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Stop Suffering: Natural Perimenopause Hacks That Actually Work.

October 21, 2024

Many women will tell you (in these exact words): “Perimenopause sucks.”

Mood swings that rival a teenager’s. Periods that play hide and seek. Night sweats that leave your sheets soaked.

But, what exactly is happening during perimenopause? Why do these symptoms appear, and what can you do about them?

Let’s take a look, and along the way, you’ll learn how you can make perimenopause more than just a phase to “get through.”

I’ll show you how to effectively use this transition time to build up the crucial resources you need—from better heart health to stronger bones to optimal hormone balance—to thrive in the next phase of life.

What Is Perimenopause and Why Does It Happen?

Perimenopause is the transitional phase leading up to menopause when your body’s hormone production begins to fluctuate. It can last anywhere from a few months to several years and typically begins around your 40s, though it can start earlier for some women. During this time, your body may stop ovulating regularly, causing estrogen and progesterone levels to rise and fall unpredictably.

Dr. Elizabeth Boham, a physician and hormone expert, explains that perimenopause is marked by irregular cycles, mood changes, hot flashes, night sweats, sleep disturbances, and even “brain fog.” Some women also experience heavy periods, premenstrual migraines, and worsening PMS.

These changes can come and go, making it a tricky time for many women.

But why do these symptoms happen?

Root Causes of Perimenopause Symptoms

As you approach menopause, your body’s production of hormones like estrogen and progesterone begins to fall out of its usual rhythm. This shift is closely tied to the decline in ovarian function, as the number of viable eggs decreases with age.

When ovulation becomes less frequent, your body produces significantly less of the hormone progesterone, leading to hormonal imbalances. While estrogen levels can still fluctuate erratically between high and low (with the overall trend being a decline in estrogen production), the lack of progesterone causes irregularities such as inconsistent menstrual cycles and bleeding.

Some women experience a quick transition, where their periods stop suddenly with minimal symptoms, while others take a slower path, facing several years of changes like hot flashes, mood swings, and shifts in body composition.

Eventually, when estrogen levels drop for good and you’ve gone a full year without a period, it marks the official end of the perimenopausal transition and the beginning of postmenopause.

What Makes Symptoms Worse?

Certain factors, such as insulin resistance, adrenal health, and exposure to toxins, can exacerbate perimenopausal symptoms, intensifying their severity.

Let’s take a look at a few examples of these factors that can contribute to making these symptoms more pronounced:

► Insulin resistance: This occurs when your cells become less responsive to insulin, the hormone that helps regulate blood sugar. As a result, your body produces more insulin to keep your blood sugar in check, leading to spikes in insulin levels. Over time, this can increase your risk of weight gain, type 2 diabetes, and heart disease.

Insulin resistance also contributes to hormonal imbalances, which can intensify perimenopausal symptoms like hot flashes and night sweats. Research shows that women who reported hot flashes more frequently, also had higher levels of insulin resistance, as measured by a test called the HOMA index.¹ This link remained even after taking into account other factors like body weight, hormones, and cardiovascular risks. Night sweats also showed a similar connection to insulin resistance, though the effect was smaller.

However, the exact relationship between insulin resistance and perimenopausal symptoms is complex and not fully understood. While we know that insulin resistance can make these symptoms worse, the hormonal changes of perimenopause may also increase the likelihood of developing insulin resistance in the first place. This can create a vicious cycle, where one can worsen the other.

That’s why addressing insulin resistance is so important—not only to manage symptoms like hot flashes and night sweats but also to support overall health during this transition.

► Stress and adrenal health: Chronic stress can overwork your adrenal glands, which play a role in managing your body’s stress response and producing small amounts of sex hormones. And overworked adrenal glands can worsen symptoms like hot flashes, irritability, and sleep disturbances.

► Environmental toxins: Exposure to hormone-disrupting chemicals, such as those found in plastics, pesticides, or cigarette smoke, can interfere with your hormone balance.

For example, xenoestrogens mimic estrogen in the body, intensifying symptoms like heavy periods, mood swings, and increasing the risk of breast cancer.²

Some studies suggest these chemicals may even accelerate the decline in hormone levels, leading to an earlier onset of menopause and more severe symptoms. A study in The Journal of Clinical Endocrinology and Metabolism found that women with higher levels of certain “forever chemicals”—like PFAS, which are found in products such as nonstick cookware—went through menopause up to two years earlier than women with lower levels of these chemicals.³

This is a big deal because early menopause may increase the risk of cardiovascular disease and osteoporosis.

► Nutritional deficiencies in key nutrients such as magnesium, B vitamins, and vitamin D can affect how your body processes estrogen and other hormones. This can worsen symptoms like fatigue, bone loss, and mood swings.

Practical Solutions for Managing Perimenopause Naturally

The good news? You don’t have to just “deal with” perimenopause. By making certain lifestyle changes and incorporating key nutrients, you can ease this transition and reduce symptoms.

1. Balance Your Blood Sugar

One of the most effective ways to manage perimenopausal symptoms is to stabilize your blood sugar. Hormonal fluctuations can make you more sensitive to insulin, leading to blood sugar swings that worsen irritability, cravings, and fatigue.

Here are some simple strategies:

Eat whole foods: Focus on a nutrient-dense diet filled with high-quality protein (like pasture-raised beef), healthy fats (like avocados, nuts, and olive oil), and low-glycemic vegetables. Here are some examples:

Leafy greens: Spinach, kale, collards, and Swiss chard
Cruciferous vegetables: Broccoli, cauliflower, Brussels sprouts, and cabbage
Root Vegetables: Carrots (raw), beets, and turnips
Other non-starchy vegetables: Cucumbers, zucchini, bell peppers (including jalapeños), eggplant, asparagus, artichokes, green beans, snow peas

These vegetables typically have a glycemic index (GI) of 55 or lower, making them suitable for those looking to manage blood sugar levels effectively.

Oftentimes supplementing may be necessary. Try this omega-3 supplement to make sure your body is getting enough of this healthy fat.

Cut out processed sugars: Ultra-processed foods and sugary snacks can spike your blood sugar, leading to more hormonal imbalance and can make your symptoms worse.
Incorporate fiber-rich foods: Fiber from vegetables, fruits, and whole grains helps regulate blood sugar and supports gut health, which plays a key role in hormone regulation.

Want to try a fiber supplement? PGX Daily is one of my favorites.

Add key supplements to support blood sugar stability: Nutrient deficiencies can interfere with how your body regulates blood sugar, making it harder to manage symptoms. Make sure you’re getting enough magnesium, B vitamins, and vitamin D, as they play essential roles in balancing blood sugar, reducing inflammation, and supporting overall hormone health.
Give fasting a try: It can also be a powerful tool to help reduce inflammation and balance insulin levels, promoting better hormone regulation and overall health.

The 12/12 method is a good place to start if you haven’t tried fasting before. This just means fasting for 12 hours and then eating during the next 12-hour period. For example, you might finish dinner by 6 p.m. and then wait until 6 a.m. the following day to eat again.

2. Manage Stress for Adrenal Health

Your adrenal glands react to stress by producing hormones like cortisol, and over time, chronic stress can worsen perimenopausal symptoms. That’s why managing your stress can make a big difference in how you experience perimenopause:

Practice stress-reducing techniques: Meditation, yoga, and deep breathing exercises can all help calm your nervous system and reduce stress hormone production.

Need more inspiration? Check out my podcast with Emily Fletcher, Dan Harris, and Daniel Goleman to explore how meditation rewires the brain, reduces anxiety, and enhances mental clarity.

Prioritize sleep: Aim for 7–9 hours of quality sleep each night to give your body time to recover and manage hormone production. Magnesium and natural progesterone supplements may also help improve sleep quality.
Consider adaptogens—herbs like ashwagandha, rhodiola, and holy basil, which help your body adapt to stress by balancing cortisol levels, boosting energy, and easing the overall impact of stress.

These herbs can also help manage perimenopausal symptoms such as hot flashes and night sweats. For example, when black cohosh and rhodiola rosea were taken together, they significantly reduced menopausal symptoms and improved quality of life in research study participants.⁴

3. Detox Your Environment

Reducing your exposure to environmental toxins can help keep your hormones in check:

Avoid plastics: Switch to glass or stainless steel containers for food storage, and avoid plastic water bottles and food packaging that may contain hormone-disrupting chemicals like BPA and phthalates.
Eat organic: Choosing organic foods helps reduce your intake of pesticides and chemicals that can interfere with your hormone balance.
Drink plenty of water: That’s about 11 cups per day.
Use a sauna: Regular sauna sessions can aid in detoxification by helping your body eliminate toxins through sweat, supporting overall hormonal health.

4. Exercise for Hormonal Balance and Bone Health

Regular exercise is a game-changer for managing perimenopause. It can help reduce hot flashes, improve mood, and strengthen your bones as estrogen declines. Try these strategies:

Strength training: Building muscle helps improve bone density and reduces the risk of osteoporosis, which becomes a concern as estrogen levels fall.

