Understanding Perimenopause: A Naturopathic Approach

As a naturopathic doctor working with women, I often meet patients navigating a phase of life that isn’t talked about nearly enough: perimenopause. It’s a time of transformation—physically, emotionally, and hormonally—and one that can be empowered through education, support, and a holistic approach to health.

What is Perimenopause?

Perimenopause is the transitional phase leading up to menopause, typically beginning in a woman’s 40s (but sometimes as early as the mid-30s). It can last anywhere from a few months to over a decade. During this time, the ovaries gradually produce less estrogen, and hormone levels can fluctuate significantly, often causing a range of symptoms that impact daily life.

Common Symptoms of Perimenopause

Every woman experiences perimenopause differently, but common symptoms include:

• Irregular menstrual cycles - including more frequent and heavier periods, leading to iron deficiency and extreme fatigue

• Hot flashes and night sweats, causing disrupted sleep patterns

• Mood changes or increased anxiety

• Sleep disturbances - waking up at 3am and unable to fall back asleep

• Brain fog or memory lapses - causing stress at work

• Vaginal dryness and decreased libido

• Fatigue

• Sudden weight gain or incredible difficulty losing weight despite calorie restriction and exercise

It’s important to remember: these changes are natural, but they don’t have to be disruptive or overwhelming.

A Naturopathic Perspective

As a naturopathic doctor, I approach perimenopause through the lens of whole-person wellness. Our goal isn’t just to alleviate symptoms—it’s to support the body’s natural rhythms, improve resilience, and optimize health during this transitional stage.

Here are some of the foundational areas I focus on with patients:

1. Hormonal Balance

We can use bloodwork or dried urine hormone testing (DUTCH) to gain a detailed picture of sex hormonal fluctuations, such as estrgen deficiency, estrogen dominance or progesterone deficiency. Based on results, herbal medicine such as DIM, chaste tree (Vitex), black cohosh, or maca can help gently support hormonal balance. Although I am unable to prescribe HRT, I am able to discuss possible benefits and risks of various forms of HRT.

2. Nutrition and Blood Sugar Stability

Diet plays a critical role in regulating hormones. I recommend diets based on your overall unique health symptoms. Some of the diets I discuss are: High-protein diet, Autoimmune/paleo diet, non-FODMAPS diet, modified Carnivore diet, and Mediterranean-style diet. I often assess blood sugar balance via HbA1C, fasting glucose and fasting insulin to determine if someone has insulin resistance or pre-diabetes. Stabilizing blood sugar helps reduce hot flashes, anxiety, and fatigue.

3. Liver Support

The liver metabolizes hormones, so keeping it functioning optimally is key. This might involve reducing alcohol, increasing cruciferous vegetables (like broccoli and kale), and using herbs like sulphoraphane from broccoli extract, milk thistle or dandelion root. Making sure your gallbladder is producing sufficient bile is also a huge part of my treatment protocols, as bile salts help eliminate excess hormones and improve fat digestion for essential hormone building blocks.

4. Adrenal Health and Stress Management

In Perimenopause, as your ovaries stop making sex hormones, your adrenal glands are supposed to take over to continue making estrogen to support your bones, skin, joints, cardiovascular system, etc. If you're already under chronic stress, you can experience your perimenopause symptoms in a much intense way. Adaptogenic herbs (like ashwagandha or holy basil), breathwork, restorative yoga, and sleep hygiene practices all help create resilience to stress and improve energy.

5. Sleep and Nervous System Regulation

Sleep disturbances are among the most frustrating and most common perimenopausal symptoms. It is crucial we reduce our overnight cortisol, which is often overlooked in treatment protocols. I use products such as Phosphatidylserine and Ashwagandha, along with tweaking sleep routines, screen time, and nighttime nutrition.

You Are Not Alone

Many women feel blindsided by perimenopause, unsure whether what they’re experiencing is “normal” or whether they should seek help. The truth is: you deserve to feel supported, heard, and empowered through every stage of your hormonal journey.

If you’re curious about naturopathic options for perimenopause, I invite you to book a 15-minute complimentary Discovery Call.

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Disclaimer: All content in this blog is created and published online for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice.