An estimated two million U.S. women reach menopause every year. But many begin to experience an array of physical, mental, and emotional symptoms long before menopause (12 consecutive months without a menstrual period). The gradual transition to non-reproductive years is called perimenopause, and usually occurs from around age 40 to 51. Perimenopause can be brought about prematurely by surgical removal of ovaries, chemotherapy, radiation therapy, or certain anti-hormone drugs. Unique for every woman, the transition can lead to symptoms that interfere with quality life. Whole-body health evaluation and care during perimenopause is vital, both to manage troubling symptoms, and to preventively address changes that can impact heart, bone, and brain health.
Perimenopause Symptoms
During perimenopause, a woman’s hormone levels change and fluctuate considerably, often leading to changes in the pattern of menstrual periods. As you become postmenopausal, reproductive hormone levels decrease, resulting in levels of estrogen and progesterone which are inadequate to produce a menstrual period. Symptoms are varied, unpredictable, and often go unrecognized as perimenopause symptoms. They may include the following:
Irregular periods. As ovulation becomes irregular, the length of time between periods may be longer or shorter, your flow may be lighter or heavier, and you may have random spotting or skip periods. It is important to manage excessive bleeding, and rule out endometrial hyperplasia (when the lining of the uterus becomes too thick).
Hot flashes. Hot flashes and night sweats are common, with varying intensity, length and frequency. They can be aggravated by lifestyle factors including environment, nutrition, stress, alcohol, and tobacco use. It is important to differentiate other medical conditions from menopause-related hot flashes, including hyperthyroidism, anxiety, and more.
Vaginal dryness and thinning. Decreased estrogen can cause vaginal tissues to become thinner, drier, and less elastic, making vaginal penetration painful. Diminishing estrogen can also leave you more vulnerable to vaginal infections, urinary tract infections, and urinary incontinence. It is important to rule out other causes of these symptoms including malignancies, vulvar dystrophies and dermatoses, infection, allergies, and skin conditions.
Skin changes. Changes such as brown spots, dryness, easy bruising, and increased wrinkling may occur. Skin is partially composed of collagen, and during the first five years after menopause, 30 percent of skin collagen is lost.1Stevenson S, Thornton J. Effect of estrogens on skin aging and the potential role of SERMs. Clin Interv Aging. 2007;2(3):283-297. https://doi.org/10.2147/cia.s798
Fatigue/sleep disturbance. Sleep problems are often due to hot flashes or night sweats, but sometimes sleep becomes unpredictable even without them.
Decreased libido and other changes in sexual response are common during perimenopause. Hormone levels, anatomy, physiology, psychological factors, stressors, and co-existing medical problems are all potential contributors to changes in sexual function.
Depression, anxiety and mood swings. The cause of these symptoms, including increased irritability and anxiety/panic disorder, may be sleep disruption associated with hot flashes, or other factors not related to the hormonal changes.
Bone loss is caused by declining estrogen levels, and can increase your risk of osteoporosis and bone fractures.
Changing lipid profiles. Decreasing estrogen levels may lead to unfavorable changes in your blood cholesterol levels, including an increase in low-density lipoprotein (LDL) cholesterol—the “bad” cholesterol—which contributes to an increased risk of heart disease. At the same time, high-density lipoprotein (HDL) cholesterol—the “good” cholesterol—decreases in many women as they age. Other symptoms associated with perimenopause can include changes in memory and cognition, scalp hair loss, facial hair growth, acne, palpitations, nausea, and headaches.
NDs Treat Perimenopause Naturally
Focusing on the whole person, licensed naturopathic doctors (NDs) take the time to identify and address the genetic, personal medical history, hormonal, and lifestyle factors that impact perimenopause and associated health changes in women. NDs provide a high level of emotional and educational support including nutrition, nutraceuticals, botanical medicine, lifestyle counseling, hormone therapy and, at times, select pharmaceuticals.
Using a whole-body approach and natural therapies whenever possible, NDs help women alleviate perimenopause symptoms and practice prevention to optimize health as the body ages. NDs typically spend one to two hours with patients in an initial appointment to gather information about physical, mental, emotional, genetic, environmental, social, and other factors that affect a woman’s health. NDs apply their , lifestyle counseling, botanical and nutraceutical medicine, and other treatment modalities (including use of pharmaceuticals when state license permits) to provide individualized evaluation and therapeutic guidance, including:
- Medicinal plants2Kargozar R, Azizi H, Salari R. A review of effective herbal medicines in controlling menopausal symptoms. Electron Physician. 2017;9(11):5826-5833. Published 2017 Nov 25. https://doi.org/10.19082/5826 that contain phytoestrogens,3Chen MN, Lin CC, Liu CF. Efficacy of phytoestrogens for menopausal symptoms: a meta-analysis and systematic review. Climacteric. 2015;18(2):260-269. https://doi.org/10.3109/13697137.2014.966241 such as ginseng,4Lee HW, Choi J, Lee Y, Kil KJ, Lee MS. Ginseng for managing menopausal woman’s health: A systematic review of double-blind, randomized, placebo-controlled trials. Medicine (Baltimore). 2016;95(38):e4914. https://doi.org/10.1097/MD.0000000000004914 red clover,5Ghazanfarpour M, Sadeghi R, Roudsari RL, Khorsand I, Khadivzadeh T, Muoio B. Red clover for treatment of hot flashes and menopausal symptoms: A systematic review and meta-analysis. J Obstet Gynaecol. 2016;36(3):301-311. https://doi.org/10.3109/01443615.2015.1049249 and soy6Schmidt M, Arjomand-Wölkart K, Birkhäuser MH, et al. Consensus: soy isoflavones as a first-line approach to the treatment of menopausal vasomotor complaints. Gynecol Endocrinol. 2016;32(6):427-430. https://doi.org/10.3109/09513590.2016.1152240 to reduce hot flashes, decrease vaginal dryness, increase energy, and improve moods.
