Staying Balanced During Perimenopause: Five Steps for Success

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The scientific explanation of perimenopause sounds so simple: a gradual slowing down of reproductive hormones until menopause. The reality, however, is that for many women the arrival of menopause isn’t a smooth, gliding descent but more of a turbulent landing complete with bumps, twists, and what can feel like the constant threat of a complete crash. That feeling is compounded by the timing since perimenopause symptoms often begin at a particularly stressful time of life with mounting work and family demands. Add in the physical and emotional effects of hormonal fluctuations, and the entire process can easily start to feel like a cruel joke.

Thankfully it doesn’t have to be that way.

If you’re frustrated by symptoms like mood swings, weight gain, and anxiety, start by taking a deep breath. The first step to thriving not just surviving perimenopause is to acknowledge that is a natural process. Don’t beat yourself up. Now is the time to give your body – and your mind – some love.

How to Recognize Perimenopause

It is interesting to note that some studies show our attitudes towards menopause (and aging in general) can impact how we experience perimenopause symptoms.

Know What to Expect

Knowing what to expect and what triggers perimenopause is important. Sometimes, women are baffled by the changes and blame themselves, telling themselves that they’re not working out hard enough or not coping well with stress. That’s why a good understanding of the changes you’re undergoing is important.

This Phase Can Last Years

Perimenopause symptoms typically begin in the mid-forties and continue for a number of years until full menopause is reached, which is defined as having gone a full year without a menstrual period, marking the cessation of the release of an ovarian egg. The average age of menopause is 52 years old.

Over this period, the ovaries’ hormonal production slows down in fits and starts, leading to fluctuating levels of estrogen, which creates shifting imbalances in the delicate seesaw of estrogen and progesterone. Earlier in life, estrogen levels are much more predictable with the menstrual cycle.

Signs You May Be in Perimenopause

Symptoms can be subtle at first and easily mistaken for something else. Of course, no woman has all the symptoms below, though most have at least one or two. They may increase gradually, or, you may find they come and go along with your fluctuating hormones, they can include:

  • Changes in menstruation, which could include changes in timing (both more frequent or less frequent) and periods that are suddenly much heavier
  • Unexplained weight gain, particularly around the midsection
  • Depression
  • Brain fog
  • Hot flashes
  • Tender breasts
  • Anxiety and panic attacks
  • Restless legs
  • Insomnia and difficulty staying asleep
  • Irritability
  • Changes in libido
  • Vaginal dryness
  • Acne (as if wrinkles weren’t enough to worry about)

5 Ways to Find Balance During Perimenopause

The good news is that several lifestyle changes can help maintain hormonal balance and make it easier to cope with the changes that do occur.

1 – Aim for a Good Night’s Sleep

Ironically, getting restful sleep can become more challenging just when we need it most, and a majority of perimenopausal women report sleep difficulties. Waking up frequently is the most common complaint, often due to hot flashes. As always, a holistic approach helps, as a hormone-supporting diet can help regulate hot flashes.

How You Can Strengthen Your Bedtime Routine

In addition, it’s important to practice good sleep hygiene:

  • Avoid using electronic devices at least one hour before bedtime.
  • Avoid caffeine, large meals, and vigorous exercise in the evening.
  • Build a predictable wind-down routine into your evenings.
  • Keep your bedroom temperature on the cooler side for better sleep.
  • Avoid synthetic materials in bedding and sleepwear in favor of natural fabrics like cotton or linen.

Since melatonin production slows with age, melatonin or other relaxing/calming supplements may be necessary to help you fall and/or stay asleep. A healthcare practitioner can help assess the need for supplements.

2 – Address Your Stress

The stress hormone cortisol rises with age, which is partly to blame for the increase in belly fat many women experience during perimenopause. Taking proactive steps to reduce stress will help get a handle on cortisol levels.

Find Out What Works Best for You

Adequate sleep helps to lower cortisol, as does gentle, mindful activity such as yoga or tai chi. In fact, studies have found that mindful activities can reduce hot flashes, which will positively impact sleep, which in turn helps to reduce belly fat – it’s all connected!

3 – Get Moving

Regular exercise helps with stress, reduces body fat, and improves your overall quality of life. It’s important to acknowledge, however, that what worked in your 20s and 30s may not be as effective at this stage of life.

Consider Reducing the Intensity

Somewhat ironically, overly intense exercise can overtax your body and result in an increase in cortisol. Remember those stress tips above? That’s why it’s important to find a form of exercise that works for you. Don’t feel pressure to do high-intensity workouts if your body responds better to lower-intensity programs like Pilates or walking. Because everybody is different, it may take a bit of trial and error to find what works for you. The best exercise is always the one that you will stick to, and the one that gives you joy instead of adding to your stress levels.

