are more likely to have earlier menopause than lighter smokers (Whitcomb 2018). This indicates the increased aging effects on the body, particularly the ovaries/eggs due to smoking.
Quitting smoking is important for healthy aging, maintaining brain health and cardiovascular health and bone health during perimenopause and post menopause.
Frequently Asked Questions about Perimenopause
What herbs and supplements are safe and effective for perimenopause?
Ashwagandha and Magnesium are both helpful, and safe to use in perimenopause.
Who needs Menopausal hormone therapy?
Read this comprehensive guide to menopausal hormone therapy. Find out who needs it, how it is beneficial, the safety and side effects.
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Dr Deborah Brunt is a primary care physician with a passion for women’s health + wellbeing. She would love to work with you to holistically navigate the perimenopausal life stage.
Book a consult with Dr Deb Brunt | Ōtepoti Integrative Health | Book Now
Join our Meno Thrive program to optimise your health and wellbeing during perimenopause and menopause.
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