- Non-phytoestrogen plants such as black cohosh7Shams T, Setia MS, Hemmings R, McCusker J, Sewitch M, Ciampi A. Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis. Altern Ther Health Med. 2010;16(1):36-44. and Kava to reduce hot flashes.
- Vitamin D, calcium, and other supplements to help prevent osteoporosis.
- Mind–body medicine such as stress reduction, meditation, and yoga8Innes KE, Selfe TK, Vishnu A. Mind-body therapies for menopausal symptoms: a systematic review. Maturitas. 2010;66(2):135-149. https://doi.org/10.1016/j.maturitas.2010.01.016 for mild to moderate depression, cognitive decline, and hot flashes.
- Bacopa9Aguiar S, Borowski T. Neuropharmacological review of the nootropic herb Bacopa monnieri. Rejuvenation Res. 2013;16(4):313-326. https://doi.org/10.1089/rej.2013.1431 to improve memory.
Lifestyle Modifications and Home Remedies
Eat Healthy
Choose unprocessed and organic fruits and vegetables, incorporating cruciferous vegetables like broccoli, kale, and cabbage to metabolize estrogen and clear excess hormones. Because the risk of osteoporosis rises with perimenopause, calcium-rich foods are essential. Beans, chicken, fish, and turkey supply amino acids—building blocks for hormone production and stable glucose levels. High-fiber food feeds the good bacteria in our intestines, supporting the elimination of excess hormones and toxins.
Get Regular Exercise
Increasing muscle mass supports the body’s metabolic and detoxification systems—both essential for hormone balance and healthy weight. Exercise also relieves stress and anxiety, which can help regulate mood shifts throughout perimenopause.
Maintain Your Microbiome
Gut bacteria may influence hormone balance and affect the severity of perimenopause symptoms. A well-functioning microbiome contributes to hormonal health, aids digestion, sustains a responsive immune system, and more. Yogurt, kefir, miso, tempeh, honey, kombucha, sauerkraut, and kimchi all contain GI-boosting probiotics.
Reduce Stress
Stress can disrupt thyroid function and interfere with other hormones. Under extreme stress, the body releases cortisol, inhibiting insulin production. Mindfulness practices like yoga, meditation, and journaling help curb stress, improve mood, and support overall well-being.
Sleep Well
Hormone changes during perimenopause can wreak havoc on regular sleep. Practicing good sleep hygiene by setting and sticking to a regular bedtime. Power devices down and dim the lights an hour or two before sleep. A soothing nighttime routine may include reading, soft music, and a warm bath.
Balancing Hormones During Perimenopause
Individual assessments and recommendations about the use of either botanicals, nutraceuticals, bio-identical hormones including customized compounds, and/or conventional hormone therapy (HT) need to be made for each woman based on her symptoms, risk factors for osteoporosis/cardiovascular disease/dementias/other conditions, and preferences. When appropriate, NDs are trained to use both conventionally available hormone replacement options and also specialty compounded hormone formulations. Their guidance both in addressing perimenopause symptoms and proactively strengthening overall health has helped countless women age through menopause with greater ease.
The AANP and INM would like to acknowledge Tori Hudson, ND for her contributions to the content of this FAQ. Some of the content first appeared in an article on Dr. Hudson’s blog.
Footnotes
- 1Stevenson S, Thornton J. Effect of estrogens on skin aging and the potential role of SERMs. Clin Interv Aging. 2007;2(3):283-297. https://doi.org/10.2147/cia.s798
- 2Kargozar R, Azizi H, Salari R. A review of effective herbal medicines in controlling menopausal symptoms. Electron Physician. 2017;9(11):5826-5833. Published 2017 Nov 25. https://doi.org/10.19082/5826
- 3Chen MN, Lin CC, Liu CF. Efficacy of phytoestrogens for menopausal symptoms: a meta-analysis and systematic review. Climacteric. 2015;18(2):260-269. https://doi.org/10.3109/13697137.2014.966241
- 4Lee HW, Choi J, Lee Y, Kil KJ, Lee MS. Ginseng for managing menopausal woman’s health: A systematic review of double-blind, randomized, placebo-controlled trials. Medicine (Baltimore). 2016;95(38):e4914. https://doi.org/10.1097/MD.0000000000004914
- 5Ghazanfarpour M, Sadeghi R, Roudsari RL, Khorsand I, Khadivzadeh T, Muoio B. Red clover for treatment of hot flashes and menopausal symptoms: A systematic review and meta-analysis. J Obstet Gynaecol. 2016;36(3):301-311. https://doi.org/10.3109/01443615.2015.1049249
- 6Schmidt M, Arjomand-Wölkart K, Birkhäuser MH, et al. Consensus: soy isoflavones as a first-line approach to the treatment of menopausal vasomotor complaints. Gynecol Endocrinol. 2016;32(6):427-430. https://doi.org/10.3109/09513590.2016.1152240
- 7Shams T, Setia MS, Hemmings R, McCusker J, Sewitch M, Ciampi A. Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis. Altern Ther Health Med. 2010;16(1):36-44.
- 8Innes KE, Selfe TK, Vishnu A. Mind-body therapies for menopausal symptoms: a systematic review. Maturitas. 2010;66(2):135-149. https://doi.org/10.1016/j.maturitas.2010.01.016
- 9Aguiar S, Borowski T. Neuropharmacological review of the nootropic herb Bacopa monnieri. Rejuvenation Res. 2013;16(4):313-326. https://doi.org/10.1089/rej.2013.1431