4 – Eat a Hormone-Supportive Diet

The concept of being gentle with your body during perimenopause extends to your diet. At this stage in life, you should focus on foods that support hormonal balance and provide nourishment. The four pillars of a healthy perimenopause diet are:


You start to lose muscle with age, so it’s important to counteract that adequate protein to retain muscle mass. Choose lean proteins, including some plant-based sources like chickpeas and lentils.


A slowed metabolism may also slow down digestion. This may lead to constipation and foods hanging around longer causing fermentation = gas and bloating. Fiber helps food move smoothly through the bowels and also helps us feel fuller for longer, limiting cravings. Fiber can be found in loads of foods from flaxseed, chia seed, beans, and legumes to spinach, broccoli, apples, and pears.


Healthy fats, like Omega-3 fatty acids, can help reduce hot flashes and may boost mood, according to some studies. Good sources of Omega-3 include salmon, hemp seeds, and flax seeds.


There are some foods to reduce during perimenopause: alcohol, caffeine, refined sugar, junk food, fast food.  As women age, they cannot handle the alcohol they once could, and alcohol and caffeine both can cause hot flashes and interfere with sleep.  Weight gain is easier post-menopause, so reducing refined sugar is important.  Since women need fewer calories but the same high-quality nutrients, wasting calories on fast food or junk food is problematic.

5 – Manage your Blood Sugar and Insulin Levels

High blood sugar can exacerbate hot flashes and other perimenopausal symptoms. This can be a bit of a vicious cycle, since changing hormonal levels can actually raise the production of the hormone insulin, which regulates blood sugar. It’s crucial to limit consumption of processed carbohydrates and sweet drinks during perimenopause, as insulin resistance becomes more commonplace. Fiber and protein can help preserve insulin sensitivity, so instead of a quick hit of something sweet for a snack, look for more satiating foods like nuts or whole grains.

Supplements and Hormones

There are many botanicals that help balance irregular hormones occurring in perimenopause, ones that help balance estrogens, progesterone, and help the liver process the estrogens.  A good formula can make a huge difference to a woman having symptoms of imbalances.

BioIdentical hormones can also be used in perimenopausal women.  Not estrogen; that is not safe to use until menopause has finally occurred.  But, in perimenopause, progesterone, testosterone, and DHEA are safe and can be effective in hormonal balance.

Naturopathic physicians are highly skilled at dosing botanicals and bioidentical hormones in peri-menopausal and post-menopausal women.


A lot is happening during perimenopause for many women – career, family, decisions about the future – but taking some time to focus on your own health will help you feel empowered with the changes in your body.

If you are looking for extra support or experiencing hormonal issues and would like to dive deeper into what’s going on and the best natural course of action give us a call. As naturopathic doctors, we can help guide you in this transition in a healthy and holistic way.




Sleep problems during the menopausal transition: prevalence, impact, and management challenges

Nat Sci Sleep. 2018 – Fiona C Baker,corresponding author1,2 Massimiliano de Zambotti,1 Ian M Colrain,1,3 and Bei Bei

Melatonin, human aging, and age-related diseases

Exp Gerontol. Nov-Dec 2004 – M Karasek

Mindfulness Training for Coping with Hot Flashes: Results of a Randomized Trial

Menopause. 2011 – James Carmody, Ph.D., Associate Professor of Medicine, corresponding author Sybil Crawford, Ph.D., Professor of Medicine, Elena Salmoirago-Blotcher, M.D., Doctoral Fellow, et al

Cortisol Levels during the Menopausal Transition and Early Postmenopause: Observations from the Seattle Midlife Women’s Health Study

Menopause 2009 – Nancy Fugate Woods, PhD, RN, FAAN, Ellen Sullivan Mitchell, PhD, and Kathleen Smith-DiJulio, PhD, RN

The role of calcium in peri-and postmenopausal women: consensus opinion of The North American Menopause Society – Menopause 2001 – The North American Menopause Society


Omega-3 fatty acids for major depressive disorder associated with the menopausal transition: a preliminary open trial –  PMC 2011 – Marlene P. Freeman, MD,1 Joseph R. Hibbeln, MD,2 Michael Silver, MS et al

Vasomotor symptoms and insulin resistance in the study of women’s health across the nation, J Clin Endocrinol Metab. 2012 – Rebecca C Thurston 1, Samar R El Khoudary et al

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