Research shows that resistance training (like lifting weights or using resistance bands) can also help lower the number and intensity of hot flashes in postmenopausal women.⁵

Aerobic exercise: Activities like walking, swimming, or biking can improve cardiovascular health and help regulate mood.

5. Consider Hormone Replacement Therapy—but Personalize It

While lifestyle changes can make a big impact, some women may still require hormone therapy to manage severe symptoms. Deciding whether to replace estrogen and progesterone in perimenopause and beyond is a deeply personal choice.

If you choose hormone replacement, it’s essential to take a personalized approach, opting for bioidentical hormones—chemically identical to your body’s natural hormones—over synthetic versions.

Working with your Functional Medicine doctor can help determine the right type of hormone replacement therapy for you. As a general guideline, consider these options:

Transdermal estrogen replacement: Hormone patches may lower the risk of inflammation and blood clots compared to oral estrogen.⁶
Progesterone replacement: If you still have a uterus, progesterone may be needed to balance estrogen and protect your uterine lining.⁷

It’s also critical to regularly monitor how your body metabolizes hormones with your practitioner to ensure your therapy is both safe and effective.

Perimenopause isn’t just about managing symptoms like hot flashes or "brain fog"—it’s an important time to take charge of your health and plan for the next phase of life.

Instead of merely enduring the changes, think of this transition as a critical opportunity to focus on prevention, particularly for your heart health. By treating perimenopause as a time to invest in your long-term wellness—through lifestyle changes, nutritional support, and cardiovascular care—you can set yourself up for a healthier future.

References

Thurston RC, El Khoudary SR, Sutton-Tyrrell K, Crandall CJ, Sternfeld B, Joffe H, Gold EB, Selzer F, Matthews KA. Vasomotor symptoms and insulin resistance in the study of women’s health across the nation. J Clin Endocrinol Metab. 2012 Oct;97(10):3487-94. doi: 10.1210/jc.2012-1410. Epub 2012 Jul 31. PMID: 22851488; PMCID: PMC3462945.
Neff AM, Laws MJ, Warner GR, Flaws JA. The Effects of Environmental Contaminant Exposure on Reproductive Aging and the Menopause Transition. Curr Environ Health Rep. 2022 Mar;9(1):53-79. doi: 10.1007/s40572-022-00334-y. Epub 2022 Feb 1. PMID: 35103957; PMCID: PMC8988816.
Ding N, Harlow SD, Randolph JF, Calafat AM, Mukherjee B, Batterman S, Gold EB, Park SK. Associations of Perfluoroalkyl Substances with Incident Natural Menopause: The Study of Women’s Health Across the Nation. J Clin Endocrinol Metab. 2020 Sep 1;105(9):e3169–82. doi: 10.1210/clinem/dgaa303. PMID: 32491182; PMCID: PMC7418447.
Pkhaladze L, Davidova N, Khomasuridze A, Shengelia R, Panossian AG. Actaea racemosa L. Is More Effective in Combination with Rhodiola rosea L. for Relief of Menopausal Symptoms: A Randomized, Double-Blind, Placebo-Controlled Study. Pharmaceuticals (Basel). 2020 May 21;13(5):102. doi: 10.3390/ph13050102. PMID: 32455817; PMCID: PMC7281162.
Choudhry DN, Saleem S, Hatim S, Irfan R. The effect of resistance training in reducing hot flushes in post-menopausal women: A meta-analysis. J Bodyw Mov Ther. 2024 Jul;39:335-342. doi: 10.1016/j.jbmt.2024.03.018. Epub 2024 Mar 7. PMID: 38876649.
Goldštajn MŠ, Mikuš M, Ferrari FA, Bosco M, Uccella S, Noventa M, Török P, Terzic S, Laganà AS, Garzon S. Effects of transdermal versus oral hormone replacement therapy in postmenopause: a systematic review. Arch Gynecol Obstet. 2023 Jun;307(6):1727-1745. doi: 10.1007/s00404-022-06647-5. Epub 2022 Jun 17. PMID: 35713694; PMCID: PMC10147786.
Memi E, Pavli P, Papagianni M, Vrachnis N, Mastorakos G. Diagnostic and therapeutic use of oral micronized progesterone in endocrinology. Rev Endocr Metab Disord. 2024 Aug;25(4):751-772. doi: 10.1007/s11154-024-09882-0. Epub 2024 Apr 23. Erratum in: Rev Endocr Metab Disord. 2024 Jun 26. doi: 10.1007/s11154-024-09887-9. PMID: 38652231; PMCID: PMC11294403.